Abstract 327: Diabetes Influences Carotid Artery Endarterectomy Plaque Lipidomics

2016 ◽  
Vol 36 (suppl_1) ◽  
Author(s):  
Mohamed A Zayed ◽  
Fong-Fu Hsu ◽  
Bruce W Patterson ◽  
Yan Yan ◽  
Uzma Naim ◽  
...  
Keyword(s):  
Arachidonic Acid ◽  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
Differentially Expressed ◽  
Diabetic Patients ◽  
Symptomatic Carotid ◽  
Asymptomatic Patients ◽  
Increased Risk

Nearly 20% of all ischemic strokes result from an atherosclerotic embolic source at the carotid arterial bifurcation. Patients with diabetes (DM) are at significantly increased risk of developing carotid artery stenosis, which predisposes to disabling strokes. Initial evidence suggests that carotid artery phospholipids are differentially expressed in patients with advanced atherosclerotic disease. However, it is unknown whether patients with DM and/or symptomatic carotid artery stenosis have unique carotid artery lipidomic profiles. To test this hypothesis, we performed a comprehensive analysis of phospholipid expression in carotid endarterectomy tissue harvested from a cohort of 18 patients (11 DM; 7 non-DM). Diabetic patients had a higher BMI (P=0.02), and increased use of b-blockers (P<0.01), but there was no difference in age, hyperlipidemia status, statin use, smoking incidence, severity of carotid stenosis, or carotid symptoms. Maximally (MAX) diseased carotid endarterectomy plaque segments at the carotid bifurcation were analyzed relative to correspondingly minimally (MIN) diseased distal internal carotid artery segments. Mass spectrometry-derived phospholipid absolute quantity profiles between MAX and MIN diseased carotid endarterectomy segments demonstrated significantly lower phosphatidylserine (PS; P<0.01), phosphatidylinositol (PI; P=0.03), and plasminogen phosphatidylethanolamine (pPE; P<0.01) phospholipids in MAX diseased segments. Paired analyses of MAX and MIN diseased segments revealed higher pPE in diabetic patients (P<0.01), and higher PI in non-diabetic and asymptomatic patients (P=0.03 and 0.05, respectively). The arachidonic acid-containing 1-(1Z-octadecenyl)-2-arachidonoyl- sn -glycero-3-phosphoethanolamine (pPE38:4) and 1-(1Z,9Z-octadecedienyl)-2-arachidonoyl- sn -glycero-3-phosphoethanolamine (pPE38:5) were the most highly (>109% increase) and differentially expressed phospholipids in the plaque segments of DM patients (P<0.01). These findings suggest that these pre-arachidonic acid phospholipids that affect plaque inflammation are more abundant in diseased carotid arteries of DM patients, which may influence disease progression and plaque vulnerability.

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.

scholarly journals Comparison of Carotid Artery Stenting and Carotid Endarterectomy in Patients with Symptomatic Carotid Artery Stenosis

2013 ◽  
Vol 62 (18) ◽  
pp. C236
Author(s):  
Hakan Muhammed Taş ◽  
Ziya Simsek ◽  
Abdurrahim Colak ◽  
Pınar Demir ◽  
Recep Demir ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Artery Stenosis ◽  
Carotid Artery Stenting ◽  
Artery Stenosis ◽  
Symptomatic Carotid

Carotid Artery Stenting May Be Losing the Battle against Carotid Endarterectomy for the Management of Symptomatic Carotid Artery Stenosis, But the Jury Is Still Out

Vascular ◽  
2009 ◽  
Vol 17 (4) ◽  
pp. 183-189 ◽  
Author(s):  
Kosmas I. Paraskevas ◽  
Dimitri P. Mikhailidis ◽  
Frank J. Veith
Keyword(s):  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Carotid Artery Stenosis ◽  
Carotid Artery Stenting ◽  
Artery Stenosis ◽  
Long Term Results ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis

Carotid artery stenting (CAS) has emerged as a potential alternative to carotid endarterectomy (CEA) for the management of carotid artery stenosis. The purpose of this article is to provide an evaluation and critical overview of the trials comparing the early and later results of CAS with CEA for symptomatic carotid stenosis. The Cochrane Controlled Trials Register, PubMed/Medline, and EMBASE databases were searched up to February 1, 2009, to identify trials comparing the long-term outcomes of CAS with CEA. The MeSH terms used were “carotid artery stenting,” “carotid endarterectomy,” “symptomatic carotid artery stenosis,” “treatment,” “clinical trial,” “randomized,” and “long-term results,” in various combinations. One single-center and three multicenter randomized studies reporting their long-term results from the comparison of CAS with CEA for symptomatic carotid stenosis were identified. All four studies independently reached the conclusion that CAS may not provide results equivalent to those of CEA for the management of symptomatic carotid stenosis. A higher incidence of recurrent stenosis and peri- and postprocedural events accounted for the inferior results reported for CAS compared with CEA. Current data from randomized studies indicate that CAS provides inferior long-term results compared with CEA for the management of symptomatic carotid artery stenosis. However, it can be argued that all of these trials were performed when both CAS equipment and CAS operators had not evolved to their current status. Given that current equipment and mature experience are required for CAS before comparing it with the current “gold standard” procedure (CEA), the results of soon-to-be reported trials (Carotid Revascularization Endarterectomy vs Stenting Trial [CREST], International Carotid Stenting Study [ICSS], or others) may alter the current impression that CAS is inferior to CEA for the treatment of symptomatic carotid stenosis.

scholarly journals Middle cerebral artery pulsatility index and cognitive improvement after carotid endarterectomy for symptomatic stenosis

2014 ◽  
Vol 120 (1) ◽  
pp. 126-131 ◽  
Author(s):  
Eric J. Heyer ◽  
Joanna L. Mergeche ◽  
E. Sander Connolly
Keyword(s):  
Carotid Artery ◽  
Middle Cerebral Artery ◽  
Carotid Endarterectomy ◽  
Cerebral Artery ◽  
Carotid Artery Stenosis ◽  
Pulsatility Index ◽  
Artery Stenosis ◽  
Symptomatic Carotid ◽  
Cognitive Improvement ◽  
Cerebral Resistance

Object Transcranial Doppler (TCD) is frequently used to evaluate peripheral cerebral resistance and cerebral blood flow (CBF) in the middle cerebral artery prior to and during carotid endarterectomy (CEA). Patients with symptomatic carotid artery stenosis may have reduced peripheral cerebral resistance to compensate for inadequate CBF. The authors aim to determine whether symptomatic patients with reduced peripheral cerebral resistance prior to CEA demonstrate increased CBF and cognitive improvement as early as 1 day after CEA. Methods Fifty-three patients with symptomatic CEA were included in this observational study. All patients underwent neuropsychometric evaluation 24 hours or less preoperatively and 1 day postoperatively. The MCA was evaluated using TCD for CBF mean velocity (MV) and pulsatility index (PI). Pulsatility index ≤ 0.80 was used as a cutoff for reduced peripheral cerebral resistance. Results Significantly more patients with baseline PI ≤ 0.80 exhibited cognitive improvement 1 day after CEA than those with PI > 0.80 (35.0% vs 6.1%, p = 0.007). Patients with cognitive improvement had a significantly greater increase in CBF MV than patients without cognitive improvement (13.4 ± 17.1 cm/sec vs 4.3 ± 9.9 cm/sec, p = 0.03). In multivariate regression model, a baseline PI ≤ 0.80 was significantly associated with increased odds of cognitive improvement (OR 7.32 [1.40–59.49], p = 0.02). Conclusions Symptomatic CEA patients with reduced peripheral cerebral resistance, measured as PI ≤ 0.80, are likely to have increased CBF and improved cognitive performance as early as 1 day after CEA for symptomatic carotid artery stenosis. Revascularization in this cohort may afford benefits beyond prevention of future stroke. Clinical trial registration no: NCT00597883 (ClinicalTrials.gov).

scholarly journals PS120. Outcomes After Early and Delayed Carotid Endarterectomy in Patients With Symptomatic Carotid Artery Stenosis

2014 ◽  
Vol 59 (6) ◽  
pp. 62S-63S
Author(s):  
Ying Huang ◽  
Peter Gloviczki ◽  
Audra A. Duncan ◽  
Manju Kalra ◽  
Gustavo S. Oderich ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
Symptomatic Carotid
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