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)
The excision of the thickened, atheromatous tunica intima of a carotid artery.
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.
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.
Branch of the common carotid artery which supplies the anterior part of the brain, the eye and its appendages, the forehead and nose.
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.
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 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.
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.
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)
The condition of an anatomical structure's being constricted beyond normal dimensions.
A plant family of the order Gentianales, subclass Asteridae, class Magnoliopsida.
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.
Narrowing or constriction of a coronary artery.
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)
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.
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.
Branch of the common carotid artery which supplies the exterior of the head, the face, and the greater part of the neck.
Narrowing of the spinal canal.
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.
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.
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.
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.
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)
Radiography of the vascular system of the brain after injection of a contrast medium.
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.
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.
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.
Radiography of blood vessels after injection of a contrast medium.
Narrowing of the pyloric canal with varied etiology. A common form is due to muscle hypertrophy (PYLORIC STENOSIS, HYPERTROPHIC) seen in infants.
Levels within a diagnostic group which are established by various measurement criteria applied to the seriousness of a patient's disorder.
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.
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.
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.
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.
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.
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.
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.
A value equal to the total volume flow divided by the cross-sectional area of the vascular bed.
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 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.
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.
Act of listening for sounds within the body.
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 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)
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.
The circulation of blood through the BLOOD VESSELS of the BRAIN.
Diseases that do not exhibit symptoms.
The return of a sign, symptom, or disease after a remission.
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 using x-ray transmission and a computer algorithm to reconstruct the image.
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)
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.
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.
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)
The innermost layer of an artery or vein, made up of one layer of endothelial cells and supported by an internal elastic lamina.
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)
Elements of limited time intervals, contributing to particular results or situations.
Blocking of a blood vessel by an embolus which can be a blood clot or other undissolved material in the blood stream.
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.
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.
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).
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).
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.
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.
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.
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.
The movement and the forces involved in the movement of the blood through the CARDIOVASCULAR SYSTEM.
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.
Pathologic deposition of calcium salts in tissues.
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).
Lesions formed within the walls of ARTERIES.
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.
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.
A pathological constriction occurring in the region below the AORTIC VALVE. It is characterized by restricted outflow from the LEFT VENTRICLE into the AORTA.
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)
A thickening and loss of elasticity of the walls of ARTERIES that occurs with formation of ATHEROSCLEROTIC PLAQUES within the ARTERIAL INTIMA.
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.
A pathological constriction occurring in the region above the AORTIC VALVE. It is characterized by restricted outflow from the LEFT VENTRICLE into the AORTA.
PRESSURE of the BLOOD on the ARTERIES and other BLOOD VESSELS.
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.
Radiography of the vascular system of the heart muscle after injection of a contrast medium.
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.
Maintenance of blood flow to an organ despite obstruction of a principal vessel. Blood flow is maintained through small vessels.
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.
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.
Substances used to allow enhanced visualization of tissues.
The degree to which BLOOD VESSELS are not blocked or obstructed.
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.
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.
Device constructed of either synthetic or biological material that is used for the repair of injured or diseased blood vessels.
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.
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.
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.
Developmental or acquired stricture or narrowing of the LARYNX. Symptoms of respiratory difficulty depend on the degree of laryngeal narrowing.
The valve between the left ventricle and the ascending aorta which prevents backflow into the left ventricle.
Subspecialty of radiology that combines organ system radiography, catheter techniques and sectional imaging.
Period of contraction of the HEART, especially of the HEART VENTRICLES.
Pathological processes of CORONARY ARTERIES that may derive from a congenital abnormality, atherosclerotic, or non-atherosclerotic cause.
INFLAMMATION of any ARTERIES.
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.
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.
A repeat operation for the same condition in the same patient due to disease progression or recurrence, or as followup to failed previous surgery.
Operative procedures for the treatment of vascular disorders.
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.
Artery originating from the internal carotid artery and distributing to the eye, orbit and adjacent facial structures.
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.
The arterial blood vessels supplying the CEREBRUM.
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.
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.
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.
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.
Pathological processes involving any one of the BLOOD VESSELS in the vasculature outside the HEART.
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.
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.
Tear or break of an organ, vessel or other soft part of the body, occurring in the absence of external force.
Narrowing of the pyloric canal due to HYPERTROPHY of the surrounding circular muscle. It is usually seen in infants or young children.
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.
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.
Obstruction of flow in biological or prosthetic vascular grafts.
The flow of BLOOD through or around an organ or region of the body.
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)
The period following a surgical operation.
Iron (II,III) oxide (Fe3O4). It is a black ore of IRON that forms opaque crystals and exerts strong magnetism.
Rhythmic, intermittent propagation of a fluid through a BLOOD VESSEL or piping system, in contrast to constant, smooth propagation, which produces laminar flow.
Surgical insertion of synthetic material to repair injured or diseased heart valves.
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)
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.
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)
NECROSIS of the MYOCARDIUM caused by an obstruction of the blood supply to the heart (CORONARY CIRCULATION).
Surgical insertion of BLOOD VESSEL PROSTHESES to repair injured or diseased blood vessels.
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.
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.
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.
The probability that an event will occur. It encompasses a variety of measures of the probability of a generally unfavorable outcome.
A stricture of the ESOPHAGUS. Most are acquired but can be congenital.
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.
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.
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.
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.
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.
Procedures in which placement of CARDIAC CATHETERS is performed for therapeutic or diagnostic procedures.
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.
The veins and arteries of the HEART.
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.
Ultrasonic recording of the size, motion, and composition of the heart and surrounding tissues. The standard approach is transthoracic.
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.
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.
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.
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.
The circulation of blood through the CORONARY VESSELS of the HEART.
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.
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)
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.
Bleeding or escape of blood from a vessel.
A method in which either the observer(s) or the subject(s) is kept ignorant of the group to which the subjects are assigned.
A plasma protein that circulates in increased amounts during inflammation and after tissue damage.
The first branch of the SUBCLAVIAN ARTERY with distribution to muscles of the NECK; VERTEBRAE; SPINAL CORD; CEREBELLUM; and interior of the CEREBRUM.
Compounds that inhibit HMG-CoA reductases. They have been shown to directly lower cholesterol synthesis.
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.
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.
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)
7-carbon saturated monocarboxylic acids.
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.
Surgical shunt allowing direct passage of blood from an artery to a vein. (From Dorland, 28th ed)
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.
A statistical technique that isolates and assesses the contributions of categorical independent variables to variation in the mean of a continuous dependent variable.
A device that substitutes for a heart valve. It may be composed of biological material (BIOPROSTHESIS) and/or synthetic material.
The main artery of the thigh, a continuation of the external iliac artery.
The neural systems which act on VASCULAR SMOOTH MUSCLE to control blood vessel diameter. The major neural control is through the sympathetic nervous system.
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.
Methods developed to aid in the interpretation of ultrasound, radiographic images, etc., for diagnosis of disease.
A branch of the abdominal aorta which supplies the kidneys, adrenal glands and ureters.
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.
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)
Receptors in the vascular system, particularly the aorta and carotid sinus, which are sensitive to stretch of the vessel walls.
Hypertension due to RENAL ARTERY OBSTRUCTION or compression.
Harmful effects of non-experimental exposure to ionizing or non-ionizing radiation in VERTEBRATES.
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.
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.
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)

TY - JOUR. T1 - Long-term results of medical and surgical therapy for Japanese patients with moderate carotid stenosis. AU - Ogata, Toshiyasu. AU - Yasaka, Masahiro. AU - Wakugawa, Yoshiyuki. AU - Inoue, Tooru. AU - Yasumori, Kotaro. AU - Kitazono, Takanari. AU - Iida, Mitsuo. AU - Okada, Yasushi. PY - 2012/1. Y1 - 2012/1. N2 - To clarify the efficacy of medication versus carotid endarterectomy (CEA), we investigated cardiovascular events and outcomes in Japanese patients with moderate carotid stenosis. We consecutively registered patients with significant carotid stenosis (50%-79%) measured by digital subtraction angiography (DSA) over 10 years and compared the incidences of stroke, myocardial infarction, and death between treatment groups (surgical group vs medical group). Of 406 registered patients, 163 (108 treated surgically and 55 treated medically) with moderate carotid stenosis were analyzed. Complete follow-up data (mean, 4.2 years) were available for 105 patients in the surgical group ...
Evidence-based recommendations on carotid artery stent placement for symptomatic extracranial carotid stenosis (narrowed carotid arteries in the neck)
We systematically compared and appraised contemporary guidelines on management of asymptomatic and symptomatic carotid artery stenosis.We systematically searched for guideline recommendations on carotid endarterectomy (CEA) or carotid angioplasty/stenting (CAS) published in any language between January 1, 2008, and January 28, 2015. Only the latest guideline per writing group was selected. Each guideline was analyzed independently by 2 to 6 authors to determine clinical scenarios covered, recommendations given, and scientific evidence used.Thirty-four eligible guidelines were identified from 23 different regions/countries in 6 languages. Of 28 guidelines with asymptomatic carotid artery stenosis procedural recommendations, 24 (86%) endorsed CEA (recommended it should or may be provided) for ≈50% to 99% average-surgical-risk asymptomatic carotid artery stenosis, 17 (61%) endorsed CAS, 8 (29%) opposed CAS, and 1 (4%) endorsed medical treatment alone. For asymptomatic carotid artery stenosis ...
BACKGROUND AND PURPOSE: Blood supply through collateral pathways improves regional cerebral blood flow and may protect against ischemic events. The effect of collaterals on the risk of stroke and transient ischemic attack (TIA), in the presence of angiographic severe internal carotid artery (ICA) stenosis, was assessed. METHODS: Angiographic collateral filling through anterior communicating and posterior communicating arteries and retrograde filling through ophthalmic arteries were determined in all patients at entry into the North American Symptomatic Carotid Endarterectomy Trial. Kaplan-Meier event-free survival analyses were performed on 339 medically treated and 342 surgically treated patients. RESULTS: The presence of collaterals supplying the symptomatic ICA increased with severity of stenosis. Two-year risk of hemispheric stroke in medically treated patients with severe ICA stenosis was reduced in the presence of collaterals: 27.8% to 11.3% (P=0.005). Similar reductions were observed for
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 ...
TY - JOUR. T1 - Usefulness of Early Stenting for Symptomatic Extracranial Carotid Stenosis. AU - Yang, Na Rae. AU - Jeon, Pyoung. AU - Kim, Byungjun. AU - Kim, Keon Ha. AU - Jo, Kyung Il. PY - 2016/12/1. Y1 - 2016/12/1. N2 - Background While carotid angioplasty and stenting (CAS) have become an established procedure, outcomes of early CAS for symptomatic extracranial carotid stenosis (SECS) remain poorly understood. The present study aimed at determining the effectiveness of early CAS in SECS. Methods Herein, 224 SECS patients underwent elective CAS between January 2008 and June 2015. The study population was stratified based on the time from symptom onset to the procedure (early CAS group: within 14 days; delayed CAS group: later than 14 days). Subgroup analysis (chi-square test, Mantel-Haenszel chi-square test, and analysis of covariance) evaluated the demographics, incidence of periprocedural thromboembolic complications, cerebral hyperperfusion syndrome (CHS), intracranial bleeding, and ...
TY - JOUR. T1 - Carotid stenting in a nonagenarian patient with symptomatic carotid stenosis. AU - Ranjan Shetty, K.. AU - Vivek, G.. AU - Gupta, Manoj K.. AU - Nayak, Krishananda. AU - Pai, Umesh. AU - Dias, Lorraine. AU - Naha, Kushal. AU - Acharya, Raviraj. PY - 2012/11/8. Y1 - 2012/11/8. N2 - Carotid artery stenosis is a disabling disease in all age groups. Elderly people are more prone to recurrent strokes due to advancing age and multiple co-morbidities. Treatment options for symptomatic carotid stenosis in the very elderly are the same as in younger patients although with a higher operative risk. We describe a successful case of carotid artery stenting in a nonagenarian with symptomatic carotid artery stenosis, a subgroup for whom treatment options are rarely discussed in guidelines.. AB - Carotid artery stenosis is a disabling disease in all age groups. Elderly people are more prone to recurrent strokes due to advancing age and multiple co-morbidities. Treatment options for symptomatic ...
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 ...
TY - JOUR. T1 - Asymptomatic carotid stenosis and cognitive improvement using transcervical stenting with protective flow reversal technique. AU - Ortega, G.. AU - Álvarez, B.. AU - Quintana, M.. AU - Yugueros, X.. AU - Álvarez-Sabin, J.. AU - Matas, M.. PY - 2014/1/1. Y1 - 2014/1/1. N2 - Objectives The relationship between carotid artery stenosis and cognitive function in individuals without a history of stroke is not clear. The possible pathomechanisms of cognitive impairment include silent embolization and hypoperfusion. In this study the aim was to assess cognitive changes after transcervical carotid artery stenting with proximal cerebral protection by flow reversal in patients with asymptomatic carotid stenosis, a novel technique that has been proved to decrease the number intraoperative emboli. Methods 25 consecutive patients were assessed, of which 22 were men (88%) mean age of 74 years with severe asymptomatic carotid stenosis who underwent revascularization by carotid artery stenting ...
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 ...
TY - JOUR. T1 - Cerebral blood flow and cerebrovascular reactivity capacity in patients with bilateral high-grade carotid artery stenosis. AU - Liu, Hon Man. AU - Tu, Yong Kwang. AU - Yip, Ping Keung. AU - Su, Cheng Tau. PY - 1996/12/1. Y1 - 1996/12/1. UR - http://www.scopus.com/inward/record.url?scp=0029689112&partnerID=8YFLogxK. UR - http://www.scopus.com/inward/citedby.url?scp=0029689112&partnerID=8YFLogxK. U2 - 10.1111/j.1600-0404.1996.tb00559.x. DO - 10.1111/j.1600-0404.1996.tb00559.x. M3 - Article. C2 - 8686451. AN - SCOPUS:0029689112. VL - 93. SP - 90. EP - 92. JO - Acta Neurologica Scandinavica. JF - Acta Neurologica Scandinavica. SN - 0001-6314. IS - SUPPL166. ER - ...
TY - JOUR. T1 - Comparative Outcomes of Carotid Artery Stent Placement and Carotid Endarterectomy in Patients with Chronic Kidney Disease and End-Stage Renal Disease. AU - Adil, Malik M.. AU - Saeed, Fahad. AU - Chaudhary, Saqib A.. AU - Malik, Ahmed. AU - Qureshi, Adnan I.. PY - 2016/7/1. Y1 - 2016/7/1. N2 - Background Patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) have a high prevalence of carotid artery stenosis but are excluded from clinical trials. We sought to determine the clinical characteristics and outcomes related to carotid endarterectomy (CEA) and carotid artery stenting (CAS) in ESRD and CKD patients. Methods We determined the frequency of CAS and CEA performed in patients with ESRD and CKD and associated in-hospital outcomes using data from the nationwide inpatient sample data files from 2005 to 2011. All the in-hospital outcomes were analyzed after adjusting for potential confounders using multivariate analysis. Results Of the 43,875 CKD patients ...
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
BACKGROUND AND PURPOSE: Contrast-enhanced MR angiography and extracranial color-coded duplex sonography are noninvasive, preoperative imaging modalities for evaluation of carotid artery stenosis. Innovative techniques and improvements in image quality require frequent reassessment of accuracy, reliability, and diagnostic value compared with those of digital subtraction angiography (DSA). We evaluated contrast-enhanced MR angiography and duplex sonography compared with DSA for detection of high-grade carotid artery stenoses. METHODS: Four readers, blinded to clinical symptoms and the outcome of other studies, independently evaluated stenoses on contrast-enhanced MR angiograms in 71 vessels of 39 symptomatic patients. Duplex sonography was also performed in all vessels. The severity of stenosis was defined according to North American Symptomatic Carotid Endarterectomy Trial criteria (0-29%, 30-69%, 70-99%, 100%). Results of both modalities were compared with the corresponding DSA finding
© 2018, The Author(s). Purpose of Review: Provide a current overview regarding the optimal strategy for managing patients with asymptomatic carotid artery stenosis. Recent Findings: Carotid endarterectomy (CEA) and carotid artery stenting (CAS) reduce long-term stroke risk in asymptomatic patients. However, CAS is associated with a higher risk of peri-procedural stroke. Improvements in best medical therapy (BMT) have renewed uncertainty regarding the extent to which results from older randomised controlled trials (RCTs) comparing outcomes following carotid intervention can be generalised to modern medical practise. Summary: Average surgical risk patients with an asymptomatic carotid artery stenosis of 60-99% and increased risk of late stroke should be considered for either CEA or CAS. In patients deemed high risk for surgery, CAS is indicated. Use of an anti-platelet, anti-hypertensive and statin, with strict glycaemic control, is recommended. Results from ongoing large, multicentre RCTs comparing
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
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. ...
Choi et al attempt to shine additional light on an already hotly debated topic. The investigators used multivariable logistic regression, propensity score matching and a grouped-treatment approach (with adjustments for baseline characteristics) to compare in-hospital death and postoperative stroke after either carotid artery stenting (CAS) or carotid endarterectomy (CEA). A cohort of 17,716 patients with asymptomatic carotid stenosis treated with CEA and 3,962 patients treated with CAS at 186 different academic medical centers which participate in the University Health System Consortium were reviewed. The patients were identified using ICD 9 codes between the years 2010-2012. Patient information, such as demographics, was obtained from the medical record. They examined the annual volume of both CAS and CEA at each hospital as well as the volume and outcomes of patients undergoing each procedure per physician. The primary outcome was defined as a composite of postoperative stroke or in-hospital ...
With the publication of randomized controlled trials on carotid endarterectomy, the appropriate indications for this surgery (when to operate) are becoming better defined. From a public health perspective, however, the benefits of carotid surgery are convincing only when surgical morbidity and mortality rates are very low. Thus, an equally important question needs to be considered: Who should operate in carotid disease?. In this issue of American Family Physician, Biller and Thies1 review evidence showing that carotid endarterectomy can be highly effective in preventing stroke. Patients with high-grade internal carotid artery stenosis (greater than 70 percent) that is ipsilateral to the side of previous symptoms or nondisabling stroke benefit dramatically from the combined use of surgery and medical therapy compared with the use of medical therapy alone. In patients with severe carotid artery stenosis, fewer than eight carotid endarterectomies are required to prevent one stroke. The benefits ...
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 ...
Objective: Radiotherapy to the head and neck often results in carotid stenosis, but the course of disease is unknown. We investigated the natural history and progression of asymptomatic carotid stenosis induced by external irradiation. Patients and Methods: The study included 130 carotid arteries in 95 patients who had received external radiation therapy to the head and neck area and who had asymptomatic, mild internal carotid artery or common carotid artery stenosis. Stenosis of 15% to 49% on duplex ultrasound (US) scans defined mild (< 50%) disease. Another 95 arteries in 74 patients with matched degree of carotid artery stenosis but who had not received radiation therapy were used as control. Both groups were followed up prospectively with serial duplex US scanning, and degree of carotid artery stenosis was categorized as 15% to 49%, 50% to 69%, 70% to 99%, and occlusion. Progression of carotid artery stenosis was defined as increase in stenosis from less than 50% to 50% or greater at ...
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, ...
TY - JOUR. T1 - Transcranial doppler assessment of the functional effects of symptomatic carotid stenosis. AU - Silvestrini, Mauro. AU - Troisi, E.. AU - Cupini, L. M.. AU - Matteis, M.. AU - Pistolese, G. R.. AU - Bernardi, G.. PY - 1994. Y1 - 1994. N2 - Mean flow velocity changes in the middle cerebral arteries (MCAs) during a 2-minute thumb-to-fin-ger opposition task were measured by means of transcranial Doppler ultrasonography in patients with severe unilateral carotid stenosis and ipsilateral transient ischemic attacks and in control subjects. The increase of flow velocity in the MCA contralateral to the hand performing the task was significantly different (p ,0.001, one-way ANOVA) in controls (+5.52 ± 2.4 cm/sec) and in patients (+ 1.76 ± 1.6 cm/sec, side of stenosis; +3.83 ± 2.1 cm/sec, normal side). A post hoc least significant difference test revealed a significant difference between controls and patients on the side of stenosis (p ,0.001) and between the normal side and the ...
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, ...
Description of disease Carotid stenosis. Treatment Carotid stenosis. Symptoms and causes Carotid stenosis Prophylaxis Carotid stenosis
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 - What should we do with asymptomatic carotid stenosis?. AU - Abbott, Anne. AU - Bladin, Christopher. AU - Levi, Christopher R. AU - Chambers, Brian. PY - 2007. Y1 - 2007. N2 - Abstract The benefit of prophylactic carotid endarterectomy (CEA) for patients with asymptomatic severe carotid stenosis in the major randomised surgical studies was small, expensive and may now be absorbed by improvements in best practice medical intervention. Strategies to identify patients with high stroke risk are needed. If surgical intervention is to be considered the complication rates of individual surgeons should be available. Clinicians will differ in their interpretation of the same published data. Maintaining professional relationships with clinicians from different disciplines often involves compromise. As such, the management of a patient will, in part, depend on what kind of specialist the patient is referred to. The clinician s discussion with patients about this complex issue must be ...
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
TY - JOUR. T1 - Restenosis and risk of stroke after stenting or endarterectomy for symptomatic carotid stenosis in the International Carotid Stenting Study (ICSS). T2 - secondary analysis of a randomised trial. AU - International carotid stenting study investigators. AU - Bonati, Leo H.. AU - Gregson, John. AU - Dobson, Joanna. AU - McCabe, Dominick J.H.. AU - Nederkoorn, Paul J.. AU - van der Worp, H. Bart. AU - de Borst, Gert J.. AU - Richards, Toby. AU - Cleveland, Trevor. AU - Müller, Mandy D.. AU - Wolff, Thomas. AU - Engelter, Stefan T.. AU - Lyrer, Philippe A.. AU - Brown, Martin M.. AU - Algra, Ale. AU - Bakke, S. J.. AU - Baldwin, Neil. AU - Beard, Jonathan. AU - Bladin, Christopher. AU - Bland, J. Martin. AU - Boiten, J.. AU - Bosiers, Mark. AU - Bradbury, Andrew W.. AU - Canovas, David. AU - Chambers, Brian. AU - Chamorro, Angel. AU - Chataway, Jonathan. AU - Clifton, Andrew. AU - Collins, Rory. AU - Coward, Lucy. AU - Czlonkowska, Anna. AU - Davis, Stephen. AU - DeJaegher, L.. AU - ...
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 ...
References for Research - good, bad, and unnecessary:. 1 Equator network resource centre for good reporting of health research studies: accessed 17th January 2012.. 2 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;351:1379-87.. 3 Cina CS, Clase CM, Haynes RB. Carotid endarterectomy for symptomatic carotid stenosis. The Cochrane Database of Systematic Reviews 1999, Issue 3. Art. No.: CD001081. QUERY - Link goes to the 2011 update of this review.. 4 The Magpie Trial Collaborative Group. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised, placebo-controlled trial. Lancet 2002;359:1877-90.. 5 Duley L, Gülmezoglu AM, Henderson-Smart DJ. Magnesium sulphate and other anticonvulsants for women with pre-eclampsia. Cochrane Database of Systematic Reviews 2003, Issue 2. Art. No.: ...
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
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%, ...
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The Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST) completed randomization on July 18, 2008. Sponsored by the National Institute of Neurological Disorders and Stroke (NINDS), the trial has enrolled 2,522 participants across North America and is the largest randomized clinical trial (RCT) comparing the efficacy of carotid artery stenting (CAS) to carotid endarterectomy (CEA). It is also the largest RCT to assess carotid revascularization in both symptomatic and asymptomatic patients with carotid artery stenosis. Conventional-risk patients with symptomatic carotid stenosis (> or =50% by angiography, > or =70% by ultrasound) or asymptomatic carotid stenosis (> or =60% by angiography, > or =70% by ultrasound) were randomized to both treatment arms in a 1:1 ratio. Eligibility criteria for CREST were similar to those of the previous NINDS-sponsored CEA RCTs. The investigational devices used in the CAS arm of the study are the RX Acculink stent and the RX Accunet embolic protection ...
TY - JOUR. T1 - Risk of early carotid endarterectomy for symptomatic carotid stenosis. AU - Brinjikji, Waleed. AU - Rabinstein, Alejandro A.. AU - Meyer, Fredric B.. AU - Piepgras, David G.. AU - Lanzino, Giuseppe. PY - 2010/10/1. Y1 - 2010/10/1. N2 - Background And Purpose-: The purpose of this study was to determine and compare the rate of stroke, myocardial infarction, and death in patients undergoing early and late carotid endarterectomy (CEA) after a symptomatic event and in asymptomatic patients. Methods-: We conducted a retrospective analysis of all CEAs performed in the Department of Neurosurgery between January 2004 and May 2009. Patients were divided into 3 groups: Group 1, asymptomatic patients; Group 2, symptomatic patients operated on ,2 weeks after their transient ischemic attack or stroke; and Group 3, symptomatic patients operated on ≤2 weeks of their transient ischemic attack or stroke. Primary outcomes were any myocardial infarction, stroke, or death occurring within 30 days ...
TY - JOUR. T1 - The use of covered stents for the endovascular treatment of extracranial internal carotid artery stenosis. T2 - A prospective study with a 5-year follow-up. AU - Szólics, Alex. AU - Sztriha, László K.. AU - Szikra, Péter. AU - Sźlics, Mikĺs. AU - Palḱ, András. AU - Vörös, Erika. PY - 2010/7/1. Y1 - 2010/7/1. N2 - Objectives: To evaluate the safety and feasibility of the use of covered stents for the treatment of extracranial carotid artery stenosis caused by highly embologenic plaques, and to study the long-term outcome of patients receiving such covered stents. Methods: Between 2002 and 2007, 46 patients (63% symptomatic, 78.3% male, 67± 8.6 years old) with internal carotid artery stenosis caused by embologenic plaques or restenosis were treated with self-expanding covered stents (Symbiot, Boston Scientific). Pre-dilatation or protecting devices were not used. Post-dilatation was applied in every patient. Each patient was followed long-term. The outcome measures were ...
Common carotid artery stenosis is often diagnosed when actually looking for internal carotid artery stenosis. The methods for diagnosis include duplex ultrasound and computed tomography. The criteria for the diagnosis of common carotid artery stenosis are unclear. The convention is that a doubling of the flow velocity between adjacent artery segments denotes significant stenosis. A retrospective analysis compared duplex ultrasound of 62 patients with common carotid artery stenosis to CT. A peak systolic velocity >182 cm/sec and an end-diastolic velocity >30 cm/sec were the most accurate as assessed by receiver-operating curves. While sensitivity was not very high, specificity was better. In this analysis duplex ultrasonography was also accurate in detection of common carotid artery occlusion, albeit in a small number of patients.. ...
[Endarterectomy for cervical internal carotid artery stenosis accompanied with severe aortic valve stenosis--case report].: A 75-year-old man, who had undergone
INTRODUCTION: Understanding the pathophysiological mechanism of procedural stroke during carotid intervention may help reduce the risk of stroke in those undergoing surgery. We therefore studied the features of procedural strokes within the first Asymptomatic Carotid Surgery Trial-1 (ACST-1) to identify the underlying pathophysiological mechanism. METHODS: In ACST-1, 3,120 patients with severe asymptomatic carotid stenosis thought suitable for surgery were randomized to CEA or indefinite deferral of surgery. Information on procedural (within 30 days) stroke type, laterality, severity and timing was collected. Eight possible mechanisms were defined: embolism from the carotid artery, haemodynamic, thrombosis or occlusion of the carotid artery, hyperperfusion syndrome, cardioembolic, either carotid embolic or haemodynamic, either carotid embolic or thrombotic occlusion, or undetermined. RESULTS: Procedural strokes occurred in 53 patients (2.7%). Strokes were predominantly ischaemic (n = 43; 81%),
Il nostro Team vanta ventanni di esperienza nella cura del piede diabetico ed è stato parte importante nella evoluzione della cura di questa patologia, in. Background Previous studies have shown that carotid endarterectomy in patients with symptomatic severe carotid stenosis (defined as stenosis of 70 to 99 percent of. Background Previous studies chirurgia vascolare carotids shown that carotid endarterectomy in patients with symptomatic severe carotid stenosis (defined as stenosis of 70 to 99 percent of. Il nostro Team vanta ventanni di esperienza nella cura del piede diabetico ed è stato parte importante nella evoluzione della cura di questa patologia, in. Background Carotid-artery stenting and carotid endarterectomy are both options for treating carotid-artery stenosis, an important cause of stroke. Methods We randomly. ...
I wish to congratulate Eric Russell for his conscientious and thought-provoking commentary on the status of carotid stenting. The technique of carotid stenting is about to begin a new phase of additional rigorous scrutiny and investigation. The National Institute of Neurologic Disorders and Stroke (NINDS) recently has approved and funded a large multicenter, multinational, randomized, controlled trial comparing carotid stenting with carotid endarterectomy. The Carotid Revascularization Endarterectomy vs. Stent Trial (CREST) plans to begin training and credentialing interventionalists this summer, and recruitment is expected to begin late this year or in early 2000. The trial will address the relevant efficacy of carotid stenting and carotid endarterectomy in a North American Symptomatic Carotid Endarterectomy Trial (NASCET)-like population of patients with symptomatic high-grade stenoses. We anticipate that 2500 patients will need to be recruited to satisfy the statistical requirements of the ...
Background and Purpose- This analysis was performed to assess the association between perioperative and clinical variables and the 30-day risk of stroke or death after carotid endarterectomy for symptomatic carotid stenosis. Methods- Individual patient-level data from the 5 largest randomized controlled carotid trials were pooled in the Carotid Stenosis Trialists Collaboration database. A total of 4181 patients who received carotid endarterectomy for symptomatic stenosis per protocol were included. Determinants of outcome included carotid endarterectomy technique, type of anesthesia, intraoperative neurophysiological monitoring, shunting, antiplatelet medication, and clinical variables. Stroke or death within 30 days after carotid endarterectomy was the primary outcome. Adjusted risk ratios (aRRs) were estimated in multilevel multivariable analyses using a Poisson regression model. Results- Mean age was 69.5±9.2 years (70.7% men). The 30-day stroke or death rate was 4.3%. In the multivariable
OBJECTIVE To decrease the procedural risk of carotid revascularisation it is crucial to understand the mechanisms of procedural stroke. This study analysed the features of procedural strokes associated with carotid artery stenting (CAS) and carotid endarterectomy (CEA) within the International Carotid Stenting Study (ICSS) to identify the underlying pathophysiological mechanism. MATERIALS AND METHODS Patients with recently symptomatic carotid stenosis (1,713) were randomly allocated to CAS or CEA. Procedural strokes were classified by type (ischaemic or haemorrhagic), time of onset (intraprocedural or after the procedure), side (ipsilateral or contralateral), severity (disabling or non-disabling), and patency of the treated artery. Only patients in whom the allocated treatment was initiated were included. The most likely pathophysiological mechanism was determined using the following classification system: (1) carotid-embolic, (2) haemodynamic, (3) thrombosis or occlusion of the revascularised carotid
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.. ...
Severe internal carotid artery (ICA) stenosis is a common cause of cerebrovascular accident (CVA) in middle-aged patients. Contralateral carotid occlusion (CCO) in patients with severe ICA stenosis is associated with high risk of CVA. Carotid endarterectomy (CEA) is associated with more complications in patients with CCO than those without CCO. In this study, we present the case of a 61-year-old patient who presented with multiple transient ischemic attack and severe ICA stenosis associated with CCO and occlusion of vertebral arteries. The patient was treated successfully with carotid angioplasty and stenting.
The primary objective of this cadaveric study was to review the morphological variations of the anatomy of the human carotid artery bifurcation relevant to carotid endarterectomy (CEA) and carotid artery stent-supported angioplasty (CSSA). We quantify carotid bifurcation plaque morphology. Results showed that the angle of deviation at the origin of the internal carotid artery (ICA), in relation to the common carotid artery (CCA), measured a mean of 21.8 degrees with a range from seven to 45 degrees. This anatomical finding is important for the interventionalist concerned with insertion of a carotid stent. The angle of the ICA origin may be an independent risk factor for early atherosclerotic changes at the ICA bulb. Carotid bifurcation plaque was observed in a small, random cohort of seven out of 13 cadavers, and contributed to a mean stenosis of 15.2% (range 5.0-34.8%). Plaque morphology (n = 7) showed haemorrhage (29%), superficial thrombosis (57%), calcification (71%), areas of focal necrosis ...
Carotid endarterectomy reduced death and strokes in patients with ipsilateral high-grade stenosis and recent hemispheric transient ischemic attacks or nondisabling strokes. The ECST and the NASCET are landmark studies. Many clinicians believed that persons with cerebral ischemic symptoms associated with high-grade carotid stenosis benefited from carotid endarterectomy. However, considerable doubt arose about a net benefit to society, given the high risk of surgery reported from some communities and the reported high frequency of inappropriate indications for carotid endarterectomy. These studies do not completely allay the doubt. In both studies the surgeons were carefully chosen and demonstrated lower perioperative morbidity and mortality than shown in community surveys. The major surprise in these studies is the high risk for stroke in the patients who did not have surgery; 22% in 3 years in ECST and 28% in 2 years in NASCET. The apparently higher risk in NASCET may be at least partly an ...
TY - JOUR. T1 - Letter to the Editor re. T2 - carotid stenting through the right brachial approach for left internal carotid artery stenosis and bovine aortic arch configuration. AU - Berko, Netanel S.. AU - Haramati, Linda B.. PY - 2010/1/1. Y1 - 2010/1/1. UR - http://www.scopus.com/inward/record.url?scp=77952094584&partnerID=8YFLogxK. UR - http://www.scopus.com/inward/citedby.url?scp=77952094584&partnerID=8YFLogxK. U2 - 10.1007/s00330-009-1609-x. DO - 10.1007/s00330-009-1609-x. M3 - Letter. C2 - 19816691. AN - SCOPUS:77952094584. VL - 20. SP - 816. EP - 817. JO - European Radiology. JF - European Radiology. SN - 0938-7994. IS - 4. ER - ...
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TY - JOUR. T1 - Correlation of continuous-wave Doppler spectral flow analysis with gross pathology in carotid stenosis. AU - Call, G. K.. AU - Abbott, W. M.. AU - Macdonald, N. R.. AU - Megerman, J.. AU - Davis, K. R.. AU - Heros, Roberto. AU - Kistler, J. P.. PY - 1988/1/1. Y1 - 1988/1/1. N2 - Preoperative continuous-wave Doppler spectral analysis was used to generate two parameters, peak frequency in the internal carotid artery (f(max)) and the ratio of peak frequencies in the internal and common carotid arteries (carotid index). These were compared with direct measurement of residual lumen diameter in pathologic specimens obtained from carotid endarterectomy in 37 patients. Doppler shift frequency parameters were well correlated with residual lumen diameter when the latter was at least 1 mm. Residual lumens of ≤2 mm were found to have an f(max) of ,7.5 kHz and a carotid index of ,3.8. If f(max) was ,14 kHz or the carotid index was ,7, the residual lumen diameter was nearly always ≤1 mm. ...
Carotid artery disease is a major cause of stroke. Carotid endarterectomy when performed with a low complication rate in patients with severe lesions has been shown to reduce the subsequent risk of stroke in a series of randomised controlled trials in both symptomatic and asymptomatic populations. The CAVATAS trial demonstrated that simple balloon angioplasty of carotid stenoses was as good as endarterectomy in terms of stroke prevention and was associated with a lower complication rate. Carotid stenting performed with the use of distal protection devices has been shown to be superior to endarterectomy in patients considered to be at increased perioperative risk as assessed by a variety of clinical and angiographic parameters. Comparisons of carotid stenting and endarterectomy in patients considered to be of normal perioperative risk are ongoing. Optimal medical therapy is mandatory for all patients with carotid artery disease. ...
EVIDENCE ACQUISITION: The studies included in the analysis were: Endarterectomy Versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis (EVA3S), Stent-Supported Percutaneous Angioplasty of the Carotid Artery versus Endarterectomy (SPACE), International Carotid Stenting Study (ICSS) and Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST). The trials characteristics and bias were considered. The outcomes analyzed were the death stroke and myocardial infarction (MI) at 30-day. The meta-analysis was performed by random effect model, results reported by odds ratio (OR) and confidence intervals (CI) according the preoperative symptomatic status ...
EVIDENCE BASED MEDICINE (MIMS April 2003) Stroke prevention Comparative effectiveness of various interventions. PRIOR TO STROKE OR TRANSIENT ISCHAEMIC ACCIDENT (TIA) Beneficial. 1. Antiplatelet treatment. 2. Cholestrerol reduction (for those patients who also have coronary heart disease). 3. Carotid endarterectomy (in patients with severe symptomatic carotid artery stenosis). Unknown effectiveness. 1. Cholesterol reduction (for patients without CHD). 2. Blood pressure reduction. 3. Carotid endarterectomy (in patients with severe symptomatic carotid artery stenosis). 4. Catotid angioplasty Likely to ineffective or even harmful. Oral anticoagulation ATRIAL FIBRILLATION AND A PRIOR STROKE OR TIA Beneficial 1. Oral anticoagulation. 2. Aspirin for patients with contraindications to an anticoagulant. ATRIAL FIBRILLATION BUT NO OTHER MAJOR RISK FACTORS FOR STROKE Likely to be beneficial.. KEY POINTS. In patients with a prior stroke or TIA. 1. Insufficient evidence to support routine blood presure ...
Carotid endarterectomy (CEA) is the most frequently performed noncardiac vascular procedure. CEA is preventative surgery aimed at reducing the rate of stroke in patients at high risk of such an event. Performing a CEA itself has considerable risk. The inherent risk of carotid surgery is perioperative stroke occurring at rates from 5 % to 7.5 % [1]. The causes of perioperative stroke are hypoperfusion, hyperperfusion or embolization during cross-clamping of the internal carotid artery. The co-morbidity associated with carotid disease is considerable. Many of these patients have existed ischaemic heart disease, chronic obstructive pulmonary disease or diabetes. In addition, they may be smokers and elderly. A significant number of patients undergoing coronary artery surgery have severe carotid artery disease. It is also true that up to half of the patients undergoing CEA have severe treatable coronary lesions. Stroke is the most serious postoperative risk. Other major complications that can occur ...
The carotid stenosis was one of the higher risk of the ischemia stroke in China.In the mean time ,more and more people accept revascularization because of carotid stenosis.NASCAT indicated that CEA is the golden standard of the therapy of the carotid stenosis.But in china , case the opposite,only little patient receive CEA,on the other hand , most patients received angioplasty.. Expected no less than 2100 cases within 2 years for the whole study. We choose 39 hospitals whose experienced in CAS or/and CEA spread all over the country as multiple centers for this clinic registration study. All cases inclusion must be continuously registration.. The subject choice:All registered patients must be signed informed consent to register for non intrusive research this study ,the researchers during the study period should be continuous registration in patients undergoing surgical treatment of carotid stenosis, to ensure that the selected participants reflect the target patient population.. Medical Center ...
As for the current trials assessing the surgery vs. stenting debate, the panel hoped the Carotid Revascularization Endarterectomy versus Stent Trial (CREST) and the Carotid Angioplasty and Stenting vs. Endarterectomy in Asymptomatic Patients with Significant Extracranial Carotid Occlusive Disease Trial (ACT I) would provide some much needed answers. CREST is a NIH/NINDS sponsored trial contrasting the relative efficacy of carotid endarterectomy and carotid stenting in preventing primary outcomes of stroke, myocardial infarction, or death during a 30-day periprocedural period, or ipsilateral stroke over the follow-up period extending up to four years. Stroke events will be verified by an Adjudication Committee masked to the assigned treatment. The primary eligibility criterion is a significant (>50%) stenosis of the carotid artery in patients with transient ischemic attack or ipsilateral non-disabling stroke within the prior 180 days.. The trial is aiming to 2,500 patients (1,100 asymptomatic, ...
The results of this study suggest that carotid stenting is as effective as carotid endarterectomy for middle-term prevention of ipsilateral stroke, but the safety of carotid stenting needs to be improved before it can be used as an alternative to carotid endarterectomy in patients with symptomatic c …
Introduction: In appropriately selected patients with severe carotid stenosis, carotid revascularization reduces risk of ischemic stroke. Prior clinical research has focused on the efficacy and safety of carotid revascularization, but few investigators have considered readmission as a clinically important outcome. We examined frequency and timing of 30-day readmission following carotid revascularization and assessed differences in 30-day readmission rates between patients undergoing carotid endarterectomy (CEA) and carotid artery stenting (CAS). We also examined whether hospital variation in procedural choice (CEA vs CAS) was associated with differences in hospitals risk standardized readmission rates (RSRR).. Methods: Medicare administrative claims data were used to identify acute care hospitalizations of CEA and CAS from 2009 to 2011. The outcome of interest was time to first hospital readmission within 30-days of carotid revascularization. Hospitals performing more than 25 carotid ...
Strokes arising from carotid stenosis are most often due to atheroembolisms.4-6 During carotid endarterectomy the plaque is completely removed; however, with carotid stenting, the plaque remains contained between the stent and the vessel wall. Stroke occurring after CAS is probably caused by the release of fractured plaque deposits through the struts of the stent. In the Carotid Revascularization Endarterectomy versus Stenting Trial,7 the periprocedural stroke rate was significantly higher in the stenting group than in the endarterectomy group (4.1% vs 2.3%, p=0.01).. Transcranial Doppler studies have demonstrated the generation of emboli with each passage across a stenosis with a guidewire, EPD, balloon or stent,8 ,9 with the highest potential for embolization occurring during post-dilatation when the balloon crushes friable plaque against the metal stent struts.8 ,9 Although the clinical significance of microemboli is unclear, Ackerstaff et al10 demonstrated in a study of 550 patients that ...
TY - JOUR. T1 - Advantages of Staged Angioplasty in a Patient with Internal Carotid Artery Pseudo-Occlusion Besides Prevention of Cerebral Hyperperfusion Syndrome. AU - Takahashi, Satoshi. AU - Akiyama, Takenori. AU - Nakahara, Jin. AU - Yoshizaki, Takahito. AU - Suzuki, Norihiro. AU - Yoshida, Kazunari. PY - 2018/1/1. Y1 - 2018/1/1. N2 - Background Staged angioplasty for carotid artery stenosis has been reported to be effective in preventing postoperative cerebral hyperperfusion syndrome (CHS) in patients with severe carotid stenosis; thus, it is also recommended for patients with internal carotid artery (ICA) pseudo-occlusion, the treatment strategy for which is controversial. Case Description This study reports the case of an Asian man in his 50s who had motor aphasia and right-side weakness caused by pseudo-occlusion of the left ICA. After medical treatment, he underwent a staged angioplasty. After the first stage of percutaneous transluminal angioplasty, anterograde blood flow to the left ...
TY - JOUR. T1 - Outcomes after carotid artery stenting and endarterectomy in the medicare population. AU - Wang, Fen Wei. AU - Esterbrooks, Dennis J.. AU - Kuo, Yong Fang. AU - Mooss, Aryan N.. AU - Mohiuddin, Syed M.. AU - Uretsky, Barry F.. PY - 2011/7. Y1 - 2011/7. N2 - Background and Purpose- Carotid artery stenting (CAS) is an alternative to carotid endarterectomy (CEA) for stroke prevention. The value of this therapy relative to CEA remains uncertain. Methods- In 10 958 Medicare patients aged 66 years or older between 2004 and 2006, we analyzed in-hospital, 1-year stroke, myocardial infarction, and death rate outcomes and the effects of potential confounding variables. Results- CAS patients (87% were asymptomatic) had a higher baseline risk profile, including having a higher percentage of coronary and peripheral arterial disease, heart failure, and renal failure. In-hospital stroke rate (1.9% CAS versus 1.4% CEA; P=0.14) and mortality (CAS 0.9% versus 0.6% CEA; P=0.20) were similar. By 1 ...
The duplex scan is the main tool used to diagnose carotid artery stenosis, and there is agreement that it might be the single preoperative diagnostic test. All limitations of carotid duplex scanning should be taken into consideration during qualification to surgical or endovascular treatment. Awareness of these limitations is especially important when neurological symptoms are typical and duplex examination is negative. The authors describe the pitfalls of the duplex scan examination in a symptomatic patient with bilateral severe distal internal carotid artery stenosis ...
TY - JOUR. T1 - Does carotid stenting measure up to endarterectomy? A vascular surgeons experience. AU - Eskandari, Mark K.. AU - Longo, G. Matthew. AU - Vijungco, Joseph D.. AU - Morasch, Mark D.. AU - Pearce, William H.. PY - 2004/7/1. Y1 - 2004/7/1. N2 - Hypothesis: Carotid angioplasty and stenting seems to have equal or better outcomes in high-risk patients than carotid endarterectomy. Design: Single-center case-control study. Setting: University hospital tertiary referral center. Patients: Individuals (n=53) undergoing elective carotid angioplasty and stenting for cervical carotid stenosis (n= 57) between April 2001 and October 2003. All patients were referred to and treated by the primary author (M.K.E.). Results: Mean±SD age was 68.8±1.2 years (64% men [34] and 36% women [19]), and overall mean±SD rate of stenosis was 79%±10%. Preprocedural neurologic symptoms were present in 42% of the group. Indications for treatment included prior neck surgery with irradiation (4), recurrent ...
INTRODUCTION. Carotid artery stenosis leads to stroke and long-lasting disabilities. Atherosclerosis, which settles inside the bifurcation of common carotid artery, is one of the major causes of recurrent ischemic stroke[1]. Current medical approaches aim to slow down the progression of the disease and prevent stroke[2]. Since the first successful carotid endarterectomy (CEA) performed in the 1950s, surgical treatment has become the gold standard in the treatment of carotid stenosis[3]. Its superiority over medical therapy in cases with symptomatic and serious carotid stenosis has definitively been revealed in many studies[4-6]. CEA is a widely performed procedure in many medical centers, with low complication rates. Within the first 30 postoperative days, local neurological damage, hematoma and bleeding, cardiovascular complications, permanent or transient stroke, and death are the most frequently encountered complications[7]. CEA techniques differ among surgeons; however, no difference ...
Background and Purpose Early carotid surgery or stenting after thrombolytic treatment for stroke has become more common during recent years. It is unclear whether this carries an increased risk of postoperative complications and death. The aim of this nationwide population-based study was, therefore, to investigate the safety of urgently performed carotid procedures in patients treated with thrombolysis for stroke. Methods Using the national Vascular and Stroke registries, we identified 3998 patients who had undergone carotid endarterectomy or carotid artery stenting for symptomatic carotid stenosis between May 2008 and December 2012. Among these, 2% (79 of 3998) had undergone previous thrombolysis for stroke. We conducted a retrospective review of registry data and individual case records with regard to postoperative complications, including surgical-site bleeding, stroke, and death. The outcome was compared with the results for the remaining patient cohort (3919 of 3998) undergoing carotid ...
Results We received 668 responses from 71 countries. The majority favored CT angiography (70.2%) to evaluate carotid stenosis, CEA (69.1%) over CAS, an aspirin-containing regimen (88.5%), and a clopidogrel-containing regimen (64.4%) if already on aspirin. Whereas diverse antithrombotic regimens were chosen, monotherapy was favored by 54.4%-70.6% of respondents across 3 scenarios. The preferred dual therapy was low-dose aspirin (75-100 mg) plus clopidogrel (22.2%) or high-dose aspirin (160-325 mg) plus clopidogrel if already on aspirin (12.2%). Respondents favoring CAS more often chose ≥2 agents (adjusted odds ratio [aOR] vs CEA: 2.00, 95% confidence interval 1.36-2.95, p = 0.001) or clopidogrel-containing regimens (aOR: 1.77, 1.16-2.70, p = 0.008). Regional differences included respondents from Europe less commonly choosing multiple agents if already on aspirin (aOR vs United States/Canada: 0.57, 0.35-0.93, p = 0.023), those from Asia more often favoring multiple agents (aOR: 1.95, 1.11-3.43, ...
Purpose: There is a lack of consensus regarding the significance of calcification in the atherosclerotic carotid plaque. While some studies suggest calcification is a stabilizing factor, others have associated it with intraplaque hemorrhage (IPH) - an indicator of plaque vulnerability. Since magnetic resonance imaging (MRI) has been proven to accurately identify the lipid-rich necrotic core (LRNC) and IPH of the carotid lesion, we sought to determine if carotid MRI can accurately detect and quantify calcification. We then tested the hypothesis that the location of calcification relative to the LRNC is an important determinant for the presence of IPH.. Methods: 24 subjects scheduled for carotid endarterectomy were imaged with high-resolution, multi-contrast carotid MRI (T1-weighted, proton density, T2-weighted, and 3D time of flight) at 1.5T. The LRNC, IPH and calcification were identified with previously established MRI criteria. Types of calcification were defined based on location as Type I: ...
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TY - JOUR. T1 - Prediction models for clinical outcome after a carotid revascularization procedure an external validation study. AU - behalf of the Carotid Stenosis Trialists Collaboration. AU - Volkers, Eline J.. AU - Algra, Ale. AU - Jaap Kappelle, L.. AU - Jansen, Olav. AU - Howard, George. AU - Hendrikse, Jeroen. AU - Halliday, Alison. AU - Gregson, John. AU - Fraedrich, Gustav. AU - Eckstein, Hans Henning. AU - Calvet, David. AU - Bulbulia, Richard. AU - Brown, Martin M.. AU - Becquemin, Jean Pierre. AU - Ringleb, Peter A.. AU - Mas, Jean Louis. AU - Bonati, Leo H.. AU - Brott, Thomas G.. AU - Greving, Jacoba P.. PY - 2018. Y1 - 2018. N2 - Background and Purpose: Prediction models may help physicians to stratify patients with high and low risk for periprocedural complications or long-term stroke risk after carotid artery stenting or carotid endarterectomy. We aimed to evaluate external performance of previously published prediction models for short- and long-term outcome after carotid ...
Aims: Carotid artery stenting (CAS) has become an alternative to carotid endarterectomy in the treatment of carotid artery disease. The use of an embolic protection device (EPD) can reduce the frequency of embolic events during CAS. Difficult vascula
Background: To determine if black-blood 3 T cardiovascular magnetic resonance (bb-CMR) can depict differences between symptomatic and asymptomatic carotid atherosclerotic plaques in acute ischemic stroke patients. Methods: In this prospective monocentric observational study 34 patients (24 males; 70 +/- 9.3 years) with symptomatic carotid disease defined as ischemic brain lesions in one internal carotid artery territory on diffusion weighted images underwent a carotid bb-CMR at 3 T with fat-saturated pre- and post-contrast T1w-, PDw-, T2w- and TOF images using surface coils and Parallel Imaging techniques (PAT factor = 2) within 10 days after symptom onset. All patients underwent extensive clinical workup (lab, brain MR, duplex sonography, 24-hour ECG, transesophageal echocardiography) to exclude other causes of ischemic stroke. Prevalence of American Heart Association lesion type VI (AHA-LT6), status of the fibrous cap, presence of hemorrhage/thrombus and area measurements of calcification, ...
Title:NSE, S100B and MMP9 Expression Following Reperfusion after Carotid Artery Stenting VOLUME: 16 ISSUE: 2. Author(s):Xiaofan Yuan , Jianhong Wang, Duozi Wang, Shu Yang, Nengwei Yu and Fuqiang Guo*. Affiliation:Department of Neurology, School of Clinical Medical, Southwest Medical University, Luzhou, Department of Neurology, Sichuan Academy of Medical Sciences & Sichuan Provincial Peoples Hospital, Chengdu, Department of Neurology, Sichuan Academy of Medical Sciences & Sichuan Provincial Peoples Hospital, Chengdu, Department of Neurology, Sichuan Academy of Medical Sciences & Sichuan Provincial Peoples Hospital, Chengdu, Department of Neurology, Sichuan Academy of Medical Sciences & Sichuan Provincial Peoples Hospital, Chengdu, Department of Neurology, School of Clinical Medical, Southwest Medical University, Luzhou. Keywords:NSE, S100B, MMP9, reperfusion, CT perfusion, carotid artery stenting, carotid artery stenosis.. Abstract:. Objective: Previous studies have shown that the ...
Thirty patients scheduled for carotid revascularization underwent preoperative carotid MRI with MATCH and the conventional multi-contrast protocol (T1W, T2W,TOF,CE-T1W) in the same examination with a 3T scanner(Table 1) and 8-channel carotid coil. All image sets were processed using plaque analysis software (MRI-Plaque View, VPDiagnostics). Blinded image review for anatomy and composition identification was performed by 2 radiologists (with 2 and 9-year experience in carotid plaque MR characterization). Images from each artery underwent location matching process (including image reformation in 3D TOF) to account for inconsistency in slice number and thickness between the two protocols and inter-scan motion. Quantitative area measurements of the lumen and wall of the bilateral carotid arteries were obtained from T2-w images. The normalized wall index (NWI) was calculated by dividing the wall area by the total vessel area (lumen+wall). The presence of intraplaque hemorrhage (IPH), calcification ...
Background: Carotid endanerectomy is emerging as the treatment of choice for patients with symptomatic carotid artery stenosis at low operative risk. We sought determine if racial variations in the rate of carotid angiography and endarterectomy exist in the Veteran Affairs health care system among patients who are insulated from the cost of...
The mission to develop safer percutaneous endovascular solutions to treat arterial stenosis was pioneered by Dotter10 and Gruntzig and Hopff11 in the 1960s and 1970s. In 1977, Klaus Mathias, an interventional radiologist, described a catheter system that could be used for performing balloon angioplasty of cervical carotid stenosis,12 and this was followed by a few case reports of successful carotid angioplasty performed in the surgical suite.13,14 In 1984, Vitek and his neuroradiology colleagues from the University of Alabama at Birmingham (UAB)15 reported angioplasty of the innominate artery aided by balloon occlusion protection of the common carotid artery (CCA). This early report represents the first percutaneous intervention performed with the benefit of distal embolic protection. During the 1980s, clinical reports of carotid angioplasty were sporadic and limited to small single-center series of patients.16 Kachel et al. summarized the results of carotid angioplasty published in the ...
Dear Craig, Thanks for asking. In the article: Moneta GL, Edwards JM, Papanicolaou G, Hatsukami T, Taylor LM Jr, Strandness DE Jr, Porter JM., Screening for asymptomatic internal carotid artery stenosis: duplex criteria for discriminating 60% to 99% stenosis. J Vasc Surg. 1995 Jun;21(6):989-94 Moneta and colleagues use a Doppler angle of 60 degrees (page 990 column 2 top) using the distal cervical ICA as a reference. If you look at Figure 2, page 991, note that the relationship between Angiographic percent diameter reduction and Doppler parameters such as PSV, EDV and ICA/CCA PSV Ratio is not a narrow line. There is considerable variation between patient in the relationship between Angiography and Doppler. I think that this variation is related to differences in intracranial collateral circulation. The experience of flownet writers contributing to this conversation thread includes this between patient variation. At the University of Washington Ultrasound Reading Center, we are measuring ...
The effect of carotid artery stenting (CAS) and carotid endarterectomy (CEA) on cognitive function is unclear. Both cognitive improvement and decline have been reported after CAS and CEA. We aimed to compare the changes in postprocedural cognitive function after CAS versus CEA. A systematic qualitat …
Stroke is ranked as the number one cause of death in Vietnam and the second leading cause of death in the world. Stenosis in the carotid arteries is one of the major risk factors for stroke, making it extremely important to confirm the diagnosis. Duplex ultrasound including measurements of the peak systolic velocity is considered the most accurate method when it comes to screening of carotid stenosis. However, the survey method is user dependent and differences in the results related to the scanning technique of the examiner may occur. The aim of this study was to determine the diagnostic variability for measuring peak systolic velocity in the common carotid artery in order to investigate whether the obtained results differ depending on the examiner. 30 healthy volunteers underwent carotid duplex ultrasound performed by two different examiners. Peak systolic velocity was measured with pulsed waved Doppler caudally of the carotid bifurcation. A T-test and a Bland-Altman plot were later applied in ...
The ICSS trial randomized 1710 patients across 50 centers with symptomatic carotid artery disease to stenting versus endarterectomy.
Ferri M, Faggioli GL, Ferri GG, Pirodda A (June 2004). "Is carotid stenosis correlated with tympanosclerosis". International ...
"Randomized Trial of Stent versus Surgery for Asymptomatic Carotid Stenosis". New England Journal of Medicine. 374 (11): 1011- ...
"Antioxidant effects of tocotrienols in patients with hyperlipidemia and carotid stenosis". Lipids. 30 (12): 1179-83. doi: ...
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 ...
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- ...
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 ...
The most frequent etiology of mixed transcortical aphasia is stenosis (narrowing) of the internal carotid artery. Mixed ...
2003). "Marburg I polymorphism of factor VII--activating protease: a prominent risk predictor of carotid stenosis". Circulation ...
... 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 ...
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 ...
"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 ...
Chambers BR, Donnan GA «Carotid endarterectomy for asymptomatic carotid stenosis». Cochrane Database Syst Rev, 4, 2005, pàg. ... 18,0 18,1 18,2 18,3 Ederle J, Brown MM «The evidence for medicine versus surgery for carotid stenosis». European Journal of ... Ringleb PA, Chatellier G, Hacke W, et al. «Safety of endovascular treatment of carotid artery stenosis compared with surgical ... Ederle J, Featherstone RL, Brown MM «Percutaneous transluminal angioplasty and stenting for carotid artery stenosis». Cochrane ...
Carotid artery stenosis is a narrowing of the carotid artery in the neck and which supplies blood to the brain. Peripheral ...
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 ...
Carotid artery stenosis is treated with angioplasty in a procedure called carotid stenting for patients at high-risk for ... Angioplasty is occasionally used to treat venous stenosis, such as stenosis of the subclavian vein caused by thoracic outlet ... To treat a narrowing in a blood vessel, a wire is passed through the stenosis in the vessel and a balloon on a catheter is ... After successful dilation of the stenosis with a guide wire and coaxial Teflon catheters, the circulation returned to her leg. ...
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 ...
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 & ...
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 ...
He also showed the relationship between stroke and carotid artery stenosis, which made preventive surgery possible and greatly ... Estol CJ (March 1996). "Dr C. Miller Fisher and the history of carotid artery disease". Stroke. 27 (3): 559-66. doi:10.1161/01. ... He contributed greatly to the understanding of stroke, more specifically carotid artery disease and lacunar infarcts and their ... He made a number of contributions to the understanding of cervical artery dissection (carotid artery dissection and vertebral ...
... renal artery stenosis and for carotid interventions. Due to rapid ambulation post procedure the radial interventions became ... Radial access has also been used successfully to treat peripheral artery disease including bilateral iliac artery stenosis, ... contralateral transradial approach for carotid artery stenting: A feasibility study. Tejas Patel, Sanjay Shat et al. ...
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 ...
Another finding displayed the prevalence of PAD, carotid artery stenosis (CAS) and AAA was higher not only with overall ... Common diseases that may be detected by such screenings include Carotid artery stenosis, osteoporosis, abdominal aortic ...
Stroke (mainly the ischemic type) Carotid artery stenosis does not occur more often in diabetes, and there appears to be a ...
"Survival from accidental strangulation from a scarf resulting in laryngeal rupture and carotid artery stenosis: the "Isadora ...
Renal artery stenosis can cause renovascular hypertension. Carotid artery disease can cause strokes and transient ischemic ... Any flow limiting stenoses found in the x-ray can be identified and treated by atherectomy, angioplasty or stenting. Contrast ... Those with known atherosclerotic coronary, carotid, or renal artery disease. All people with a Framingham risk score 10%-20% ...
"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 ...
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) ...
... or occlusion or stenosis of the External carotid artery. The term is derived by analogy from claudication of the leg, where ...
... 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 ...
Peripheral vascular disease; femoral artery stenosis Renal artery stenosis Stroke, carotid artery stenosis Aortic aneurysm ... Carotid bruit "bruit" at Dorland's Medical Dictionary "vascular murmur" at Dorland's Medical Dictionary American Heart ... celiac artery stenosis - external compression Arteriovenous (AV) fistula - pathologic or surgically created Graves' disease, ...
... which is associated with lumbar spinal stenosis. It is strongly associated with smoking, hypertension, and diabetes.[2] ... Stenosis. *Carotid artery stenosis. *Renal artery stenosis. Other. *Aortoiliac occlusive disease. *Degos disease ...
The left and right internal carotid arteries arise from the left and right common carotid arteries. ... Subclavian steal syndrome results from a proximal stenosis (narrowing) of the subclavian artery, an artery supplied by the ... The posterior communicating artery is given off as a branch of the internal carotid artery just before it divides into its ... In another variation the anterior communicating artery is a large vessel, such that a single internal carotid supplies both ...
Bilateral renal artery stenosis should always be considered as a differential diagnosis for the presentation of HN. Kidney ... This leads to a build-up of plaques and they can be deposited in the renal arteries causing stenosis and ischemic kidney ... Stenosis. *Carotid artery stenosis. *Renal artery stenosis. Other. *Aortoiliac occlusive disease. *Degos disease ...
The word tachycardia came to English from New Latin as a neoclassical compound built from the combining forms tachy- + -cardia, which are from the Greek ταχύς tachys, "quick, rapid" and καρδία, kardia, "heart". As a matter both of usage choices in the medical literature and of idiom in natural language, the words tachycardia and tachyarrhythmia are usually used interchangeably, or loosely enough that precise differentiation is not explicit. Some careful writers have tried to maintain a logical differentiation between them, which is reflected in major medical dictionaries[7][8][9] and major general dictionaries.[10][11][12] The distinction is that tachycardia be reserved for the rapid heart rate itself, regardless of cause, physiologic or pathologic (that is, from healthy response to exercise or from cardiac arrhythmia), and that tachyarrhythmia be reserved for the pathologic form (that is, an arrhythmia of the rapid rate type). This is why five of the previously referenced ...
Stenosis merupakan efek vasodilasi endotelium yang umumnya disebabkan oleh turunnya sekresi NO oleh sel endotelial, dapat ... Beberapa ahli lain mempertimbangan klasifikasi berdasarkan fenotipe seperti keberadaan internal carotid artery plaque, intima- ... Dalam pronosis LVD, leukoaraiosis memiliki kecenderungan ke arah grup stenosis intrakranial dengan 40,3% untuk grup ... Intra-cranial stenting yang diterapkan pada gejala penyumbatan intracranial arterial stenosis, boleh dikatakan sukses ...
Stenosis. *Carotid artery stenosis. *Renal artery stenosis. Other. *Aortoiliac occlusive disease. *Degos disease ...
In humans, hypoxia is detected by the peripheral chemoreceptors in the carotid body and aortic body, with the carotid body ... Therefore, in patients with chronic mitral stenosis, pulmonary capillary pressures of 40 to 45 mm Hg have been measured without ...
This is known as renovascular hypertension; it is thought that decreased perfusion of renal tissue due to stenosis of a main or ... Voiculescu A, Rump LC (January 2009). "[Hypertension in patients with renal artery stenosis]". Der Internist (in German). 50 (1 ... Kidney disease / renal artery stenosis - the normal physiological response to low blood pressure in the renal arteries is to ... Kendrick J, Chonchol M (October 2008). "Renal artery stenosis and chronic ischemic nephropathy: epidemiology and diagnosis". ...
Left common carotid artery. Left subclavian artery. Descending aorta, thoracic part: Left bronchial arteries. esophageal ... Aortic stenosis. *Aortitis, inflammation of the aorta that can be seen in trauma, infections, and autoimmune disease ... For example, the left vertebral artery may arise from the aorta, instead of the left common carotid artery.[9]:188 ... The aortic arch has three major branches: from proximal to distal, they are the brachiocephalic trunk, the left common carotid ...
The other type, carotid artery dissection, involves the carotid arteries. Vertebral artery dissection is further classified as ... It is therefore possible for the symptoms to occur on both sides, or for symptoms of carotid artery dissection to occur at the ... Prior to this, there had been isolated case reports about carotid dissection. In 1971, C. Miller Fisher, a Canadian neurologist ... While dissection of the carotid and vertebral arteries accounts for only 2% of strokes (which are usually caused by high blood ...
They are used to diagnose and monitor esophageal reflux, dysphagia, hiatus hernia, strictures, diverticula, pyloric stenosis, ... and stenosis in Barium X-rays.[26] Anisakiasis is demonstrated by Barium X-rays as bowel wall oedema, thickening, ulceration, ... Carotid ultrasonography. *Contrast-enhanced. *3D ultrasound. *Endoscopic ultrasound. *Emergency ultrasound *FAST. *Pre-hospital ...
Stenosis. *Carotid artery stenosis. *Renal artery stenosis. Other. *Aortoiliac occlusive disease. *Degos disease ...
precerebral: Carotid artery stenosis. *cerebral: MCA. *ACA. *Amaurosis fugax. *Moyamoya disease. POCI. *precerebral: Anterior ...
To the front left lie the large blood vessels the aortic arch and its branches the left common carotid artery and the ... These O rings are smaller than the normal C-shaped rings and can cause narrowing (stenosis) of the trachea, resulting in ... Xue, B; Liang, B; Wang, S; Zhu, L; Lu, Z; Xu, Z (January 2015). "One-stage surgical correction of congenital tracheal stenosis ... tracheal stenosis).[10] Obstruction invariably causes a harsh breathing sound known as stridor.[10] A camera inserted via the ...
Q42.0) Congenital absence, atresia and stenosis of rectum with fistula. *(Q42.2) Congenital absence, atresia and stenosis of ... H05.81) Carotid cavernous fistula. *(H70.1) Mastoid fistula *Craniosinus fistula: between the intracranial space and a ...
The most important arterial baroreceptors are located in the left and right carotid sinuses and in the aortic arch.[70] ... The presence of an arterial stenosis increases resistance to flow, however this increase in resistance rarely increases ...
"Aortic Stenosis: Overview - eMedicine Emergency Medicine". Retrieved 2009-02-28.. *^ Redington AN, Gray HH, Hodson ME, Rigby ML ... "Prediction of left ventricular pressure in infants with aortic stenosis". British Heart Journal. 44 (4): 406-10. doi:10.1136/ ... elevated pressure difference between the aortic pressure and the left ventricular pressure may be indicative of aortic stenosis ...
... where ultrasound is used for assessing blood flow and stenoses in the carotid arteries (Carotid Ultrasonography) and ... Echocardiography is an essential tool in cardiology, assisting in evaluation of heart valve function, such as stenosis or ... stenosis, vasospasm from a subarachnoid hemorrhage (bleeding from a ruptured aneurysm), and other problems. ...
... grafts are also used to treat stenoses in vascular grafts and fistulas used for hemodialysis. ... Common sites treated with peripheral artery stents include the carotid, iliac, and femoral arteries. Because of the external ...
Aortic stenosis, hypertrophic cardiomyopathy, left bundle branch block (LBBB), and a ventricular pacemaker could all cause a ... Wide splitting: seen in conditions that delay RV emptying (pulmonic stenosis, RBBB). Delay in RV emptying causes delayed ... It is seen in conditions that delay left ventricular emptying (e.g., aortic stenosis, left bundle branch block). ...
The cavernous sinus also contains the carotid artery, which supplies blood to the brain; occasionally, compression of the ... Stenosis. *Carotid artery stenosis. *Renal artery stenosis. Other. *Aortoiliac occlusive disease. *Degos disease ...
Stenosis. *Carotid artery stenosis. *Renal artery stenosis. Other. *Aortoiliac occlusive disease. *Degos disease ...
This separates the carotid artery from the vertebral artery and the carotid artery can be massaged against this tubercle to ... Cervical degenerative changes arise from conditions such as spondylosis, stenosis of intervertebral discs, and the formation of ... The carotid tubercle is also used as a landmark for anaesthesia of the brachial plexus and cervical plexus. ... The anterior tubercle of the sixth cervical vertebra is known as the carotid tubercle or Chassaignac tubercle. ...
Carotid artery stenosis. *Renal artery stenosis. Other. *Aortoiliac occlusive disease. *Degos disease ...
... by the aortic and carotid bodies, as well as by the blood gas and pH sensor on the anterior surface of the medulla oblongata in ... Laryngotracheal stenosis. Lower RT/lung disease. (including LRTIs). Bronchial/. obstructive. acute. Acute bronchitis. chronic. ... The aortic and carotid bodies, are the peripheral blood gas chemoreceptors which are particularly sensitive to the arterial ...
Stenosis of the carotid arteries can presage cerebral infarcts (strokes). DVT in the legs can be found via ultrasound before it ... Interventional radiologists diagnose and treat several disorders including peripheral vascular disease, renal artery stenosis, ... rapid administration of IV contrast during the CT scan these fine detail images can be reconstructed into 3D images of carotid ...
The former affects vessels such as the internal carotids, vertebral and the circle of Willis. The latter can affect smaller ... Stenosis. *Carotid artery stenosis. *Renal artery stenosis. Other. *Aortoiliac occlusive disease. *Degos disease ...
I65.2) Occlusion and stenosis of carotid artery. *(I65.3) Occlusion and stenosis of multiple and bilateral precerebral arteries ... I65) Occlusion and stenosis of precerebral arteries, not resulting in cerebral infarction *(I65.0) Occlusion and stenosis of ... I66) Occlusion and stenosis of cerebral arteries, not resulting in cerebral infarction *(I66.0) Occlusion and stenosis of ... I66.4) Occlusion and stenosis of multiple and bilateral cerebral arteries. *(I66.5) Occlusion and stenosis of other cerebral ...
... 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). ...
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 ...
Which patients having asymptomatic carotid artery stenosis might benefit from screening? Response (letter). Greving, J. P., ...
Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial - Hemodynamics (CREST-H). * Print ... Phase 3 clinical trials for patients with asymptomatic high-grade carotid artery stenosis which will compare carotid ... If cognitive decline can be reversed in these patients, then we will have established a new indication for carotid ... impairment attributable to cerebral hemodynamic impairment in patients with high-grade asymptomatic carotid artery stenosis is ...
CEA is indicated for symptomatic severe carotid stenosis, whereas CAS is indicated for symptomatic severe stenosis with special ... Experts Continue to Grapple With Stenting or Endarterectomy for Carotid Stenosis By Todd Neale ... She concluded that CEA is superior to CAS for symptomatic carotid stenosis, while pointing out that the evidence of a benefit ... Intensive medical therapy is needed for all patients with carotid stenosis and is the best treatment for 90% of patients with ...
Treatment Carotid stenosis. Symptoms and causes Carotid stenosis Prophylaxis Carotid stenosis ... Carotid stenosis , carotid artery disease. Carotid artery disease, carotid stenosis info, Carotid stenosis is a narrowing of ... Carotid Stenosis Surgery - Surgery for Carotid Stenosis. Carotid stenosis is a dangerous narrowing of the largest blood vessels ... For More Information «Carotid stenosis». *. Carotid Artery Stenosis Imaging. Stroke (brain attack) represents one of the most ...
Keywords: Cerebral hypoperfusion, Carotid artery stenosis, Carotid atherosclerosis, Cognitive impairment, Microembolization, ... Keywords:Cerebral hypoperfusion, Carotid artery stenosis, Carotid atherosclerosis, Cognitive impairment, Microembolization, ... Cerebral Hypoperfusion During Carotid Artery Stenosis can Lead to Cognitive Deficits that may be Independent of White Matter ... Grade of maximum carotid artery stenosis was categorized into three groups (mild, moderate, or severe). White matter lesion ...
Patients were grouped into quartiles based on the degree of carotid stenosis. The association among carotid stenosis, vascular ... When patients with significant carotid stenosis were compared to those without significant carotid stenosis, pv-WMH was ... The quartile with the greatest carotid stenosis had a mean internal/common carotid artery peak systolic velocity ratio of 2.36 ... Carotid stenosis is an important risk factor for WMH. Volumes of pv-WMH significantly increase with higher grades of carotid ...
Currently, it is unclear whether carotid angioplasty and stenting is as safe as CEA in patients with carotid artery stenosis ... Currently, it is unclear whether carotid angioplasty and stenting is as safe as CEA in patients with carotid artery stenosis ... Currently, it is unclear whether carotid angioplasty and stenting is as safe as CEA in patients with carotid artery stenosis ... Currently, it is unclear whether carotid angioplasty and stenting is as safe as CEA in patients with carotid artery stenosis ...
The internal carotid artery supplies the brain. Plaque often builds up at that division, and causes a narrowing (stenosis). ... Plaque can also build up at the origin of the carotid artery at the aorta.] ... of the carotid artery, usually caused by atherosclerosis. ... Carotid stenosis is a narrowing or constriction of the inner ... Carotid stenosis is a narrowing or constriction of the inner surface (lumen) of the carotid artery, usually caused by ...
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 ...
arotid artery stenosis refers to a narrowing of the carotid arteries, the major arteries in the neck that supply the brain with ... Carotid artery stenosis refers to a narrowing of the carotid arteries, the major arteries in the neck that supply the brain ... Carotid Artery Stenosis Diagnosis. News-Medical. 29 May 2020. ,https://www.news-medical.net/health/Carotid-Artery-Stenosis- ... Carotid Artery Stenosis Diagnosis. News-Medical. https://www.news-medical.net/health/Carotid-Artery-Stenosis-Diagnosis.aspx. ( ...
In carotid artery disease, a waxy substance (plaque) clogs the arteries that bring blood to your brain and head. Find out how ... Carotid artery disease (Medical Encyclopedia) Also in Spanish * Carotid artery stenosis -- self-care (Medical Encyclopedia) ... ClinicalTrials.gov: Carotid Artery Diseases (National Institutes of Health) * ClinicalTrials.gov: Carotid Stenosis (National ... Carotid Artery Disease (Texas Heart Institute) Also in Spanish * What Is Carotid Artery Disease? (National Heart, Lung, and ...
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 ...
A red eye from carotid stenosis. BMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i364 (Published 29 January 2016) Cite this as: ...
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 ...
The carotid arteries provide the main blood supply to the brain. They are located on each side of your neck. You can feel their ... Carotid artery stenosis occurs when the carotid arteries become narrowed or blocked. This can lead to stroke. ... Management of recurrent carotid stenosis. In: Cameron AM, Cameron JL, eds. Current Surgical Therapy. 13th ed. Philadelphia, PA ... The carotid arteries provide the main blood supply to the brain. They are located on each side of your neck. You can feel their ...
Learn about this procedure and about carotid stenosis with this neurosurgeon-edited guide. ... What is carotid endarterectomy, and how can it help prevent stroke? ... Severe blockage is called carotid stenosis. Carotid stenosis may cause the patient to experience a TIA. Common temporary ... Carotid stenosis is frequently asymptomatic. A doctor may detect it through an abnormal sound called a bruit (BROOe) when ...
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 ...
... 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 ...
... 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; ...
encoded search term (Carotid Artery Stenosis Imaging) and Carotid Artery Stenosis Imaging What to Read Next on Medscape. ... CEMRA detected stenosis in 24 (52%) of 46 carotid arteries, while TOF detected stenosis in 27 (59%) of 46 carotid arteries. ... both the carotid stenosis (arrows) and the carotid ulcerations (arrowheads) are demonstrated. ICA = internal carotid artery. ... for carotid artery stenosis evaluation at 3T. Twenty-three patients with internal carotid artery stenosis detected with ...
Carotid artery stenosis is a condition in which the carotid arteries become abnormally narrow, making it hard for the brain to ... the patient will likely undergo a Doppler ultrasound of the carotid artery to confirm stenosis. When carotid artery stenosis is ... The carotid arteries, located in the neck, are the major source of oxygen-rich blood flow to the brain. Carotid artery stenosis ... When carotid artery stenosis is greater than 50%, several strategies may be employed to treat it. Carotid endarterectomy is a ...
Carotid artery stenosis occurs when the carotid arteries narrow. The carotid arteries are major arteries found on each side of ... Carotid artery stenosis occurs when the carotid arteries narrow. The carotid arteries are major arteries found on each side of ... Carotid artery stenosis is caused by the build-up of plaque along the lining of the arteries. This build-up is known as ... Carotid artery stenosis is caused by the build-up of plaque along the lining of the arteries. This build-up is known as ...
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 ...
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 ...
... as a viable therapy to treat carotid disease and stroke prevention is growing. One of the limitations of carotid stenting is ... Gore Medical Products Related to Carotid Artery Stenosis. GORE® ACUSEAL Cardiovascular Patch. The GORE® ACUSEAL Cardiovascular ... Carotid artery stenting (CAS) as a viable therapy to treat carotid disease and stroke prevention is growing. One of the ... The GORE® Embolic Filter features a unique diamond frame that expands the safety of neuro protection during carotid ...
What are the risk numbers for a stroke with a 50% and 69% carotid blockage, if one follows a protocol of aspirin, statins ( ...
... 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. ...
Investigate the current situation of carotid stenosis therapy in China. Establish the data bank of carotid stenosis ... CAS:the patient who accepted carotid angioplasty due to catotid artery stenosis CEA:the patient who accepted carotid ... Carotid Stenosis. Carotid Artery Diseases. Constriction, Pathologic. Pathological Conditions, Anatomical. Cerebrovascular ... The carotid stenosis was one of the higher risk of the ischemia stroke in China.In the mean time ,more and more people accept ...
... issued a draft recommendation statement and draft evidence review on screening asymptomatic adults for carotid artery stenosis ... Dont Screen for Carotid Artery Stenosis, Says Task Force USPSTF Draft Recommendation. Dont Screen for Carotid Artery Stenosis ... The task force wants to help prevent people from having a stroke, but screening for carotid artery stenosis in those without ... 17, 2020, 08:00 am News Staff - Asymptomatic carotid artery stenosis is one of several factors for increased stroke risk. ...
To evaluate the feasibility and safety of elective carotid stent implantation in patients with carotid stenoses and concomitant ... Elective stenting of carotid artery stenosis in patients with severe coronary artery disease.. Waigand J1, Gross CM, Uhlich F, ... In three patients the opposite carotid artery was occluded; nine patients had bilateral stenoses of which two received stents ... We treated 50 patients with ,70%, stenoses in 53 carotid arteries with balloon angioplasty followed by elective stent ...
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 ...
... stenosis of the left internal carotid artery. This carotid stenosis was asymptomatic because the patient did not have any ... Proportion of carotid revascularization (mainly using surgery) performed in patients with asymptomatic carotid stenosis in ... Echo-Doppler showed an atherosclerotic stenosis at the site of the left carotid bifurcation. On grayscale, this stenosis was ... Most patients in early trials of carotid surgery for asymptomatic carotid stenosis did not receive medical treatment that is ...
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 ...
... and recurrent stenosis. The results of a nonrandomized study with... ... We examined the operative risks and long-term results of carotid endarterectomy for asymptomatic patients in terms of stroke, ... Efficacy of carotid endarterectomy for asymptomatic carotid stenosis. N Engl J Med 1993;328:221-227.CrossRefPubMedGoogle ... Asymptomatic contralateral carotid artery stenosis: A five-year follow-up study following carotid endarterectomy. Surgery 1980; ...
... reliable methods to determine who is at increased risk of carotid artery stenosis or of stroke when carotid artery stenosis is ... reliable tools that can determine who is at increased risk of carotid artery stenosis or of stroke when carotid artery stenosis ... Reported sensitivity of carotid auscultation for detecting carotid artery stenosis ranges from 46% to 77%, and specificity ... Screening for asymptomatic carotid artery stenosis: a systematic review and meta-analysis for the U.S. Preventive Services Task ...
  • If cognitive decline can be reversed in these patients, then we will have established a new indication for carotid revascularization independent of the risk of recurrent stroke. (mayo.edu)
  • The planned CREST-2 (Carotid Revascularization Endarterectomy versus Stenting-2) study is expected to provide important data for future recommendations regarding screening and CAS treatment decisions. (avalere.com)
  • Background The revascularization of carotid stenosis can increase ipsilateral cerebral blood flow (CBF). (fujita-hu.ac.jp)
  • Conclusion Revascularization by CAS for unilateral carotid stenosis can increase hemispheric CBF on both sides. (fujita-hu.ac.jp)
  • As the patient had previously undergone a carotid endarterectomy on that side, a minimally invasive Transcarotid Artery Revascularization (TCAR) was performed to reduce risks of stroke and nerve damage. (medstarheartinstitute.org)
  • Transcarotid Artery Revascularization (TCAR) is an attractive option for treating carotid artery stenosis in patients instead of carotid endarterectomy or the transfemoral approach. (medstarheartinstitute.org)
  • By combining surgical principles of neuroprotection with minimally invasive endovascular techniques," says Dr. Vallabhaneni, "Transcarotid Artery Revascularization (TCAR) offers tremendous potential for the treatment of carotid artery stenosis as an alternative to conventional carotid endarterectomy and stenting procedures. (medstarheartinstitute.org)
  • Individual patient data were pooled from the following four studies: Endarterectomy versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis trial, Stent-Protected Percutaneous Angioplasty of the Carotid Artery versus Endarterectomy trial, the International Carotid Stenting Study, and Carotid Revascularization Endarterectomy versus Stenting trial. (reliasmedia.com)
  • Methods 25 consecutive patients were assessed, of which 22 were men (88%) mean age of 74 years with severe asymptomatic carotid stenosis who underwent revascularization by carotid artery stenting (CAS) with flow reversal. (uab.cat)
  • Conclusions Revascularization by transcervical CAS with flow reversal for cerebral protection results in improved neurocognitive performance in asymptomatic elderly patients with severe carotid artery stenosis. (uab.cat)
  • In the past decade, carotid angioplasty and stenting has been proposed as a valid alternative to CEA. (elsevier.com)
  • Currently, it is unclear whether carotid angioplasty and stenting is as safe as CEA in patients with carotid artery stenosis who need invasive treatment. (elsevier.com)
  • Background While carotid angioplasty and stenting (CAS) have become an established procedure, outcomes of early CAS for symptomatic extracranial carotid stenosis (SECS) remain poorly understood. (elsevier.com)
  • We systematically compared and appraised contemporary guidelines on management of asymptomatic and symptomatic carotid artery stenosis.We systematically searched for guideline recommendations on carotid endarterectomy (CEA) or carotid angioplasty/stenting (CAS) published in any language between January 1, 2008, and January 28, 2015. (edu.au)
  • Interventions for CAS include carotid endarterectomy (CEA) and carotid angioplasty and stenting (CAAS), and can cause death, stroke and myocardial infarction. (avalere.com)
  • Residual stenosis following stent placement can usually be successfully treated with poststent balloon angioplasty. (thoracickey.com)
  • Inability to cross the carotid stenosis has multiple etiologies that include tortuous artic arch and a tortuous common carotid artery. (thoracickey.com)
  • 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). (mayo.edu)
  • Five things you should know about carotid artery stenosis, one of the leading risk factors for stroke. (mhealth.org)
  • We asked University of Minnesota Health Neurosurgeon Ramachandra Tummala, MD, to tell us five things we should know about carotid artery stenosis and its link to stroke risk. (mhealth.org)
  • 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. (mhealth.org)
  • Carotid artery stenosis can lead to a stroke. (mhealth.org)
  • Patients with carotid artery stenosis are at increased risk for a stroke, which can lead to disability or death. (mhealth.org)
  • Carotid stenosis can cause a stroke in two ways. (mhealth.org)
  • Good heart health practices can help reduce carotid artery stenosis-and therefore stroke risk. (mhealth.org)
  • The investigators used multivariable logistic regression, propensity score matching and a grouped-treatment approach (with adjustments for baseline characteristics) to compare in-hospital death and postoperative stroke after either carotid artery stenting (CAS) or carotid endarterectomy (CEA). (heart.org)
  • The stroke risk in patients with asymptomatic carotid stenosis varies in the literature but has been documented around 1-3% with higher rates cited with increasing degrees of stenosis. (heart.org)
  • Some literature has cited a stroke rate as low as 1% per year if intensive medical therapy is used among those with asymptomatic carotid stenosis. (heart.org)
  • A second conventional open carotid artery endarterectomy would have put the patient at greater risk for nerve damage and stroke, given the likely presence of scar tissue from the earlier procedure. (medstarheartinstitute.org)
  • Keywords: Catorid endarterectomy, Problems, New human SRT1720 HCl brain lesions, Risk elements Launch Carotid artery stenosis, caused by atherosclerosis usually, may cause ischemic heart stroke [1]. (tak-632.net)
  • CEA may be the regular treatment for the principal and secondary avoidance of stroke connected with carotid artery stenosis because of its basic safety and durability [3]. (tak-632.net)
  • Symptomatic individuals had been defined as those that got skilled amaurosis fugax, a transient ischemic assault (TIA), or a stroke in the territory from the ipsilateral carotid artery within six months before admittance. (tak-632.net)
  • We consecutively registered patients with significant carotid stenosis (50%-79%) measured by digital subtraction angiography (DSA) over 10 years and compared the incidences of stroke, myocardial infarction, and death between treatment groups (surgical group vs medical group). (elsevier.com)
  • The annual rates of ischemic stroke per person-year were similar in both treatment groups, but the addition of periprocedural risk favored carotid endarterectomy. (reliasmedia.com)
  • Background: The risk of stroke associated with carotid artery restenosis after stenting or endarterectomy is unclear. (edu.au)
  • We aimed to compare the long-term risk of restenosis after these treatments and to investigate if restenosis causes stroke in a secondary analysis of the International Carotid Stenting Study (ICSS). (edu.au)
  • abstract = "Objectives The relationship between carotid artery stenosis and cognitive function in individuals without a history of stroke is not clear. (uab.cat)
  • 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. (uni-muenchen.de)
  • 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. (uni-muenchen.de)
  • Discussion: CAPIAS will provide important insights into the role of non-stenosing carotid artery plaques in cryptogenic stroke. (uni-muenchen.de)
  • Periprocedural complications include inability to cross the lesion with the stent, severe residual stenosis, and postprocedure stroke. (thoracickey.com)
  • After more than a decade of clinical trials specifically comparing the two approaches, the choice of carotid artery stenting (CAS) or endarterectomy (CEA) for patients with asymptomatic or symptomatic carotid stenosis continues to be debated. (tctmd.com)
  • Treatment of carotid artery stenosis: Medical therapy, surgery, or stenting? (elsevier.com)
  • Fingerprint Dive into the research topics of 'Treatment of carotid artery stenosis: Medical therapy, surgery, or stenting? (elsevier.com)
  • We describe a successful case of carotid artery stenting in a nonagenarian with symptomatic carotid artery stenosis, a subgroup for whom treatment options are rarely discussed in guidelines. (elsevier.com)
  • Given the coming era of carotid stenting and a renewed need for arteriography before carotid intervention, knowledge of variability and correct interpretation of carotid stenosis using available technology remains paramount to warranted treatment. (elsevier.com)
  • Early Outcomes After Carotid Artery Stenting Compared With Endarterectomy for Asymptomatic Carotid Stenosis. (heart.org)
  • Materials and methods We retrospectively analyzed 40 patients with unilateral cervical carotid stenosis treated by carotid artery stenting (CAS). (fujita-hu.ac.jp)
  • Carotid stenting would be the most appropriate means of treatment. (medstarheartinstitute.org)
  • Treatment for carotid artery stenosis, carotid endarterectomy (CEA) and carotid artery stenting (CAS) have already been trusted [2]. (tak-632.net)
  • Long-term outcomes of stenting and endarterectomy for symptomatic carotid stenosis: A preplanned pooled analysis of individual patient data. (reliasmedia.com)
  • Periprocedural risk is higher in patients undergoing carotid artery stenting compared to carotid endarterectomy. (reliasmedia.com)
  • Patients aged 40 years or older with symptomatic carotid stenosis measuring 50% or more were randomly assigned either stenting or endarterectomy in a 1:1 ratio. (edu.au)
  • In this study the aim was to assess cognitive changes after transcervical carotid artery stenting with proximal cerebral protection by flow reversal in patients with asymptomatic carotid stenosis, a novel technique that has been proved to decrease the number intraoperative emboli. (uab.cat)
  • The use of carotid artery stenting to treat carotid bifurcation stenosis remains a topic of recent investigation and vigorous debate regarding safety and efficacy. (thoracickey.com)
  • Multiple prospective randomized controlled trials have compared carotid endarterectomy (CEA) with carotid artery stenting (CAS) and have shown comparable outcomes in asymptomatic patients. (thoracickey.com)
  • Asymptomatic carotid atherosclerotic stenosis is associated with impaired mobility and cognitive function that are accompanied by an increased risk of falls in older adults," Anthony and colleagues wrote in an abstract. (healio.com)
  • CONCLUSIONS: We propose that sCD36 may be a marker of plaque instability and symptomatic carotid atherosclerosis, possibly at least partly as a result of CD36 release to the circulation from the foam cells within the atherosclerotic lesion. (forskningsdatabasen.dk)
  • 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. (mayo.edu)
  • This study investigated the diagnostic value of miR-186-5p for asymptomatic carotid artery stenosis (CAS), and its predictive value for future cerebral ischemic events (CIEs). (biomedcentral.com)
  • Randomisation was computer-generated and done centrally, with allocation by telephone or fax, stratified by centre, and with minimisation for sex, age, side of stenosis, and occlusion of the contralateral carotid artery. (edu.au)
  • It replaces the previous guidance on carotid artery stent placement for carotid stenosis (NICE interventional procedures guidance 191, September 2006). (nice.org.uk)
  • A follow-up scan verified that the stent is performing as expected, with no recurrence of stenosis. (medstarheartinstitute.org)
  • In general, the open cell stents such as the PRECISE (Cordis, Hialeah, FL) and ACCULINK (Abbott Laboratories, Chicago, IL) are more flexible than the closed cell XACT stent and may cross tortuous aortic arch-carotid anatomy, which the XACT (Abbott Laboratories, Chicago, IL) may not successfully track despite the use of stiffer embolic protection delivery wires. (thoracickey.com)
  • The higher radial force of the closed cell XACT stent may be more resistant to compressive forces at the bifurcation when compared with open cell nitinol stents and may be beneficial in limiting residual stenosis. (thoracickey.com)
  • The procedure is also effective in selected patients with asymptomatic stenosis, but the benefit is marginal. (elsevier.com)
  • Quantification of carotid stenosis on CT angiography. (acrdsi.org)
  • The luminal region size by computed tomographic (CT) angiography was useful for the evaluation of carotid artery stenosis. (tak-632.net)
  • All cases performed carotid artery color Doppler ultrasonography (CDUS), and the degree of CAS was determined according to the measurement results of computed tomography angiography (CTA). (biomedcentral.com)
  • Preoperative evaluation of carotid artery stenosis: comparison of contrast-enhanced MR angiography and duplex sonography with digital subtraction angiography. (unil.ch)
  • Class I evidence shows that carotid endarterectomy (CEA) is effective in preventing ipsilateral ischemic events in patients with symptomatic moderate- and high-grade stenosis. (elsevier.com)
  • 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. (elsevier.com)
  • Methods-Consecutive patients presenting 50% to 99% carotid stenoses were included. (unipv.it)
  • METHODS: We tested whether soluble CD36 is a marker of plaque stability in patients with high-grade internal carotid stenoses (n=62). (forskningsdatabasen.dk)
  • The number 70%, signifying severe stenosis and warranting intervention, has been indelibly etched in the mind of neurologists. (heart.org)
  • Abstract The benefit of prophylactic carotid endarterectomy (CEA) for patients with asymptomatic severe carotid stenosis in the major randomised surgical studies was small, expensive and may now be absorbed by improvements in best practice medical intervention. (monash.edu)
  • Asymptomatic Carotid Stenosis: Intervention or Best Medical Therapy? (ox.ac.uk)
  • However, in certain critically stenotic lesions, especially in the presence of calcification of the carotid bifurcation, residual carotid stenosis can be a problem. (thoracickey.com)
  • The indicator of CEA had been symptomatic individuals with stenosis over 70 % according to UNITED STATES Symptomatic Carotid Endarterectomy Trial (NASCET) requirements and asymptomatic individuals had been regarded as when they got a stenosis over eighty percent or higher 50 percent if the lesion was ulcerative. (tak-632.net)
  • 70% NASCET) internal carotid artery plaques will be enrolled in the prospective multicenter study CAPIAS. (uni-muenchen.de)
  • abstract = "With the aging of the general population and the availability of noninvasive imaging studies, carotid artery stenosis is a disease commonly seen in general medical practice. (elsevier.com)
  • abstract = "Carotid artery stenosis is a disabling disease in all age groups. (elsevier.com)
  • abstract = "Background and purpose: Data on current cardiovascular event rates in patients with asymptomatic carotid artery stenosis (ACAS) are sparse. (elsevier.com)
  • To clarify the efficacy of medication versus carotid endarterectomy (CEA), we investigated cardiovascular events and outcomes in Japanese patients with moderate carotid stenosis. (elsevier.com)
  • Conclusions-Risk index was significantly higher in the presence of symptoms and could therefore be a valuable tool to assess the clinical risk of a carotid plaque. (unipv.it)
  • 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. (elsevier.com)
  • The distal normal internal carotid artery was used as a frame of reference. (elsevier.com)
  • Additionally, tortuosity or obliquity of the internal carotid arteries can make perpendicular measurements challenging further limiting accurate stenosis estimation. (acrdsi.org)
  • The proximal internal carotid arteries are automatically segmented, and elongated, curved reconstructions are generated (centerline technique). (acrdsi.org)
  • On Feb. 18, the United States Prevention Services Task Force (USPSTF) released for public comment a draft recommendation statement, "Screening for Carotid Artery Stenosis. (avalere.com)
  • Hodgson, Kim J. / The inaccuracy of simple visual interpretation for measurement of carotid stenosis by arteriography . (elsevier.com)
  • 47 men) without outward symptoms of carotid stenosis and after carotid ultrasonography stratified them into three groups: no carotid stenosis (n = 54), moderate carotid stenosis (n = 17) and high-grade carotid stenosis (n = 9). (healio.com)
  • 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. (healio.com)
  • Carotid endarterectomy, which is a preventive surgery that removes plaque buildup from the inside of the carotid artery. (mhealth.org)
  • 2 European Carotid Surgery Trialists' Collaborative Group. (testingtreatments.org)
  • Accuracy of a novel risk index combining degree of stenosis of the carotid artery and plaque surface echogenicity. (unipv.it)
  • Risk index was based on a combination of degree of stenosis and the proportion of the red color (reflecting low echogenicity) on the surface or on the whole plaque. (unipv.it)
  • on receiver operating characteristic curves, risk index presented a stronger predictive power compared with degree of stenosis or surface echogenicity alone. (unipv.it)