Optimal Medical Management Reduces Risk of Disease Progression and Ischemic Events in Asymptomatic Carotid Stenosis Patients: A Long-Term Follow-Up Study

2017 ◽  
Vol 44 (3-4) ◽  
pp. 150-159 ◽  
Author(s):  
Zubair Shah ◽  
Reza Masoomi ◽  
Rashmi Thapa ◽  
Mashhood Wani ◽  
John Chen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Carotid Artery ◽  
Carotid Stenosis ◽  
Medical Management ◽  
Carotid Artery Stenosis ◽  
Univariate Analysis ◽  
Artery Stenosis ◽  
Asymptomatic Carotid ◽  
Optimal Medical Management

Background and Purpose: To assess the effect of optimal medical management including atherosclerotic risk factor control on ischemic stroke (IS), transient ischemic attack (TIA), carotid revascularization (CRV), and progression of severity of carotid stenosis (PSCS) in patients with asymptomatic carotid artery stenosis (ACAS). Methods: We conducted a retrospective analysis of patients with ACAS (who had at least 3 serial carotid duplex ultrasounds) for incidence of IS, TIA, and PSCS. Results: Eight hundred sixty-four patients with a mean follow-up duration of 79 ± 36 months were included. IS/TIA and CRV occurred in 12.2% of the patients and PCSS was observed in 21.5% vessels. On univariate analysis it was found that low-density lipoprotein (LDL) levels >100 mg/dL, no statin or low-potency statins, average systolic blood pressure (SBP) ≥140 mm Hg and/or diastolic blood pressure (DBP) ≥90 mm Hg and history of smoking were predictors of the combined endpoint of IS/TIA/CRV and PSCS. On multivariate analysis, it was found that LDL >100 mg/dL, no statin or low-potency statin, SBP ≥140 mm Hg and/or DBP ≥90 mm Hg, and Hx of smoking were independent predictors of PSCS. Similarly no statin or low-potency statin, SBP ≥140 mm Hg and/or DBP ≥90 mm Hg, Hx of atrial fibrillation/flutter, Hx of chronic kidney disease, and PSCS were independent predictors of IS/TIA. No statin or low-potency statin, SBP ≥140 mm Hg and/or DBP ≥90 mm Hg, diabetes mellitus, baseline carotid artery stenosis ≥70%, and PSCS were found to be independent predictors of combined endpoint IS/TIA and CRV. Conclusion: Intensive medical therapy in the patients with ACAS results in lower incidence of IS/TIA, CRV, and PSCS with a significant incremental beneficial effect.

scholarly journals Carotid artery stenosis – Current evidence and treatment recommendations

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.

Prevalence and risk factors of asymptomatic carotid artery stenosis in Indian population: An 8-year follow-up study

2017 ◽  
Vol 65 (2) ◽  
pp. 279 ◽  
Author(s):  
Subhash Kaul ◽  
Suvarna Alladi ◽  
KRukmini Mridula ◽  
V C SSrinivasarao Bandaru ◽  
Matapathi Umamashesh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Indian Population ◽  
Artery Stenosis ◽  
Asymptomatic Carotid ◽  
Follow Up Study ◽  
Asymptomatic Carotid Artery Stenosis

Stenting versus Endarterectomy for Treatment of Carotid-Artery Stenosis

2017 ◽  
Author(s):  
Clint S. Schoolfield ◽  
Wayne W. Zhang ◽  
Tze-Woei Tan
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Perioperative Period ◽  
Artery Stenosis ◽  
Asymptomatic Carotid ◽  
Asymptomatic Patients ◽  
Increased Risk ◽  
Asymptomatic Carotid Artery Stenosis ◽  
Study Intervention

This chapter provides a summary of the landmark CREST study that compared carotid endarterectomy (CEA) and carotid artery stenting (CAS) for patients with symptomatic or asymptomatic carotid artery stenosis. The study found that the combined overall rate of stroke, myocardial infarction (MI) or death between CEA and CAS did not differ significantly in symptomatic or asymptomatic patients. However, during the perioperative period, CAS was associated with an increased risk of stroke and CEA was associated with an increased risk of MI. The chapter describes the basics of the study, including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a relevant clinical case.

Efficacy of Contemporary Medical Management for Asymptomatic Carotid Artery Stenosis

2013 ◽  
Vol 79 (10) ◽  
pp. 987-991
Author(s):  
Jason Chang ◽  
Joseph E. Ahn ◽  
Nicholas Landsman ◽  
Katherine Rhee ◽  
Linda Chun ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Medical Management ◽  
Carotid Artery Stenosis ◽  
Stroke Prevention ◽  
International Classification Of Diseases ◽  
Artery Stenosis ◽  
Published Data ◽  
Asymptomatic Carotid ◽  
Kaiser Permanente ◽  
Asymptomatic Carotid Artery Stenosis

In the Asymptomatic Carotid Artery Stenosis trial (1995), medical management was defined as aspirin in addition to adequate control of comorbidities. Since then, medical management of asymptomatic carotid artery stenosis (CAS) has progressed to include broader use of statins. Our purpose was to review the effect of contemporary medical management on stroke prevention. A retrospective review of the Kaiser Permanente, Southern California medical group database was performed. All patients with a diagnosis of asymptomatic CAS by International Classification of Diseases, 9th Revision codes from 2007 to 2011 were identified. Intervention for stroke prevention was the criteria for exclusion. Medications used were evaluated as was the rate of stroke. Asymptomatic CAS was noted in 7255 patients. Of these, 158 (2.2%) sustained a stroke within a mean follow-up of 37 months. Patients who were taking a statin had a statistically significant lower risk of stroke (1.6 vs 3.9%). The data support that contemporary medical management of asymptomatic CAS has decreased the incidence of stroke in comparison to previously published data. The use of statins was protective against the development of stroke. Future prospective randomized trials are needed to evaluate the efficacy of carotid intervention versus current medical management.

scholarly journals Impairments in Brain Perfusion, Metabolites, Functional Connectivity, and Cognition in Severe Asymptomatic Carotid Stenosis Patients: An Integrated MRI Study

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Tao Wang ◽  
Feng Xiao ◽  
Guangyao Wu ◽  
Jian Fang ◽  
Zhenmeng Sun ◽  
...  
Keyword(s):  
Executive Function ◽  
Carotid Artery ◽  
Carotid Stenosis ◽  
Carotid Artery Stenosis ◽  
Anterior Part ◽  
Brain Perfusion ◽  
Posterior Cingulate Cortex ◽  
Artery Stenosis ◽  
Asymptomatic Carotid Stenosis ◽  
Asymptomatic Carotid

Carotid artery stenosis without transient ischemic attack (TIA) or stroke is considered as “asymptomatic.” However, recent studies have demonstrated that these asymptomatic carotid artery stenosis (aCAS) patients had cognitive impairment in tests of executive function, psychomotor speed, and memory, indicating that “asymptomatic” carotid stenosis may not be truly asymptomatic. In this study, when 19 aCAS patients compared with 24 healthy controls, aCAS patients showed significantly poorer performance on global cognition, memory, and executive function. By utilizing an integrated MRI including pulsed arterial spin labeling (pASL) MRI, Proton MR Spectroscopy (MRS), and resting-state functional MRI (R-fMRI), we also found that aCAS patients suffered decreased cerebral blood flow (CBF) mainly in the Left Frontal Gyrus and had decreased NAA/Cr ratio in the left hippocampus and decreased connectivity to the posterior cingulate cortex (PCC) in the anterior part of default mode network (DMN).

scholarly journals Comparison of different carotid stent designs in endovascular therapy of severe carotid artery stenosis

2020 ◽  
Vol 4 (1) ◽  
pp. 2514183X2093241
Author(s):  
Philipp Gruber ◽  
Jatta Berberat ◽  
Timo Kahles ◽  
Javier Anon ◽  
Michael Diepers ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Stenosis ◽  
Carotid Artery Stenosis ◽  
Recurrent Stroke ◽  
Artery Stenosis ◽  
High Grade ◽  
Carotid Stent ◽  
Asymptomatic Carotid ◽  
Stent System ◽  
Elective Patients

Background: One of the major periprocedural risks of carotid artery stenting is embolism caused either by plaque debris or by local thrombus forming. Double-layer micromesh stent design has shown to lower the chance of debris embolism but might have a slightly higher risk of local thrombus forming. Thus, we compared two different stent designs regarding safety and outcome profile in elective patients with high-grade carotid artery stenosis using a self-expanding, double-layer micromesh carotid stent system (DLCS) or a self-expanding hybrid carotid stent system (HCS). Methods: A single-center, open-label, retrospective cohort study of 67 consecutive, elective patients with high-grade symptomatic and asymptomatic carotid stenosis was executed at a comprehensive stroke center. Outcome measures were reocclusion rate, periprocedural symptomatic ischemic events, as well as other periprocedural complications, and recurrent stroke and mortality at 30 days’ follow-up. Results: Thirty-two patients (24% women, median age 75 years (interquartile range (IQR) 71–80) were treated with DLCS, and 35 patients (29% women, median age 71 years (IQR 63–76) years) with HCS. In both groups, pretreatment carotid stenosis degree was similar (median NASCET of 80%). Successful deployment was achieved in all cases without technical failure, and both groups did not differ in reocclusion rates, recurrent stroke, and mortality within 30 days. Conclusions: DCLS and HCS revealed to have similar safety and outcome profile in elective patients with high-grade symptomatic as well as asymptomatic carotid artery stenosis.

scholarly journals Cognitive function and carotid stenosis: review of the literature

2012 ◽  
Vol 6 (3) ◽  
pp. 127-130 ◽  
Author(s):  
Aurélio Pimenta Dutra
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Function ◽  
Carotid Artery ◽  
Carotid Stenosis ◽  
Carotid Artery Stenosis ◽  
Internal Carotid ◽  
Artery Stenosis ◽  
Asymptomatic Carotid ◽  
Asymptomatic Carotid Artery Stenosis ◽  
The Relationship

ABSTRACT Stroke is a known cause of cognitive impairment but the relationship between asymptomatic carotid artery stenosis and cognitive function is not clear. The main risk factors for vascular disease are also related to carotid stenosis and cognitive impairment. The association of high-grade stenosis of the internal carotid artery with cognitive impairment is related to silent embolization and hypoperfusion, but it may also be present without evidence of infarction on magnetic resonance imaging. Carotid stenosis treatment may lead to a decline in cognitive function due to complications related to the procedures (endarterectomy or stenting). On the other hand, reperfusion may improve cognitive impairment. The best treatment choice is unclear, considering possible deterioration of cognitive function related to carotid artery stenosis. There is insufficient evidence to consider cognitive impairment an important factor in determining the therapy for carotid stenosis.

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