Neutrophil‐to‐lymphocyte ratio is associated with carotid intraplaque neovascularization in asymptomatic carotid stenosis patients

Background/Aim. A certain percentage of patients with asymptomatic carotid stenosis have an unstable carotid plaque. For these patients it is possible to register by modern imaging methods the existence of lesions of the brain parenchyma - the silent brain infarction. These patients have a greater risk of ischemic stroke. The aim of this study was to analyze the connection between the morphology of atherosclerotic carotid plaque in patients with asymptomatic carotid stenosis and the manifestation of silent brain infarction, and to analyze the influence of risk factors for cardiovascular diseases on the occurrence of silent brain infarction and the morphology of carotid plaque. Methods. This retrospective study included patients who had been operated for high grade (> 70%) extracranial atherosclerotic carotid stenosis at the Clinic for Vascular and Transplantation Surgery of the Clinical Center of Vojvodina over a period of 5 years. The patients analyzed had no clinical manifestation of cerebrovascular insufficiency of the carotid artery territory up to the time of operation. The classification of carotid plaque morphology was carried out according to the Gray-Weale classification, after which all the types were subcategorized into two groups: stable and unstable. Brain lesions were verified using preoperative imaging of the brain parenchyma by magnetic resonance. We analyzed ipsilateral lesions of the size > or = 3 mm. Results. Out of a 201 patients 78% had stable plaque and 22% unstable one. Unstable plaque was prevalent in the male patients (male/female ratio = 24.8% : 17.8%), but without a statistically significant difference (p > 0.05). The risk factors (hypertension, nicotinism, hyperlipoproteinemia, and diabetes mellitus) showed no statistically significant impact on carotid plaque morphology and the occurrence of silent brain infarction. Silent brain infarction was detected in 30.8% of the patients. Unstable carotid plaque was found in a larger percentage of patients with silent brain infarction (36.4% : 29.3%) but without a significant statistical difference (p > 0.05). Conclusions. Even though silent brain infarction is more frequent in patients with unstable plaque of carotid bifurication, the difference is of no statistical significance. The effects of the number and type of risk factors bear no statistical significance on the incidence of morphological asymptomatic carotid plaque.

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COATED-PLATELETS ENHANCE TIA/STROKE RISK PREDICTION IN ASYMPTOMATIC CAROTID STENOSIS PATIENTS FOLLOWED WITH CAROTID DOPPLER SURVEILLANCE

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(21)03173-9 ◽

2021 ◽

Vol 77 (18) ◽

pp. 1817

Author(s):

Mohamad Khattab ◽

Arleen Ramirez-Jimenez ◽

Andrea Vincent ◽

George Dale ◽

Calin Prodan ◽

...

Keyword(s):

Carotid Stenosis ◽

Risk Prediction ◽

Stroke Risk ◽

Asymptomatic Carotid Stenosis ◽

Asymptomatic Carotid ◽

Carotid Doppler

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Surface-based cortical morphometry, white matter hyperintensity, and multidomain cognitive performance in asymptomatic carotid stenosis

Neuroscience ◽

10.1016/j.neuroscience.2021.05.013 ◽

2021 ◽

Author(s):

Lei Gao ◽

Zhao Ruan ◽

Yaqiong Xiao ◽

Haibo Xu

Keyword(s):

White Matter ◽

Carotid Stenosis ◽

Cognitive Performance ◽

White Matter Hyperintensity ◽

Asymptomatic Carotid Stenosis ◽

Asymptomatic Carotid ◽

Cortical Morphometry

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Carotid artery stenosis – Current evidence and treatment recommendations

Clinical and Translational Neuroscience ◽

10.1177/2514183x211001654 ◽

2021 ◽

Vol 5 (1) ◽

pp. 2514183X2110016

Author(s):

Mandy D Müller ◽

Leo H Bonati

Keyword(s):

Carotid Artery ◽

Carotid Stenosis ◽

Carotid Artery Stenosis ◽

Artery Stenosis ◽

Current Evidence ◽

Asymptomatic Carotid Stenosis ◽

Asymptomatic Carotid ◽

Risk Of Death ◽

Asymptomatic Patients

Background: Carotid artery stenosis is an important cause for stroke. Carotid endarterectomy (CEA) reduces the risk of stroke in patients with symptomatic carotid stenosis and to some extent in patients with asymptomatic carotid stenosis. More than 20 years ago, carotid artery stenting (CAS) emerged as an endovascular treatment alternative to CEA. Objective and Methods: This review summarises the available evidence from randomised clinical trials in patients with symptomatic as well as in patients with asymptomatic carotid stenosis. Results: CAS is associated with a higher risk of death or any stroke between randomisation and 30 days after treatment than CEA (odds ratio (OR) = 1.74, 95% CI 1.3 to 2.33, p < 0.0001). In a pre-defined subgroup analysis, the OR for stroke or death within 30 days after treatment was 1.11 (95% CI 0.74 to 1.64) in patients <70 years old and 2.23 (95% CI 1.61 to 3.08) in patients ≥70 years old, resulting in a significant interaction between patient age and treatment modality (interaction p = 0.007). The combination of death or any stroke up to 30 days after treatment or ipsilateral stroke during follow-up also favoured CEA (OR = 1.51, 95% CI 1.24 to 1.85, p < 0.0001). In asymptomatic patients, there is a non-significant increase in death or stroke occurring within 30 days of treatment with CAS compared to CEA (OR = 1.72, 95% CI 1.00 to 2.97, p = 0.05). The risk of peri-procedural death or stroke or ipsilateral stroke during follow-up did not differ significantly between treatments (OR = 1.27, 95% CI 0.87 to 1.84, p = 0.22). Discussion and Conclusion: In symptomatic patients, randomised evidence has consistently shown CAS to be associated with a higher risk of stroke or death within 30 days of treatment than CEA. This extra risk is mostly attributed to an increase in strokes occurring on the day of the procedure in patients ≥70 years. In asymptomatic patients, there may be a small increase in the risk of stroke or death within 30 days of treatment with CAS compared to CEA, but the currently available evidence is insufficient and further data from ongoing randomised trials are needed.

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