Evidence-based recommendations on carotid artery stent placement for symptomatic extracranial carotid stenosis (narrowed carotid arteries in the neck)
Background: Moderate to severe or bilateral carotid stenosis is associated with cerebral atrophy and cognitive decline. Prior studies have evaluated global atrophy and its correlation with the degree of stenosis. It is unclear whether carotid stenosis can lead to unilateral cerebral changes.. Objective: To evaluate for unilateral cerebral atrophy in asymptomatic patients with moderated to severe extracranial unilateral carotid stenosis.. Methods: Subjects were selected from patients who had undergone carotid vascular imaging and MRI of the brain, from January 2007 to January 2013 at our institution. Patients with history of TIA or ischemic stroke were excluded. Carotid stenosis (CS) group consisted of patients with unilateral moderate to severe carotid stenosis (n=9). Patients without any stenosis (n=5) were used as controls. T1-weighted brain images (FOV 256 x 256 x128, resolution 1.5 x 1.5 x 5 mm) were registered to Talairach space using FSL software. Non-brain tissue was removed using the BET ...
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 ...
The investigators of the Asymptomatic Carotid Atherosclerosis Study (ACAS) are reporting the interim results of a randomized controlled clinical trial of carotid endarterectomy in patients who have asymptomatic carotid stenosis of greater than 60% reduction in diameter. In addition to aspirin and aggressive management of modifiable risk factors, one half of the patients were randomly assigned to receive surgery after angiographic confirmation of the lesion. Carotid endarterectomy is beneficial with a statistically significant absolute reduction of 5.8% in the risk of the primary end point of stroke within 5 years and a relative risk reduction of 55%. As a consequence of the trial reaching statistical significance in favor of endarterectomy, and on the recommendation of the studys data monitoring committee, physicians participating in the study were immediately notified and advised to reevaluate patients who did not receive surgery. It is important to note that the success of the operation is ...
BACKGROUND AND PURPOSE: The use of three methods of measuring carotid stenosis, which produce different values on the same angiograms, has caused confusion and reduced the generalizability of the results of research. If the results of future studies are to be properly applied to clinical practice, and if noninvasive methods of imaging are to be properly validated against angiography, a single, standard method of measurement of stenosis on angiograms must be adopted. This standard method should be selected on the bases of its ability to predict risk of ipsilateral carotid distribution ischemic stroke and its reproducibility. METHODS: The method of measurement of carotid stenosis used in the European Carotid Surgery Trial (ECST), that used in the North American Symptomatic Carotid Endarterectomy Trial (NASCET), and a method based on the measurement of the common carotid (CC) lumen diameter were studied. Their use in the prediction of ipsilateral carotid distribution ischemic stroke was assessed in 1001
We aim to determine whether cognitive impairment attributable to cerebral hemodynamic impairment in patients with high-grade asymptomatic carotid artery stenosis is reversible with restoration of flow. To accomplish this aim CREST-H will add on to the NINDS-sponsored CREST-2 trial (parallel, outcome-blinded Phase 3 clinical trials for patients with asymptomatic high-grade carotid artery stenosis which will compare carotid endarterectomy plus intensive medical management (IMM) versus IMM alone (n=1,240), and carotid artery stenting plus IMM versus IMM alone (n=1,240) to prevent stroke and death). CREST-H addresses the intriguing question of whether cognitive impairment can be reversed when it arises from abnormal cerebral hemodynamic perfusion in a hemodynamically impaired subset of the CREST-2 -randomized patients. We will enroll 500 patients from CREST-2, all of whom receive cognitive assessments at baseline and yearly thereafter. We anticipate identifying 100 patients with hemodynamic ...
Severe carotid stenosis patients in the North American Symptomatic Carotid Endarterectomy Trial (NASCET) were shown to have a high risk of stroke and significant benefit from carotid endarterectomy. More than 20 years after the 1991 NASCET results for severe stenosis, there is a common claim to use the NASCET method to determine % carotid stenosis, but without following the details necessary to properly identify the group most benefitting from carotid endarterectomy. NASCET interpreted for loss of diameter of the cervical ICA, near occlusion, and didnt calculate % stenosis if present as it is fallacious. NASCET measured the distal ICA for well beyond the tapering ICA bulb where the ICA walls are parallel. The pitfalls of stenosis quantification and differences between methods are problems of the ratios denominator, and may potentially be resolved by the use of absolute measurements for stenosis on CTA or MRA. Furthermore, trials evaluating vessel wall components including intraplaque hemorrhage such
The Asymptomatic Carotid Atherosclerosis Study (ACAS) results suggest that carotid endarterectomy combined with aspirin and risk factor reduction is superior to aspirin and risk factor reduction alone in preventing ipsilateral stroke in asymptomatic patients with diameter stenosis of the carotid artery of 60% or more. The absolute risk reduction over 5 years conferred by surgical therapy is modest (5.9%) compared with the risk reduction conferred by surgical therapy for symptomatic carotid disease but compares favorably with the degree of stroke prevention shown for antihy-pertensive therapy in the elderly. For prevention of stroke in women and for prevention of major stroke, the ACAS results favoring surgery did not reach statistical significance. The combined arteriographic and perioperative surgery-related mortality and stroke rates achieved by the carefully selected surgical teams was low (2.3%). Accordingly, carotid endarterectomy can be recommended for preventing stroke in the setting of ...
The current trend to often err on the side of using endarterectomy or stenting when significant carotid disease is found - regardless of whether there are symptoms - appears based primarily on two large trials in the 1990s. The Asymptomatic Carotid Artery Study and the Asymptomatic Carotid Surgery Trial basically showed the approaches were more effective than medical therapy. For example, the Asymptomatic Carotid Atherosclerosis study showed surgery reduced the five-year stroke risk by more than half in symptom-free patients with significant blockage of 60-99 percent. The original CREST, which started in 2000 and also followed about 2,500 patients, was the first to compare endarterectomy to stenting in patients with and without symptoms of carotid artery disease, and found they were essentially the same in both risks and stroke prevention. But a more current study, the SAMMPRIS trial, comparing stenting and current medical therapy in patients who have had recent transient ischemic attacks or a ...
OBJECTIVES: several ancillary surgical techniques, such as shunting and patching, are used in association with carotid endarterectomy. However, the balance of risks and benefits of these techniques is uncertain because of the lack of large randomised controlled trials (RCTs). To assess the potential for further trials, we studied the variation in use of these techniques by surgeon and by country in the European Carotid Surgery Trial (ECST). METHODS: use of each ancillary technique was assessed by surgeon and by country. For each technique, the relationships between the use of the technique and baseline patient characteristics, use of other techniques, and the 30-day operative risk of stroke and death were determined. RESULTS: there was considerable variation between surgeons in the use of ancillary operative techniques both within (p|0.001 for shunting and patching), and between countries (p|0.001 for shunting and patching). Some surgeons used techniques selectively, and so the characteristics of
It is well known that risk of fatal and non-fatal stroke is increased in patients with significant carotid atherosclerosis. For asymptomatic patients, AHA guidelines recommend carotid endarterectomy (CEA) for stenosis 60% to 99%, if the risk of perioperative stroke or death is less than 3%.. Although clinical trial data support CEA in asymptomatic patients with carotid stenosis 60% to 79%, the AHA guidelines indicate that some physicians delay revascularization until there is greater than 80% stenosis in asymptomatic patients.. Our study is designed to determine whether optimal medical therapy alone reduces the risk of death and nonfatal stroke in patients with carotid artery stenosis as compared with CEA coupled with optimal medical therapy. ...
Background: We sought to study the association between carotid stenosis and white-matter hyperintensity (WMH) among patients without intracranial large-vessel stenosis. Methods: This was a prospective study of patients with acute lacunar infarcts without concomitant intracranial large-vessel stenosis having undergone carotid ultrasonography. WMH was quantified using the modified Fazekas scale. Patients were grouped into quartiles based on the degree of carotid stenosis. The association among carotid stenosis, vascular risk factors, and WMH were modeled using logistic regression analysis. Results: In all, 100 patients with a mean age of 56.2 ± 11.7 years were studied. The quartile with the greatest carotid stenosis had a mean internal/common carotid artery peak systolic velocity ratio of 2.36. Total WMH was 4.64 in the highest quartile and 2.52 in the lowest quartile of carotid stenosis. Periventricular (pv)-WMH was significantly greater between the highest and lowest quartiles (2.80 versus ...
TY - JOUR. T1 - High cardiovascular event rates in patients with asymptomatic carotid stenosis. T2 - The REACH registry. AU - Aichner, F. T.. AU - Topakian, R.. AU - Alberts, M. J.. AU - Bhatt, D. L.. AU - Haring, H. P.. AU - Hill, M. D.. AU - Montalescot, G.. AU - Goto, S.. AU - Touzé, E.. AU - Mas, J. L.. AU - Steg, P. G.. AU - Röther, J.. PY - 2009/8. Y1 - 2009/8. N2 - Background and purpose: Data on current cardiovascular event rates in patients with asymptomatic carotid artery stenosis (ACAS) are sparse. We compared the 1-year outcomes of patients with ACAS ≥70% versus patients without ACAS in an international, prospective cohort of outpatients with or at risk of atherothrombosis. Methods: The Reduction of Atherothrombosis for Continued Health Registry enrolled patients with either ≥3 atherothrombotic risk factors or established atherothrombotic disease. We investigated the 1-year follow-up data of patients for whom physicians reported presence/absence of ACAS at the time of ...
BACKGROUND AND PURPOSE: Carotid endarterectomy reduces the risk of carotid territory ischemic stroke ipsilateral to a recently symptomatic severe carotid stenosis. However, the benefit is limited by the risks of stroke and death associated with the operation. Although reported surgical risks vary enormously, there has been no systematic review of the published literature. METHODS: We performed a systematic review of mortality and the risk of stroke and/or death due to endarterectomy for symptomatic carotid stenosis in studies published since 1980. RESULTS: Fifty-one studies fulfilled our criteria. Overall mortality was 1.62% (95% confidence interval [CI], 1.3 to 1.9), and the risk of stroke and/or death was 5.64% (95% CI, 4.4 to 6.9). However, there was significant heterogeneity of risk of stroke and/or death (P | .001). The risk varied systematically with the methods and the authorship of the study. The risk of stroke and/or death was highest in studies in which patients were assessed by a neurologist
BACKGROUND: The anatomy of carotid stenosis may influence the outcome of endovascular treatment or carotid endarterectomy. Whether anatomy favors one treatment over the other in terms of safety or efficacy has not been investigated in randomized trials. METHODS: In 414 patients with mostly symptomatic carotid stenosis randomized to endovascular treatment (angioplasty or stenting; n = 213) or carotid endarterectomy (n = 211) in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS), the degree and length of stenosis and plaque surface irregularity were assessed on baseline intraarterial angiography. Outcome measures were stroke or death occurring between randomization and 30 days after treatment, and ipsilateral stroke and restenosis ≥50% during follow-up. RESULTS: Carotid stenosis longer than 0.65 times the common carotid artery diameter was associated with increased risk of peri-procedural stroke or death after both endovascular treatment [odds ratio 2.79 (1.17-6.65), P = 0.02] and
Stroke is the third-leading cause of death in America, and carotid artery stenosis-also known as carotid artery disease-is one of the leading risk factors for stroke, accounting for about 20 percent of strokes. To mark National Stroke Month in May, we asked University of Minnesota Health Neurosurgeon and Neurointerventionist Ramachandra Tummala, MD, to tell us five things we should know about carotid artery stenosis and its link to stroke risk.. Carotid stenosis occurs when buildup begins blocking blood flow.. Stenosis is a medical term for narrowing of blood vessels in the body due to a buildup of inflammatory substances and cholesterol deposits-called plaque. Two carotid arteries in the neck carry most of the blood flow from the heart to the brain. When stenosis occurs in these arteries it is known as carotid artery stenosis. Carotid artery stenosis can lead to a stroke.. Patients with carotid artery stenosis are at increased risk for a stroke, which can lead to disability or death. Sometimes, ...
Backgorund: Chronic cerebral hypoperfusion may lead to impairment in neurocognitive performance in patients with severe carotid artery stenosis (CAS) or occlusion (CAO), and the effects of carotid artery stenting on neurocognitive function were unclear.. Methods and Results: We prospectively enrolled 18 patients (7 CAS, 11 CAO) with objective ipsilateral hemisphere ischemia, in whom carotid artery stenting was attempted. A battery of 5 neuropsychological tests were applied prior to and 3 months after intervention. Procedural success was achieved in 6 of 11 CAOs and all CASs. The demographics and baseline cognitive performances were similar between the successful (group 1, n=13) and failed (group 2, n=5) patients. Significant improvement in Alzheimer Disease Assessment Scale (ADAS) (pre 9.2±8.4 vs post 6.8±6.8, p=0.011) and Mini-Mental State Examination score (pre 24.1±4.1 vs post 26.1±4.0, p=0.012), and a trend towards improvement in Color Trail test A (pre 115.0±64.0 vs post 95.1±47.2, ...
Carotid artery stenting is associated with a higher microembolic burden than carotid endarterectomy. The rate and procedural stage of highest risk depends on the embolic protection device used," said Sumaira Macdonald, consultant vascular radiologist and honorary clinical senior lecturer, Newcastle, UK, at the annual iCON meeting in Phoenix, USA, in February.. She presented the results of a recent non-randomised comparison of carotid endarterectomy, filter-protected carotid artery stenting and carotid artery stenting with flow reversal utilising microembolic signals on transcranial Doppler as primary outcome event.. Results from the study (Gupta N, Corriere MA, Dodson TF et al. JVS Dec 1st 2010 [Epub]) showed that carotid endarterectomy had the fewest microembolic signals (largely in the post-protection phase). This was followed by flow reversal carotid artery stenting; in this case, signals detected were mostly in the pre-protection phase. Of the three procedures, filter-protected carotid ...
Asymptomatic carotid artery stenosis confers mobility impairment and cognitive dysfunction and increases the risk for falls, according to data presented at the Society for Vascular Surgery Vascular Annual Meeting. The researchers analyzed 80 older adults (mean age, 74 years; 47 men) without outward symptoms of carotid stenosis and after carotid ultrasonography stratified them into three groups:
TY - JOUR. T1 - MR perfusion studies of brain for patients with unilateral carotid stenosis or occlusion. T2 - Evaluation of maps of "time to peak" and "percentage of baseline at peak". AU - Teng, Michael Mu Huo. AU - Cheng, Hui Cheng. AU - Kao, Yi Hsuan. AU - Hsu, Li Chi. AU - Yeh, Tzu Chen. AU - Hung, Chung Shiou. AU - Wong, Wen Jang. AU - Hu, Han Hwa. AU - Chiang, Jen Huey. AU - Chang, Cheng Yen. PY - 2001/2/6. Y1 - 2001/2/6. N2 - Maps of "time to peak" (TTP) and "percentage of baseline at peak" (PBP) were compared with maps of conventional brain perfusion parameters, namely, mean transit time (MTT) and relative cerebral blood volume (rCBV). We performed MR perfusion studies in 11 patients. All of them had occlusion or high-grade stenosis of the unilateral carotid artery. Three areas of old infarct, 4 areas of new infarct, and 10 areas of brain without infarct were evaluated specifically. In all these cases, the TTP maps appeared similar to the MTT maps. They showed increases, normal values, ...
Randomised controlled trials (RCT) have demonstrated a net benefit of carotid endarterectomy (CEA) in stroke prevention for patients with severe carotid artery stenosis as compared to best medical treatment. Results in routine clinical practice must not be inferior to those in the RCTs. The carotid arteries are clamped during CEA which may impair the cerebral perfusion. The aim of this thesis was to assess population-based outcomes from CEA, investigate risk factors for perioperative complications/late mortality and to evaluate effects of carotid clamping during CEA. In the Swedish vascular registry 6182 CEAs were registered during 1994-2003. Data on all CEAs were retrieved, analysed and validated. In the validation process no death or disabling stroke was unreported. The perioperative stroke or death rate was 4.3% for those with symptomatic and 2.1% for asymptomatic stenosis (the latter decreasing over time). Risk factors for perioperative complications were age, indication, diabetes, cardiac ...
OBJECTIVE Carotid stenoses ≥50% are associated with increased risk for stroke that can be reduced by prophylactic carotid endarterectomy (CEA). Calcifications in arteries can be detected in panoramic radiographs (PRs). In a cross-sectional study, we analyzed (1) extirpated plaques for calcification, (2) how often PRs disclosed calcified plaques, (3) how often patients with stenoses ≥50% presented calcifications in PRs, and (4) the additional value of frontal radiographs (FRs). STUDY DESIGN Patients (n = 100) with carotid stenosis ≥50% were examined with PRs and FRs before CEA. Extirpated carotid plaques were radiographically examined (n = 101). RESULTS It was found that 100 of 101 (99%) extirpated plaques were calcified, of which 75 of 100 (75%) were detected in PRs; 84 of 100 (84%) patients presented carotid calcifications in the PRs, in 9.5% contralateral to the stenosis ≥50%. CONCLUSIONS Carotid calcifications are seen in PRs in 84% of patients with carotid stenosis ≥50%, independent
A carotid artery duplex scan is a type of vascular ultrasound study done to assess the blood flow of the arteries that supply blood from the heart through the neck to the brain. There are six carotid arteries--the right and left common carotid arteries, which divide and form the right and left internal carotid arteries and the right and left external carotid arteries. One pair (external and internal) is located on each side of the neck.. A carotid artery duplex scan is a noninvasive (the skin is not pierced) procedure. The term "duplex" refers to the fact that two modes of ultrasound are used--Doppler and B-mode. The B-mode transducer (like a microphone) obtains an image of the carotid artery being studied. The Doppler probe within the transducer evaluates the velocity and direction of blood flow in the vessel.. A transducer sends out ultrasonic sound waves at a frequency too high to be heard. When the transducer is placed on the carotid arteries at certain locations and angles, the ultrasonic ...
A carotid artery duplex scan is a type of vascular ultrasound study done to assess the blood flow of the arteries that supply blood from the heart through the neck to the brain. There are six carotid arteries--the right and left common carotid arteries, which divide and form the right and left internal carotid arteries and the right and left external carotid arteries. One pair (external and internal) is located on each side of the neck.. A carotid artery duplex scan is a noninvasive (the skin is not pierced) procedure. The term "duplex" refers to the fact that two modes of ultrasound are used--Doppler and B-mode. The B-mode transducer (like a microphone) obtains an image of the carotid artery being studied. The Doppler probe within the transducer evaluates the velocity and direction of blood flow in the vessel.. A transducer sends out ultrasonic sound waves at a frequency too high to be heard. When the transducer is placed on the carotid arteries at certain locations and angles, the ultrasonic ...
The efficiency of carotid surgery on an asymptomatic carotid artery stenosis and its superiority to conservative treatment was clearly demonstrated in the ACAS study. The stroke risk over a five year follow-up period could be reduced by 55 % and the combined stroke and mortality rate was shown to be a mere 2. 3 %. The efficacy of surgical treatment in also reducing stroke rates in the case of a symptomatic carotid stenosis was proven in the NASCET and ECTS prospective randomized studies. Of extreme importance in these procedures is, however, precise quality control and quality assessment. This is presently a topic of tremendous interest in reconstructive vascular surgery and is constantly being discussed in specialist circles and beyond. Documentation and the possibility of accurate reconstruction of the intraoperative situation are in high demand. Perioperative monitoring of neurological function, particularly the monitoring during carotid surgery, are the aspects underlying constant revision and
e- semptomatik hastalardaki ameliyatın mortalite ve morbiditesi asemptomatik hastalardan daha fazladır. Dolayısı ile beklemekle geçen zaman hastaların semptomatik olmasına ve böylece mortalite ve morbiditenin artmasına yol açabilmektedir [7,19,20].. Yukarıda belirtilen görüşler doğrultusunda uyguladığımız toplam 513 KEA olgusunun perioperatif mortalitesi %0.19 bulunmuş olup, geçici nörolojik bulgu %0.97 olarak gerçekleşmiştir [6]. Bilateral olguları kapsayan bu çalışmamızda mortalite %1.48 n=74, geçici nörolojik bulular %4.0 n=74 olarak gerçekleşmiştir.. Bu sonuçlar American Heart Association tarafından belirtilen perioperatif komplikasyon oranlarından daha azdır (asemptomatik %3, semptomatik %5, III. Evre %7, Rezidif %10 veya daha az) [19].. Bilateral karotis darlıklarını içeren bu serimizde bulunan perioperatif mortalite ve morbidite, toplam olguları kapsayan serimizden daha fazla olarak gerçekleşmiştir. Literatürde de bilateral uygulanan KEA nin ...
Title:Cerebral Hypoperfusion During Carotid Artery Stenosis can Lead to Cognitive Deficits that may be Independent of White Matter Lesion Load. VOLUME: 9 ISSUE: 3. Author(s):Martin Scherr, Eugen Trinka, Mark Mc Coy, Yvonne Krenn, Wolfgang Staffen, Margarita Kirschner, Hans Jurgen Bergmann and Johannes Sebastian Mutzenbach. Affiliation:Universitatsklinik fur Neurologie Paracelsus Medizinische Privatuniversität Christian Doppler Klinik Ignaz Harrer Straße 79 A-5020 Salzburg Austria.. Keywords:Cerebral hypoperfusion, Carotid artery stenosis, Carotid atherosclerosis, Cognitive impairment, Microembolization, White matter lesions, atherosclerosis, stroke-free, stenosis, neuropsychological, hemodynamically, pathophysiological, MRI, Cerebral microembolization. Abstract:Studies investigating cognitive impairment in stroke-free patients with carotid artery stenosis have led to inconsistent results. Furthermore, the pathophysiological mechanism leading to cognitive impairment remains unclear. Cerebral ...
Background:B-mode ultrasound measurements of the echolucency of the carotid intima-media may hold information on cardiovascular risk. The information obtained from this measurement may depend on which gain settings are used. We studied the effect of gain settings on echolucency measurements and its consequences on risk factor relations and treatment effects.Methods:We used two approaches. In the first, we examined the relationship between calibration, gain and common grey-scale median (GSM) from repeated ultrasound images obtained from four healthy individuals at gain settings ranging from -20 to 20dB. In the second, we evaluated the effect of gain settings on the relation of risk factors and statin treatment with common GSM, using images from 325 participants of the Measuring Effects on Intima-Media Thickness: an Evaluation of Rosuvastatin (METEOR) study with documented gain settings. Echolucency of the carotid intima-media was measured from ultrasound images using PaintShop Pro and Artery ...
Greving, J. P., Bots, M. L. & Buskens, E., 2010, In : Stroke. 41, 11, p. E588-E588. Research output: Contribution to journal › Article › Academic ...
Carotid endarterectomy is the main treatment for narrowing of the carotid arteries, but sometimes an alternative procedure called carotid artery stent placement may be available.. Its a less invasive procedure than a carotid endarterectomy because theres no need to make a cut in the neck. Instead, a thin flexible tube is guided to the carotid artery through a small cut in the groin. A mesh cylinder (stent) is then placed into the narrowed section of artery to widen it and allow blood to flow through it more easily.. Current guidelines recommend that a carotid endarterectomy should be the first line of treatment for most people. This is because carotid stenting is associated with a higher risk of stroke during the procedure, particularly if its carried out in the first few days after symptoms appear. But its an important alternative for some people who may otherwise be considered to be high risk because of other medical problems.. Find out more about carotid artery stent placement. ...
Carotid endarterectomy is the main treatment for narrowing of the carotid arteries, but sometimes an alternative procedure called carotid artery stent placement may be available.. Its a less invasive procedure than a carotid endarterectomy because theres no need to make a cut in the neck. Instead, a thin flexible tube is guided to the carotid artery through a small cut in the groin. A mesh cylinder (stent) is then placed into the narrowed section of artery to widen it and allow blood to flow through it more easily.. Current guidelines recommend that a carotid endarterectomy should be the first line of treatment for most people. This is because carotid stenting is associated with a higher risk of stroke during the procedure, particularly if its carried out in the first few days after symptoms appear. But its an important alternative for some people who may otherwise be considered to be high risk because of other medical problems.. Find out more about carotid artery stent placement. ...
Carotid artery stenosis is a frequent cause of ischemic stroke. While any degree of stenosis can cause embolic stroke, a higher degree of stenosis can also cause hemodynamic infarction. The hemodynamic effect of a stenosis can be assessed via perfusion weighted MRI (PWI). Our aim was to investigate the ability of PWI-derived parameters such as TTP (time-to-peak) and Tmax (time to the peak of the residue curve) to predict outcome in patients with unilateral acute symptomatic internal carotid artery (sICA) stenosis. Patients with unilateral acute sICA stenosis (≥50 % according to NASCET), without intracranial stenosis or occlusion, who underwent PWI, were included. Clinical characteristics, volume of restricted diffusion, volume of prolonged TTP and Tmax were retrospectively analyzed and correlated with outcome represented by the modified Rankin Scale (mRS) score at discharge. TTP and Tmax volumes were dichotomized using a ROC curve analysis. Multivariate analysis was performed to determine which PWI
Vulnerable carotid plaque can cause an ischemic stroke, but its detection is elusive. The aim was to study the mechanical properties of carotid plaques using ultrasound speckle tracking.. Methods: Study population consisted of 61 (aged 53-89, median 68) patients with carotid atherosclerosis: 21 with acute atherothrombotic stroke (7 day after stroke onset) and 40 without symptoms. The stroke subtype was classified according to TOAST criteria. In total, 21 symptomatic and 47 asymptomatic plaques were analyzed. For plaque-free area (PFA) and for each plaque, maximum circumferential and longitudinal strains (S[[Unable to Display Character: с]], Sl) and strain rates (SRc SRl) were measured (with separate measurements for plaque cap, core and base). Plaque characteristics (echogenicity, length, degree of stenosis) were also assessed.. Results: plaque and PFA differed in Sl and SRl values, whereas no difference was observed for Sc and SRc (Table 1). Sc and SRc for cap and core of echolucent plaques ...
By Matthew E. Fink, MD Louis and Gertrude Feil Professor and Chair, Department of Neurology, Associate Dean for Clinical Affairs, NYP/Weill Cornell Medical College Dr. Fink reports no financial relationships relevant to this field of study. SOURCE: Brott TG, Calvet D, Howard G, et al; Carotid Stenosis Trialists Collaboration. Long-term outcomes of stenting and endarterectomy for symptomatic carotid stenosis: A preplanned pooled analysis of individual patient data. Lancet Neurol 2019;18:348-356. In previous studies, researchers demonstrated that the risk of periprocedural complications, specifically stroke or death, . . .
By Matthew E. Fink, MD Louis and Gertrude Feil Professor and Chair, Department of Neurology, Associate Dean for Clinical Affairs, NYP/Weill Cornell Medical College Dr. Fink reports no financial relationships relevant to this field of study. SOURCE: Brott TG, Calvet D, Howard G, et al; Carotid Stenosis Trialists Collaboration. Long-term outcomes of stenting and endarterectomy for symptomatic carotid stenosis: A preplanned pooled analysis of individual patient data. Lancet Neurol 2019;18:348-356. In previous studies, researchers demonstrated that the risk of periprocedural complications, specifically stroke or death, . . .
Patients suffering from symptomatic carotid artery stenosis, transient ischemic attacks (TIAs), amaurosis fugax or stroke receive either Revacept (single dose) plus antiplatelet monotherapy or monotherapy alone.. Patients receive a single dose of trial medication by intravenous infusion for 20 minutes. Patients are followed up one and three days after treatment, at 3 months and by a telephone interview at 12 months. ...
EUCAS is a multicenter Registry of carotid artery stenting (CAS) in patients with acute cerebral ischemia (TIA or minor stroke), designed to determine the role of early endovascular intervention in a selected population with a vulnerable lesion of carotid bifurcation. The aim of the registry is to study the safety and efficacy of emergent/urgent CAS and to improve patient selection and consequently reduce the time loss between the index event and the intervention. Secondary aim is to study the plasma levels of plaque vulnerability biomarkers before and after carotid intervention in high risk patients to compare these value with a control group of patients with asymptomatic severe carotid stenosis, and to test the hypothesis that carotid stenting stabilizes the plaque at 1 month. The Registry is open to expert interventionists performing carotid stenting with a documented experience of at least 100 CAS, and the participants are free to apply the preferred endovascular techniques and devices, ...
Our prospective study demonstrates that LE-PAD patients with a hypoechoic plaque in the femoral arteries are exposed to a significantly higher risk of developing myocardial infarction or stroke compared with those with a hyperechoic femoral plaque. Similar findings were obtained with both computer-assisted and visual analyses of plaque echogenicity. Notably, these results remained unaltered after accounting for factors known to have important impacts on LE-PAD patients outcome, including age, sex, previous cardiovascular events, and ABI.. Acute ischemic events are more closely related to the histopathological characteristics of atherosclerotic plaques than to the number of plaques or the degree of vascular stenosis (2,5-8,28,29). In this regard, the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) trial (8) has recently shown that lesions responsible for recurrent cardiac ischemic events are frequently angiographically mild, most are thin-cap ...
OBJECTIVES: ACST-2 is currently the largest trial ever conducted to compare carotid artery stenting (CAS) with carotid endarterectomy (CEA) in patients with severe asymptomatic carotid stenosis requiring revascularization. METHODS: Patients are entered into ACST-2 when revascularization is felt to be clearly indicated, when CEA and CAS are both possible, but where there is substantial uncertainty as to which is most appropriate. Trial surgeons and interventionalists are expected to use their usual techniques and CE-approved devices. We report baseline characteristics and blinded combined interim results for 30-day mortality and major morbidity for 986 patients in the ongoing trial up to September 2012. RESULTS: A total of 986 patients (687 men, 299 women), mean age 68.7 years (SD ± 8.1) were randomized equally to CEA or CAS. Most (96%) had ipsilateral stenosis of 70-99% (median 80%) with contralateral stenoses of 50-99% in 30% and contralateral occlusion in 8%. Patients were on appropriate medical
The group analyzed 101 patients with symptomatic 30-69% carotid artery stenosis who underwent a 3T MRI of the carotid arteries and the brain within 45 days of symptom onset. They used two different readers blinded to the brain MRI results, to analyze the carotid artery MRI and examine them for IPH and TRFC. They found that IPH was present in 40 out of the 101 patient with 55% having infarcts on the side of the carotid plaque however in the patients without IPH, 41% had infarcts on the symptomatic side (p= 0.22). A TRFC was present in 49 out of 86 patients (15 patients could not have fibrous cap assessed), with 45% having infarcts on the side of the symptomatic carotid however this was not significantly different from the 49% in the 37 patients with a thick fibrous cap. The significance did not change when only cortical (instead of both subcortical and cortical) infarcts were taken into account. Though the data was a bit underwhelming in terms of significance, the study still provides important ...
TY - JOUR. T1 - Carotid stenting for unilateral stenosis can increase contralateral hemispheric cerebral blood flow. AU - Sadato, Akiyo. AU - Maeda, Shingo. AU - Hayakawa, Motoharu. AU - Adachi, Kazuhide. AU - Toyama, Hiroshi. AU - Nakahara, Ichiro. AU - Hirose, Yuichi. PY - 2018/4. Y1 - 2018/4. N2 - Background The revascularization of carotid stenosis can increase ipsilateral cerebral blood flow (CBF). Occasionally, elevated CBF is also evident on the contralateral side, but this phenomenon is poorly understood. Objective To analyze retrospectively the relationship between a contralateral CBF increase and several clinical and radiologic features. Materials and methods We retrospectively analyzed 40 patients with unilateral cervical carotid stenosis treated by carotid artery stenting (CAS). Using 123 I-iodamphetamine single-photon emission computed tomography (SPECT); we compared pre-and postoperative hemispheric CBF on both sides. We investigated the influence of the following five factors on ...
TY - JOUR. T1 - Carotid stenting for unilateral stenosis can increase contralateral hemispheric cerebral blood flow. AU - Sadato, Akiyo. AU - Maeda, Shingo. AU - Hayakawa, Motoharu. AU - Adachi, Kazuhide. AU - Toyama, Hiroshi. AU - Nakahara, Ichiro. AU - Hirose, Yuichi. PY - 2018/4. Y1 - 2018/4. N2 - Background The revascularization of carotid stenosis can increase ipsilateral cerebral blood flow (CBF). Occasionally, elevated CBF is also evident on the contralateral side, but this phenomenon is poorly understood. Objective To analyze retrospectively the relationship between a contralateral CBF increase and several clinical and radiologic features. Materials and methods We retrospectively analyzed 40 patients with unilateral cervical carotid stenosis treated by carotid artery stenting (CAS). Using 123 I-iodamphetamine single-photon emission computed tomography (SPECT); we compared pre-and postoperative hemispheric CBF on both sides. We investigated the influence of the following five factors on ...
Recent data on carotid artery stenting have been encouraging, and technologies and studies on the horizon also seem promising. However, good outcomes are dependent on the experience of the operator and on appropriately selecting patients. In this Q&A, Chris Metzger, MD, shares his thoughts on recent studies and on best practices for performing carotid artery stenting. Dr Metzger is an interventional cardiologist at the Wellmont CVA Heart Institute in Kingsport, Tennessee, and he will be speaking on this topic at the International Symposium on Endovascular Therapy (ISET) in Hollywood, Florida.. Are there any changes in recent data or technology advances that you want to highlight?. I am very excited that the newest data supplements the safety, durability, and effectiveness of carotid stenting. The CREST 10-year data were published and showed that carotid stenting was at least equivalent to carotid endarterectomy at 10 years in terms of preventing strokes and keeping the carotid artery open. ...
TY - JOUR. T1 - The inaccuracy of simple visual interpretation for measurement of carotid stenosis by arteriography. AU - Schmittling, Zachary C.. AU - McLafferty, Robert B.. AU - Danetz, Jeffrey S.. AU - Hussain, Syed M.. AU - Ramsey, Don E.. AU - Hodgson, Kim J.. PY - 2005/7. Y1 - 2005/7. N2 - Purpose: To determine intraobserver and interobserver variability of carotid arteriography interpretation as well as the reliability of simple visual interpretation (SVI) or "eyeballing" of arteriography in the measurement of internal carotid artery stenoses. Methods: Intraobserver and interobserver measurements of 200 carotid arteriograms were performed in a blinded fashion by two vascular surgeons (VS1 and VS2) using a digital caliber computer program similar to software available in catheterization laboratories. The distal normal internal carotid artery was used as a frame of reference. These computer-derived measurements were compared with previous SVI measurements, found by retrospective chart ...
Impact of baseline characteristics on outcomes of carotid artery stenting in acute ischemic stroke patients Cheng-Sheng Yu,1,* Chih-Ming Lin,2,3,* Chi-Kuang Liu,4 Henry Horng-Shing Lu1 1Institute of Statistics and Big Data Research Center, National Chiao Tung University, Hsinchu, 2Stroke Centre and Department of Neurology, Chunghua Christian Hospital, Chunghua, 3Graduate Institute of Biological Science and Technology, National Chiao Tung University, Hsinchu, 4Department of Medical Imaging, Chunghua Christian Hospital, Chunghua, Taiwan, Republic of China *These authors contributed equally to this work Abstract: Carotid artery stenting is an effective treatment for ischemic stroke patients with moderate-to-severe carotid artery stenosis. However, the midterm outcome for patients undergoing this procedure varies considerably with baseline characteristics. To determine the impact of baseline characteristics on outcomes following carotid artery stenting, data from 107 eligible patients with a first
The association between metabolic syndrome and asymptomatic carotid artery stenosis in menopausal women: a cross-sectional study in a Chinese population Bin Zhu,1 Lei Zhang,2 Xiao Ping Cheng,3 Lei Wang,4 Yue Tian,1 Xi Xi Li,1 Ying Ping Liu,5 Zhi Gang Zhao11Department of Pharmacy, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing 100050, China; 2Department of Pharmacy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100050, China; 3Department of Nephrology, Shaanxi Hospital of Traditional Chinese Medical, ShaaXi 710003, China; 4Department of Endocrinology, Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing 100029, China; 5Obstetrics Department, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, ChinaBackground: To examine the association of metabolic syndrome (MetS) with carotid artery stenosis (CAS), especially in menopausal women in China.Materials and methods: A cross-sectional study of menopause
Carotid Stenosis Assessment Training Video is designed to provide an overview of carotid duplex/color flow imaging techniques and criteria to diagnose cerebrovascular disease. The lecture includes how to analyze the spectral Doppler waveform characteristics, integration of routine measurements, and carotid case presentations. The participant will be able to apply current diagnostic criteria to evaluate carotid stenosis and other associated abnormalities after viewing this video ...
Background: In up to 30% of patients with ischemic stroke no definite etiology can be established. A significant proportion of cryptogenic stroke cases may be due to non-stenosing atherosclerotic plaques or low grade carotid artery stenosis not fulfilling common criteria for atherothrombotic stroke. The aim of the CAPIAS study is to determine the frequency, characteristics, clinical and radiological long-term consequences of ipsilateral complicated American Heart Association lesion type VI (AHA-LT VI) carotid artery plaques in patients with cryptogenic stroke. Methods/Design: 300 patients (age , 49 years) with unilateral DWI-positive lesions in the anterior circulation and non- or moderately stenosing (,70% NASCET) internal carotid artery plaques will be enrolled in the prospective multicenter study CAPIAS. Carotid plaque characteristics will be determined by high-resolution black-blood carotid MRI at baseline and 12 month follow up. Primary outcome is the prevalence of complicated AHA-LT VI ...
In this nationwide registry of patients undergoing carotid artery revascularization, the prevalence of CCOs in patients undergoing elective carotid artery stenting was 10%. The rate of composite in-hospital events, including death, nonfatal myocardial infarction, and nonfatal stroke, did not differ between patients with and without a CCO after elective CAS. Lastly, CCO was not associated with higher complications following CAS in older patients or individuals with prior neurological symptoms.. The prognosis of medically treated patients with carotid artery stenosis and a CCO is poor, with 2-year stroke rates ranging from 40% to 70% (11,12). This excess risk is believed to be related to inadequate collateral circulation at the level of the circle of Willis (13), from compromised ipsilateral blood supply in the setting of a complete CCO. CCO is a well-recognized high-risk anatomic criterion for patients undergoing CEA (5). Patients with CCO have higher rates of perioperative stroke and death, as ...