Carotid Stenosis: Narrowing or stricture of any part of the CAROTID ARTERIES, most often due to atherosclerotic plaque formation. Ulcerations may form in atherosclerotic plaques and induce THROMBUS formation. Platelet or cholesterol emboli may arise from stenotic carotid lesions and induce a TRANSIENT ISCHEMIC ATTACK; CEREBROVASCULAR ACCIDENT; or temporary blindness (AMAUROSIS FUGAX). (From Adams et al., Principles of Neurology, 6th ed, pp 822-3)Endarterectomy, Carotid: The excision of the thickened, atheromatous tunica intima of a carotid artery.Carotid Arteries: Either of the two principal arteries on both sides of the neck that supply blood to the head and neck; each divides into two branches, the internal carotid artery and the external carotid artery.Carotid Artery Diseases: Pathological conditions involving the CAROTID ARTERIES, including the common, internal, and external carotid arteries. ATHEROSCLEROSIS and TRAUMA are relatively frequent causes of carotid artery pathology.Carotid Artery, Internal: Branch of the common carotid artery which supplies the anterior part of the brain, the eye and its appendages, the forehead and nose.Carotid Artery, Common: The two principal arteries supplying the structures of the head and neck. They ascend in the neck, one on each side, and at the level of the upper border of the thyroid cartilage, each divides into two branches, the external (CAROTID ARTERY, EXTERNAL) and internal (CAROTID ARTERY, INTERNAL) carotid arteries.Aortic Valve Stenosis: A pathological constriction that can occur above (supravalvular stenosis), below (subvalvular stenosis), or at the AORTIC VALVE. It is characterized by restricted outflow from the LEFT VENTRICLE into the AORTA.Ultrasonography, Doppler, Duplex: Ultrasonography applying the Doppler effect combined with real-time imaging. The real-time image is created by rapid movement of the ultrasound beam. A powerful advantage of this technique is the ability to estimate the velocity of flow from the Doppler shift frequency.Endarterectomy: Surgical excision, performed under general anesthesia, of the atheromatous tunica intima of an artery. When reconstruction of an artery is performed as an endovascular procedure through a catheter, it is called ATHERECTOMY.Ischemic Attack, Transient: Brief reversible episodes of focal, nonconvulsive ischemic dysfunction of the brain having a duration of less than 24 hours, and usually less than one hour, caused by transient thrombotic or embolic blood vessel occlusion or stenosis. Events may be classified by arterial distribution, temporal pattern, or etiology (e.g., embolic vs. thrombotic). (From Adams et al., Principles of Neurology, 6th ed, pp814-6)Constriction, Pathologic: The condition of an anatomical structure's being constricted beyond normal dimensions.Stents: Devices that provide support for tubular structures that are being anastomosed or for body cavities during skin grafting.Angioplasty: Reconstruction or repair of a blood vessel, which includes the widening of a pathological narrowing of an artery or vein by the removal of atheromatous plaque material and/or the endothelial lining as well, or by dilatation (BALLOON ANGIOPLASTY) to compress an ATHEROMA. Except for ENDARTERECTOMY, usually these procedures are performed via catheterization as minimally invasive ENDOVASCULAR PROCEDURES.Coronary Stenosis: Narrowing or constriction of a coronary artery.Stroke: A group of pathological conditions characterized by sudden, non-convulsive loss of neurological function due to BRAIN ISCHEMIA or INTRACRANIAL HEMORRHAGES. Stroke is classified by the type of tissue NECROSIS, such as the anatomic location, vasculature involved, etiology, age of the affected individual, and hemorrhagic vs. non-hemorrhagic nature. (From Adams et al., Principles of Neurology, 6th ed, pp777-810)Cerebrovascular Disorders: A spectrum of pathological conditions of impaired blood flow in the brain. They can involve vessels (ARTERIES or VEINS) in the CEREBRUM, the CEREBELLUM, and the BRAIN STEM. Major categories include INTRACRANIAL ARTERIOVENOUS MALFORMATIONS; BRAIN ISCHEMIA; CEREBRAL HEMORRHAGE; and others.Carotid Body: A small cluster of chemoreceptive and supporting cells located near the bifurcation of the internal carotid artery. The carotid body, which is richly supplied with fenestrated capillaries, senses the pH, carbon dioxide, and oxygen concentrations in the blood and plays a crucial role in their homeostatic control.Carotid Artery, External: Branch of the common carotid artery which supplies the exterior of the head, the face, and the greater part of the neck.Spinal Stenosis: Narrowing of the spinal canal.Carotid Sinus: The dilated portion of the common carotid artery at its bifurcation into external and internal carotids. It contains baroreceptors which, when stimulated, cause slowing of the heart, vasodilatation, and a fall in blood pressure.Tracheal StenosisUltrasonography, Doppler, Transcranial: A non-invasive technique using ultrasound for the measurement of cerebrovascular hemodynamics, particularly cerebral blood flow velocity and cerebral collateral flow. With a high-intensity, low-frequency pulse probe, the intracranial arteries may be studied transtemporally, transorbitally, or from below the foramen magnum.Magnetic Resonance Angiography: Non-invasive method of vascular imaging and determination of internal anatomy without injection of contrast media or radiation exposure. The technique is used especially in CEREBRAL ANGIOGRAPHY as well as for studies of other vascular structures.Angiography, Digital Subtraction: A method of delineating blood vessels by subtracting a tissue background image from an image of tissue plus intravascular contrast material that attenuates the X-ray photons. The background image is determined from a digitized image taken a few moments before injection of the contrast material. The resulting angiogram is a high-contrast image of the vessel. This subtraction technique allows extraction of a high-intensity signal from the superimposed background information. The image is thus the result of the differential absorption of X-rays by different tissues.Amaurosis Fugax: Transient complete or partial monocular blindness due to retinal ischemia. This may be caused by emboli from the CAROTID ARTERY (usually in association with CAROTID STENOSIS) and other locations that enter the central RETINAL ARTERY. (From Adams et al., Principles of Neurology, 6th ed, p245)Cerebral Angiography: Radiography of the vascular system of the brain after injection of a contrast medium.Angioplasty, Balloon: Use of a balloon catheter for dilation of an occluded artery. It is used in treatment of arterial occlusive diseases, including renal artery stenosis and arterial occlusions in the leg. For the specific technique of BALLOON DILATION in coronary arteries, ANGIOPLASTY, BALLOON, CORONARY is available.Carotid Artery Thrombosis: Blood clot formation in any part of the CAROTID ARTERIES. This may produce CAROTID STENOSIS or occlusion of the vessel, leading to TRANSIENT ISCHEMIC ATTACK; CEREBRAL INFARCTION; or AMAUROSIS FUGAX.Risk Factors: An aspect of personal behavior or lifestyle, environmental exposure, or inborn or inherited characteristic, which, on the basis of epidemiologic evidence, is known to be associated with a health-related condition considered important to prevent.Angiography: Radiography of blood vessels after injection of a contrast medium.Pyloric Stenosis: Narrowing of the pyloric canal with varied etiology. A common form is due to muscle hypertrophy (PYLORIC STENOSIS, HYPERTROPHIC) seen in infants.Severity of Illness Index: Levels within a diagnostic group which are established by various measurement criteria applied to the seriousness of a patient's disorder.Intracranial Embolism: Blocking of a blood vessel in the SKULL by an EMBOLUS which can be a blood clot (THROMBUS) or other undissolved material in the blood stream. Most emboli are of cardiac origin and are associated with HEART DISEASES. Other non-cardiac sources of emboli are usually associated with VASCULAR DISEASES.Mitral Valve Stenosis: Narrowing of the passage through the MITRAL VALVE due to FIBROSIS, and CALCINOSIS in the leaflets and chordal areas. This elevates the left atrial pressure which, in turn, raises pulmonary venous and capillary pressure leading to bouts of DYSPNEA and TACHYCARDIA during physical exertion. RHEUMATIC FEVER is its primary cause.Ultrasonography: The visualization of deep structures of the body by recording the reflections or echoes of ultrasonic pulses directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz.Prospective Studies: Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group.Pulmonary Valve Stenosis: The pathologic narrowing of the orifice of the PULMONARY VALVE. This lesion restricts blood outflow from the RIGHT VENTRICLE to the PULMONARY ARTERY. When the trileaflet valve is fused into an imperforate membrane, the blockage is complete.Treatment Outcome: Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series.Follow-Up Studies: Studies in which individuals or populations are followed to assess the outcome of exposures, procedures, or effects of a characteristic, e.g., occurrence of disease.Blood Flow Velocity: A value equal to the total volume flow divided by the cross-sectional area of the vascular bed.Arterial Occlusive Diseases: Pathological processes which result in the partial or complete obstruction of ARTERIES. They are characterized by greatly reduced or absence of blood flow through these vessels. They are also known as arterial insufficiency.Ultrasonography, Doppler, Color: Ultrasonography applying the Doppler effect, with the superposition of flow information as colors on a gray scale in a real-time image. This type of ultrasonography is well-suited to identifying the location of high-velocity flow (such as in a stenosis) or of mapping the extent of flow in a certain region.Intracranial Arteriosclerosis: Vascular diseases characterized by thickening and hardening of the walls of ARTERIES inside the SKULL. There are three subtypes: (1) atherosclerosis with fatty deposits in the ARTERIAL INTIMA; (2) Monckeberg's sclerosis with calcium deposits in the media and (3) arteriolosclerosis involving the small caliber arteries. Clinical signs include HEADACHE; CONFUSION; transient blindness (AMAUROSIS FUGAX); speech impairment; and HEMIPARESIS.Auscultation: Act of listening for sounds within the body.Predictive Value of Tests: In screening and diagnostic tests, the probability that a person with a positive test is a true positive (i.e., has the disease), is referred to as the predictive value of a positive test; whereas, the predictive value of a negative test is the probability that the person with a negative test does not have the disease. Predictive value is related to the sensitivity and specificity of the test.Ultrasonography, Doppler: Ultrasonography applying the Doppler effect, with frequency-shifted ultrasound reflections produced by moving targets (usually red blood cells) in the bloodstream along the ultrasound axis in direct proportion to the velocity of movement of the targets, to determine both direction and velocity of blood flow. (Stedman, 25th ed)Brain Ischemia: Localized reduction of blood flow to brain tissue due to arterial obstruction or systemic hypoperfusion. This frequently occurs in conjunction with brain hypoxia (HYPOXIA, BRAIN). Prolonged ischemia is associated with BRAIN INFARCTION.Cerebrovascular Circulation: The circulation of blood through the BLOOD VESSELS of the BRAIN.Asymptomatic Diseases: Diseases that do not exhibit symptoms.Recurrence: The return of a sign, symptom, or disease after a remission.Retrospective Studies: Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons.Tomography, X-Ray Computed: Tomography using x-ray transmission and a computer algorithm to reconstruct the image.Carotid Artery Injuries: Damages to the CAROTID ARTERIES caused either by blunt force or penetrating trauma, such as CRANIOCEREBRAL TRAUMA; THORACIC INJURIES; and NECK INJURIES. Damaged carotid arteries can lead to CAROTID ARTERY THROMBOSIS; CAROTID-CAVERNOUS SINUS FISTULA; pseudoaneurysm formation; and INTERNAL CAROTID ARTERY DISSECTION. (From Am J Forensic Med Pathol 1997, 18:251; J Trauma 1994, 37:473)Postoperative Complications: Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery.Arteriosclerosis: Thickening and loss of elasticity of the walls of ARTERIES of all sizes. There are many forms classified by the types of lesions and arteries involved, such as ATHEROSCLEROSIS with fatty lesions in the ARTERIAL INTIMA of medium and large muscular arteries.Sensitivity and Specificity: Binary classification measures to assess test results. Sensitivity or recall rate is the proportion of true positives. Specificity is the probability of correctly determining the absence of a condition. (From Last, Dictionary of Epidemiology, 2d ed)Tunica Intima: The innermost layer of an artery or vein, made up of one layer of endothelial cells and supported by an internal elastic lamina.Risk Assessment: The qualitative or quantitative estimation of the likelihood of adverse effects that may result from exposure to specified health hazards or from the absence of beneficial influences. (Last, Dictionary of Epidemiology, 1988)Time Factors: Elements of limited time intervals, contributing to particular results or situations.Embolism: Blocking of a blood vessel by an embolus which can be a blood clot or other undissolved material in the blood stream.Tunica Media: The middle layer of blood vessel walls, composed principally of thin, cylindrical, smooth muscle cells and elastic tissue. It accounts for the bulk of the wall of most arteries. The smooth muscle cells are arranged in circular layers around the vessel, and the thickness of the coat varies with the size of the vessel.Carotid Intima-Media Thickness: A measurement of the thickness of the carotid artery walls. It is measured by B-mode ULTRASONOGRAPHY and is used as a surrogate marker for ATHEROSCLEROSIS.Cerebral Infarction: The formation of an area of NECROSIS in the CEREBRUM caused by an insufficiency of arterial or venous blood flow. Infarcts of the cerebrum are generally classified by hemisphere (i.e., left vs. right), lobe (e.g., frontal lobe infarction), arterial distribution (e.g., INFARCTION, ANTERIOR CEREBRAL ARTERY), and etiology (e.g., embolic infarction).Observer Variation: The failure by the observer to measure or identify a phenomenon accurately, which results in an error. Sources for this may be due to the observer's missing an abnormality, or to faulty technique resulting in incorrect test measurement, or to misinterpretation of the data. Two varieties are inter-observer variation (the amount observers vary from one another when reporting on the same material) and intra-observer variation (the amount one observer varies between observations when reporting more than once on the same material).Retinal Artery Occlusion: Sudden ISCHEMIA in the RETINA due to blocked blood flow through the CENTRAL RETINAL ARTERY or its branches leading to sudden complete or partial loss of vision, respectively, in the eye.Doppler Effect: Changes in the observed frequency of waves (as sound, light, or radio waves) due to the relative motion of source and observer. The effect was named for the 19th century Austrian physicist Johann Christian Doppler.Middle Cerebral Artery: The largest of the cerebral arteries. It trifurcates into temporal, frontal, and parietal branches supplying blood to most of the parenchyma of these lobes in the CEREBRAL CORTEX. These are the areas involved in motor, sensory, and speech activities.Cranial Nerve Injuries: Dysfunction of one or more cranial nerves causally related to a traumatic injury. Penetrating and nonpenetrating CRANIOCEREBRAL TRAUMA; NECK INJURIES; and trauma to the facial region are conditions associated with cranial nerve injuries.Hemodynamics: The movement and the forces involved in the movement of the blood through the CARDIOVASCULAR SYSTEM.Patient Selection: Criteria and standards used for the determination of the appropriateness of the inclusion of patients with specific conditions in proposed treatment plans and the criteria used for the inclusion of subjects in various clinical trials and other research protocols.Calcinosis: Pathologic deposition of calcium salts in tissues.Renal Artery Obstruction: Narrowing or occlusion of the RENAL ARTERY or arteries. It is due usually to ATHEROSCLEROSIS; FIBROMUSCULAR DYSPLASIA; THROMBOSIS; EMBOLISM, or external pressure. The reduced renal perfusion can lead to renovascular hypertension (HYPERTENSION, RENOVASCULAR).Plaque, Atherosclerotic: Lesions formed within the walls of ARTERIES.Intracranial Embolism and Thrombosis: Embolism or thrombosis involving blood vessels which supply intracranial structures. Emboli may originate from extracranial or intracranial sources. Thrombosis may occur in arterial or venous structures.Reproducibility of Results: The statistical reproducibility of measurements (often in a clinical context), including the testing of instrumentation or techniques to obtain reproducible results. The concept includes reproducibility of physiological measurements, which may be used to develop rules to assess probability or prognosis, or response to a stimulus; reproducibility of occurrence of a condition; and reproducibility of experimental results.Aortic Stenosis, Subvalvular: A pathological constriction occurring in the region below the AORTIC VALVE. It is characterized by restricted outflow from the LEFT VENTRICLE into the AORTA.Acetazolamide: One of the CARBONIC ANHYDRASE INHIBITORS that is sometimes effective against absence seizures. It is sometimes useful also as an adjunct in the treatment of tonic-clonic, myoclonic, and atonic seizures, particularly in women whose seizures occur or are exacerbated at specific times in the menstrual cycle. However, its usefulness is transient often because of rapid development of tolerance. Its antiepileptic effect may be due to its inhibitory effect on brain carbonic anhydrase, which leads to an increased transneuronal chloride gradient, increased chloride current, and increased inhibition. (From Smith and Reynard, Textbook of Pharmacology, 1991, p337)Atherosclerosis: A thickening and loss of elasticity of the walls of ARTERIES that occurs with formation of ATHEROSCLEROTIC PLAQUES within the ARTERIAL INTIMA.Life Tables: Summarizing techniques used to describe the pattern of mortality and survival in populations. These methods can be applied to the study not only of death, but also of any defined endpoint such as the onset of disease or the occurrence of disease complications.Aortic Stenosis, Supravalvular: A pathological constriction occurring in the region above the AORTIC VALVE. It is characterized by restricted outflow from the LEFT VENTRICLE into the AORTA.Blood Pressure: PRESSURE of the BLOOD on the ARTERIES and other BLOOD VESSELS.Vertebrobasilar Insufficiency: Localized or diffuse reduction in blood flow through the vertebrobasilar arterial system, which supplies the BRAIN STEM; CEREBELLUM; OCCIPITAL LOBE; medial TEMPORAL LOBE; and THALAMUS. Characteristic clinical features include SYNCOPE; lightheadedness; visual disturbances; and VERTIGO. BRAIN STEM INFARCTIONS or other BRAIN INFARCTION may be associated.Coronary Angiography: Radiography of the vascular system of the heart muscle after injection of a contrast medium.Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques.Collateral Circulation: Maintenance of blood flow to an organ despite obstruction of a principal vessel. Blood flow is maintained through small vessels.Carotid Artery, Internal, Dissection: The splitting of the vessel wall in one or both (left and right) internal carotid arteries (CAROTID ARTERY, INTERNAL). Interstitial hemorrhage into the media of the vessel wall can lead to occlusion of the internal carotid artery and aneurysm formation.Catheterization: Use or insertion of a tubular device into a duct, blood vessel, hollow organ, or body cavity for injecting or withdrawing fluids for diagnostic or therapeutic purposes. It differs from INTUBATION in that the tube here is used to restore or maintain patency in obstructions.Contrast Media: Substances used to allow enhanced visualization of tissues.Vascular Patency: The degree to which BLOOD VESSELS are not blocked or obstructed.Carotid Body Tumor: Benign paraganglioma at the bifurcation of the COMMON CAROTID ARTERIES. It can encroach on the parapharyngeal space and produce dysphagia, pain, and cranial nerve palsies.Coronary Artery Bypass: Surgical therapy of ischemic coronary artery disease achieved by grafting a section of saphenous vein, internal mammary artery, or other substitute between the aorta and the obstructed coronary artery distal to the obstructive lesion.Blood Vessel Prosthesis: Device constructed of either synthetic or biological material that is used for the repair of injured or diseased blood vessels.Embolic Protection Devices: Vascular filters or occlusive devices that provide mechanical protection of the distal end organ from blood clots or EMBOLISM-causing debri dislodged during ENDOVASCULAR PROCEDURES.Coronary Disease: An imbalance between myocardial functional requirements and the capacity of the CORONARY VESSELS to supply sufficient blood flow. It is a form of MYOCARDIAL ISCHEMIA (insufficient blood supply to the heart muscle) caused by a decreased capacity of the coronary vessels.Disease Progression: The worsening of a disease over time. This concept is most often used for chronic and incurable diseases where the stage of the disease is an important determinant of therapy and prognosis.Laryngostenosis: Developmental or acquired stricture or narrowing of the LARYNX. Symptoms of respiratory difficulty depend on the degree of laryngeal narrowing.Aortic Valve: The valve between the left ventricle and the ascending aorta which prevents backflow into the left ventricle.Radiology, Interventional: Subspecialty of radiology that combines organ system radiography, catheter techniques and sectional imaging.Systole: Period of contraction of the HEART, especially of the HEART VENTRICLES.Coronary Artery Disease: Pathological processes of CORONARY ARTERIES that may derive from a congenital abnormality, atherosclerotic, or non-atherosclerotic cause.Arteritis: INFLAMMATION of any ARTERIES.Odds Ratio: The ratio of two odds. The exposure-odds ratio for case control data is the ratio of the odds in favor of exposure among cases to the odds in favor of exposure among noncases. The disease-odds ratio for a cohort or cross section is the ratio of the odds in favor of disease among the exposed to the odds in favor of disease among the unexposed. The prevalence-odds ratio refers to an odds ratio derived cross-sectionally from studies of prevalent cases.Tricuspid Valve Stenosis: The pathologic narrowing of the orifice of the TRICUSPID VALVE. This hinders the emptying of RIGHT ATRIUM leading to elevated right atrial pressure and systemic venous congestion. Tricuspid valve stenosis is almost always due to RHEUMATIC FEVER.Reoperation: A repeat operation for the same condition in the same patient due to disease progression or recurrence, or as followup to failed previous surgery.Vascular Surgical Procedures: Operative procedures for the treatment of vascular disorders.Age Factors: Age as a constituent element or influence contributing to the production of a result. It may be applicable to the cause or the effect of a circumstance. It is used with human or animal concepts but should be differentiated from AGING, a physiological process, and TIME FACTORS which refers only to the passage of time.Ophthalmic Artery: Artery originating from the internal carotid artery and distributing to the eye, orbit and adjacent facial structures.Image Processing, Computer-Assisted: A technique of inputting two-dimensional images into a computer and then enhancing or analyzing the imagery into a form that is more useful to the human observer.Cerebral Arteries: The arterial blood vessels supplying the CEREBRUM.Chi-Square Distribution: A distribution in which a variable is distributed like the sum of the squares of any given independent random variable, each of which has a normal distribution with mean of zero and variance of one. The chi-square test is a statistical test based on comparison of a test statistic to a chi-square distribution. The oldest of these tests are used to detect whether two or more population distributions differ from one another.Discrete Subaortic Stenosis: A type of constriction that is caused by the presence of a fibrous ring (discrete type) below the AORTIC VALVE, anywhere between the aortic valve and the MITRAL VALVE. It is characterized by restricted outflow from the LEFT VENTRICLE into the AORTA.Cohort Studies: Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics.Intraoperative Complications: Complications that affect patients during surgery. They may or may not be associated with the disease for which the surgery is done, or within the same surgical procedure.Peripheral Vascular Diseases: Pathological processes involving any one of the BLOOD VESSELS in the vasculature outside the HEART.Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from INCIDENCE, which refers to the number of new cases in the population at a given time.Incidence: The number of new cases of a given disease during a given period in a specified population. It also is used for the rate at which new events occur in a defined population. It is differentiated from PREVALENCE, which refers to all cases, new or old, in the population at a given time.Rupture, Spontaneous: Tear or break of an organ, vessel or other soft part of the body, occurring in the absence of external force.Pyloric Stenosis, Hypertrophic: Narrowing of the pyloric canal due to HYPERTROPHY of the surrounding circular muscle. It is usually seen in infants or young children.Imaging, Three-Dimensional: The process of generating three-dimensional images by electronic, photographic, or other methods. For example, three-dimensional images can be generated by assembling multiple tomographic images with the aid of a computer, while photographic 3-D images (HOLOGRAPHY) can be made by exposing film to the interference pattern created when two laser light sources shine on an object.Comorbidity: The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival.Graft Occlusion, Vascular: Obstruction of flow in biological or prosthetic vascular grafts.Regional Blood Flow: The flow of BLOOD through or around an organ or region of the body.Preoperative Care: Care given during the period prior to undergoing surgery when psychological and physical preparations are made according to the special needs of the individual patient. This period spans the time between admission to the hospital to the time the surgery begins. (From Dictionary of Health Services Management, 2d ed)Postoperative Period: The period following a surgical operation.Ferrosoferric Oxide: Iron (II,III) oxide (Fe3O4). It is a black ore of IRON that forms opaque crystals and exerts strong magnetism.Pulsatile Flow: Rhythmic, intermittent propagation of a fluid through a BLOOD VESSEL or piping system, in contrast to constant, smooth propagation, which produces laminar flow.Heart Valve Prosthesis Implantation: Surgical insertion of synthetic material to repair injured or diseased heart valves.Filtration: A process of separating particulate matter from a fluid, such as air or a liquid, by passing the fluid carrier through a medium that will not pass the particulates. (McGraw-Hill Dictionary of Scientific and Technical Terms, 4th ed)ROC Curve: A graphic means for assessing the ability of a screening test to discriminate between healthy and diseased persons; may also be used in other studies, e.g., distinguishing stimuli responses as to a faint stimuli or nonstimuli.Aspirin: The prototypical analgesic used in the treatment of mild to moderate pain. It has anti-inflammatory and antipyretic properties and acts as an inhibitor of cyclooxygenase which results in the inhibition of the biosynthesis of prostaglandins. Aspirin also inhibits platelet aggregation and is used in the prevention of arterial and venous thrombosis. (From Martindale, The Extra Pharmacopoeia, 30th ed, p5)Myocardial Infarction: NECROSIS of the MYOCARDIUM caused by an obstruction of the blood supply to the heart (CORONARY CIRCULATION).Blood Vessel Prosthesis Implantation: Surgical insertion of BLOOD VESSEL PROSTHESES to repair injured or diseased blood vessels.Logistic Models: Statistical models which describe the relationship between a qualitative dependent variable (that is, one which can take only certain discrete values, such as the presence or absence of a disease) and an independent variable. A common application is in epidemiology for estimating an individual's risk (probability of a disease) as a function of a given risk factor.Hypertension: Persistently high systemic arterial BLOOD PRESSURE. Based on multiple readings (BLOOD PRESSURE DETERMINATION), hypertension is currently defined as when SYSTOLIC PRESSURE is consistently greater than 140 mm Hg or when DIASTOLIC PRESSURE is consistently 90 mm Hg or more.Platelet Aggregation Inhibitors: Drugs or agents which antagonize or impair any mechanism leading to blood platelet aggregation, whether during the phases of activation and shape change or following the dense-granule release reaction and stimulation of the prostaglandin-thromboxane system.Risk: The probability that an event will occur. It encompasses a variety of measures of the probability of a generally unfavorable outcome.Esophageal Stenosis: A stricture of the ESOPHAGUS. Most are acquired but can be congenital.Multivariate Analysis: A set of techniques used when variation in several variables has to be studied simultaneously. In statistics, multivariate analysis is interpreted as any analytic method that allows simultaneous study of two or more dependent variables.Case-Control Studies: Studies which start with the identification of persons with a disease of interest and a control (comparison, referent) group without the disease. The relationship of an attribute to the disease is examined by comparing diseased and non-diseased persons with regard to the frequency or levels of the attribute in each group.Brain: The part of CENTRAL NERVOUS SYSTEM that is contained within the skull (CRANIUM). Arising from the NEURAL TUBE, the embryonic brain is comprised of three major parts including PROSENCEPHALON (the forebrain); MESENCEPHALON (the midbrain); and RHOMBENCEPHALON (the hindbrain). The developed brain consists of CEREBRUM; CEREBELLUM; and other structures in the BRAIN STEM.Prognosis: A prediction of the probable outcome of a disease based on a individual's condition and the usual course of the disease as seen in similar situations.Ultrasonics: A subfield of acoustics dealing in the radio frequency range higher than acoustic SOUND waves (approximately above 20 kilohertz). Ultrasonic radiation is used therapeutically (DIATHERMY and ULTRASONIC THERAPY) to generate HEAT and to selectively destroy tissues. It is also used in diagnostics, for example, ULTRASONOGRAPHY; ECHOENCEPHALOGRAPHY; and ECHOCARDIOGRAPHY, to visually display echoes received from irradiated tissues.Cardiac Catheterization: Procedures in which placement of CARDIAC CATHETERS is performed for therapeutic or diagnostic procedures.Biological Markers: Measurable and quantifiable biological parameters (e.g., specific enzyme concentration, specific hormone concentration, specific gene phenotype distribution in a population, presence of biological substances) which serve as indices for health- and physiology-related assessments, such as disease risk, psychiatric disorders, environmental exposure and its effects, disease diagnosis, metabolic processes, substance abuse, pregnancy, cell line development, epidemiologic studies, etc.Coronary Vessels: The veins and arteries of the HEART.Sex Factors: Maleness or femaleness as a constituent element or influence contributing to the production of a result. It may be applicable to the cause or effect of a circumstance. It is used with human or animal concepts but should be differentiated from SEX CHARACTERISTICS, anatomical or physiological manifestations of sex, and from SEX DISTRIBUTION, the number of males and females in given circumstances.Echocardiography: Ultrasonic recording of the size, motion, and composition of the heart and surrounding tissues. The standard approach is transthoracic.Randomized Controlled Trials as Topic: Works about clinical trials that involve at least one test treatment and one control treatment, concurrent enrollment and follow-up of the test- and control-treated groups, and in which the treatments to be administered are selected by a random process, such as the use of a random-numbers table.Regression Analysis: Procedures for finding the mathematical function which best describes the relationship between a dependent variable and one or more independent variables. In linear regression (see LINEAR MODELS) the relationship is constrained to be a straight line and LEAST-SQUARES ANALYSIS is used to determine the best fit. In logistic regression (see LOGISTIC MODELS) the dependent variable is qualitative rather than continuously variable and LIKELIHOOD FUNCTIONS are used to find the best relationship. In multiple regression, the dependent variable is considered to depend on more than a single independent variable.Survival Rate: The proportion of survivors in a group, e.g., of patients, studied and followed over a period, or the proportion of persons in a specified group alive at the beginning of a time interval who survive to the end of the interval. It is often studied using life table methods.Chemoreceptor Cells: Cells specialized to detect chemical substances and relay that information centrally in the nervous system. Chemoreceptor cells may monitor external stimuli, as in TASTE and OLFACTION, or internal stimuli, such as the concentrations of OXYGEN and CARBON DIOXIDE in the blood.Coronary Circulation: The circulation of blood through the CORONARY VESSELS of the HEART.Proportional Hazards Models: Statistical models used in survival analysis that assert that the effect of the study factors on the hazard rate in the study population is multiplicative and does not change over time.Time: The dimension of the physical universe which, at a given place, orders the sequence of events. (McGraw-Hill Dictionary of Scientific and Technical Terms, 6th ed)Diagnostic Imaging: Any visual display of structural or functional patterns of organs or tissues for diagnostic evaluation. It includes measuring physiologic and metabolic responses to physical and chemical stimuli, as well as ultramicroscopy.Hemorrhage: Bleeding or escape of blood from a vessel.Single-Blind Method: A method in which either the observer(s) or the subject(s) is kept ignorant of the group to which the subjects are assigned.C-Reactive Protein: A plasma protein that circulates in increased amounts during inflammation and after tissue damage.Vertebral Artery: The first branch of the SUBCLAVIAN ARTERY with distribution to muscles of the NECK; VERTEBRAE; SPINAL CORD; CEREBELLUM; and interior of the CEREBRUM.Hydroxymethylglutaryl-CoA Reductase Inhibitors: Compounds that inhibit HMG-CoA reductases. They have been shown to directly lower cholesterol synthesis.Fractional Flow Reserve, Myocardial: The ratio of maximum blood flow to the MYOCARDIUM with CORONARY STENOSIS present, to the maximum equivalent blood flow without stenosis. The measurement is commonly used to verify borderline stenosis of CORONARY ARTERIES.Linear Models: Statistical models in which the value of a parameter for a given value of a factor is assumed to be equal to a + bx, where a and b are constants. The models predict a linear regression.Kaplan-Meier Estimate: A nonparametric method of compiling LIFE TABLES or survival tables. It combines calculated probabilities of survival and estimates to allow for observations occurring beyond a measurement threshold, which are assumed to occur randomly. Time intervals are defined as ending each time an event occurs and are therefore unequal. (From Last, A Dictionary of Epidemiology, 1995)Heptanoic Acids: 7-carbon saturated monocarboxylic acids.Image Enhancement: Improvement of the quality of a picture by various techniques, including computer processing, digital filtering, echocardiographic techniques, light and ultrastructural MICROSCOPY, fluorescence spectrometry and microscopy, scintigraphy, and in vitro image processing at the molecular level.Arteriovenous Shunt, Surgical: Surgical shunt allowing direct passage of blood from an artery to a vein. (From Dorland, 28th ed)Intracranial Arterial Diseases: Pathological conditions involving ARTERIES in the skull, such as arteries supplying the CEREBRUM, the CEREBELLUM, the BRAIN STEM, and associated structures. They include atherosclerotic, congenital, traumatic, infectious, inflammatory, and other pathological processes.Analysis of Variance: A statistical technique that isolates and assesses the contributions of categorical independent variables to variation in the mean of a continuous dependent variable.Heart Valve Prosthesis: A device that substitutes for a heart valve. It may be composed of biological material (BIOPROSTHESIS) and/or synthetic material.Femoral Artery: The main artery of the thigh, a continuation of the external iliac artery.Vasomotor System: The neural systems which act on VASCULAR SMOOTH MUSCLE to control blood vessel diameter. The major neural control is through the sympathetic nervous system.Brain Infarction: Tissue NECROSIS in any area of the brain, including the CEREBRAL HEMISPHERES, the CEREBELLUM, and the BRAIN STEM. Brain infarction is the result of a cascade of events initiated by inadequate blood flow through the brain that is followed by HYPOXIA and HYPOGLYCEMIA in brain tissue. Damage may be temporary, permanent, selective or pan-necrosis.Image Interpretation, Computer-Assisted: Methods developed to aid in the interpretation of ultrasound, radiographic images, etc., for diagnosis of disease.Renal Artery: A branch of the abdominal aorta which supplies the kidneys, adrenal glands and ureters.Nervous System Diseases: Diseases of the central and peripheral nervous system. This includes disorders of the brain, spinal cord, cranial nerves, peripheral nerves, nerve roots, autonomic nervous system, neuromuscular junction, and muscle.Dogs: The domestic dog, Canis familiaris, comprising about 400 breeds, of the carnivore family CANIDAE. They are worldwide in distribution and live in association with people. (Walker's Mammals of the World, 5th ed, p1065)Pressoreceptors: Receptors in the vascular system, particularly the aorta and carotid sinus, which are sensitive to stretch of the vessel walls.Hypertension, Renovascular: Hypertension due to RENAL ARTERY OBSTRUCTION or compression.Radiation Injuries: Harmful effects of non-experimental exposure to ionizing or non-ionizing radiation in VERTEBRATES.Hypotension: Abnormally low BLOOD PRESSURE that can result in inadequate blood flow to the brain and other vital organs. Common symptom is DIZZINESS but greater negative impacts on the body occur when there is prolonged depravation of oxygen and nutrients.GreeceCircle of Willis: A polygonal anastomosis at the base of the brain formed by the internal carotid (CAROTID ARTERY, INTERNAL), proximal parts of the anterior, middle, and posterior cerebral arteries (ANTERIOR CEREBRAL ARTERY; MIDDLE CEREBRAL ARTERY; POSTERIOR CEREBRAL ARTERY), the anterior communicating artery and the posterior communicating arteries.Jugular Veins: Veins in the neck which drain the brain, face, and neck into the brachiocephalic or subclavian veins.

Studies on structural changes of the carotid arteries and the heart in asymptomatic renal transplant recipients. (1/2863)

BACKGROUND: The present study was designed to characterize early structural changes of large arteries in renal transplant recipients with no clinical evidence of cardiovascular disease and normal blood pressure values, and to analyse the relationship between arterial alterations and those of the heart. METHODS: Intima media thickness and atherosclerotic plaques of the carotid arteries as well as left ventricular geometry and function were examined in 35 asymtomatic renal transplant recipients and 29 age- and sex-matched healthy controls by high resolution B-mode ultrasound and by echocardiography. RESULTS: Intima-media thickness of the carotid arteries was significantly higher in renal transplant recipients (1.21+/-0.08 mm) than in healthy controls (0.74+/-0.04 mm) (P<0.001). Atherosclerotic plaques were found in the majority of renal transplant recipients (71% vs 14% in healthy controls, P<0.001). Left ventricular mass index was significantly increased in the group of renal transplant recipients (264+/-13 g, 146+/-7 g/m2) when compared with healthy controls (155+/-8 g, 83+/-4 g/m2) (P<0.001). Multiple regression analysis in renal transplant recipients showed that intima media thickness of the carotid arteries was significantly related to left ventricular mass index (P<0.02), but not to age, blood pressure, body mass index, serum creatinine, cholesterol and lipoprotein (a) levels. In the group of healthy controls, intima-media thickness of the carotid artery was related to age (P<0.002), but not to left ventricular mass index or the other independent variables. CONCLUSIONS: The present study documents pronounced intima-media thickening in asymptomatic renal transplant recipients. Atherosclerotic lesions are present in most renal transplant recipients with no clinical evidence of cardiovascular disease. We observed a parallelism between arterial wall thickening and left ventricular hypertrophy, although blood pressure levels were normal during haemodialysis therapy and after renal transplantation.  (+info)

Combined carotid endarterectomy and coronary artery bypass graft. (2/2863)

Atherosclerosis is a generalized disease which afflicts a considerable number of patients in both the carotid and coronary arteries. Although the risk of stroke or death use to combined carotid endarterectomy (CEA) and coronary artery bypass graft (CABG) is thought to be higher than that of each individual operation, the combined procedure is generally preferred over staged operations to treat such patients. We performed the combined procedure safely with the aid of intraoperative portable digital subtraction angiography (DSA). This report describes our experience with the operative strategy of simultaneous CEA and CABG. Ninety CEA and 404 CABG were carried out between January 1989 and December 1997. A total of six patients received the combined procedure with the aid of intraoperative DSA; they were studied retrospectively. Postoperative mortality and morbidity after the combined procedure was 0%. In the combined procedure, neurological complications are difficult to detect after CEA because the patient must be maintained under general anesthesia and extracorporeal circulation during the subsequent CABG. However, intraoperative DSA can confirm patency of the internal carotid artery and absence of flap formation after CEA, and the CABG can be performed safely. Intraoperative portable DSA between CEA and CABG is helpful in preventing perioperative stroke in the combined procedure.  (+info)

Brain-specific protein C activation during carotid artery occlusion in humans. (3/2863)

BACKGROUND AND PURPOSE: Activation of plasma protein C (PC) zymogen by thrombin-thrombomodulin at the endothelial surface is an important endogenous antithrombotic mechanism. It is unknown whether activated protein C (APC) is generated in vivo in the cerebrovasculature, because there is only limited thrombomodulin expression in human brain vascular endothelium. Therefore, we tested the hypothesis that carotid occlusion produces brain-specific PC activation. METHODS: Blood samples were simultaneously collected from the ipsilateral internal jugular vein and radial artery before and during carotid cross-clamping and on "de-occlusion" in 8 awake patients undergoing routine carotid endarterectomy. Plasma PC zymogen and circulating APC levels were measured using enzyme immunocapture assay and expressed as percent of pooled plasma controls. RESULTS: Internal jugular vein APC levels increased 28% exclusively during carotid occlusion and then decreased 32% with de-occlusion (F=8.1, P<0.005). PC zymogen increased only 5.9% with occlusion (F=6.3, P<0.02), consistent with hemoconcentration. There were no changes in radial artery PC or APC levels. CONCLUSIONS: These findings demonstrate brain-specific protein C activation in humans during carotid occlusion and suggest a protective role for endogenous APC generation during cerebrovascular occlusion.  (+info)

Outcome of carotid artery occlusion is predicted by cerebrovascular reactivity. (4/2863)

BACKGROUND AND PURPOSE: The purpose of this study was to investigate the possibility of obtaining prognostic indications in patients with internal carotid occlusion on the basis of intracranial hemodynamic status, presence of previous symptoms of cerebrovascular failure, and baseline characteristics. METHODS: Cerebral hemodynamics were studied with transcranial Doppler ultrasonography. Cerebrovascular reactivity to apnea was calculated by means of the breath-holding index (BHI) in the middle cerebral arteries. Sixty-five patients with internal carotid artery occlusion were followed-up prospectively (median, 24 months), 23 patients were asymptomatic and 42 symptomatic (20 with transient ischemic attack and 22 with stroke). RESULTS: During the follow-up period, 11 symptomatic patients and 1 asymptomatic patient had another ischemic event ipsilateral to carotid occlusion. Among factors considered, only lower BHI values in the middle cerebral arteries ipsilateral to carotid occlusion and older age were significantly associated with the risk of developing symptoms (P=0.002 and P=0.003, respectively; Cox regression multivariate analysis). Based on our data, a cut point of the BHI value for distinguishing between pathological and normal cerebrovascular reactivity was determined to be 0.69. All patients except one, who developed TIA or stroke during the follow-up period, had BHI values ipsilateral to carotid occlusion of <0.69. CONCLUSIONS: These data suggest that impaired cerebrovascular reactivity is predictive for cerebral ischemic events in patients with carotid occlusion.  (+info)

Prevention of neointimal formation by a serine protease inhibitor, FUT-175, after carotid balloon injury in rats. (5/2863)

BACKGROUND AND PURPOSE: In vivo and vitro studies revealed the activation of thrombin and the complement system in vascular lesion formation during the process of atherosclerosis, along with pathological proliferation of smooth muscle cells. We examined the effect of the synthetic serine protease inhibitor FUT-175 (developed as a potent inhibitor of thrombin and the complement system) on vascular lesions using balloon dilatation-induced neointimal formation in the carotid artery of rats. METHODS: Sprague-Dawley (SD) rats underwent balloon dilatation injury of the left carotid artery to induce neointimal formation. Three groups of these rats (n=8, each) were treated with daily intraperitoneal injections of 1 of the following doses of FUT-175: 0.5, 1.0, or 2.0 mg/d in 1 mL of saline for 7 consecutive days. The control group (n=8) was similarly treated with 1 mL of saline for 7 days. The injections were started immediately after balloon injury. Two weeks after the injury, the left carotid arteries were perfusion-fixed, and the areas of the neointimal and medial layer were analyzed under a microscope. RESULTS: A morphometric analysis revealed that there were significant differences in the intima-media ratio between the 4 groups treated with vehicle (saline) or a low, medium, or high dose of FUT-175 (1.45+/-0.11, 1.08+/-0.06, 0.71+/-0.04, or 0.32+/-0.04, respectively). This suppression was achieved in a dose-dependent manner by the administration of FUT-175 after balloon injury. In the histological study, it was demonstrated that FUT-175 suppresses the production of platelet-derived growth factor (PDGF)-BB in the neointima and the medial smooth muscle cell layer. CONCLUSIONS: After balloon injury activated proteases that were inhibited by FUT-175 were demonstrated to have an essential role in the development of the pathological thickening of the arterial wall.  (+info)

Prostacyclin synthase gene transfer accelerates reendothelialization and inhibits neointimal formation in rat carotid arteries after balloon injury. (6/2863)

Prostacyclin (PGI2), a metabolite of arachidonic acid, has the vasoprotective effects of vasodilation, anti-platelet aggregation, and inhibition of smooth muscle cell proliferation. We hypothesized that an overexpression of endogenous PGI2 may accelerate the recovery from endothelial damage and inhibit neointimal formation in the injured artery. To test this hypothesis, we investigated in vivo transfer of the PGI2 synthase (PCS) gene into balloon-injured rat carotid arteries by a nonviral lipotransfection method. Seven days after transfection, a significant regeneration of endothelium was observed in the arteries transfected with a plasmid carrying the rat PCS gene (pCMV-PCS), but little regeneration was seen in those with the control plasmid carrying the lacZ gene (pCMV-lacZ) (percent luminal circumference lined by newly regenerated endothelium: 87. 1+/-6.9% in pCMV-PCS-transfected vessels and 6.9+/-0.2% in pCMV-lacZ vessels, P<0.001). BrdU staining of arterial segments demonstrated a significantly lower incorporation in pCMV-PCS-transfected vessels (7. 5+/-0.3% positive nuclei in vessel cells) than in pCMV-lacZ (50. 7+/-9.6%, P<0.01). Moreover, 2 weeks after transfection, the PCS gene transfer resulted in a significant inhibition of neointimal formation (88% reduction in ratio of intima/media areas), whereas medial area was similar among the groups. Arterial segments transfected with pCMV-PCS produced significantly higher levels of 6-keto-PGF1alpha, the main metabolite of PGI2, compared with the segments transfected with pCMV-lacZ (10.2+/-0.55 and 2.1+/-0.32 ng/mg tissue for pCMV-PCS and pCMV-placZ, P<0.001). In conclusion, this study demonstrated that an in vivo PCS gene transfer increased the production of PGI2 and markedly inhibited neointimal formation with accelerated reendothelialization in rat carotid arteries after balloon injury.  (+info)

Continuous perivascular L-arginine delivery increases total vessel area and reduces neointimal thickening after experimental balloon dilatation. (7/2863)

The aim of this study was to evaluate whether vascular remodeling and neointimal thickening occur after balloon dilatation of the nonatherosclerotic rabbit carotid artery, and whether both processes are influenced by continuous perivascular delivery of L-arginine or the nitric oxide synthase inhibitor NG-nitro-L-arginine methyl ester (L-NAME). In the first experiment, histological and morphometric evaluation of arteries was performed at different time points after balloon dilatation: 10 minutes (n=7), and 1 (n=7), 2 (n=9), 3 (n=20), or 10 (n=5) weeks. Neointimal thickening progressively contributed to luminal narrowing for at least 10 weeks after angioplasty. During the first 2 weeks after dilatation, a significant decrease of the total vessel area was measured. Ten weeks after dilatation, both the neointimal and total vessel area were increased without further changing of the luminal area. In the second experiment, endothelial injured rabbits were randomly assigned to receive 2 weeks of continuous local perivascular physiological salt solution (n=6), L-arginine (n=8), or L-NAME (n=7), starting immediately after balloon dilatation (ie, local drug delivery during the first phase of the biphasic vascular remodeling process). Perivascular L-arginine delivery significantly reduced the neointimal area, despite an increased number of neointimal Ki-67-positive smooth muscle cells. Both the luminal area and total vessel area were significantly increased. Serum L-arginine levels remained unchanged. L-NAME administration had no effect on the neointimal area, nor on the luminal and total vessel area. Neointimal formation and biphasic vascular remodeling occur after experimental balloon dilatation of the nonatherosclerotic rabbit carotid artery, and can be influenced by continuous local perivascular delivery of L-arginine.  (+info)

Lumen reduction measurements of the internal carotid artery before and after Levovist enhancement: reproducibility and agreement with angiography. (8/2863)

Our aim was to assess reproducibility of three different lumen reduction measuring methods--North American Symptomatic Carotid Endarterectomy Trial, European Carotid Surgery Trial, and common carotid--using power Doppler and color Doppler sonography before and after Levovist enhancement. We included 20 symptomatic patients with mild or severe carotid disease. North American Symptomatic Carotid Endarterectomy Trial, European Carotid Surgery Trial, and common carotid measurements on longitudinal views and European Carotid Surgery Trial measurements on transverse views were performed. Examinations were repeated and the results compared to assess reproducibility of measurements. Correlation with angiography was obtained by calculating Pearson correlation coefficients. Reproducibility was significantly better (P < 0.05) for European Carotid Surgery Trial and common carotid measurements (95% limits of agreement between -10% to 10% and -19% to 17%) as compared to North American Symptomatic Carotid Endarterectomy Trial measurements (95% limits of agreement between -11% to 21% and -21% to 23%). Variability of measurements after enhancement increased slightly (not significant) for both power and color Doppler sonography. Additionally, European Carotid Surgery Trial measurements, using nonenhanced power Doppler or color Doppler sonography, did not correlate significantly with angiography, whereas North American Symptomatic Carotid Endarterectomy Trial and common carotid measurements correlated well with angiography, particularly in power Doppler mode after enhancement (r = 0.88 and r = 0.82, respectively). We conclude that for lumen reduction measurements of the internal carotid artery with power and color Doppler sonography, the common carotid method is the only method that is reproducible and has good correlation with angiography, which slightly improves after Levovist enhancement.  (+info)

*Carotid artery stenosis

The carotid artery divides into the internal carotid artery and the external carotid artery. The internal carotid artery ... Carotid endarterectomy reduces the risk of stroke or death from carotid emboli by about half. For people with stenosis but no ... Carotid artery stenosis is a narrowing or constriction of any part of the carotid arteries, usually caused by atherosclerosis. ... In selected trial participants with asymptomatic severe carotid artery stenosis, carotid endarterectomy reduces the risk of ...

*Tympanosclerosis

Ferri M, Faggioli GL, Ferri GG, Pirodda A (June 2004). "Is carotid stenosis correlated with tympanosclerosis". International ...

*Stefan D. Anker

"Randomized Trial of Stent versus Surgery for Asymptomatic Carotid Stenosis". New England Journal of Medicine. 374 (11): 1011- ...

*Tocotrienol

"Antioxidant effects of tocotrienols in patients with hyperlipidemia and carotid stenosis". Lipids. 30 (12): 1179-83. doi: ...

*Andrew Nicolaides

He was the organiser and coordinator of the multicentre Asymptomatic Carotid Stenosis and Risk of Stroke (ACSRS) prospective ... Nicolaides, A: "The Asymptomatic Carotid Stenosis and Risk of Stroke (ACSRS) study. Aims and results of quality control.", ... results from the asymptomatic carotid stenosis and risk of stroke study.", Vascular, Vol. 13, Issue 4, Pages 211-21. ... "Carotid plaque characterization using digital image processing and its potential in future studies of carotid endarterectomy ...

*American Academy of Neurology

Don't recommend CEA for asymptomatic carotid stenosis unless the complication rate is low (. ... Don't perform imaging of the carotid arteries for simple syncope without other neurologic symptoms. Don't use opioid or ...

*Digital subtraction angiography

... including carotid artery stenosis, pulmonary embolisms, and acute limb ischaemia. Arterial stenosis, which is particularly ... and digital subtraction angiography in severe carotid stenoses" (PDF). European Journal of Neurology. 11: 774-5. doi:10.1111/j. ... It also helps detect and diagnose lesions in the carotid arteries, a potential cause of strokes. IV-DSA has also been useful in ... However, IV-DSA has been used successfully to study the vessels of the brain and heart and has helped detect carotid artery ...

*HABP2

2003). "Marburg I polymorphism of factor VII--activating protease: a prominent risk predictor of carotid stenosis". Circulation ...

*Amaurosis fugax

"Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. North American ... and a carotid endarterectomy considered based on the location and grade of the stenosis. Generally, if the carotid artery is ... Most episodes of amaurosis fugax are the result of stenosis of the ipsilateral carotid artery. With that being the case, ... However, a severely atherosclerotic carotid artery may also cause amaurosis fugax due to its stenosis of blood flow, leading to ...

*Watershed stroke

Often considered one of the safest ways to treat symptomatic carotid stenosis, carotid endarterectomy is a procedure by which a ... Microemboli can be common in some high-risk patients, such as those with carotid stenosis. However, in healthier patients ... During carotid angioplasty, an angiography cather with a small deflated balloon attached on the tip is advanced to a carotid ... which can lead to deformed red blood cells clogging blood vessels and impeding blood flow Carotid artery stenosis, or narrowing ...

*Neurosurgery

Endovascular neurosurgery utilizes endovascular image-guided procedures for the treatment of aneurysms, AVMs, carotid stenosis ... Microvascular techniques are used in EC-IC bypass surgery and in restoration carotid endarterectomy. The clipping of an ... nervous system infections including abscesses Spinal disc herniation Cervical spinal stenosis and Lumbar spinal stenosis ...

*Transient ischemic attack

Carotid ultrasonography is often used to screen for carotid artery stenosis, as it is more readily available. However, all of ... Confirming a diagnosis of carotid artery stenosis is important because the treatment for this condition, carotid endarterectomy ... Also, carotid stenosis secondary to atherosclerosis narrowing the diameter of the lumen and thus limiting blood flow is another ... Individuals with carotid stenosis may present with TIA symptoms, thus labeled symptomatic, while others may not experience ...

*Timeline of stroke

"Beneficial Effect of Carotid Endarterectomy in Symptomatic Patients with High-Grade Carotid Stenosis". The New England Journal ... In the 1960s carotid endarterectomy is greatly improved but is used mostly for stroke prevention and there is still no ... Reports of successful closures of injuries to the carotid arteries are documented. Early in the 20th century, most of the ... The earliest known stroke treatments start to happen, when surgeons begin performing surgery on the carotid arteries. Surgeons ...

*David Sackett

Beneficial effect of carotid endarterectomy in symptomatic patients with high grade carotid stenosis. N Engl J Med 1991;325:445 ... Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid ... ISBN 0-316-76595-3. North American Symptomatic Carotid Endarterectomy Trial Collaborators. ... carotid endarterectomy) prevented both stroke and death, and the ability of nurse practitioners to provide effective, high- ...

*Long-term complications of standing

The authors also found that men with carotid stenosis or ischemic heart disease were at greater risk for the progression of ... 2000) the authors examined the relationship between standing at work and the progression of carotid atherosclerosis in men. ... This study provides evidence that hemodynamic changes from standing can influence the progressions of carotid atherosclerosis. ... Krause, N (2000). "Standing at work and progression of carotid atherosclerosis". Scandinavian Journal of Work, Environment & ...

*John David Spence

... that with intensive medical therapy most patients with asymptomatic carotid stenosis cannot benefit from endarterectomy or ... Carotid Plaque Area: A Tool for Targeting and Evaluating Vascular Preventive Therapy Stroke. 2002;33:2916-2922 Stroke 1986; 17( ... Carotid Plaque Area: A Tool for Targeting and Evaluating Vascular Preventive Therapy Stroke. 2002;33:2916-2922 Stroke 1999;30: ... The effect of drug therapies on carotid plaque volume can now be evaluated in a very cost-effective way. Development of ...

*Intra-aortic balloon pump

Severe aortic valve insufficiency Aortic dissection Severe aortoiliac occlusive disease and bilateral carotid stenosis The ... Preoperative use is suggested for high-risk patients such as those with unstable angina with stenosis greater than 70% of main ...

*Doppler echocardiography

"Grading Carotid Stenosis Using Ultrasonic Methods," Stroke, Journal of the American Heart Association, vol. 43, pp. 916-921, ... 2D velocity is useful even if complex flow conditions such as stenosis and bifurcation exist. There are two major methods of 2D ... It is the most needed information in some cases, such as diagnosing stenosis. There are mainly three methods of finding the ... such as those due to stenosis and/or bifurcation. Volumetric flow estimation requires integrating velocity across the vessel ...

*Morning glory disc anomaly

MGDA can be associated with midline cranial defects and abnormal carotid circulation, such as carotid stenosis/aplasia or ... 2005). "Morning glory disc anomaly, midline cranial defects and abnormal carotid circulation: an association worth looking for ...

*Weekend effect

... carotid stenosis, diabetes mellitus, peripheral vascular disease, hypertension, history of dyslipidemia, current smoking, and ...

*List of MeSH codes (C14)

... carotid artery, internal, dissection MeSH C14.907.253.123.360 --- carotid stenosis MeSH C14.907.253.123.490 --- carotid- ... carotid artery diseases MeSH C14.907.253.123.331 --- carotid artery thrombosis MeSH C14.907.253.123.345 --- carotid artery ... carotid stenosis MeSH C14.907.137.372 --- fibromuscular dysplasia MeSH C14.907.137.427 --- leriche's syndrome MeSH C14.907. ... carotid artery injuries MeSH C14.907.253.535.500.300 --- carotid artery, internal, dissection MeSH C14.907.253.535.500.350 --- ...

*Carotid bruit

It may occur as the result of carotid artery stenosis (though some disagree); however, most carotid bruits, particularly those ... Likewise, a stenosis of greater than 90% may not be heard, as the flow may be too low.[citation needed] Many carotid bruits are ... The presence of a carotid bruit alone does not necessarily indicate the presence of stenosis, and the physical examination ... A carotid bruit is a systolic sound heard over the carotid artery area during auscultation. ...

*Ocular ischemic syndrome

Severe ipsilateral or bilateral carotid artery stenosis or occlusion is the most common cause of ocular ischemic syndrome. The ... internal carotid artery, and less frequently the external carotid artery. Other causes include: Takayasu's arteritis Giant cell ... If carotid occlusive disease results in ophthalmic artery occlusion, general ocular ischemia may result in retinal ... Those caused by a carotid artery embolism or occlusion have the potential for further stroke by detachment of embolus and ...

*Carotid stenting

... stenosis of the carotid artery, or are asymptomatic with >80% stenosis of the internal carotid artery. Carotid stenting may be ... when carotid endarterectomy is considered too risky. Carotid artery stenosis can present with no symptoms or with symptoms such ... Features that favor carotid stenting include non-atherosclerotic cause of the stenosis (fibrodysplasia, radiation, early post- ... "Health-related quality of life after carotid stenting versus carotid endarterectomy: Results from CREST (Carotid ...

*Artery disease

Carotid artery stenosis is a narrowing of the carotid artery in the neck and which supplies blood to the brain. Peripheral ...

*List of ICD-9 codes 390-459: diseases of the circulatory system

Occlusion and stenosis of basilar artery (433.1) Occlusion and stenosis of carotid artery (433.2) Occlusion and stenosis of ... 440) Atherosclerosis (440.1) Stenosis of renal artery (440.2) Peripheral Arterial Disease (440.21) Peripheral Arterial Disease ... Dissection of carotid artery (443.22) Dissection of iliac artery (443.23) Dissection of renal artery (443.24) Dissection of ... Occlusion and stenosis of precerebral arteries (433.0) ...
Evidence-based recommendations on carotid artery stent placement for symptomatic extracranial carotid stenosis (narrowed carotid arteries in the neck)
Background: Moderate to severe or bilateral carotid stenosis is associated with cerebral atrophy and cognitive decline. Prior studies have evaluated global atrophy and its correlation with the degree of stenosis. It is unclear whether carotid stenosis can lead to unilateral cerebral changes.. Objective: To evaluate for unilateral cerebral atrophy in asymptomatic patients with moderated to severe extracranial unilateral carotid stenosis.. Methods: Subjects were selected from patients who had undergone carotid vascular imaging and MRI of the brain, from January 2007 to January 2013 at our institution. Patients with history of TIA or ischemic stroke were excluded. Carotid stenosis (CS) group consisted of patients with unilateral moderate to severe carotid stenosis (n=9). Patients without any stenosis (n=5) were used as controls. T1-weighted brain images (FOV 256 x 256 x128, resolution 1.5 x 1.5 x 5 mm) were registered to Talairach space using FSL software. Non-brain tissue was removed using the BET ...
1. European Carotid Surgery Trialists Collaborative Group: Randomised trial of endarterectomy for recently symptomatic carotid stenosis: Final results of the MRC European Carotid Surgery Trial (ECST). Lancet 1998;351:1379-1387. [Abstract] [PDF] 2. Rothwell PM, Gutnikov SA, Warlow CP for the ECST: Re-analysis of the final results of the European Carotid Surgery Trial. Stroke 2003;34:514-523. [Abstract] [PDF] 3. Rothwell PM, Warlow CP on behalf of the ECST Collaborators: Prediction of benefit from carotid endarterectomy in individual patients: A risk-modelling study. Lancet 1999;353:2105--2110. [Abstract] [PDF] 4. Rothwell PM, Mehta Z, Howard SC, Gutnikov SA, CP Warlow. From subgroups to individuals: general principles and the example of carotid endartectomy. Lancet 2005; 365: 256-65. [Abstract] [PDF] 5. Rothwell PM, Eliasziw M, Gutnikov SA, Warlow CP, Barnett HJM for the Carotid Endarterectomy Trialists Collaboration. Endarterectomy for symptomatic carotid stenosis in relation to clinical ...
The investigators of the Asymptomatic Carotid Atherosclerosis Study (ACAS) are reporting the interim results of a randomized controlled clinical trial of carotid endarterectomy in patients who have asymptomatic carotid stenosis of greater than 60% reduction in diameter. In addition to aspirin and aggressive management of modifiable risk factors, one half of the patients were randomly assigned to receive surgery after angiographic confirmation of the lesion. Carotid endarterectomy is beneficial with a statistically significant absolute reduction of 5.8% in the risk of the primary end point of stroke within 5 years and a relative risk reduction of 55%. As a consequence of the trial reaching statistical significance in favor of endarterectomy, and on the recommendation of the studys data monitoring committee, physicians participating in the study were immediately notified and advised to reevaluate patients who did not receive surgery. It is important to note that the success of the operation is ...
BACKGROUND AND PURPOSE: The use of three methods of measuring carotid stenosis, which produce different values on the same angiograms, has caused confusion and reduced the generalizability of the results of research. If the results of future studies are to be properly applied to clinical practice, and if noninvasive methods of imaging are to be properly validated against angiography, a single, standard method of measurement of stenosis on angiograms must be adopted. This standard method should be selected on the bases of its ability to predict risk of ipsilateral carotid distribution ischemic stroke and its reproducibility. METHODS: The method of measurement of carotid stenosis used in the European Carotid Surgery Trial (ECST), that used in the North American Symptomatic Carotid Endarterectomy Trial (NASCET), and a method based on the measurement of the common carotid (CC) lumen diameter were studied. Their use in the prediction of ipsilateral carotid distribution ischemic stroke was assessed in 1001
We aim to determine whether cognitive impairment attributable to cerebral hemodynamic impairment in patients with high-grade asymptomatic carotid artery stenosis is reversible with restoration of flow. To accomplish this aim CREST-H will add on to the NINDS-sponsored CREST-2 trial (parallel, outcome-blinded Phase 3 clinical trials for patients with asymptomatic high-grade carotid artery stenosis which will compare carotid endarterectomy plus intensive medical management (IMM) versus IMM alone (n=1,240), and carotid artery stenting plus IMM versus IMM alone (n=1,240) to prevent stroke and death). CREST-H addresses the intriguing question of whether cognitive impairment can be reversed when it arises from abnormal cerebral hemodynamic perfusion in a hemodynamically impaired subset of the CREST-2 -randomized patients. We will enroll 500 patients from CREST-2, all of whom receive cognitive assessments at baseline and yearly thereafter. We anticipate identifying 100 patients with hemodynamic ...
Severe carotid stenosis patients in the North American Symptomatic Carotid Endarterectomy Trial (NASCET) were shown to have a high risk of stroke and significant benefit from carotid endarterectomy. More than 20 years after the 1991 NASCET results for severe stenosis, there is a common claim to use the NASCET method to determine % carotid stenosis, but without following the details necessary to properly identify the group most benefitting from carotid endarterectomy. NASCET interpreted for loss of diameter of the cervical ICA, near occlusion, and didnt calculate % stenosis if present as it is fallacious. NASCET measured the distal ICA for well beyond the tapering ICA bulb where the ICA walls are parallel. The pitfalls of stenosis quantification and differences between methods are problems of the ratios denominator, and may potentially be resolved by the use of absolute measurements for stenosis on CTA or MRA. Furthermore, trials evaluating vessel wall components including intraplaque hemorrhage such
The Asymptomatic Carotid Atherosclerosis Study (ACAS) results suggest that carotid endarterectomy combined with aspirin and risk factor reduction is superior to aspirin and risk factor reduction alone in preventing ipsilateral stroke in asymptomatic patients with diameter stenosis of the carotid artery of 60% or more. The absolute risk reduction over 5 years conferred by surgical therapy is modest (5.9%) compared with the risk reduction conferred by surgical therapy for symptomatic carotid disease but compares favorably with the degree of stroke prevention shown for antihy-pertensive therapy in the elderly. For prevention of stroke in women and for prevention of major stroke, the ACAS results favoring surgery did not reach statistical significance. The combined arteriographic and perioperative surgery-related mortality and stroke rates achieved by the carefully selected surgical teams was low (2.3%). Accordingly, carotid endarterectomy can be recommended for preventing stroke in the setting of ...
The current trend to often err on the side of using endarterectomy or stenting when significant carotid disease is found - regardless of whether there are symptoms - appears based primarily on two large trials in the 1990s. The Asymptomatic Carotid Artery Study and the Asymptomatic Carotid Surgery Trial basically showed the approaches were more effective than medical therapy. For example, the Asymptomatic Carotid Atherosclerosis study showed surgery reduced the five-year stroke risk by more than half in symptom-free patients with significant blockage of 60-99 percent. The original CREST, which started in 2000 and also followed about 2,500 patients, was the first to compare endarterectomy to stenting in patients with and without symptoms of carotid artery disease, and found they were essentially the same in both risks and stroke prevention. But a more current study, the SAMMPRIS trial, comparing stenting and current medical therapy in patients who have had recent transient ischemic attacks or a ...
OBJECTIVES: several ancillary surgical techniques, such as shunting and patching, are used in association with carotid endarterectomy. However, the balance of risks and benefits of these techniques is uncertain because of the lack of large randomised controlled trials (RCTs). To assess the potential for further trials, we studied the variation in use of these techniques by surgeon and by country in the European Carotid Surgery Trial (ECST). METHODS: use of each ancillary technique was assessed by surgeon and by country. For each technique, the relationships between the use of the technique and baseline patient characteristics, use of other techniques, and the 30-day operative risk of stroke and death were determined. RESULTS: there was considerable variation between surgeons in the use of ancillary operative techniques both within (p|0.001 for shunting and patching), and between countries (p|0.001 for shunting and patching). Some surgeons used techniques selectively, and so the characteristics of
It is well known that risk of fatal and non-fatal stroke is increased in patients with significant carotid atherosclerosis. For asymptomatic patients, AHA guidelines recommend carotid endarterectomy (CEA) for stenosis 60% to 99%, if the risk of perioperative stroke or death is less than 3%.. Although clinical trial data support CEA in asymptomatic patients with carotid stenosis 60% to 79%, the AHA guidelines indicate that some physicians delay revascularization until there is greater than 80% stenosis in asymptomatic patients.. Our study is designed to determine whether optimal medical therapy alone reduces the risk of death and nonfatal stroke in patients with carotid artery stenosis as compared with CEA coupled with optimal medical therapy. ...
Background: We sought to study the association between carotid stenosis and white-matter hyperintensity (WMH) among patients without intracranial large-vessel stenosis. Methods: This was a prospective study of patients with acute lacunar infarcts without concomitant intracranial large-vessel stenosis having undergone carotid ultrasonography. WMH was quantified using the modified Fazekas scale. Patients were grouped into quartiles based on the degree of carotid stenosis. The association among carotid stenosis, vascular risk factors, and WMH were modeled using logistic regression analysis. Results: In all, 100 patients with a mean age of 56.2 ± 11.7 years were studied. The quartile with the greatest carotid stenosis had a mean internal/common carotid artery peak systolic velocity ratio of 2.36. Total WMH was 4.64 in the highest quartile and 2.52 in the lowest quartile of carotid stenosis. Periventricular (pv)-WMH was significantly greater between the highest and lowest quartiles (2.80 versus ...
TY - JOUR. T1 - High cardiovascular event rates in patients with asymptomatic carotid stenosis. T2 - The REACH registry. AU - Aichner, F. T.. AU - Topakian, R.. AU - Alberts, M. J.. AU - Bhatt, D. L.. AU - Haring, H. P.. AU - Hill, M. D.. AU - Montalescot, G.. AU - Goto, S.. AU - Touzé, E.. AU - Mas, J. L.. AU - Steg, P. G.. AU - Röther, J.. PY - 2009/8. Y1 - 2009/8. N2 - Background and purpose: Data on current cardiovascular event rates in patients with asymptomatic carotid artery stenosis (ACAS) are sparse. We compared the 1-year outcomes of patients with ACAS ≥70% versus patients without ACAS in an international, prospective cohort of outpatients with or at risk of atherothrombosis. Methods: The Reduction of Atherothrombosis for Continued Health Registry enrolled patients with either ≥3 atherothrombotic risk factors or established atherothrombotic disease. We investigated the 1-year follow-up data of patients for whom physicians reported presence/absence of ACAS at the time of ...
BACKGROUND AND PURPOSE: Carotid endarterectomy reduces the risk of carotid territory ischemic stroke ipsilateral to a recently symptomatic severe carotid stenosis. However, the benefit is limited by the risks of stroke and death associated with the operation. Although reported surgical risks vary enormously, there has been no systematic review of the published literature. METHODS: We performed a systematic review of mortality and the risk of stroke and/or death due to endarterectomy for symptomatic carotid stenosis in studies published since 1980. RESULTS: Fifty-one studies fulfilled our criteria. Overall mortality was 1.62% (95% confidence interval [CI], 1.3 to 1.9), and the risk of stroke and/or death was 5.64% (95% CI, 4.4 to 6.9). However, there was significant heterogeneity of risk of stroke and/or death (P | .001). The risk varied systematically with the methods and the authorship of the study. The risk of stroke and/or death was highest in studies in which patients were assessed by a neurologist
BACKGROUND: The anatomy of carotid stenosis may influence the outcome of endovascular treatment or carotid endarterectomy. Whether anatomy favors one treatment over the other in terms of safety or efficacy has not been investigated in randomized trials. METHODS: In 414 patients with mostly symptomatic carotid stenosis randomized to endovascular treatment (angioplasty or stenting; n = 213) or carotid endarterectomy (n = 211) in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS), the degree and length of stenosis and plaque surface irregularity were assessed on baseline intraarterial angiography. Outcome measures were stroke or death occurring between randomization and 30 days after treatment, and ipsilateral stroke and restenosis ≥50% during follow-up. RESULTS: Carotid stenosis longer than 0.65 times the common carotid artery diameter was associated with increased risk of peri-procedural stroke or death after both endovascular treatment [odds ratio 2.79 (1.17-6.65), P = 0.02] and
Stroke is the third-leading cause of death in America, and carotid artery stenosis-also known as carotid artery disease-is one of the leading risk factors for stroke, accounting for about 20 percent of strokes. To mark National Stroke Month in May, we asked University of Minnesota Health Neurosurgeon and Neurointerventionist Ramachandra Tummala, MD, to tell us five things we should know about carotid artery stenosis and its link to stroke risk.. Carotid stenosis occurs when buildup begins blocking blood flow.. Stenosis is a medical term for narrowing of blood vessels in the body due to a buildup of inflammatory substances and cholesterol deposits-called plaque. Two carotid arteries in the neck carry most of the blood flow from the heart to the brain. When stenosis occurs in these arteries it is known as carotid artery stenosis. Carotid artery stenosis can lead to a stroke.. Patients with carotid artery stenosis are at increased risk for a stroke, which can lead to disability or death. Sometimes, ...
Backgorund: Chronic cerebral hypoperfusion may lead to impairment in neurocognitive performance in patients with severe carotid artery stenosis (CAS) or occlusion (CAO), and the effects of carotid artery stenting on neurocognitive function were unclear.. Methods and Results: We prospectively enrolled 18 patients (7 CAS, 11 CAO) with objective ipsilateral hemisphere ischemia, in whom carotid artery stenting was attempted. A battery of 5 neuropsychological tests were applied prior to and 3 months after intervention. Procedural success was achieved in 6 of 11 CAOs and all CASs. The demographics and baseline cognitive performances were similar between the successful (group 1, n=13) and failed (group 2, n=5) patients. Significant improvement in Alzheimer Disease Assessment Scale (ADAS) (pre 9.2±8.4 vs post 6.8±6.8, p=0.011) and Mini-Mental State Examination score (pre 24.1±4.1 vs post 26.1±4.0, p=0.012), and a trend towards improvement in Color Trail test A (pre 115.0±64.0 vs post 95.1±47.2, ...
Carotid artery stenting is associated with a higher microembolic burden than carotid endarterectomy. The rate and procedural stage of highest risk depends on the embolic protection device used," said Sumaira Macdonald, consultant vascular radiologist and honorary clinical senior lecturer, Newcastle, UK, at the annual iCON meeting in Phoenix, USA, in February.. She presented the results of a recent non-randomised comparison of carotid endarterectomy, filter-protected carotid artery stenting and carotid artery stenting with flow reversal utilising microembolic signals on transcranial Doppler as primary outcome event.. Results from the study (Gupta N, Corriere MA, Dodson TF et al. JVS Dec 1st 2010 [Epub]) showed that carotid endarterectomy had the fewest microembolic signals (largely in the post-protection phase). This was followed by flow reversal carotid artery stenting; in this case, signals detected were mostly in the pre-protection phase. Of the three procedures, filter-protected carotid ...
Asymptomatic carotid artery stenosis confers mobility impairment and cognitive dysfunction and increases the risk for falls, according to data presented at the Society for Vascular Surgery Vascular Annual Meeting. The researchers analyzed 80 older adults (mean age, 74 years; 47 men) without outward symptoms of carotid stenosis and after carotid ultrasonography stratified them into three groups:
TY - JOUR. T1 - MR perfusion studies of brain for patients with unilateral carotid stenosis or occlusion. T2 - Evaluation of maps of "time to peak" and "percentage of baseline at peak". AU - Teng, Michael Mu Huo. AU - Cheng, Hui Cheng. AU - Kao, Yi Hsuan. AU - Hsu, Li Chi. AU - Yeh, Tzu Chen. AU - Hung, Chung Shiou. AU - Wong, Wen Jang. AU - Hu, Han Hwa. AU - Chiang, Jen Huey. AU - Chang, Cheng Yen. PY - 2001/2/6. Y1 - 2001/2/6. N2 - Maps of "time to peak" (TTP) and "percentage of baseline at peak" (PBP) were compared with maps of conventional brain perfusion parameters, namely, mean transit time (MTT) and relative cerebral blood volume (rCBV). We performed MR perfusion studies in 11 patients. All of them had occlusion or high-grade stenosis of the unilateral carotid artery. Three areas of old infarct, 4 areas of new infarct, and 10 areas of brain without infarct were evaluated specifically. In all these cases, the TTP maps appeared similar to the MTT maps. They showed increases, normal values, ...
Randomised controlled trials (RCT) have demonstrated a net benefit of carotid endarterectomy (CEA) in stroke prevention for patients with severe carotid artery stenosis as compared to best medical treatment. Results in routine clinical practice must not be inferior to those in the RCTs. The carotid arteries are clamped during CEA which may impair the cerebral perfusion. The aim of this thesis was to assess population-based outcomes from CEA, investigate risk factors for perioperative complications/late mortality and to evaluate effects of carotid clamping during CEA. In the Swedish vascular registry 6182 CEAs were registered during 1994-2003. Data on all CEAs were retrieved, analysed and validated. In the validation process no death or disabling stroke was unreported. The perioperative stroke or death rate was 4.3% for those with symptomatic and 2.1% for asymptomatic stenosis (the latter decreasing over time). Risk factors for perioperative complications were age, indication, diabetes, cardiac ...
OBJECTIVE Carotid stenoses ≥50% are associated with increased risk for stroke that can be reduced by prophylactic carotid endarterectomy (CEA). Calcifications in arteries can be detected in panoramic radiographs (PRs). In a cross-sectional study, we analyzed (1) extirpated plaques for calcification, (2) how often PRs disclosed calcified plaques, (3) how often patients with stenoses ≥50% presented calcifications in PRs, and (4) the additional value of frontal radiographs (FRs). STUDY DESIGN Patients (n = 100) with carotid stenosis ≥50% were examined with PRs and FRs before CEA. Extirpated carotid plaques were radiographically examined (n = 101). RESULTS It was found that 100 of 101 (99%) extirpated plaques were calcified, of which 75 of 100 (75%) were detected in PRs; 84 of 100 (84%) patients presented carotid calcifications in the PRs, in 9.5% contralateral to the stenosis ≥50%. CONCLUSIONS Carotid calcifications are seen in PRs in 84% of patients with carotid stenosis ≥50%, independent
A carotid artery duplex scan is a type of vascular ultrasound study done to assess the blood flow of the arteries that supply blood from the heart through the neck to the brain. There are six carotid arteries--the right and left common carotid arteries, which divide and form the right and left internal carotid arteries and the right and left external carotid arteries. One pair (external and internal) is located on each side of the neck.. A carotid artery duplex scan is a noninvasive (the skin is not pierced) procedure. The term "duplex" refers to the fact that two modes of ultrasound are used--Doppler and B-mode. The B-mode transducer (like a microphone) obtains an image of the carotid artery being studied. The Doppler probe within the transducer evaluates the velocity and direction of blood flow in the vessel.. A transducer sends out ultrasonic sound waves at a frequency too high to be heard. When the transducer is placed on the carotid arteries at certain locations and angles, the ultrasonic ...
A carotid artery duplex scan is a type of vascular ultrasound study done to assess the blood flow of the arteries that supply blood from the heart through the neck to the brain. There are six carotid arteries--the right and left common carotid arteries, which divide and form the right and left internal carotid arteries and the right and left external carotid arteries. One pair (external and internal) is located on each side of the neck.. A carotid artery duplex scan is a noninvasive (the skin is not pierced) procedure. The term "duplex" refers to the fact that two modes of ultrasound are used--Doppler and B-mode. The B-mode transducer (like a microphone) obtains an image of the carotid artery being studied. The Doppler probe within the transducer evaluates the velocity and direction of blood flow in the vessel.. A transducer sends out ultrasonic sound waves at a frequency too high to be heard. When the transducer is placed on the carotid arteries at certain locations and angles, the ultrasonic ...
The efficiency of carotid surgery on an asymptomatic carotid artery stenosis and its superiority to conservative treatment was clearly demonstrated in the ACAS study. The stroke risk over a five year follow-up period could be reduced by 55 % and the combined stroke and mortality rate was shown to be a mere 2. 3 %. The efficacy of surgical treatment in also reducing stroke rates in the case of a symptomatic carotid stenosis was proven in the NASCET and ECTS prospective randomized studies. Of extreme importance in these procedures is, however, precise quality control and quality assessment. This is presently a topic of tremendous interest in reconstructive vascular surgery and is constantly being discussed in specialist circles and beyond. Documentation and the possibility of accurate reconstruction of the intraoperative situation are in high demand. Perioperative monitoring of neurological function, particularly the monitoring during carotid surgery, are the aspects underlying constant revision and
e- semptomatik hastalardaki ameliyatın mortalite ve morbiditesi asemptomatik hastalardan daha fazladır. Dolayısı ile beklemekle geçen zaman hastaların semptomatik olmasına ve böylece mortalite ve morbiditenin artmasına yol açabilmektedir [7,19,20].. Yukarıda belirtilen görüşler doğrultusunda uyguladığımız toplam 513 KEA olgusunun perioperatif mortalitesi %0.19 bulunmuş olup, geçici nörolojik bulgu %0.97 olarak gerçekleşmiştir [6]. Bilateral olguları kapsayan bu çalışmamızda mortalite %1.48 n=74, geçici nörolojik bulular %4.0 n=74 olarak gerçekleşmiştir.. Bu sonuçlar American Heart Association tarafından belirtilen perioperatif komplikasyon oranlarından daha azdır (asemptomatik %3, semptomatik %5, III. Evre %7, Rezidif %10 veya daha az) [19].. Bilateral karotis darlıklarını içeren bu serimizde bulunan perioperatif mortalite ve morbidite, toplam olguları kapsayan serimizden daha fazla olarak gerçekleşmiştir. Literatürde de bilateral uygulanan KEA nin ...
Title:Cerebral Hypoperfusion During Carotid Artery Stenosis can Lead to Cognitive Deficits that may be Independent of White Matter Lesion Load. VOLUME: 9 ISSUE: 3. Author(s):Martin Scherr, Eugen Trinka, Mark Mc Coy, Yvonne Krenn, Wolfgang Staffen, Margarita Kirschner, Hans Jurgen Bergmann and Johannes Sebastian Mutzenbach. Affiliation:Universitatsklinik fur Neurologie Paracelsus Medizinische Privatuniversität Christian Doppler Klinik Ignaz Harrer Straße 79 A-5020 Salzburg Austria.. Keywords:Cerebral hypoperfusion, Carotid artery stenosis, Carotid atherosclerosis, Cognitive impairment, Microembolization, White matter lesions, atherosclerosis, stroke-free, stenosis, neuropsychological, hemodynamically, pathophysiological, MRI, Cerebral microembolization. Abstract:Studies investigating cognitive impairment in stroke-free patients with carotid artery stenosis have led to inconsistent results. Furthermore, the pathophysiological mechanism leading to cognitive impairment remains unclear. Cerebral ...
Background:B-mode ultrasound measurements of the echolucency of the carotid intima-media may hold information on cardiovascular risk. The information obtained from this measurement may depend on which gain settings are used. We studied the effect of gain settings on echolucency measurements and its consequences on risk factor relations and treatment effects.Methods:We used two approaches. In the first, we examined the relationship between calibration, gain and common grey-scale median (GSM) from repeated ultrasound images obtained from four healthy individuals at gain settings ranging from -20 to 20dB. In the second, we evaluated the effect of gain settings on the relation of risk factors and statin treatment with common GSM, using images from 325 participants of the Measuring Effects on Intima-Media Thickness: an Evaluation of Rosuvastatin (METEOR) study with documented gain settings. Echolucency of the carotid intima-media was measured from ultrasound images using PaintShop Pro and Artery ...
Carotid endarterectomy is the main treatment for narrowing of the carotid arteries, but sometimes an alternative procedure called carotid artery stent placement may be available.. Its a less invasive procedure than a carotid endarterectomy because theres no need to make a cut in the neck. Instead, a thin flexible tube is guided to the carotid artery through a small cut in the groin. A mesh cylinder (stent) is then placed into the narrowed section of artery to widen it and allow blood to flow through it more easily.. Current guidelines recommend that a carotid endarterectomy should be the first line of treatment for most people. This is because carotid stenting is associated with a higher risk of stroke during the procedure, particularly if its carried out in the first few days after symptoms appear. But its an important alternative for some people who may otherwise be considered to be high risk because of other medical problems.. Find out more about carotid artery stent placement. ...
Carotid endarterectomy is the main treatment for narrowing of the carotid arteries, but sometimes an alternative procedure called carotid artery stent placement may be available.. Its a less invasive procedure than a carotid endarterectomy because theres no need to make a cut in the neck. Instead, a thin flexible tube is guided to the carotid artery through a small cut in the groin. A mesh cylinder (stent) is then placed into the narrowed section of artery to widen it and allow blood to flow through it more easily.. Current guidelines recommend that a carotid endarterectomy should be the first line of treatment for most people. This is because carotid stenting is associated with a higher risk of stroke during the procedure, particularly if its carried out in the first few days after symptoms appear. But its an important alternative for some people who may otherwise be considered to be high risk because of other medical problems.. Find out more about carotid artery stent placement. ...
Carotid artery stenosis is a frequent cause of ischemic stroke. While any degree of stenosis can cause embolic stroke, a higher degree of stenosis can also cause hemodynamic infarction. The hemodynamic effect of a stenosis can be assessed via perfusion weighted MRI (PWI). Our aim was to investigate the ability of PWI-derived parameters such as TTP (time-to-peak) and Tmax (time to the peak of the residue curve) to predict outcome in patients with unilateral acute symptomatic internal carotid artery (sICA) stenosis. Patients with unilateral acute sICA stenosis (≥50 % according to NASCET), without intracranial stenosis or occlusion, who underwent PWI, were included. Clinical characteristics, volume of restricted diffusion, volume of prolonged TTP and Tmax were retrospectively analyzed and correlated with outcome represented by the modified Rankin Scale (mRS) score at discharge. TTP and Tmax volumes were dichotomized using a ROC curve analysis. Multivariate analysis was performed to determine which PWI
Vulnerable carotid plaque can cause an ischemic stroke, but its detection is elusive. The aim was to study the mechanical properties of carotid plaques using ultrasound speckle tracking.. Methods: Study population consisted of 61 (aged 53-89, median 68) patients with carotid atherosclerosis: 21 with acute atherothrombotic stroke (7 day after stroke onset) and 40 without symptoms. The stroke subtype was classified according to TOAST criteria. In total, 21 symptomatic and 47 asymptomatic plaques were analyzed. For plaque-free area (PFA) and for each plaque, maximum circumferential and longitudinal strains (S[[Unable to Display Character: с]], Sl) and strain rates (SRc SRl) were measured (with separate measurements for plaque cap, core and base). Plaque characteristics (echogenicity, length, degree of stenosis) were also assessed.. Results: plaque and PFA differed in Sl and SRl values, whereas no difference was observed for Sc and SRc (Table 1). Sc and SRc for cap and core of echolucent plaques ...
By Matthew E. Fink, MD Louis and Gertrude Feil Professor and Chair, Department of Neurology, Associate Dean for Clinical Affairs, NYP/Weill Cornell Medical College Dr. Fink reports no financial relationships relevant to this field of study. SOURCE: Brott TG, Calvet D, Howard G, et al; Carotid Stenosis Trialists Collaboration. Long-term outcomes of stenting and endarterectomy for symptomatic carotid stenosis: A preplanned pooled analysis of individual patient data. Lancet Neurol 2019;18:348-356. In previous studies, researchers demonstrated that the risk of periprocedural complications, specifically stroke or death, . . .
By Matthew E. Fink, MD Louis and Gertrude Feil Professor and Chair, Department of Neurology, Associate Dean for Clinical Affairs, NYP/Weill Cornell Medical College Dr. Fink reports no financial relationships relevant to this field of study. SOURCE: Brott TG, Calvet D, Howard G, et al; Carotid Stenosis Trialists Collaboration. Long-term outcomes of stenting and endarterectomy for symptomatic carotid stenosis: A preplanned pooled analysis of individual patient data. Lancet Neurol 2019;18:348-356. In previous studies, researchers demonstrated that the risk of periprocedural complications, specifically stroke or death, . . .
Patients suffering from symptomatic carotid artery stenosis, transient ischemic attacks (TIAs), amaurosis fugax or stroke receive either Revacept (single dose) plus antiplatelet monotherapy or monotherapy alone.. Patients receive a single dose of trial medication by intravenous infusion for 20 minutes. Patients are followed up one and three days after treatment, at 3 months and by a telephone interview at 12 months. ...
EUCAS is a multicenter Registry of carotid artery stenting (CAS) in patients with acute cerebral ischemia (TIA or minor stroke), designed to determine the role of early endovascular intervention in a selected population with a vulnerable lesion of carotid bifurcation. The aim of the registry is to study the safety and efficacy of emergent/urgent CAS and to improve patient selection and consequently reduce the time loss between the index event and the intervention. Secondary aim is to study the plasma levels of plaque vulnerability biomarkers before and after carotid intervention in high risk patients to compare these value with a control group of patients with asymptomatic severe carotid stenosis, and to test the hypothesis that carotid stenting stabilizes the plaque at 1 month. The Registry is open to expert interventionists performing carotid stenting with a documented experience of at least 100 CAS, and the participants are free to apply the preferred endovascular techniques and devices, ...
Our prospective study demonstrates that LE-PAD patients with a hypoechoic plaque in the femoral arteries are exposed to a significantly higher risk of developing myocardial infarction or stroke compared with those with a hyperechoic femoral plaque. Similar findings were obtained with both computer-assisted and visual analyses of plaque echogenicity. Notably, these results remained unaltered after accounting for factors known to have important impacts on LE-PAD patients outcome, including age, sex, previous cardiovascular events, and ABI.. Acute ischemic events are more closely related to the histopathological characteristics of atherosclerotic plaques than to the number of plaques or the degree of vascular stenosis (2,5-8,28,29). In this regard, the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) trial (8) has recently shown that lesions responsible for recurrent cardiac ischemic events are frequently angiographically mild, most are thin-cap ...
OBJECTIVES: ACST-2 is currently the largest trial ever conducted to compare carotid artery stenting (CAS) with carotid endarterectomy (CEA) in patients with severe asymptomatic carotid stenosis requiring revascularization. METHODS: Patients are entered into ACST-2 when revascularization is felt to be clearly indicated, when CEA and CAS are both possible, but where there is substantial uncertainty as to which is most appropriate. Trial surgeons and interventionalists are expected to use their usual techniques and CE-approved devices. We report baseline characteristics and blinded combined interim results for 30-day mortality and major morbidity for 986 patients in the ongoing trial up to September 2012. RESULTS: A total of 986 patients (687 men, 299 women), mean age 68.7 years (SD ± 8.1) were randomized equally to CEA or CAS. Most (96%) had ipsilateral stenosis of 70-99% (median 80%) with contralateral stenoses of 50-99% in 30% and contralateral occlusion in 8%. Patients were on appropriate medical
The group analyzed 101 patients with symptomatic 30-69% carotid artery stenosis who underwent a 3T MRI of the carotid arteries and the brain within 45 days of symptom onset. They used two different readers blinded to the brain MRI results, to analyze the carotid artery MRI and examine them for IPH and TRFC. They found that IPH was present in 40 out of the 101 patient with 55% having infarcts on the side of the carotid plaque however in the patients without IPH, 41% had infarcts on the symptomatic side (p= 0.22). A TRFC was present in 49 out of 86 patients (15 patients could not have fibrous cap assessed), with 45% having infarcts on the side of the symptomatic carotid however this was not significantly different from the 49% in the 37 patients with a thick fibrous cap. The significance did not change when only cortical (instead of both subcortical and cortical) infarcts were taken into account. Though the data was a bit underwhelming in terms of significance, the study still provides important ...
TY - JOUR. T1 - Carotid stenting for unilateral stenosis can increase contralateral hemispheric cerebral blood flow. AU - Sadato, Akiyo. AU - Maeda, Shingo. AU - Hayakawa, Motoharu. AU - Adachi, Kazuhide. AU - Toyama, Hiroshi. AU - Nakahara, Ichiro. AU - Hirose, Yuichi. PY - 2018/4. Y1 - 2018/4. N2 - Background The revascularization of carotid stenosis can increase ipsilateral cerebral blood flow (CBF). Occasionally, elevated CBF is also evident on the contralateral side, but this phenomenon is poorly understood. Objective To analyze retrospectively the relationship between a contralateral CBF increase and several clinical and radiologic features. Materials and methods We retrospectively analyzed 40 patients with unilateral cervical carotid stenosis treated by carotid artery stenting (CAS). Using 123 I-iodamphetamine single-photon emission computed tomography (SPECT); we compared pre-and postoperative hemispheric CBF on both sides. We investigated the influence of the following five factors on ...
TY - JOUR. T1 - Carotid stenting for unilateral stenosis can increase contralateral hemispheric cerebral blood flow. AU - Sadato, Akiyo. AU - Maeda, Shingo. AU - Hayakawa, Motoharu. AU - Adachi, Kazuhide. AU - Toyama, Hiroshi. AU - Nakahara, Ichiro. AU - Hirose, Yuichi. PY - 2018/4. Y1 - 2018/4. N2 - Background The revascularization of carotid stenosis can increase ipsilateral cerebral blood flow (CBF). Occasionally, elevated CBF is also evident on the contralateral side, but this phenomenon is poorly understood. Objective To analyze retrospectively the relationship between a contralateral CBF increase and several clinical and radiologic features. Materials and methods We retrospectively analyzed 40 patients with unilateral cervical carotid stenosis treated by carotid artery stenting (CAS). Using 123 I-iodamphetamine single-photon emission computed tomography (SPECT); we compared pre-and postoperative hemispheric CBF on both sides. We investigated the influence of the following five factors on ...
Recent data on carotid artery stenting have been encouraging, and technologies and studies on the horizon also seem promising. However, good outcomes are dependent on the experience of the operator and on appropriately selecting patients. In this Q&A, Chris Metzger, MD, shares his thoughts on recent studies and on best practices for performing carotid artery stenting. Dr Metzger is an interventional cardiologist at the Wellmont CVA Heart Institute in Kingsport, Tennessee, and he will be speaking on this topic at the International Symposium on Endovascular Therapy (ISET) in Hollywood, Florida.. Are there any changes in recent data or technology advances that you want to highlight?. I am very excited that the newest data supplements the safety, durability, and effectiveness of carotid stenting. The CREST 10-year data were published and showed that carotid stenting was at least equivalent to carotid endarterectomy at 10 years in terms of preventing strokes and keeping the carotid artery open. ...
TY - JOUR. T1 - The inaccuracy of simple visual interpretation for measurement of carotid stenosis by arteriography. AU - Schmittling, Zachary C.. AU - McLafferty, Robert B.. AU - Danetz, Jeffrey S.. AU - Hussain, Syed M.. AU - Ramsey, Don E.. AU - Hodgson, Kim J.. PY - 2005/7. Y1 - 2005/7. N2 - Purpose: To determine intraobserver and interobserver variability of carotid arteriography interpretation as well as the reliability of simple visual interpretation (SVI) or "eyeballing" of arteriography in the measurement of internal carotid artery stenoses. Methods: Intraobserver and interobserver measurements of 200 carotid arteriograms were performed in a blinded fashion by two vascular surgeons (VS1 and VS2) using a digital caliber computer program similar to software available in catheterization laboratories. The distal normal internal carotid artery was used as a frame of reference. These computer-derived measurements were compared with previous SVI measurements, found by retrospective chart ...
Impact of baseline characteristics on outcomes of carotid artery stenting in acute ischemic stroke patients Cheng-Sheng Yu,1,* Chih-Ming Lin,2,3,* Chi-Kuang Liu,4 Henry Horng-Shing Lu1 1Institute of Statistics and Big Data Research Center, National Chiao Tung University, Hsinchu, 2Stroke Centre and Department of Neurology, Chunghua Christian Hospital, Chunghua, 3Graduate Institute of Biological Science and Technology, National Chiao Tung University, Hsinchu, 4Department of Medical Imaging, Chunghua Christian Hospital, Chunghua, Taiwan, Republic of China *These authors contributed equally to this work Abstract: Carotid artery stenting is an effective treatment for ischemic stroke patients with moderate-to-severe carotid artery stenosis. However, the midterm outcome for patients undergoing this procedure varies considerably with baseline characteristics. To determine the impact of baseline characteristics on outcomes following carotid artery stenting, data from 107 eligible patients with a first
The association between metabolic syndrome and asymptomatic carotid artery stenosis in menopausal women: a cross-sectional study in a Chinese population Bin Zhu,1 Lei Zhang,2 Xiao Ping Cheng,3 Lei Wang,4 Yue Tian,1 Xi Xi Li,1 Ying Ping Liu,5 Zhi Gang Zhao11Department of Pharmacy, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing 100050, China; 2Department of Pharmacy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100050, China; 3Department of Nephrology, Shaanxi Hospital of Traditional Chinese Medical, ShaaXi 710003, China; 4Department of Endocrinology, Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing 100029, China; 5Obstetrics Department, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, ChinaBackground: To examine the association of metabolic syndrome (MetS) with carotid artery stenosis (CAS), especially in menopausal women in China.Materials and methods: A cross-sectional study of menopause
Carotid Stenosis Assessment Training Video is designed to provide an overview of carotid duplex/color flow imaging techniques and criteria to diagnose cerebrovascular disease. The lecture includes how to analyze the spectral Doppler waveform characteristics, integration of routine measurements, and carotid case presentations. The participant will be able to apply current diagnostic criteria to evaluate carotid stenosis and other associated abnormalities after viewing this video ...
Background: In up to 30% of patients with ischemic stroke no definite etiology can be established. A significant proportion of cryptogenic stroke cases may be due to non-stenosing atherosclerotic plaques or low grade carotid artery stenosis not fulfilling common criteria for atherothrombotic stroke. The aim of the CAPIAS study is to determine the frequency, characteristics, clinical and radiological long-term consequences of ipsilateral complicated American Heart Association lesion type VI (AHA-LT VI) carotid artery plaques in patients with cryptogenic stroke. Methods/Design: 300 patients (age , 49 years) with unilateral DWI-positive lesions in the anterior circulation and non- or moderately stenosing (,70% NASCET) internal carotid artery plaques will be enrolled in the prospective multicenter study CAPIAS. Carotid plaque characteristics will be determined by high-resolution black-blood carotid MRI at baseline and 12 month follow up. Primary outcome is the prevalence of complicated AHA-LT VI ...
In this nationwide registry of patients undergoing carotid artery revascularization, the prevalence of CCOs in patients undergoing elective carotid artery stenting was 10%. The rate of composite in-hospital events, including death, nonfatal myocardial infarction, and nonfatal stroke, did not differ between patients with and without a CCO after elective CAS. Lastly, CCO was not associated with higher complications following CAS in older patients or individuals with prior neurological symptoms.. The prognosis of medically treated patients with carotid artery stenosis and a CCO is poor, with 2-year stroke rates ranging from 40% to 70% (11,12). This excess risk is believed to be related to inadequate collateral circulation at the level of the circle of Willis (13), from compromised ipsilateral blood supply in the setting of a complete CCO. CCO is a well-recognized high-risk anatomic criterion for patients undergoing CEA (5). Patients with CCO have higher rates of perioperative stroke and death, as ...
In patients presenting with a suspected acute stroke, clinicians attempt to confirm the presence of cerebral ischemia, identify the extent of the neurological deficit, and determine the etiology of the event. To detect a carotid source, patients usually undergo carotid duplex scan, CT angiography, conventional MRA, or digital subtraction angiography, all of which rely heavily on percent stenosis. Although these methods can detect luminal narrowing to a high degree of certainty, they cannot identify unstable plaque components. The current study and others have shown that stenosis does not fully determine the potential for embolization from the carotid artery. Traditionally, mild and moderate carotid artery stenoses have been overlooked as potential sources for thromboembolic stroke.. Although studies have found that complex carotid plaques (American Heart Association Type VI plaques) are associated with increased risk of subsequent events,7 the final common pathway has not been evaluated ...
TY - JOUR. T1 - Detection of carotid artery stenosis by in vivo duplex ultrasound. T2 - Correlation with planimetric measurements of the corresponding postmortem specimens. AU - Schulte-Altedorneburg, Gernot. AU - Droste, Dirk W.. AU - Felszeghy, S.. AU - Csiba, L.. AU - Popa, Vasile. AU - Hegedüs, Katalin. AU - Kollár, J.. AU - Módis, László. AU - Ringelstein, E. Bernd. PY - 2002/10/1. Y1 - 2002/10/1. N2 - Background and Purpose - The correct detection and quantification of carotid artery disease are of decisive impact on patient prognosis and adequate treatment. In this study, we evaluated the ability of ultrasonography to detect and to grade carotid artery stenosis through a comparison of the in vivo ultrasound findings with the planimetric analysis of the corresponding postmortem specimens. Methods - Shortly before their death, 59 critically ill neurological patients (mean age, 70 years) were prospectively examined by extracranial and intracranial Doppler sonography and color-coded ...
BACKGROUND: Treatment method in patients with coronary artery disease undergoing coronary bypass surgery with accompanying carotid artery disease is still a hot topic among clinicians. This study is designed to investigate if there is an effect on myocardial infarction, cerebrovascular events and mortality during postoperative period of simultaneous carotid endarterectomy with coronary bypass surgery compared to staged carotid artery stenting before coronary bypass surgery. METHODS: 102 patients (79 male, 23 female) who underwent simultaneous carotid endarterectomy with coronary bypass surgery or staged carotid artery stenting with coronary bypass surgery in the same center with the same surgical team were divided into 2 groups and retrospectively reviewed ...
Main results. At 120 days, pooled analyses showed that CAS increased risk for stroke and the composite endpoint of stroke or death more than CEA; groups did not differ for all-cause mortality or the composite endpoint of disabling stroke or death (Table). Prespecified subgroup analyses showed that CAS increased risk for the composite endpoint of stroke or death more than CEA in patients ≥ 70 years of age (relative risk increase [RRI] 104%, 95% CI 48 to 182) but not those , 70 years of age (RRI 0%, CI −32 to 47, P = 0.005 for interaction). ...
1. Bots ML, Breslau PJ, Briet E, et al. Cardiovascular determinants of carotid artery disease. The Rotterdam elderly study. Hypertension. 1992;19:717-20. 2. North American Symptomatic CarotidEndarterectomy Trial collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med. 1991;325:445-53. 3. Spence JD. Antihypertensive drugs and prevention of atherosclerotic stroke. Stroke. 1986;17:808-10. 4. Chimowitz MJ, Weiss DG, Cohen SL, et al. Cardiac prognosis of patients with carotid stenosis and no history of coronary artery disease. Veterans Affairs Cooperative Study Group 167. Stroke. 1994;25:759-65. 5. Bots ML, Breslau PJ, Briet E, et al. Cardiovascular determinants of carotid artery disease. The Rotterdam Elderly Study. Hypertension. 1992;19:717-20. 6. Hachinski VC, Graffagnino C, Beaudry M, et al. Lipids and stroke: a paradox resolved. Arch Neurol. 1996;53:303-8. 7. Peterson JC, Spence JD. Vitamins and progression of ...
Using a simple and reproducible plaque measurement on CTA, we found a strong association between increasing soft-plaque thickness measurements and symptomatic carotid artery plaques. Previous studies have shown that CTA plaque thickness measures can predict high-risk plaque as defined on correlative MR imaging12 or symptomatic plaque in high-grade stenosis.13 In the current study, we found that such CTA plaque measures can differentiate asymptomatic and symptomatic carotid plaques despite the relatively smaller volume of plaque and lower absolute stroke risk present in moderate-grade stenosis. Moreover, we found no significant differences in traditional vascular risk factors in the asymptomatic and symptomatic groups, suggesting that plaque thickness measurements may be able to discriminate high-risk and stable plaque more accurately than clinical factors. This is the first report, to our knowledge, applying this CTA technique to patients with a tightly defined and clinically relevant NASCET ...
People living in areas with more air pollution face a greater risk of carotid artery stenosis, a narrowing of the arteries that supply blood to the brain, according to new research. Carotid artery stenosis, which results when fatty substances build up in the arteries in the neck, is associated with more than half of the…
Types of Carotid artery stenosis including their causes, diagnosis, and related symptoms from a list of 5 total causes of symptom Carotid artery stenosis.
ObjectiveTo determine the value of visible retinal emboli as a diagnostic test for the detection of hemodynamically significant carotid artery stenosis in the
This weeks View discusses some recent studies on a number of vascular topics, including blood pressure in patients with ischemic stroke, diagnosis and management of resistant hypertension, the plaque burden of subclinical atherosclerosis, and carotid stenting versus endarterectomy for asymptomatic carotid artery stenosis.
60 mmHg Baseline hematocrit > 50% FEV1 or DLCO < 50% of normal Abnormal stress test Age greater than 80 years Using the criteria of successful trials, candidates are either symptomatic (TIA or stroke) patients with >50% stenosis of the carotid artery, or are asymptomatic with >80% stenosis of the internal carotid artery. Carotid stenting may be considered an alternative to carotid surgery in average surgical risk patients, albeit with a higher risk of death or stroke as seen in the SAPPHIRE and CREST trials. Features that favor carotid stenting include non-atherosclerotic cause of the stenosis (fibrodysplasia, radiation, early post-surgical stenosis or flap) an experienced center and experienced physician performing the procedure. Features that make stent placement more difficult include significant aortic arch tortuosity, thrombus containing lesions, occluded carotid artery, heavily calcified vessels, symptomatic patients and very tortuous and twisting vessels. None of these affect open, ...
Question - Clicking in throat, louder when open mouth. Could this clicking be the valve or carotid stenosis?. Ask a Doctor about diagnosis, treatment and medication for Carotid artery stenosis, Ask a Cardiologist
The U.S. Preventive Services Task Force (USPSTF) has published its final research plan for its review of screening for asymptomatic carotid artery stenosis.
Carotid artery stenting (CAS) is a validated treatment to reduce the incidence of stroke in patients with moderate-to-severe symptomatic carotid stenosis as well as among those with severe asymptomatic carotid stenosis.
Execution of carotid artery stenting (CAS) requires not only excellent manual dexterity, and a high level of competence, but also in-depth knowledge of the carotid pathology, of the materials available on the market and of the different techniques to apply in given situations. Actually each individual moment of the procedure can be determining for the final result. This review describes each individual step of CAS, including arterial access, carotid engagement, pre-dilatation, the characteristics and use of cerebral protection devices, stent selection and deployment, and post-dilatation. Technical notes and some suggestions are provided on how to minimize the event of periprocedural neurological complications.. ...
Carotid artery stent placement is less invasive than a carotid endarterectomy because it doesnt involve a cut being made in the neck.. Stenting is carried out under local anaesthetic and involves a narrow flexible tube called a catheter being inserted into an artery in your groin. Its then threaded up into the carotid artery using X-rays to guide it into place.. A small balloon at the end of the catheter is inflated to around 5mm at the site of the narrowed artery, and a small mesh cylinder called a stent is then inserted. The balloon will be deflated and removed, leaving the stent in place to keep the artery open and allow blood to flow through it.. After the procedure, youll need to lie flat and keep still for about an hour to prevent any bleeding from the artery. Youll need to stay in hospital overnight, but will be able to return home the next day.. Like carotid endarterectomy, there are some risks associated with stenting. The risk of having another stroke or dying is slightly higher ...
Carotid artery stent placement is less invasive than a carotid endarterectomy because it doesnt involve a cut being made in the neck.. Stenting is carried out under local anaesthetic and involves a narrow flexible tube called a catheter being inserted into an artery in your groin. Its then threaded up into the carotid artery using X-rays to guide it into place.. A small balloon at the end of the catheter is inflated to around 5mm at the site of the narrowed artery, and a small mesh cylinder called a stent is then inserted. The balloon will be deflated and removed, leaving the stent in place to keep the artery open and allow blood to flow through it.. After the procedure, youll need to lie flat and keep still for about an hour to prevent any bleeding from the artery. Youll need to stay in hospital overnight, but will be able to return home the next day.. Like carotid endarterectomy, there are some risks associated with stenting. The risk of having another stroke or dying is slightly higher ...
In the absence of randomized data, the optimal management of patients with severe carotid and coronary artery disease (CAD), especially those undergoing open heart surgery (OHS) and coronary bypass grafting (CABG), remains undetermined. (1-3). As a general rule (2), in patients with multilevel atherosclerotic disease, the symptomatic vascular area should be treated first. The entirely surgical approach with carotid endarterectomy (CEA) and CABG is associated with high event rates. Therefore, whenever severe carotid disease is identified in the work-up prior to cardiac surgery, the indication for CABG should be reassessed and the feasibility of percutaneous coronary intervention (PCI) as an alternative treatment should be explored. If PCI is not an option, carotid artery stenting (CAS) prior to open heart should be considered if the expertise is available ...
During carotid angioplasty (also called carotid artery stenting), a small, expandable tube called a stent is permanently inserted into the carotid artery.. To insert the stent, the doctor uses another tube called a catheter. The doctor inserts the catheter into a large artery-most often the femoral artery in the groin-and threads it through other arteries to the carotid artery.. A very thin guide wire is inside the catheter. The guide wire is used to move a balloon and the stent into the carotid artery. The balloon is placed inside the stent and inflated. This opens the stent and pushes it into place against the artery wall. The balloon is then deflated and removed, leaving the stent in place. After time, the cells lining the blood vessel will grow through and around the stent to help hold it in place. ...
The results of the internal carotid artery stenting and carotid endarterectomy in the hospital with high volume cardiac interventions and open ...
Placing a stent in a key artery in the neck is safer than ever in patients ineligible for the standard surgical treatment of carotid artery disease, according to a new study published online today in the Journal of Vascular Surgery.. A team of researchers led by Dr. Jon Matsumura, head of the vascular surgery division at University of Wisconsin School of Medicine and Public Health, found the clinical trial PROTECT (Carotid Artery Stenting with Distal Embolic Protection with Improved System) had the lowest rate of complications ever in patients considered high risk for carotid endarterectomy (CEA)-the gold standard for opening a blocked carotid artery. Carotid artery stenosis, or the narrowing of blood vessels in the neck, is one of the leading causes of strokes in the United States.. "Recent improvements in devices designed specifically for carotid artery stenting have resulted in safer procedures and better clinical outcomes," says Matsumura. "These technological advances, combined with a ...
Carotid plaques were revealed in 144 (43%) of patients. Of them, 45 (31%) patients had soft plaques, and 99 (69%) patients had hard plaques. The groups were of similar age, had similar values of left ventricular ejection fraction, did not differ significantly with regard to the prevalence of risk factors (hypertension, diabetes mellitus, dyslipidaemia, smoking), one, two, or three vessel coronary artery disease, and treatment strategies. The proportion of medications (statins, β blockers, angiotensin converting enzyme inhibitors, aspirin) taken during follow up were similar in both groups. Nineteen (13%) patients had carotid stenosis , 50%, and nine patients (6%) had carotid stenosis , 70%. Bilateral carotid disease was revealed in 116 patients (79%).. Follow up was completed for all 337 patients who had enrolled in the study. Median time from enrolment to last contact with patient or target event was 19 months (interquartile range 12-24 months). During follow up, 13 patients (4%) experienced ...
1. Imori Y, Akasaka T, Ochiai T, Oyama K, Tobita K, Shishido K, et al.Co-existence of carotid artery disease, renal artery stenosis, and lowerextremity peripheral arterial disease in patients with coronary artery disease.Am J Cardiol. 2014;113(1):30-5.doi:10.1016/j.amjcard.2013.09.015.. 2. Steinvil A, Sadeh B, Arbel Y, Justo D, Belei A, Borenstein N, et al.Prevalence and predictors of concomitant carotid and coronary arteryatherosclerotic disease. J Am Coll Cardiol. 2011;57(7):779-83.doi:10.1016/j.jacc.2010.09.047.. 3. Podolecka E, Wanha W, Michalewska-Wludarczyk A, Wludarczyk W,Bachowski R, Deja M, et al. Effect of a significant asymptomatic unilateralcarotid artery stenosis on outcomes in patients undergoing coronary arterybypass grafting. Kardiol Pol. 2014;72(10):954-9.doi:10.5603/KP.a2014.0113.. 4. Narayan P, Khan MW, Das D, Guha Biswas R, Das M, Rupert E. Carotidartery screening at the time of coronary artery bypass - Does it influenceneurological outcomes? Int J Cardiol. ...
Developed by renowned radiologists in each specialty, STATdx provides comprehensive decision support you can rely on - Carotid Stenosis, Extracranial
Li, Y., Jenny, D., & Castaldo, J. (2010). Cardiac surgery, carotid stenosis, and stroke prevention. Hospital Practice (1995), 38(2), 29-39.. ...
Carotid artery stenosis is a condition in which the carotid arteries become abnormally narrow, making it hard for the brain to...
To the Editor: I read with interest the article by Hender and colleagues recently published in the Journal.1 I agree with the authors conclusion that there is presently insufficient evidence to suggest the widespread use of endoluminal treatment for carotid artery disease. However, there are a number of problems with the authors interpretation of our recent article comparing the outcome of surgical and endoluminal treatment of symptomatic carotid stenosis.2. ...
Serial monitoring of patients participating in clinical trials of carotid artery therapy requires noninvasive precision methods that are inexpensive, safe and widely available. Noninvasive ultrasonic duplex Doppler velocimetry provides a precision method that can be used for recruitment qualification, pre-treatment classification and post treatment surveillance for remodeling and restenosis. The University of Washington Ultrasound Reading Center (UWURC) provides a uniform examination protocol and interpretation of duplex Doppler velocity measurements. Doppler waveforms from 6 locations along the common carotid and internal carotid artery path to the brain plus the external carotid and vertebral arteries on each side using a Doppler examination angle of 60 degrees are evaluated. The UWURC verifies all measurements against the images and waveforms for the database, which includes pre-procedure, post-procedure and annual follow-up examinations. Doppler angle alignment errors greater than 3 degrees and
Carotid artery stenting (CAS) as a viable therapy to treat carotid disease and stroke prevention is growing. One of the limitations of carotid stenting is the risk of liberating embolic particles during the procedure that could cause a stroke or compromise cognitive function.
J Vasc Surg. 2014 Apr;59(4):956-967.e1. doi: 10.1016/j.jvs.2013.10.073. Epub 2013 Dec 28. Multicenter Study; Research Support, Non-U.S. Govt
The Adapt carotid stent features thin struts and an innovative design engineered for flexibility in the carotid arteries. It incorporates a self-expanding, rolled nitinol sheet with patented Dynamic tapering technology designed to conform to varying carotid anatomies. This second-generation carotid stent also provides excellent visibility and has a closed-cell geometry that facilitates consistent lesion coverage. It has been sold in Europe and other countries since receiving CE mark in 2010.. "The Adapt stent offers outstanding deliverability and scaffolding of the vessel wall, which are critical attributes for carotid stents," said Marc Bosiers, principal investigator of the study and head of the Department of Vascular Surgery, A.Z. Sint-Blasius Hospital, Dendermonde, Belgium. "I look forward to seeing how the features of this new technology may be reflected in clinical outcomes from the ASTI study.". ...
Stroke Research and Treatment is a peer-reviewed, Open Access journal that publishes original research articles, review articles, and clinical studies in all aspects of stroke.
This study demonstrates a correlation of in vivo 3T MR plaque and lumen findings with recent symptoms in patients with mild/moderate versus severe carotid stenosis. The ability to noninvasively characterize carotid plaque on 3T MR imaging extends our knowledge of which distinctive wall features are associated with symptoms to include a patient population that does not meet established criteria for surgical resection. The preliminary results from this study suggest that there may be specific wall features that discriminate symptomatic from asymptomatic plaque in the cohort of people with mild/moderate stenosis as measured by CE-MRA, including: the presence of a thin or ruptured fibrous cap as well as the presence and size of a lipid-rich necrotic core. The presence and size of plaque hemorrhage demonstrate a tendency to be associated with recent symptoms. The quantitative analysis of the size of percentage volume lipid-rich necrotic core demonstrates the highest AUC in the ROC of the strength of ...
There is increasing evidence that carotid plaque morphology plays a significant role in the generation of cerebral ischemic symptoms in addition to-and potentially independent from-carotid artery stenosis. Imaging techniques that have the ability to characterize atheromatous plaque noninvasively may therefore be used to identify vessel wall disease that is associated with clinical events. Magnetic resonance imaging (MRI) is emerging as one such noninvasive imaging tool that is able to distinguish different plaque constituents.. When vessel wall MRI is coupled with the proven benefit of brain MRI to identify acute ischemic brain lesions, this technique provides a single imaging modality for comprehensive carotico-cerebral imaging not provided by computed tomography (CT) or ultrasound, which are both commonly used imaging techniques for the carotid artery and brain. The feasibility of imaging the causative carotid artery lesion and end-organ brain injury in patients with acute stroke has been ...
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Ozturk S, Sahin M. Syntax Score I and II for Predicting Carotid Artery Stenosis in Patients with Multivessel Coronary Artery Disease: A Propensity Score Matching Analysis. Braz J Cardiovasc Surg. Ahead of Print ...
Learn more about Carotid Artery Stenosis at Largo Medical Center DefinitionCausesRisk FactorsSymptomsDiagnosisTreatmentPreventionrevision ...
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Carotid artery stenosis is a narrowing of the artery located on either side of the neck. Discover the latest procedures available at GNI. Contact us today.
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Find the best carotid stenting doctors in Thane. Get guidance from medical experts to select carotid stenting specialist in Thane from trusted hospitals - credihealth.com
Background and aim: Ischemic cerebrovascular events are the most common reason for patients to be bedridden and the third most common reason for death. Many studies in recent years have demonstrated that carotid artery stenting (CAS) may be an altern
RESULTS: We identified 154 HIV+ patients, of whom 91 (59%) presented with occlusive disease. There were 71 males and 20 females with a mean age of 44.2 years. The usual risk factors for atherosclerosis were present, but the incidence was less than reported in the classic atherosclerosis population. More than 90% of the patients presented with advanced stage vascular disease (Fontaine III/IV), which explains the high rate (31.9%) of primary amputation. Eighty-seven patients presented with lower-limb ischaemia, 2 patients with upper-limb ischaemia and 2 patients with symptomatic carotid artery stenosis. Seventy-eight procedures were performed on 72 patients, with a perioperative mortality of 6.95%. The limb salvage rate for femoro-popliteal bypass procedures was poor (36.1%), resulting in a high incidence of secondary amputations and prolonged hospital stay. Long-term mortality for the operated patients was 20% over a mean follow-up period of 15.4 months. Hypo-albuminaemia was found to be an ...
Carotid angioplasty (kuh-ROT-id AN-jee-o-plas-tee) is a procedure that opens clogged arteries to prevent or treat stroke. The carotid arteries are located on each side of your neck and are the main arteries supplying blood to your brain. The procedure involves temporarily inserting and inflating a tiny balloon where your carotid artery is clogged to widen the artery.
Back to Top. Treatment carotid artery stenosis (narrowing):. Carotid artery stenosis (or narrowing) is often due to plaque build-up from atherosclerosis (hardening) within the vessel. Blood clots can subsequently form on top of the plaque and can dislodge and go into the blood vessels within the brain, leading to stroke. Carotid doppler studies as well as CTA and MRA (see above) can be used to assess the degree of narrowing. If the carotid artery is narrowed along the same side as the TIA, i.e. right or left brain, then opening the vessel either surgically (called carotid endarterectomy) or through balloon angioplasty might be an option. Procedures might be consider for patients with stroke symptoms who have moderate 50-69% or severe greater than 70% narrowing of the carotids. Patients are usually referred to a neurologist to discuss this and assist with deciding on whether the patient may be a good candidate to have the vessel opened and if so, which procedure would be the best option. For ...
Carotid Artery Stenting is a minimally invasive in which the blockage is treated with balloon angioplasty & the placement of a stent to keep the vessel open
Carotid Artery Stenting: The Basics von Jacqueline Saw und Buchbewertungen gibt es auf ReadRate.com. Bücher können hier direkt online erworben werden.
Methods In our prospective database, we identified 72 patients free of clinical stroke with ≥70% carotid artery stenosis, who were treated with CAS. They were administered a neurocognitive test battery before and 3 months after CAS to compare cognitive performance before and after CAS. To avoid ceiling and floor effects of test performances, we additionally analysed subgroups of patients without baseline floor and ceiling cognitive performance. ...
Increased platelet activation in early symptomatic vs. asymptomatic carotid stenosis and relationship with microembolic status: results from the Platelets and Carotid Stenosis Study.Authors: Kinsella JA, Tobin WO, Tierney S, Feeley TM, Egan B, Collins DR, Coughlan T, ONeill D, Harbison J, Madhavan P, Moore DJ, ONeill SM, Colgan MP, Doherty CP, Murphy RP, Saqqur M, Moran N, Hamilton G, McCabe ...
Dean said she was "shocked" at the severity of the blockages, as she had never felt any symptoms from the condition.. Nevertheless, the state of Deans carotid arteries gave her a highly increased risk of stroke, Laird said, and the main reason for treating severe carotid blockages, either through surgery or stenting, is to reduce the risk of stroke.. The stenting procedure used by Laird has limited approval by the FDA for certain high-risk patients, but Dean was treated as part of an experimental protocol. The procedure is part of several ongoing research studies being conducted by the Vascular Center to assess different ways of performing carotid artery stenting.. The established way of treating carotid artery blockages is a surgical procedure known as cardiac endarterectomy. Carotid artery stenting is a less-invasive method, as it requires no incision in the neck, and thus presents a reduced risk of cardiac complications or complications from anesthesia. In this procedure, a physician reaches ...
臺大位居世界頂尖大學之列,為永久珍藏及向國際展現本校豐碩的研究成果及學術能量,圖書館整合機構典藏(NTUR)與學術庫(AH)不同功能平台,成為臺大學術典藏NTU scholars。期能整合研究能量、促進交流合作、保存學術產出、推廣研究成果。. To permanently archive and promote researcher profiles and scholarly works, Library integrates the services of "NTU Repository" with "Academic Hub" to form NTU Scholars.. ...
TY - JOUR. T1 - Endarterectomy for asymptomatic high-grade internal carotid artery stenosis-Does age alone really matter?. AU - Assadian, Afshin. AU - Taher, Fadi. AU - Assadian, Ojan. PY - 2016/9/20. Y1 - 2016/9/20. N2 - Background The aim of this retrospective observational study was to assess whether patients ≥ 75 years of age had a significantly inferior 5-year stroke free survival rate compared to patients ,75 years of age after carotid endarterectomy under regional anesthesia. Methods All consecutive patients with asymptomatic high-grade internal carotid artery (ICA) stenosis operated on from January 1997 to December 1999. Of 273 consecutive patients with asymptomatic carotid artery stenosis, follow up was complete for 253 patients. Results Of 253 patients, 152 were younger and 102 older than 75 years at surgery (65 ± 8 years (range 43-74) and 79 ± 4 years (range 75-90); P , 0.001), respectively. Perioperatively, 4 patient developed stoke (1.6%), 2 in each group (1.3% and 1.6%, ...
Arterial baroreflex and cardiac autonomic control play important roles in hemodynamic instability after carotid artery stenting (CAS). Spontaneous baroreflex sensitivity (BRS), heart rate variability (HRV) and blood pressure variability (BPV) are established tools for the assessment of arterial baroreflex and cardiac autonomic activity. Aim of the study was to evaluate cardiac autonomic activity (by means of HRV, BPV and BRS) after CAS and to explore the impact of internal carotid artery stenosis on BRS changes after CAS. 37 patients (68±10.45 years) with internal carotid stenosis underwent CAS. HRV, BPV and BRS were measured in all subjects before and at 1 and 72h after CAS. ANOVA was performed to compare BRS, HRV and BPV parameters before and after CAS. Spearman analysis was performed to determine a possible correlation between carotid stenosis degree (or carotid plaque diameter) and BRS changes (ΔBRS). LF/HF (index of sympatho-vagal balance) decreased during postoperative period, in ...
TY - JOUR. T1 - Subdural hematoma in the setting of internal carotid artery occlusion. T2 - CT studies. AU - Pascuzzi, Robert. AU - Boyko, Orest. AU - Voelker, Joseph L.. PY - 1989. Y1 - 1989. N2 - A 72-year-old woman with previously symptomatic internal carotid artery occlusion subsequently presented with an acute hemispheric deficit. The patient was initially diagnosed as having an ischemic infarction but eventually was shown to have a subacute subdural hematoma with delay in surgical evacuation and a major permanent deficit. We speculate that internal carotid artery occlusion may predispose the patient to greater morbidity from subdural hematoma. Patchy hemispheric infarction may reflect greater vulnerability to extrinsic hemispheric compression in the setting of carotid occlusion. This case illustrates the necessity for vigorous pursuit of the diagnosis of subdural hematoma in patients presumed to have transient ischemic attacks or acute cerebral infarction.. AB - A 72-year-old woman with ...
Looking for online definition of cervical part of internal carotid artery in the Medical Dictionary? cervical part of internal carotid artery explanation free. What is cervical part of internal carotid artery? Meaning of cervical part of internal carotid artery medical term. What does cervical part of internal carotid artery mean?
The internal carotid artery is a major paired artery, one on each side of the head and neck, in human anatomy. They arise from the common carotid arteries where these bifurcate into the internal and external carotid arteries at cervical vertebral level 3 or 4; the internal carotid artery supplies the brain, while the external carotid nourishes other portions of the head, such as face, scalp, skull, and meninges. Terminologia Anatomica in 1998 subdivided the artery into four parts: "cervical", "petrous", "cavernous", and "cerebral". However, in clinical settings, the classification system of the internal carotid artery usually follows the 1996 recommendations by Bouthillier, describing seven anatomical segments of the internal carotid artery, each with a corresponding alphanumeric identifier-C1 cervical, C2 petrous, C3 lacerum, C4 cavernous, C5 clinoid, C6 ophthalmic, and C7 communicating. The Bouthillier nomenclature remains in widespread use by neurosurgeons, neuroradiologists and neurologists. ...
0002] At the present time, physicians often treat carotid artery obstructive disease with the placement of a stent. This stent is typically placed in the internal carotid artery, in the common carotid artery, or spanning both arteries with the distal portion of the stent in the internal carotid artery and the proximal portion of the stent in the distal common carotid artery. The start of this procedure necessitates the placement of either a long sheath or a guiding catheter into the common carotid artery proximal to the carotid stenosis to be treated. The placement of such a sheath or guiding catheter can often be extremely challenging due to the tortuous course for access from the aortic arch into the common carotid artery. This is particularly an issue when accessing the right common carotid artery, which typically arises as a proximal branch from the inominate artery. Many different "tricks" are used to try to place relatively stiff sheaths and guiding catheters into the carotid circulation. ...
... s are uncommon and occur in a broad range of patients due to many etiologies. True aneurysms involving all layers of the carotid arterial wall and false aneurysms both occur. Overall, extracranial carotid artery an
Carotid artery pseudoaneurysms can refer to pseudoaneurysms involving any segment of the carotid arteries: common carotid artery pseudoaneurysm internal carotid artery pseudoaneurysm external carotid artery pseudoaneurysm Pathology As with p...
We studied the extra cranial portion of the internal carotid artery and structures associated with it, which are vulnerable to iatrogenic injury during surgical approach to the neck region in 18 individuals. Distances from the origin of the artery to hypoglossal nerve and posterior belly of digastric muscle were measured. The mastoid process and the hyoid bone were also used as landmarks in locating the nerve and respective distances measured. Hypoglossal nerve and posterior belly of digastric muscle crossed the ICA at variable positions with a mean distance of 10.1mm and 17.9mm respectively from the common carotid bifurcation. From the mastoid process, the internal carotid artery ascends underneath the posterior belly of the digastric muscle a third the distance to the hyoid bone. The external carotid artery is located lateral to the internal carotid artery in 63.8% of the cases, posterior in 16.7% and anterior in 19.4%. The posterior belly of digastric muscle and its attachments are key ...

Fatigue Carotid stenosis  - Neurology - MedHelpFatigue Carotid stenosis - Neurology - MedHelp

Fatigue Carotid stenosis Chris511 History of progressive fatigue for past 5 years, now so bad that I returned to my physician. ... Fatigue Carotid stenosis History of progressive fatigue for past 5 years, now so bad that I returned to my physician. I was ... CT angiography show stenosis. So, heres the question. Can the level of fatigue I am experiencing be due to the carotid ... CT angiography show stenosis. So, heres the question. Can the level of fatigue I am experiencing be due to the carotid ...
more infohttps://www.medhelp.org/posts/Neurology/Fatigue-Carotid-stenosis-/show/587001

carotid stenosis and headache - Neurology - MedHelpcarotid stenosis and headache - Neurology - MedHelp

carotid stenosis and headache luckyfivetimes in April 2006 I developed a migrainlike headache. A catscan was done and the ... carotid stenosis and headache. in April 2006 I developed a migrainlike headache. A catscan was done and the diagnosis was a ... one lasting a week prompted me to seek attention thus the stenosis was diagnosed.I am starting to wonder if the panic episodes ... one lasting a week prompted me to seek attention thus the stenosis was diagnosed.I am starting to wonder if the panic episodes ...
more infohttps://www.medhelp.org/posts/Neurology/carotid-stenosis-and-headache/show/11971

Carotid endarterectomy for asymptomatic carotid stenosis | The BMJCarotid endarterectomy for asymptomatic carotid stenosis | The BMJ

Carotid endarterectomy for asymptomatic carotid stenosis: a meta-analysis. Published: 28 November 1998; BMJ 317 doi:10.1136/bmj ... Carotid endarterectomy for asymptomatic carotid stenosis Better data, but the case is still not convincing ... Carotid endarterectomy for asymptomatic carotid stenosis. BMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7171.1468 ( ... Variations in rates of appropriate and inappropriate carotid endarterectomy for stroke prevention in 4 Canadian provinces ...
more infohttps://www.bmj.com/content/317/7171/1468/related

Recurrent Carotid Stenosis - Full Text View - ClinicalTrials.govRecurrent Carotid Stenosis - Full Text View - ClinicalTrials.gov

Carotid Stenosis. Cerebrovascular Disorders. Pathological Conditions, Anatomical. Carotid Artery Diseases. Brain Diseases. ... Recurrent Carotid Stenosis. The safety and scientific validity of this study is the responsibility of the study sponsor and ... Cardiovascular Diseases Carotid Stenosis Cerebrovascular Disorders Heart Diseases Vascular Diseases Drug: aspirin Drug: ... The Recurrent Carotid Stenosis Study established whether antiplatelet therapy was beneficial in the prevention of recurrent ...
more infohttps://clinicaltrials.gov/ct2/show/NCT00000527

Stenting Equals Surgery for Carotid Stenosis | Medpage TodayStenting Equals Surgery for Carotid Stenosis | Medpage Today

... carotid stenting was as effective as endarterectomy, the randomized, controlled CREST trial showed. ... Stenting Equals Surgery for Carotid Stenosis. For patients with carotid stenosis, carotid stenting was as effective as ... For patients with carotid stenosis, carotid stenting was as effective as endarterectomy, the randomized, controlled CREST trial ... Source Reference: Brott T, et al "Stenting versus endarterectomy for treatment of carotid-artery stenosis" N Engl J Med 2010; ...
more infohttps://www.medpagetoday.com/cardiology/strokes/20325

Carotid stenosis treatments compared - Harvard HealthCarotid stenosis treatments compared - Harvard Health

... a disease known as carotid stenosis. If these interfere with blood flow, a stroke can occur. ... A less-invasive option, called carotid stenting, involves inserting a catheter into an artery in the groin, advancing it to the ... The same process that causes obstructions in the hearts arteries can block the carotid arteries in the neck, ... carotid artery, opening the blockage with a balloon, and leaving behind a wire cage (or stent) to hold the artery open. ...
more infohttps://www.health.harvard.edu/heart-health/carotid-stenosis-treatments-compared

Asymptomatic and Symptomatic Carotid Stenosis: An Obsolete Classification?Asymptomatic and Symptomatic Carotid Stenosis: An Obsolete Classification?

... carotid stenosis.. 2. Pathophysiology of Carotid Stenosis. In most cases, carotid stenosis is the result of atherosclerotic ... carotid stenosis and decisions on the degree of carotid stenosis alone could therefore be misleading. Carotid disease should be ... Hence, 93 patients (58.9%) had an "asymptomatic" carotid stenosis despite suggested acute stroke from carotid stenosis. ... for high-grade stenosis (,70% distal degree of stenosis) and about 7% for moderate stenosis. Carotid occlusions were found to ...
more infohttps://www.hindawi.com/journals/srt/2012/340798/

carotid stenosis | Circulation Researchcarotid stenosis | Circulation Research

Suzanne M. Eken, Hong Jin, Ekaterina Chernogubova, Yuhuang Li, Nancy Simon, Changyan Sun, Greg Korzunowicz, Albert Busch, Alexandra Bäcklund, Cecilia Österholm, Anton Razuvaev, Thomas Renné, Hans Henning Eckstein, Jaroslav Pelisek, Per Eriksson, María González Díez, Ljubica Perisic Matic, Isabel N. Schellinger, Uwe Raaz, Nicholas J. Leeper, Göran K. Hansson, Gabrielle Paulsson-Berne, Ulf Hedin and Lars Maegdefessel ...
more infohttp://circres.ahajournals.org/keyword/carotid-stenosis

Ask an Expert: Surgical Risks in Carotid StenosisAsk an Expert: Surgical Risks in Carotid Stenosis

What are the risk numbers for a stroke with a 50% and 69% carotid blockage, if one follows a protocol of aspirin, statins ( ...
more infohttps://www.netwellness.org/question.cfm/77214.htm

Asymptomatic carotid stenosis raises risk for fallsAsymptomatic carotid stenosis raises risk for falls

... without outward symptoms of carotid stenosis and after carotid ultrasonography stratified them into three groups: ... Asymptomatic carotid artery stenosis confers mobility impairment and cognitive dysfunction and increases the risk for falls, ... no carotid stenosis (n = 54), moderate carotid stenosis (n = 17) and high-grade carotid stenosis (n = 9). ... no carotid stenosis (n = 54), moderate carotid stenosis (n = 17) and high-grade carotid stenosis (n = 9). ...
more infohttps://www.healio.com/cardiac-vascular-intervention/cerebrovascular/news/online/%7Be03fc10b-62b4-42e9-a674-6cc11f475a9e%7D/asymptomatic-carotid-stenosis-raises-risk-for-falls

Most Carotid Stenosis Cases Treatable with Medical Therapy | Medpage TodayMost Carotid Stenosis Cases Treatable with Medical Therapy | Medpage Today

Treating carotid stenosis with intensive medical therapy may eliminate the need for either angioplasty or endarterectomy, a new ... Most Carotid Stenosis Cases Treatable with Medical Therapy. Treating carotid stenosis with intensive medical therapy may ... Treating carotid stenosis with intensive medical therapy may eliminate the need for either angioplasty or endarterectomy, a new ... Explain to interested patients that asymptomatic carotid stenosis refers to blockages of the main artery serving the brain that ...
more infohttps://www.medpagetoday.com/neurology/strokes/17524

Surgical and Endovascular Treatment of Extracranial Carotid Stenosis (27.10.2017)Surgical and Endovascular Treatment of Extracranial Carotid Stenosis (27.10.2017)

The available methods of preventing carotid-associated stroke are optimal medical therapy, carotid endarterectomy (CEA), and... ... Arteriosclerotic lesions of the extracranial portion of the carotid artery are the cause of 10 20% of all ischemic strokes. ... asymptomatic stenosis, 50 69% stenosis, and contralateral carotid occlusion (for CEA only). ... Carotid Stenosis Trialist Collaboration [Table 2], only for symptomatic stenosis) (26, 27) has shown that CEA is associated ...
more infohttps://www.aerzteblatt.de/int/archive/article/194103

Carotid stenosis - X-ray of the right artery: MedlinePlus Medical Encyclopedia ImageCarotid stenosis - X-ray of the right artery: MedlinePlus Medical Encyclopedia Image

... stenosis) of the internal carotid artery just past the carotid fork. There is enlargement of the artery or ulceration in the ... This is an angiogram of the right carotid artery showing a severe narrowing ( ... This is an angiogram of the right carotid artery showing a severe narrowing (stenosis) of the internal carotid artery just past ... the carotid fork. There is enlargement of the artery or ulceration in the area after the stenosis in this close-up film. Note ...
more infohttps://medlineplus.gov/ency/imagepages/1153.htm

Carotid stenosis - X-ray of the left artery: MedlinePlus Medical Encyclopedia ImageCarotid stenosis - X-ray of the left artery: MedlinePlus Medical Encyclopedia Image

This is an angiogram of the left common carotid ... A carotid arteriogram is an X-ray study designed to determine ... if there is narrowing or other abnormality in the carotid artery, a main artery to the brain. ... stenosis) of the internal carotid artery just beyond the division of the common carotid artery into the internal and external ... A carotid arteriogram is an x-ray study designed to determine if there is narrowing or other abnormality in the carotid artery ...
more infohttps://medlineplus.gov/ency/imagepages/1152.htm

Revacept in Symptomatic Carotid Stenosis (Revacept/CS/02) - Tabular View - ClinicalTrials.govRevacept in Symptomatic Carotid Stenosis (Revacept/CS/02) - Tabular View - ClinicalTrials.gov

Revacept in Symptomatic Carotid Stenosis (Revacept/CS/02). Official Title ICMJE Revacept, an Inhibitor of Platelet Adhesion in ... Revacept in Symptomatic Carotid Stenosis (Revacept/CS/02) (Revacept/CS/02). This study is currently recruiting participants. ... Extracranial carotid artery stenosis (diagnosed by vascular duplex ultrasound peak flow or angiography) ... Asymptomatic embolization predicts stroke and TIA risk in patients with carotid artery stenosis. Stroke. 1999 Jul;30(7):1440-3. ...
more infohttps://clinicaltrials.gov/ct2/show/record/NCT01645306?term=Atherosclerosis&lup_s=11%2F01%2F2013&lup_d=14&show_rss=Y&sel_rss=mod14

Stroke, Aneurysm, AVM, Carotid Stenosis: Expertise | NewYork-PresbyterianStroke, Aneurysm, AVM, Carotid Stenosis: Expertise | NewYork-Presbyterian

Carotid Stenosis. A Leader in Stroke and Cerebrovascular Disease Care. Our patients who have had a stroke or other ...
more infohttps://www.nyp.org/neuro/services/cerebrovascular-disease

Managing Your Carotid Stenosis - Symptoms & Treatment | Carle.orgManaging Your Carotid Stenosis - Symptoms & Treatment | Carle.org

Were you diagnosed with Carotid Stenosis? Learn more about your condition including DOs and DONTs for how to manage your ... What Is Carotid Stenosis?. Carotid stenosis is a narrowing of the lumen of the carotid artery. This artery is the main one that ... How Is Carotid Stenosis Treated?. Treatment depends on the degree of stenosis and symptoms. It can be medical or surgical. ... Surgery for carotid stenosis is called carotid endarterectomy (CEA). Its usually done in people with recent symptoms and 70% ...
more infohttps://carle.org/Conditions/Neurological-Conditions/Carotid-Artery-Disease

Connectivity Features for Identifying Cognitive Impairment in Presymptomatic Carotid StenosisConnectivity Features for Identifying Cognitive Impairment in Presymptomatic Carotid Stenosis

Cognitive decline in stroke-free individuals with severe carotid stenosis may arise from nonselective widespread disconnections ... Thirty cognitively intact subjects with asymptomatic, severe (≧70%), unilateral stenosis of the ICA were compared with 30 ... Severe asymptomatic stenosis of the internal carotid artery (ICA) leads to increased incidence of mild cognitive impairment ( ... Stenosis Is the Subject Area "Stenosis" applicable to this article? Yes. No. ...
more infohttps://journals.plos.org/plosone/article?id=10.1371/journal.pone.0085441

Waiting for operation of carotid stenosis : The patients´ perspectiveWaiting for operation of carotid stenosis : The patients´ perspective

Carotid stenosis, coping, nursing, patient´s experience, surgery, waiting Identifiers. URN: urn:nbn:se:umu:diva-29940OAI: oai: ... Waiting for operation of carotid stenosis: The patients´ perspective. Rådström, E Jonsén, Elisabeth Umeå University, Faculty of ...
more infohttp://umu.diva-portal.org/smash/record.jsf?pid=diva2:278619

Management of cervical bruits and carotid stenosis in preoperative patients. | StrokeManagement of cervical bruits and carotid stenosis in preoperative patients. | Stroke

Management of cervical bruits and carotid stenosis in preoperative patients.. R G Hart, J D Easton ...
more infohttp://stroke.ahajournals.org/content/14/2/290

Carotid artery stent placement for asymptomatic extracranial carotid stenosis | Guidance and guidelines | NICECarotid artery stent placement for asymptomatic extracranial carotid stenosis | Guidance and guidelines | NICE

Evidence-based recommendations on carotid artery stent placement for asymptomatic extracranial carotid stenosis (narrowed ... Carotid artery stent placement for asymptomatic extracranial carotid stenosis. Interventional procedures guidance [IPG388]. ... In addition the ICD-10 codes I65.2 Occlusion and stenosis of carotid artery or I65.3 Occlusion and stenosis of multiple and ... NICE has also produced guidance on carotid artery stent placement for symptomatic extracranial carotid stenosis (NICE ...
more infohttps://www.nice.org.uk/guidance/ipg388

Carotid artery stent placement for symptomatic extracranial carotid stenosis | Guidance and guidelines | NICECarotid artery stent placement for symptomatic extracranial carotid stenosis | Guidance and guidelines | NICE

Evidence-based recommendations on carotid artery stent placement for symptomatic extracranial carotid stenosis (narrowed ... Carotid artery stent placement for symptomatic extracranial carotid stenosis. Interventional procedures guidance [IPG389]. ... NICE has also published guidance on carotid artery stent placement for asymptomatic extracranial carotid stenosis (NICE ... It replaces the previous guidance on carotid artery stent placement for carotid stenosis (NICE interventional procedures ...
more infohttps://www.nice.org.uk/guidance/IPG389

Natural Supplements for Carotid Stenosis | Herbal RemediesNatural Supplements for Carotid Stenosis | Herbal Remedies

Natural supplements for Carotid Stenosis, as well as knowledgeable support from our friendly staff. Discover true health the ... You are here: Online Shop Supplements by Health ConditionCarotid Stenosis Natural Supplements for Carotid Stenosis. Click here ... Read our detailed Carotid Stenosis article. Need Advice?. We understand there can be a lot to take in at first! If you would ... Above, we detail targeted remedy recommendations for Carotid Stenosis, but we further suggest that you view the core regime ...
more infohttps://www.regenerativenutrition.com/supplements-for-carotid-stenosis-c-866.asp

Carotid Velocities Determine Cerebral Blood Flow Deficits in Elderly Men with Carotid Stenosis |50%Carotid Velocities Determine Cerebral Blood Flow Deficits in Elderly Men with Carotid Stenosis |50%

Carotid Velocities Determine Cerebral Blood Flow Deficits in Elderly Men with Carotid Stenosis ,50%. Arkadiusz Siennicki-Lantz, ... R. W. Hobson II, D. G. Weiss, W. S. Fields et al., "Efficacy of carotid endarterectomy for asymptomatic carotid stenosis," The ... Out of 123 stroke-free patients, carotid stenosis ,50% was observed in 94% in the right and 89% in the left internal carotid ... "Endarterectomy for asymptomatic carotid artery stenosis. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study ...
more infohttps://www.hindawi.com/journals/ijvm/2012/579531/

Neuropsychological Impairment in Stroke, Carotid Stenosis, and Peripheral Vascular Disease | StrokeNeuropsychological Impairment in Stroke, Carotid Stenosis, and Peripheral Vascular Disease | Stroke

This study found that 33% of patients had carotid stenosis of 16% to 50%, 14% had stenosis of ,50%, and in 5% the stenosis was ... However, frontal lobe dysfunction in patients with carotid stenosis has been a more consistent finding.8 12 14 15 ... Carotid Stenosis and Cognitive Impairment. Few studies have compared cognitive function between patients with stroke and those ... Alexandrova NA, Gibson WC, Norris JW, Maggisano R. Carotid artery stenosis in peripheral vascular disease. J Vasc Surg. 1996;23 ...
more infohttp://stroke.ahajournals.org/content/30/10/2167
  • During the latter period, Spence and colleagues focused on using increasingly aggressive drug regimens to slow progression of carotid stenosis. (medpagetoday.com)
  • In the 1980s, with the introduction of vascular ultrasound, the true dimensions of carotid disease became apparent. (hindawi.com)
  • Carotid ultrasound was performed at age 81, and cerebral blood flow (CBF) was measured with SPECT at age 82. (hindawi.com)
  • In most cases, carotid ultrasound is performed in association with TIA or stroke and, in case of significant stenosis, an operative treatment or pharmacotherapy is initiated as a secondary prevention. (hindawi.com)
  • When estimating cerebral blood supply and carotid stenosis with ultrasound in the elderly, one must be aware, that age and DBP-level decrease PSV, while SBP and pulse pressure increase PSV in elderly [ 8 , 9 ]. (hindawi.com)
  • Typically duplex ultrasound scan is the only investigation required for decision making in carotid stenosis as it is widely available and rapidly performed. (wikipedia.org)
  • First descriptions of carotid stenosis related to cerebrovascular events date back to T. Willis (1621-1675) and J. J. Wepfer (1620-1695). (hindawi.com)
  • The same is true for the "symptomatic" carotid stenosis too, but with one difference: there is a higher risk of stroke (10-20%) within the first 14-28 days following a cerebrovascular event (TIA or stroke) [ 13 ]. (hindawi.com)
  • Significant carotid stenosis occurs in 5 out of 1000 people 50 to 60 years old. (carle.org)
  • A carotid stenosis of 50% or more in diameter was considered significant. (ebscohost.com)
  • A carotid artery calcification (CAC) can indicate presence of significant (≥ 50%) carotid stenosis (SCS). (diva-portal.org)
  • Can the level of fatigue I am experiencing be due to the carotid stenosis and yet not show any brain dysfunction on the MRI, CT or SPEC scan? (medhelp.org)
  • Early descriptions of "organic impairment" associated with angiographically demonstrable carotid stenosis failed to provide data on areas of cognitive dysfunction. (ahajournals.org)