scholarly journals ABCD2 risk score does not predict the presence of cerebral microemboli in patients with hyper-acute symptomatic critical carotid artery stenosis

2017 ◽  
Vol 2 (2) ◽  
pp. 41-46 ◽  
Author(s):  
Mahmud Saedon ◽  
Charles E Hutchinson ◽  
Christopher H E Imray ◽  
Donald R J Singer
Keyword(s):  
Carotid Artery ◽  
Risk Score ◽  
Carotid Artery Stenosis ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Artery Stenosis ◽  
Minor Stroke ◽  
Early Assessment ◽  
Symptomatic Carotid ◽  
Significant Difference

IntroductionABCD2 risk score and cerebral microemboli detected by transcranial Doppler (TCD) have been separately shown to the predict risk of recurrent acute stroke. We studied whether ABCD2 risk score predicts cerebral microemboli in patients with hyper-acute symptomatic carotid artery stenosis.Participants and methodsWe studied 206 patients presenting within 2 weeks of transient ischaemic attack or minor stroke and found to have critical carotid artery stenosis (≥50%). 86 patients (age 70±1 (SEM: years), 58 men, 83 Caucasian) had evidence of microemboli; 72 (84%) of these underwent carotid endarterectomy (CEA). 120 patients (age 72±1 years, 91 men, 113 Caucasian) did not have microemboli detected; 102 (85%) of these underwent CEA. Data were analysed using X2 and Mann–Whitney U tests and receiver operating characteristic (ROC) curves.Results140/206 (68%: 95% CI 61.63 to 74.37) patients with hyper-acute symptomatic critical carotid stenosis had an ABCD2 risk score ≥4. There was no significant difference in the NICE red flag criterion for early assessment (ABCD2 risk score ≥4) for patients with cerebral microemboli versus those without microemboli (59/86 vs 81/120 patients: OR 1.05 ABCD2 risk score ≥4 (95% CI 0.58 to 1.90, p=0.867)). The ABCD2 risk score was <4 in 27 of 86 (31%: 95% CI 21 to 41) embolising patients and in 39 of 120 (31%: 95% CI 23 to 39) without cerebral microemboli. After adjusting for pre-neurological event antiplatelet treatment (APT), area under the curve (AUC) of ROC for ABCD2 risk score showed no prediction of cerebral microemboli (no pre-event APT, n=57: AUC 0.45 (95% CI 0.29 to 0.60, p=0.531); pre-event APT, n=147: AUC 0.51 (95% CI 0.42 to 0.60, p=0.804)).ConclusionsThe ABCD2 score did not predict the presence of cerebral microemboli or carotid disease in over one-quarter of patients with symptomatic critical carotid artery stenosis. On the basis of NICE guidelines (refer early if ABCD2 ≥4), assessment of high stroke risk based on ABCD2 scoring may lead to inappropriate delay in urgent treatment in many patients.

Mycophenolate mofetil attenuates plaque inflammation in patients with symptomatic carotid artery stenosis

2010 ◽  
Vol 211 (1) ◽  
pp. 231-236 ◽  
Author(s):  
Sander I. van Leuven ◽  
Diederik F. van Wijk ◽  
Oscar L. Volger ◽  
Jean-Paul P.M. de Vries ◽  
Chris M. van der Loos ◽  
...  
Keyword(s):  
Mycophenolate Mofetil ◽  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
Symptomatic Carotid ◽  
Plaque Inflammation

Abstract 16464: Coronary Artery Calcium Score and Incidence of Clinically Significant Carotid Stenosis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Aditya Singh ◽  
Tom Stys ◽  
Valerie Bares ◽  
Jeffrey Wilson ◽  
Adam Stys
Keyword(s):  
Coronary Artery ◽  
Carotid Artery ◽  
Carotid Stenosis ◽  
Coronary Artery Calcium ◽  
Carotid Artery Stenosis ◽  
Coronary Artery Calcium Score ◽  
Calcium Score ◽  
Artery Stenosis ◽  
Plaque Burden ◽  
Significant Difference

Introduction: Coronary artery calcium (CAC) has been found to be associated with coronary artery plaque burden and is a major predictor of coronary heart disease (CHD) events. The data on its role in predicting carotid artery stenosis (CAS) is limited. Methods: Participants age ≥ 18 years with heart screen done from Nov 2008- Feb 2019 were selected and were assessed for documented diagnosis of carotid artery stenosis after their heart screen. Only the most recent heart screen per person and earliest documented CAS was considered. The chi-squared test and Welch’s 2-sample t-test was used to test for significant association between CAS and the nominal variables and mean calcium score respectively. Results: A total of 35,084 patient were screened for CAC score and 1439 (4.1%), were recorded to have a diagnosis of carotid artery stenosis. 53.5% being females and mean age of 63.69±9.31 years. The mean time between heart screen and documented diagnosis of CAS was 1529.4 ± 1211.0 days. The presence of CAS was significantly higher in patients ≥ 60 years (8.5%) as compared to those age <60 years (2%). There was a significant difference in mean CAC score between those with CAS as compared to non- carotid stenosis group (324.2, vs 107.27, p<.0001). In patient with elevated CAC ≥ 100, 9.98% had diagnosis of CAS, as compared to 2.82% in patients with CAC <100, however among patients with diagnosis of CAS 46.6% had elevated CAC ≥ 100. Conclusions: The presence of carotid artery stenosis (CAS) was significantly associated with elevated coronary artery calcium score (≥100) and was significantly higher in patients with age ≥ 60 years, which in correct clinical context is helpful in suspecting CAS.

Abstract 2509: Standardized Reports Are Needed To Describe Carotid Artery Stenosis

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Eric Cheng ◽  
Salomeh Keyhani ◽  
Susan Ofner ◽  
Linda Williams ◽  
Dawn Bravata
Keyword(s):  
Decision Making ◽  
Clinical Trials ◽  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Diagnostic Tests ◽  
Artery Stenosis ◽  
Fiscal Year ◽  
Symptomatic Carotid ◽  
Imaging Results ◽  
Exact Degree

Background: Landmark clinical trials have shown that carotid procedures can greatly reduce the risk of stroke in persons with symptomatic carotid artery stenosis between 70 and 99% and can somewhat reduce the risk of stroke in persons with symptomatic carotid stenosis between 50 and 69%. Guidelines have recommended that results from carotid artery imaging tests be presented in these ranges to facilitate decision-making. We sought to determine how carotid imaging results were reported across Veterans Administration (VA) facilities. Methods: Carotid artery imaging results were obtained as part of a comprehensive chart review of veterans hospitalized with ischemic stroke at 127 VA hospitals in fiscal year 2007. Abstractors recorded the results of carotid ultrasound, MR angiography, CT angiography, or catheter angiography performed in the twelve months prior to admission to six months after admission. We excluded carotid artery imaging reports with results of “no stenosis”, “mild stenosis”, exact degree of stenosis <50%, or any range of stenosis <50% to focus on those reports that would likely inform decisions about carotid procedures. The unit of analysis was the carotid artery. We described how often the results were presented as an exact degree (such as 60%), as a range (such as 50 to 69%), or as a descriptive category (“moderate” or “severe” stenosis). For results described as a range, we examined how often it matched those used in landmark trials. Results: Of 6527 results of carotid artery imaging, there were 1315 results of greater than 50% or at least “moderate stenosis” (see Table ). Only 234 of the reports used a range to describe the stenosis; among this set, only 55 of the reports used a 50-69% or 70-99% range to describe the stenosis. Conclusions: In this national healthcare system, significant carotid artery stenosis was rarely reported in a way that exactly mapped onto recommendations from landmark clinical trials and guidelines. Clinicians who order these diagnostic tests as well as clinicians who interpret these diagnostic tests should collaborate to produce standardized reports that facilitate decision-making.

The Casper Stent System for carotid artery stenosis

2018 ◽  
Vol 10 (9) ◽  
pp. 869-873 ◽  
Author(s):  
Sebastian J Mutzenbach ◽  
Katharina Millesi ◽  
Cornelia Roesler ◽  
Erasmia Broussalis ◽  
Slaven Pikija ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Double Layer ◽  
Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
Minor Stroke ◽  
Technical Failure ◽  
Safety And Efficacy ◽  
Asymptomatic Patients ◽  
Proximal Internal Carotid Artery ◽  
Cerebral Mri

PurposeTo report the results of a retrospective analysis of prospectively collected data evaluating the safety and efficacy of a double layer stent engineered for carotid artery occlusive disease.MethodsBetween January 2014 and February 2017, 138 patients (25.4% women; median age 71 years) underwent Casper stent implantation for carotid artery stenosis. Eligibility criteria included stenosis >70% of vessel diameter (or >50% diameter with ulceration) in symptomatic patients or asymptomatic patients with >80% stenosis at the carotid bifurcation or in the proximal internal carotid artery. For all procedures, a distal embolic protection device was used. The primary endpoint was the rate of 90 day major adverse neurological events, defined as minor stroke, major stroke, or death by independent neurological assessment.ResultsStent deployment was completed successfully in all cases without documented technical failure. There were no adverse neurological events or mortalities within 90 days. One thromboembolic occlusion of a small distal branch of the anterior cerebral artery occurred during the procedure and resolved with systemic recombinant tissue plasminogen activator administration. New ischemic lesions, all clinically silent, were seen in 6.5% of patients on post-procedure cerebral MRI.ConclusionThe Casper carotid stent demonstrated safety and efficacy in the treatment of carotid stenosis, with no technical failures and no adverse neurological events seen throughout the 90 day follow-up period. Its double layer structure seems to combine adequate plaque scaffolding with high vessel adaptability.

scholarly journals Periprocedural Thromboembolic Events Associated with Angioplasty and Stenting of the Extra- and Intracranial Carotid Artery Assessed by Neurological Status and Diffusion-Weighted Magnetic Resonance Imaging (DWI)

2012 ◽  
Vol 2012 ◽  
pp. 1-7
Author(s):  
Frank Ahlhelm ◽  
Johanna Lieb ◽  
Stefan Ulmer ◽  
Dirk Ahlhelm ◽  
Wolfgang Reith
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Vessel Diameter ◽  
Internal Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
Thromboembolic Events ◽  
Intracranial Stenting ◽  
Symptomatic Carotid ◽  
Diffusion Weighted ◽  
Angioplasty And Stenting

Objective. The purpose of this study was to determine the frequency of thromboembolic events associated with angioplasty and stenting of the carotid artery with special regard to extra- or intracranial localization of stenosis. Methods. Twenty patients with symptomatic intracranial or extracranial internal carotid artery stenosis were treated with stenting and/or angioplasty. In 4 patients stenting was technically not feasible (all in the group with intracranial stenosis). All patients underwent diffusion-weighted imaging (DWI) and neurological examination within 48 hours before and after the procedure to detect periprocedural thrombembolic events. Results. Extracranial carotid angioplasty and stenting (eCAS) was technically feasible and successfull without procedure-related neurological complications in all cases. Intracranial stenting (iCAS) was not feasible in four cases including one patient with a fateful course. Concerning the restoration of the vessel diameter intracranial stenting was not as successful as eCAS, but more effective than balloon angioplasty alone. Incidence of thrombembolic events assessed by DWI was low. The detected periprocedural thrombembolic events were small and clinically silent. Conclusion. The risk of thromboembolic events during the endovascular treatment of symptomatic carotid artery stenosis was rather low for intra- and extracranial stenosis of the ICA in our patient sample, but one fatal course was observed.

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