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: ...
BACKGROUND Low plasma concentrations of high-density lipoprotein (HDL) are associated with increased risk of cardiovascular disease. However, recently several studies have questioned the protective role of high plasma HDL levels. OBJECTIVE This study was designed to evaluate HDL functions in women with high plasma HDL cholesterol and very low risk profile with relation to subclinical carotid atherosclerosis (ATS). METHODS Included were 158 middle-aged women with plasma HDL |60 mg/dL and Framingham risk score |7% who had B-mode ultrasound of the carotid arteries. Subclinical ATS was determined by the presence of plaques and/or intima-media thickness (IMT) |1.0 mm. RESULTS ATS was observed in 51 women, with the majority (n=41) having carotid plaques, some with advanced morphology. In a multivariable model analysis, each, HDL or age, were independently associated with increased prevalence of ATS. Odds ratios for ATS were 3.1 and 2.5 greater for age|60 years and HDL |70 mg/dL, respectively. None of
TY - JOUR. T1 - Prospective observation on the association of snoring with subclinical changes in carotid atherosclerosis over four years. AU - Kim, Jinyoung. AU - Pack, Allan. AU - Maislin, Greg. AU - Lee, Seung Ku. AU - Kim, Seong Hwan. AU - Shin, Chol. PY - 2014/7. Y1 - 2014/7. N2 - Objective: Although there is a growing interest in the independent effect of snoring on carotid atherosclerosis, few studies have observed the relationship between snoring and change in carotid atherosclerosis prospectively. Therefore, the present study aimed to prospectively examine the association of snoring with subclinical changes in carotid atherosclerosis during a four-year period. Methods: Participants in an ongoing prospective cohort study (n= 3129) were enrolled. Subclinical changes in carotid atherosclerosis were assessed using: (i) mean and maximum intima-media thickness (IMT) on both common carotid arteries; (ii) prevalence of elevated IMT (maximum IMT ≥1.0. mm); and (iii) presence of plaque. ...
Carotid artery disease is a disease in which a waxy substance called plaque builds up inside the arteries. You have two carotid arteries, one on each side of the neck which divide into the internal and external carotid arteries. The internal arteries supply blood to the brain and the external arteries supply blood to the face, scalp, and neck... Carotid artery disease is serious because it can cause a stroke if the plaque should build up to the point it cuts off blood supply to the brain, or the plaque ruptures and a blood clot forms in the artery cutting off blood supply to the brain.. Carotid artery disease causes over half the strokes that occur in the United States. Carotid artery disease may not have any symptoms until the arteries are severely narrowed or blocked. For some people, a stroke is the first sign of the disease.. ...
TY - JOUR. T1 - Carotid artery atherosclerosis, MRI indices of brain ischemia, aging, and cognitive impairment. T2 - The framingham study. AU - Romero, José R.. AU - Beiser, Alexa. AU - Seshadri, Sudha. AU - Benjamin, Emelia J.. AU - Polak, Joseph F.. AU - Vasan, Ramachandran S.. AU - Au, Rhoda. AU - Decarli, Charles. AU - Wolf, Philip A.. PY - 2009/5/1. Y1 - 2009/5/1. N2 - Background and Purpose-: Carotid atherosclerosis has been associated with increased risk of stroke and poorer cognitive performance in older adults. The relation of carotid atherosclerosis to cognitive impairment and MRI indices of ischemia and aging in midlife is less clear. Methods-: We studied 1975 Framingham Offspring Study participants free of stroke and dementia with available carotid ultrasound, brain MRI, and neuropsychological testing. We related common and internal carotid artery intima-media thickness and internal carotid stenosis to large white matter hyperintensity (,1 SD above age-specific mean), total brain ...
Methods 5 carotid atherosclerotic plaques were obtained at the time of operation (2 symptomatic, 2 asymptomatic, and 1 control). RNA was isolated and 5 cDNA libraries were constructed and sequenced with single-reads100nt in length using one line of flow cell of HySeq 2000 (Illumina Inc). Standard bioinformatic techniques were used to ensure quality screening of raw reads. Ingenuity Systems IPA software was used to determine canonical biological pathways overrepresented in plaques. We compared our data to the data of Illumina Human Body Map processed by a similar analytical pipeline. Linkage analysis was performed. ...
Accumulation of tissue iron has been implicated in development of atherosclerotic lesions mainly because of increased iron-catalyzed oxidative injury. However, it remains unknown whether cellular iron import and storage in human atheroma are related to human atheroma development. We found that transferrin receptor 1 (TfR1), a major iron importer, is highly expressed in foamy macrophages and some smooth muscle cells in intimal lesions of human carotid atheroma, mainly in cytoplasmic accumulation patterns. In 52 human carotid atherosclerotic lesions, TfR1 expression was positively correlated with macrophage infiltration, ectopic lysosomal cathepsin L, and ferritin expression. Highly expressed TfR1 and ferritin in CD68-positive macrophages were significantly associated with development and severity of human carotid plaques, smoking, and patients symptoms. The findings suggest that pathologic macrophage iron metabolism may contribute to vulnerability of human atheroma, established risk factors, and ...
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, ...
Primary Objective:. Atherosclerosis of the carotid arteries is a common cause of stroke. The prevalence and progression of carotid atherosclerosis are believed to be influenced by genetically inherited variations in lipoprotein metabolism. This study investigates the specific role of paraoxonase, an enzyme thought to detoxify atherogenic oxidized low-density lipoprotein. This study compares veterans who have significant carotid atherosclerosis on ultrasound examination with controls without carotid atherosclerosis. Both paraoxonase activity and genotype will be determined and compared between groups. The results may eventually make it possible to screen for a paraoxonase allele that confers high risk of atherosclerosis, and to diminish the risk by early treatment.. Study Abstract:. The general aim of the proposed research is to evaluate the contribution and mechanism of paraoxonase (PON1) genotypic and phenotypic variation (PON1 status) in risk and progression of carotid artery disease (CAAD). ...
Introduction: The Womens Health Initiative (WHI) previously reported that a diet aimed at reducing total fat intake, while increasing fruit vegetable and grain intake, did not result in a significant reduction in incident stroke. Since the diagnosis and treatment of carotid artery disease may reduce the rate of stroke, the aim of this study was to determine whether the same diet intervention was associated with incident carotid artery disease.. Methods: Participants were 48,835 postmenopausal women aged 50 to 79 years who were randomly assigned to the intervention or comparison groups in the WHI Dietary Modification Trial. The intervention included intensive behavior modification designed to reduce fat intake to 20% of total calories and increase intake of fruits and vegetables to 5 servings/day and grains to at least 6 servings/day. The comparison group received diet-related education materials. The outcome measure of incident carotid artery disease was defined as either symptomatic or ...
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Approach and Results-Histological analysis of 143 endarterectomized human carotid atherosclerotic plaques revealed that ATG16L1 was expressed in areas surrounding the necrotic core and the shoulder regions. Double immunofluorescence labeling revealed that ATG16L1 was abundantly expressed in phagocytic cells (CD68), endothelial cells (CD31), and mast cells (tryptase) in human advanced plaques. ATG16L1 immunogold labeling was predominantly observed in endothelial cells and foamy smooth muscle cells of the plaques. ATG16L1 protein expression correlated with plaque content of proinflammatory cytokines and matrix metalloproteinases. Analysis of Atg16L1 at 2 distinct stages of the atherothrombotic process in a murine model of plaque vulnerability by incomplete ligation and cuff placement in carotid arteries of apolipoprotein-E-deficient mice revealed a strong colocalization of Atg16L1 and smooth muscle cells only in early atherosclerotic lesions. An increase in ATG16L1 expression and autophagy flux ...
Carotid artery symptoms explains why carotid artery disease occurs. A family member has carotid artery disease. Recently he had to have two operations, one on each side of his neck. The operations had to be done a few months apart, with the worst affected artery being done first. Continue reading Carotid Artery Symptoms →. ...
Xie, Gaoqiang, Myint, Phyo K, Zhao, Liancheng, Li, Ying, Wang, Hao, Liang, Lirong and Wu, Yangfeng (2010) Relationship between -592A/C polymorphism of interleukin-10 (IL-10) gene and risk of early carotid atherosclerosis. International Journal of Cardiology, 143 (1). pp. 102-104. ISSN 1874-1754 Full text not available from this repository. (Request a copy ...
Many people are unaware that approximately 30 percent of strokes are caused by blockages in the carotid artery. Carotid artery disease is a condition characterized by a narrowing or blockage of one or both of the carotid arteries in the neck, which supply blood to the brain. Plaque, which is made up of an accumulation of fats, cholesterol, and fibrous tissue, can build up in the arteries over time, as a result of age, genetics, or an unhealthy lifestyle. The team of specialists at Stony Brook Medicine utilizes a multidisciplinary approach to diagnose and treat stroke and pre-stroke conditions, many of which are caused by a narrowing in the carotid arteries. We offer both nonsurgical and traditional treatment options. Specialists from cardiology, vascular surgery, and neurology work together to care for you and your family with compassion and expertise. What is it? Stroke is the leading cause of serious, long-term disability in the United States, and occurs when there is an interruption of blood flow
Carotid Artery Disease by Mark K Eskandari, William H Pearce, James S T Yao starting at . Carotid Artery Disease has 1 available editions to buy at Alibris
ADMA-SDMA in Elderly Subjects with Asymptomatic Carotid Atherosclerosis: Values and Site-Specific Association. . Biblioteca virtual para leer y descargar libros, documentos, trabajos y tesis universitarias en PDF. Material universiario, documentación y tareas realizadas por universitarios en nuestra biblioteca. Para descargar gratis y para leer online.
AIM: The traditional morphological parameters for the description of a carotid atherosclerotic plaque (degree of stenosis, echogenicity, systolic peak velocity etc.) are insufficient for the prediction of the risk of embolization. Contrast enhanced ultrasound (CEUS), based on the theory of inflammation and neoangiogenesis, seems to have a great potential for the detection of unstable plaques. The purpose of our work was to compare echogenicity of the plaque (evaluated with the Grey Scale Median; GSM), the degree of stenosis and CEUS with the histopathological findings ...
Your doctor will start by taking a health history and examining you. This will help determine your risk factors for developing carotid artery disease. These include smoking, high blood pressure, high cholesterol and family history. The first test your doctor will usually order is an ultrasound of the carotid vessels. This is a noninvasive test that uses sound waves to look at the carotid arteries and to assess the blood flow through them. Sometimes more information is required and a CT angiogram or Magnetic Resonance Angiogram (MRA) may be ordered. These tests involve giving contast (dye) and use of either xrays for CT, or magnetic fields for MRA to create a picture of the artery.. ...
Carotid artery disease is when the carotid arteries, which provide the main blood supply to your brain, become narrow or blocked. Carotid disease is very highly associated with stroke.
[Bryan, TX] - [July 13, 2020] - CHI St. Joseph Health is the first in the Brazos Valley to treat carotid artery disease and prevent future strokes using a new procedure called TransCarotid Artery Revascularization (TCAR). TCAR (tee-kahr) is a clinically proven, minimally invasive and safe approach for high surgical risk patients who need carotid artery treatment.
Vidant Health - Carotid Artery Disease occurs when the carotid arteries (main blood vessels that carry blood and oxygen to the brain) become narrowed.
Abstract: Introduction: Carotid Endarterectomy (CEA) is widely recognized as effective in significantly reducing the risk of recurrent stroke emanating from extracranial carotid atherosclerosis and approximately 140,000 carotid endarterectomies are performed annually in the United States (US). As such, data are scarce on the prevalence and clinical outcomes of CEA across different age groups. This study aimed to determine and analyze the prevalence, demographic and clinical outcomes of CEA across six decades of life. Methods: Data on 40,276,240 patients were abstracted from discharge data obtained from the Nationwide Inpatient Sample (NIS) database, a part of the Healthcare Cost and Utilization Project (HCUP) of the Agency for Healthcare Research and Quality (2004-2008). Demographic and clinical characteristics of patients undergoing CEA as the primary procedure were abstracted including age, gender, elective or non-elective admission, comorbidities, Length of Stay (LOS), secondary procedures, ...
Ajduk, Marko and Bulimbašić, Stela and Pavić, Ladislav and Šarlija, Mirko and Patrlj, Leonardo and Brkljačić, Boris and Pavić, Predrag and Čikara, Igor and Ivanac, Gordana (2013) Comparison of multidetector-row computed tomography and duplex Doppler ultrasonography in detecting atherosclerotic carotid plaques complicated with intraplaque hemorrhage. Collegium Antropologicum, 37 (1). pp. 213-9. ISSN 0350-6134 Jukić, Mladen and Pavić, Ladislav and Čerkez Habek, Jasna and Medaković, Petar and Delić Brkljačić, Diana and Brkljačić, Boris (2012) Influence of coronary computed tomography-angiography on patient management. Croatian Medical Journal, 53 (1). pp. 4-10. ISSN 0353-9504 Ajduk, Marko and Pavić, Ladislav and Bulimbašić, Stela and Šarlija, Mirko and Pavić, Predrag and Patrlj, Leonardo and Brkljačić, Boris (2009) Multidetector-row computed tomography in evaluation of atherosclerotic carotid plaques complicated with intraplaque hemorrhage. Annals of Vascular Surgery, 23 ...
In a population-based prospective study of more than 5000 men and women aged 65 years or older, the Cardiovascular Health Study1 found a strong relation between three different measures of carotid atherosclerosis and the presence of any major abnormality, including T-wave inversions, on the resting ECG. Unfortunately, this study did not examine the prevalence of isolated T-wave abnormalities in relation to carotid disease separately from other major ECG abnormalities and included subjects with angina, myocardial infarction, and coronary revascularization.1 The strong association between nonspecific repolarization abnormalities, which included localized T-wave inversions, and subsequent coronary morbidity and mortality found in large population studies8 9 10 11 12 13 14 and the increased mortality in asymptomatic patients with carotid disease and similar nonspecific ECG abnormalities27 suggest that asymptomatic individuals with carotid hypertrophy and localized T-wave inversions on the resting ...
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Indirect noninvasive neurovascular tests provide information on hemodynamic changes cephalad to the carotid bifurcation, whereas direct tests measure anatomic or physiologic changes at the bifurcation itself. Batteries of tests are often done and should combine both indirect and direct methods. Results with two ultrasonic techniques and digital subtraction intravenous angiography suggest a larger role for these methods. Carotid arteriography is the definitive procedure for evaluating the carotid artery, although it should only be done when carotid endarterectomy is contemplated. The relative risks and benefits of other diagnostic and therapeutic management strategies should guide the decision to do noninvasive neurovascular tests, or to proceed directly to arteriography. ...
Diagnosis of carotid artery disease (stenosis) (costs for program #167077) ✔ University Hospital RWTH Aachen ✔ Department of Thoracic, Vascular Surgery and Cardiac Surgery ✔ BookingHealth.com
Diagnosis of carotid artery disease (stenosis) (costs for program #141431) ✔ Academic Hospital Schwabing ✔ Department of Vascular Surgery ✔ BookingHealth.com
... causes a narrowing of the major blood vessels that supply the brain. It is caused by atherosclerosis and can lead to a stroke.
... causes a narrowing of the major blood vessels that supply the brain. It is caused by atherosclerosis and can lead to a stroke.
CHI St. Joseph Health was the first in the Brazos Valley to perform TCAR, a safer procedure for treating carotid artery disease and preventing stroke.
Our New Medical Therapies(TM) Trial Results database provides a snapshot of results from completed and ongoing clinical trials, based on published materials from medical conferences, journals and CenterWatch reports. View Carotid Artery Disease clinical trial results here.
Find out more about Carotid Artery Disease and the screening procedures MedStar St. Marys Hospital uses for early detection and treatment.
Question - Have difficulty breathing, phlegm, have COPD, CHF, carotid artery disease, relief vicks inhaler, senile. Ask a Doctor about diagnosis, treatment and medication for Copd, Ask a Cardiologist
The present study shows for the first time that image-guided 1H-MRS of carotid atherosclerotic plaques is feasible in vivo in humans. We successfully quantified the allylic methylene (2.0 ppm) to methylene (1.2 ppm) ratio, which reflects the ratio of the fatty acid composition of plaque cholesteryl ester to that of perivascular tissue triglyceride. Furthermore, the allylic methylene (2.0 ppm) to methylene (1.2 ppm) ratio was shown to have good reproducibility. 1H-MRS of plaques still has a limited spatial resolution and is technically challenging, illustrated by the fact only 49% of the obtained 1H-MRS spectra was of adequate quality for analysis. The present data imply that in vivo in humans, 1H-MRS of carotid artery plaques offers a promising and valuable tool that can specifically identify liquid cholesteryl ester through its specific proton resonances.. The type of lipids and their physical properties in atherosclerotic lesions have been well investigated over the past decades (1). ...
Mean HDL-C/P ratio was 46.4 (standard deviation = 9.3, range = 23.8-86.9). HDL-C/P ratio was associated with 5-year progression of carotid atherosclerosis. Participants with the highest HDL-C/P ratio had 1.56-fold (p = 0.006) increased progression compared to those with the lowest level. Among participants without baseline plaque, plaque area in re-examination was larger by 9.4 mm2 in the subgroup with the highest level when compared to the lowest level.. ...
The initial formulation and testing of CAS was based on data from a cross-sectional study (17). The serial carotid MRI study reported herein demonstrates that CAS measures are predictive of future carotid luminal surface disruption, thus providing prospective confirmation of the earlier single time-point study findings. Furthermore, a significant association was noted between CAS and plaque progression in asymptomatic patients with 50% to 79% stenosis and who did not have carotid DLS or IPH at baseline. We caution the reader against over-interpretation of the data presented given the relatively low number of events. Nevertheless, the data are promising for a simplification of carotid risk stratification using CAS and provide strong evidence for conducting future studies that use a larger study sample to validate these initial findings.. Findings from randomized clinical trials indicate that the benefit of CEA or stenting in this group of individuals is marginal. However, the further risk ...
What is Carotid Artery Disease? Carotid Artery Disease is a form of Peripheral Artery Disease that affects blood flow through the carotid arteries, the two
PubMed journal article: Iron concentrations in atherosclerotic plaque and serum in patients with carotid atherosclerosis. Download Prime PubMed App to iPhone, iPad, or Android
Pathophysiology. As in many other vascular diseases, common risk factors for the development of large artery atherosclerosis include hypertension, tobacco use, and diabetes. Male gender also increases the risk of progression, as does radiation for head and neck cancers. Temporally speaking, carotid atherosclerosis develops over decades (see figure), and while genetics plays a large role, there are no congenital atherosclerotic lesions.. So we are left with the question of, "when should physicians intervene?" In a pooled analysis of two international trials trials, there was a 4.6% absolute reduction in 5-year ipsilesional stroke in patients with revascularization for 50-69% stenosis by NASCET criteria, and a more impressive 16% 5-year risk reduction in patients with severe stenosis (70-99%). After pooling data from 3 major trials, the NNT to prevent an ipsilateral stroke or peri-operative death is 22 for a 50-69% stenosis, but drops to 6.3 for 70-99%, and for a near occlusive lesion, there is no ...
Carotid artery disease is a major cause of stroke in the United States. Other conditions, such as certain heart problems and bleeding in the brain, also can cause strokes. Lifestyle changes, medicines, and medical procedures can help prevent or treat carotid artery disease and may reduce the risk of stroke.. If you think youre having a stroke, you need urgent treatment. Call 9-1-1 right away if you have symptoms of a stroke. Do not drive yourself to the hospital. You have the best chance for full recovery if treatment to open a blocked artery is given within 4 hours of symptom onset. The sooner treatment occurs, the better your chances of recovery.. How Can Atherosclerosis Be Prevented or Delayed?. Taking action to control your risk factors can help prevent or delay atherosclerosis and its related diseases. Your risk for atherosclerosis increases with the number of risk factors you have.. One step you can take is to adopt a healthy lifestyle, which can include:. Heart-Healthy Eating. Adopt ...
Heavy snorers might be at an increased risk of developing carotid atherosclerosis, which may progress to be associated with stroke.
Results Fasting blood glucose, haemoglobin A1c, insulin, triglyceride, and ADMA levels, and mean IMT, plaque score were higher in diabetic patients compared with the controls. Univariate and multivariate analyses demonstrated an independent association between ADMA and mean IMT in diabetic patients. On a multiple logistic regression analysis, ADMA was the sole predictor of carotid plaque formation (plaque score ≥1.1) (OR 2.43, 95% CI 1.19 to 4.94, p,0.05).. ...
RESULTS Carotid atherosclerosis was common in men aged 70-89 years. There was no significant difference in the maximal carotid intimal-medial thickness between diabetic and nondiabetic men and over different age-groups; it was 1.28, 1.33, and 1.36 mm in subjects with diabetes, impaired glucose tolerance, and normal glucose tolerance, respectively (P = 0.69). No association between the presence of a nonmineralized or a mineralized atherosclerotic lesion with diabetes was found. Fasting plasma insulin did not relate to ultrasonographically detectable atherosclerotic lesions.. ...
Results The mean age was 68.8 years, and 65.3% of subjects had intermediate Framingham Risk Score (6% to 20% 10-year risk). Carotid plaques were identified in 78% of cases, abnormal ABI in 10%, AAD ,20 mm in 28%, and coronary calcium in 68% of participants. Carotid plaque burden was found to correlate stronger with CACS (chi-square 450, p , 0.0001) than did cIMT (chi-square 24, p , 0.0001), AAD (chi-square 2.9, p = 0.091), and ABI (chi-square 35.2, p , 0.0001). ...
Objective: To determine the association of TRIB3 Q84R polymorphism with metabolic syndrome (MetS) and carotid atherosclerosis.. Research design and Methods: A case-control study enrolled 513 Chinese subjects in three groups: control, MetS and obese groups. The functional TRIB3 Q84R polymorphism was genotyped among subjects undergoing carotid ultrasonography. The clinical and biochemical characteristics were determined.. Results: For individuals with the TRIB3 R84 allele, the odds ratio for developing MetS was 2.349 (P=0.018), abdominal obesity 2.351 (P=0.012), hypertriglyceridemia 2.314 (P=0.00003) and insulin resistance 1.697 (P=0.023). Likewise, the odds ratio for those with the TRIB3 R84 allele to develop thickened intima-media thickness was 2.208 (P=0.040).. Conclusions: Individuals with the functional TRIB3 Q84R polymorphism are at risk for MetS. Especially, the TRIB3 R84 allele predisposes to carotid atherosclerosis in part through the effects of abdominal obesity, hypertriglyceridemia and ...
Results. One hundred seventy patients (mean age 61.4 ± 11 years, 58.8% men) were included. Average FSCV, FSCD and NS values were 33.6% ± 21%, 20.6% ± 12% and 24.8% ± 18%, respectively. According to the UKPDS score, average risk of coronary disease and stroke were 22.1% ± 16% and 14.3% ± 19% respectively. Comparing the risks estimated by the different scores a significant correlation was found. The prevalence of CAP was 51%, in patients with the higher scores this prevalence was increased. ROC analysis showed a good discrimination power between subjects with or without CAP. ...
Blockage or narrowing of the arteries in the neck can cause patients to suffer a stroke which occurs when part of the brain gets inadequate blood flow and dies. Since it is very difficult to reverse the damage once it has occurred, successful management of this condition requires early recognition of the disease, often even before symptoms occur, and prompt, safe treatment.