scholarly journals Carotid Revascularization Improves Balance and Mobility, Particularly in Patients That Are Most Impaired

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 117-118
Author(s):  
Vicki Gray ◽  
Sarasijhaa Desikan ◽  
Amir Khan ◽  
Dawn Barth ◽  
Siddhartha Sikdar ◽  
...  
Keyword(s):  
Blood Flow ◽  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
Step Test ◽  
High Grade ◽  
Timed Up And Go ◽  
Carotid Revascularization ◽  
The Impact ◽  
The Brain

Abstract Balance and mobility function worsen with age, and more so for those with underlying diseases. Our research has demonstrated that asymptomatic carotid artery stenosis (ACAS) is associated with worse balance and mobility, and a higher fall risk, compared to older adults with similar comorbidities, but without ACAS. Thus, ACAS, with attendant blood flow-restriction to the brain is a potentially modifiable risk factor for balance and mobility dysfunction. The purpose of this study was to evaluate the impact of restoring blood flow to the brain by carotid revascularization, on balance and mobility in patients with high-grade ACAS (≥70% diameter-reducing stenosis). Twenty adults (67.0±9.4 years) undergoing carotid revascularization for high-grade stenosis were enrolled. A balance and mobility assessment was performed before- and six weeks- after carotid revascularization and included: Short Physical Performance Battery (SPPB), Berg Balance Scale (BBS), Four Square Step Test (FSST), Dynamic Gait Index (DGI) Timed Up and Go (TUG), gait speed, MiniBESTest, and Walk While Talk (WWT) test. Paired t-tests assessed changes in outcome measures between the two-time points. Significant improvements were observed in measures that combined walking with dynamic movements, DGI (P=0.003), and MiniBESTest (P=0.021). Pearson’s correlations examined the relationship between balance and mobility before surgery and change score after surgery. Patients with lower baseline DGI and MiniBest scores demonstrated the most improvement on follow-up testing (r=-0.70, p=0.001, and r=-0.59, p=0.006, respectively). In conclusion, revascularization of a carotid artery stenosis improves balance and mobility; the greatest improvements are observed in those patients that are the most impaired.

Intracranial Blood Flow Changes in Patients with High-Grade Severe Carotid Artery Stenosis After Stenting

2017 ◽  
Vol 104 ◽  
pp. 863-868 ◽  
Author(s):  
Lei Huang ◽  
Wenjie Cao ◽  
Liang Ge ◽  
Gang Lu ◽  
Xiaolong Zhang ◽  
...  
Keyword(s):  
Blood Flow ◽  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
High Grade ◽  
Flow Changes

Association between Pre-Existing Coronary Artery Disease and 5-Year Mortality in Stroke Patients with High-Grade Carotid Artery Stenosis

2020 ◽  
pp. 1-7
Author(s):  
Ching-I Wu ◽  
Chia-Lun Wu ◽  
Feng-Chieh Su ◽  
Shun-Wen Lin ◽  
Wen-Yi Huang
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Significant Risk ◽  
Cox Proportional Hazards Model ◽  
Artery Stenosis ◽  
High Grade ◽  
Increased Risk ◽  
Artery Disease

<b><i>Background:</i></b> The coincidence of coronary artery disease (CAD) and carotid artery stenosis (CAS) was observed. However, the association between pre-existing CAD and ischemic stroke (IS) outcome in patients with high-grade CAS remains unclear. We aimed to investigate the association between pre-existing CAD and outcomes of acute IS patients with high-grade CAS. <b><i>Methods:</i></b> From January 1, 2007, to April 30, 2012, we enrolled 372 acute IS patients with high-grade CAS and prospectively observed them for 5 years. Demographic features, vascular risk factors, comorbidities, and outcomes were compared between patients with and without pre-existing CAD. <b><i>Results:</i></b> Among 372 individuals, 75 (20.2%) patients had pre-existing CAD and 297 (79.8%) patients did not have pre-existing CAD. The prevalence rates of hypertension, congestive heart failure, chronic kidney disease, and gout in patients with pre-existing CAD were significantly higher than in those without pre-existing CAD (<i>p</i> = 0.017, <i>p</i> &#x3c; 0.001, <i>p</i> = 0.002, and <i>p</i> &#x3c; 0.001, respectively). The multivariate Cox proportional hazards model revealed that pre-existing CAD was a significant risk factor for a 5-year all-cause mortality in acute IS patients with high-grade CAS (hazard ratio = 2.26; 95% confidence interval = 1.35–3.79; <i>p</i> = 0.002). <b><i>Conclusion:</i></b> Pre-existing CAD was associated with an increased risk of 5-year mortality in acute IS patients with high-grade CAS. Intensive treatment for the pre-existing CAD may reduce long-term mortality in acute IS patients with high-grade CAS.

scholarly journals Diagnostic dilemmas of multislice CT angiography in the evaluation of the degree of common carotid artery stenosis

2010 ◽  
Vol 138 (7-8) ◽  
pp. 494-497
Author(s):  
Dragoslav Nenezic ◽  
Slobodan Tanaskovic ◽  
Predrag Gajin ◽  
Nenad Ilijevski ◽  
Goran Vucurevic
Keyword(s):  
Carotid Artery ◽  
Ct Angiography ◽  
Common Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Soft Tissues ◽  
Multislice Ct ◽  
Diagnostic Procedures ◽  
Left Common Carotid Artery ◽  
Artery Stenosis ◽  
High Grade

Introduction. Multislice CT angiography (CTA) is a noninvasive and quick technique to image carotid artery stenosis, as well as intracerebral vasculature. Modern multidetector CTA produces images with a high resolution of, not only the contrast-filled lumen, but also of the vessel wall and the surrounding soft tissues. Multiple studies have verified the ability of CTA to provide an accurate representation of the degree of carotid stenosis in comparison to digital subtraction angiography, both for moderate and high-grade stenosis. Because of its fast and accurate vessel imaging, CT angiography is increasingly used in the assessment of carotid artery stenosis. Case Outline. A 37-year-old female patient was admitted at the Vascular Surgery Clinic of the Institute for Cardiovascular Diseases 'Dedinje', Belgrade, for angiography and endovascular procedure of a high-grade stenosis of the left common carotid artery based on Multislice CT findings brought by the patient. She complained of problems which we considered to be the result of cerebral circulation ischemia. After detailed diagnostic procedures, we concluded that no pathological lesions could be verified either on the left common carotid artery or other supraaortic branches. Therefore, the patient was discharged for further neurological examinations. Conclusion. Although Multislice CTA has many advantages over classical angiography, its validity should be taken with reserve, especially in younger patients.

Contralateral High-Grade Carotid Artery Stenosis or Occlusion Is Not Associated with Increased Risk for Poor Neurologic Outcome after Elective Carotid Stent Placement

Radiology ◽  
2004 ◽  
Vol 230 (1) ◽  
pp. 70-76 ◽  
Author(s):  
Schila Sabeti ◽  
Martin Schillinger ◽  
Wolfgang Mlekusch ◽  
Tassilo Nachtmann ◽  
Wilfried Lang ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Stent Placement ◽  
Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
Neurologic Outcome ◽  
High Grade ◽  
Carotid Stent ◽  
Increased Risk

Abstract WP167: Changing Face of Carotid Revascularization Procedures in the United States

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Saqib A Chaudhry ◽  
Iqra N Akhtar ◽  
Wei Huang ◽  
Ameer E Hassan ◽  
Mohammad Rauf A Chaudhry ◽  
...  
Keyword(s):  
United States ◽  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
The United States ◽  
Artery Stenosis ◽  
Teaching Hospitals ◽  
Trend Test ◽  
Carotid Revascularization ◽  
Asymptomatic Patients ◽  
Revascularization Procedures

Background: Carotid revascularization procedure, carotid endarterectomy (CEA) and carotid stent placement (CAS), are some of the most common procedures performed in United States and expected to change due to wider adoption of CAS. We performed this study to determine the changes in utilization of CEA and CAS in United States using nationally representative data. Methods: We used the National Inpatient Sample (NIS) from 2005 to 2014 to assess the changes in utilization of CEA and CAS over last 10 years in patients with symptomatic and asymptomatic carotid artery stenosis. NIS is the largest all payer dataset that includes diagnoses, admissions and discharge, demographics, and outcomes data of patients admitted to short stay non-Federal hospitals in the United States. We analyzed patterns of changes in utilization in various subsets of patients with carotid artery stenosis. Results: A total of 1,186,182 patients underwent carotid revascularization procedures during study period; 1,032,148 (87.1%) and 154,035 (12.9%) were CEA and CAS, respectively. The overall carotid revascularization procedures decreased over last 10 years (11.1% in 2005 to 8.4%in 2014, trend test p <.0001). Carotid revascularization in symptomatic patients increased (7.64% in 2005 to 11.01% in 2014, trend test p <.0001) while it decreased in asymptomatic patients (92.36% in 2006 to 88.99% in 2014, trend test p <.0001). There was an overall decrease in CEA (11.6% in 2005 to 8.3% in 2014, trend test <.0001) while in CAS remained unchanged (8.1% in 2005 to 8.9% in 2014, p=NS). There was an increase in carotid revascularization in teaching hospitals (40.9% in 2005 to 67.1% in 2014, trend test p <.0001) while decrease in non-teaching hospitals (50.9% in 2006 to 27.1% in 2014, trend test p <.0001). There was a decrease in carotid revascularization procedures in patients aged ≥80 years (19.8% in 2005 to 18.7% in 2014, trend test p <.0001) and CEA (19.6% in 2006 to 18.8% in 2014, trend test P<.0001) and CAS (21.2% in 2006 to 18.6% in 2014, trend test p=<.0001). Conclusion: Although CAS is increasing in a disproportionate manner within patient subgroups in United States, overall carotid revascularization procedures have decreased for unclear reasons.

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