Cerebral Hemodynamics in Symptomatic and Asymptomatic Patients with Severe Unilateral Carotid Stenosis before and after Carotid Endarterectomy

Purpose. Carotid endarterectomy (CEA) is considered an effective therapeutic method for improving ocular circulation. The choroid is a predominantly vascular tissue; thus, systemic and local vascular alterations may influence its morphology and function. The aim of the current study was to analyse changes in choroidal thickness and volume in patients with significant internal carotid artery stenosis (ICAS) before and after unilateral CEA. Methods. The 42 eyes of the 21 asymptomatic patients included in the study were divided into two groups: those ipsilateral (EIE) and those contralateral (ECE) to CEA. All participants underwent a complete ophthalmologic examination, including enhanced depth imaging-optical coherence tomography (EDI-OCT). A comparative analysis of subfoveal thickness (CT) and choroidal volume (CV) measured in nine Early Treatment of Diabetic Retinopathy Study (ETDRS) subfields at baseline, on the 2nd day after CEA, and in the 3rd month after CEA was performed. Results. In the EIE and ECE groups, no significant differences in either CT or CV values before and on the 2nd day after the CEA were observed. In the EIE group, a significant increase in CT and CV in the 3rd month after CEA compared to baseline was noted in the specific ETDRS region. Changes in CT and CV after surgery were positively correlated with the participants’ physical activity status and diastolic blood pressure and negatively correlated with the participants’ age and smoking status. Additionally, the analysis of changes in CV after CEA showed a positive correlation between the EIE and ECE groups. Conclusions. CT and CV fluctuations in the central and perifoveal areas visualized with EDI-OCT enabled the observation of the processes of tissue adaptation to variable blood flow conditions.

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Cognitive Performance following Carotid Endarterectomy or Stenting in Asymptomatic Patients with Severe ICA Stenosis

Cardiovascular Psychiatry and Neurology ◽

10.1155/2013/342571 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 13

Author(s):

Livio Picchetto ◽

Gianfranco Spalletta ◽

Barbara Casolla ◽

Claudia Cacciari ◽

Michele Cavallari ◽

...

Keyword(s):

Carotid Stenosis ◽

Cognitive Functions ◽

Verbal Fluency ◽

Stroke Risk ◽

Brain Functions ◽

Immediate Recall ◽

Asymptomatic Patients ◽

Before And After ◽

Overall Performance ◽

Ica Stenosis

Background. Endarterectomy (CEA) or stenting (CAS) of a stenotic carotid artery is currently undertaken to reduce stroke risk. In addition removal of the arterial narrowing has been hypothesized to improve cerebral hemodynamics and provide benefits in cognitive functions, by supposedly resolving a “hypoperfusion” condition. Methods. In this study we sought to test whether resolution of a carotid stenosis is followed by measurable changes in cognitive functions in 22 subjects with “asymptomatic” stenosis. Results. A main finding of the study was the statistically significant pre-post difference observed in the performance of phonological verbal fluency and Rey’s 15-word immediate recall. Remarkably, there was a significant interaction between phonological verbal fluency performance and side of the carotid intervention, as the improvement in the verbal performance, a typical “lateralized” skill, was associated with resolution of the left carotid stenosis. Conclusion. The results reflect a substantial equivalence of the overall performance at the before- and after- CEA or CAS tests. In two domains, however, the postintervention performance resulted improved. The findings support the hypothesis that recanalization of a stenotic carotid could improve brain functions by resolving hypothetical “hypoperfusion” states, associated with the narrowing of the vessels.

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The prognostic value of the serum inflammatory biomarkers in patients with carotid atherosclerosis

EUREKA Health Sciences ◽

10.21303/2504-5679.2021.001969 ◽

2021 ◽

pp. 26-33

Author(s):

Olga Dubenko ◽

Tetyana Litovchenko ◽

Victoria Anysienkova ◽

Maryna Nessonova ◽

Liudmyla Kovalenko

Keyword(s):

Ischemic Stroke ◽

Carotid Endarterectomy ◽

Carotid Stenosis ◽

Prognostic Value ◽

Enzyme Linked Immunosorbent Assay ◽

Control Group ◽

Operating Characteristics ◽

Asymptomatic Group ◽

Logistic Regression Models ◽

Asymptomatic Patients

20 % of ischemic stroke appear to originate from carotid artery atherosclerotic disease. Serum biomarkers reflecting the activity of atherosclerotic process and may help for estimate risk of acute cerebrovascular events. Several serum inflammatory markers have been proposed for risk assessment, but their prognostic role less known. The aim of this study is to clarify the prognostic value of biomarkers of atherosclerosis lipoprotein-associated phospholipase A2 (Lp-PLA2) and E-selectin in patients with symptomatic and asymptomatic carotid stenosis. Materials and methods. The study involved 106 patients with atherosclerotic carotid stenosis >50 % (74 men and 32 women, mean age 62.6±0.9) from which 76 symptomatic (35 with acute ipsilateral atherothrombotic stroke and 41 after carotid endarterectomy) and 30 asymptomatic patients. The control group consisted of age- and sex-matched 20 healthy subjects. The level of serum Lp-PLA2 and E-selectin was determined using a commercially available enzyme-linked immunosorbent assay kit. Results. The level of Lp-PLA 2 was in general significantly higher (p<0.05) in patients groups than in the control group and most high Lp-PLA2 concentration was in groups of symptomatic patients who underwent carotid endarterectomy. The level of E-selectin in the study patients was significantly higher than in the control group (p<0.05). The correlation of Lp-PLA 2 with E-selectin was significant for total patients (R=0.365664, p=0.00085) and group after carotid endarterectomy (R=0.429143, p=0.01796), but not for asymptomatic group (p>0.05). Receiver Operating Characteristics curves of logistic regression models which takes into joint both indicators was specificity and sensitive for predicting the occurrence of ischemic stroke. Conclusion. Conducted study show that the levels of Lp-PLA 2 and E-selectin have a significant impact on the development of stroke in patients with atherosclerotic carotid stenosis and can be used to predict it. A multidimensional model of the dependence of the probability of stroke on a linear combination of Lp-PLA 2 and E-selectin allows to obtaining significantly higher characteristics of the accuracy of stroke prediction than models with each factor alone.

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Is Carotid Endarterectomy Effective and Safe in Asymptomatic Patients with Carotid Stenosis?

Neuroepidemiology ◽

10.1159/000068749 ◽

2003 ◽

Vol 22 (2) ◽

pp. 153-154

Author(s):

Cristina Cusi ◽

Livia Candelise

Keyword(s):

Carotid Endarterectomy ◽

Carotid Stenosis ◽

Asymptomatic Patients

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Early results of carotid endarterectomy versus carotid stenting: Outcomes from a Mediterranean country

Vascular ◽

10.1177/1708538119841451 ◽

2019 ◽

Vol 27 (5) ◽

pp. 468-474

Author(s):

Ricardo Castro-Ferreira ◽

Alberto Freitas ◽

Sérgio M Sampaio ◽

Paulo G Dias ◽

Armando Mansilha ◽

...

Keyword(s):

Carotid Artery ◽

Hospital Mortality ◽

Carotid Endarterectomy ◽

Carotid Stenosis ◽

Carotid Artery Stenting ◽

Public Hospitals ◽

Hospital Length Of Stay ◽

Mediterranean Country ◽

Main Diagnosis ◽

Asymptomatic Patients

Introduction and objectives Which is the best carotid stenosis treatment remains a controversial issue. To present day, no study has compared the results of carotid artery stenting versus carotid endarterectomy in Portugal. We aim to provide real life numbers regarding the outcomes of both procedures in Portuguese public hospitals. Methods Every patient registered between 2005 and 2015 with the main diagnosis of carotid stenosis and submitted to carotid endarterectomy or carotid artery stenting was included. The information was obtained through the Central National Healthcare Administrative database, a mandatory registry for hospital refunding. Primary outcomes were hospital mortality and stroke. Patient demographics, comorbidities and hospital length of stay were also evaluated. Results The study included 6094 patients: 1399 were symptomatic (mention of prior stroke) and 4695 asymptomatic. Carotid artery stenting was performed on 22% of the symptomatic and 18% of the asymptomatic patients. In the symptomatic patients, the in-hospital mortality was significantly higher in those submitted to stenting (3.6% vs. 1.6% in carotid endarterectomy, p = 0.025). No significant differences in outcomes were observed in the asymptomatic group (mortality 0.9% vs. 0.8%, p = 0.852; stroke rate of 2.6% vs. 2.3%, p = 0.652 – carotid artery stenting vs. carotid endarterectomy). In both groups, there was an important increase in the proportion of stenting between 2005 and 2012, followed by a gradual decline until 2015. Conclusion Despite its increasing frequency, a higher early mortality was documented for CAS in symptomatic patients. No worse outcome was observed in asymptomatic patients.

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Cerebral hemodynamics in asymptomatic and symptomatic patients with high-grade carotid stenosis undergoing carotid endarterectomy

Journal of Vascular Surgery ◽

10.1016/j.jvs.2003.11.013 ◽

2004 ◽

Vol 39 (1) ◽

pp. 273-274

Keyword(s):

Carotid Endarterectomy ◽

Carotid Stenosis ◽

Cerebral Hemodynamics ◽

High Grade

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Ultrasonografic monitoring of hemodynamic parameters in symptomatic and asymptomatic patients with high-grade carotid stenosis prior and following carotid endarterectomy

Vojnosanitetski pregled ◽

10.2298/vsp1205399m ◽

2012 ◽

Vol 69 (5) ◽

pp. 399-404 ◽

Cited By ~ 1

Author(s):

Anka Mitrasinovic ◽

Jovo Kolar ◽

Sandra Radak ◽

Dragoslav Nenezic ◽

Ivana Kupresanin ◽

...

Keyword(s):

Blood Flow ◽

Carotid Endarterectomy ◽

Carotid Stenosis ◽

Diagnostic Tool ◽

Doppler Ultrasonography ◽

Resistance Index ◽

Peak Systolic Velocity ◽

Hemodynamic Parameters ◽

Diagnostic Modality ◽

Asymptomatic Patients

Background/Aim. Doppler ultrasonography is now a reliable diagnostic tool for noninvasive examination of the morphology and hemodynamic parameters of extracranial segments of blood vessels that participate in the brain vascularisation. This diagnostic modality in recent years become the only diagnostic tool prior to surgery. The aim of the study was to determine hemodynamic status in symptomatic and asymtomatic patients with severe carotid stenosis prior to and after carotid endarterectomy (CEA). Methods. A total of 124 symptomatic and 94 asymptomatic patients who had underwent CEA at the Clinic for Cardiovasculare Disease ?Dedinje? in Belgrade were included in this study. Doppler ultrasonography examinations were performed one day before CEA and seven days after it. The peak systolic velocity (PSV), end-dyastolic velocity (EDV), time-averaged maximum blood flow velocity (MV), resistance index (RI) and the blood flow volume (BFV) of the ipsilateral and the contralateral internal carotid artery (ICA) were measured. Results. Diabetes was the only risk factor found significantly more frequent in symptomatic patients. There were significantly more occluded contralateral ICAs in the group of symptomatic patients. There was a significant increase in PSV, EDV, MV and BFV of the ipsilateral ICA after CEA and a significant decrease in PSV, EDV, MV and BFV of the contralateral ICA after CEA. RI is the only hemodynamic parameter without significant changes after CEA in both groups of patients. Comparing the values of hemodynamic parameters after CEA between the group of symptomatic and the group of asymptomatic patients no significant differences were found. Conclusion. The occlusion of the contralateral ICA is an important factor differentiating between symptomatic and asymptomatic patients with severe carotid stenosis. Successful surgery provides good recovery of cerebral hemodynamics in both symtomatic and asymptomatic patients.

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