Abstract 212: Factors Associated with Symptom Development in Asymptomatic Carotid Artery Stenosis: Multimodal Carotid and Perfusion Imaging Study

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Soonwook Kwon ◽  
Mi Ji Lee ◽  
Keon-Ha Kim ◽  
Pyoung Jeon ◽  
Young-wook Kim ◽  
...  
Keyword(s):  
White Matter ◽  
Carotid Stenosis ◽  
White Matter Hyperintensity ◽  
Symptom Development ◽  
Asymptomatic Carotid Stenosis ◽  
Asymptomatic Carotid ◽  
Deep White Matter ◽  
Symptomatic Carotid ◽  
Factors Associated ◽  
Symptomatic Carotid Stenosis

Background: The predictors of symptom development in asymptomatic carotid stenosis are still unclear. We sought to identify factors associated with symptom development in asymptomatic carotid stenosis using multimodal imaging technique. Methods: We retrospectively collected patients who had carotid artery revascularization procedures (carotid endarterectomy [CEA] or carotid artery stenting [CAS]) from April 2007 to May 2013. Patients who had event of cerebral ischemic stroke during 6 months before CEA or CAS were categorized as a symptomatic carotid stenosis. Results from carotid Duplex sonography, CT angiography, brain MRI and MRA, perfusion-weighted MRI (PWI), and demographic profiles were compared. Multivariate logistic regression analysis was performed to identify factors associated with symptom carotid stenosis. Results: A total of 684 patients (asymptomatic 58%, symptomatic 42%) with carotid stenosis more than 50% were included. The presence of ischemic heart diseases, peripheral artery occlusive disease and use of statin were higher in the asymptomatic carotid stenosis. On Duplex scan, ulceration, echolucent plaque, and heterogeneous components of plaque were more frequent in symptomatic carotid stenosis. Angiographic data showed the length of plaque was longer in symptomatic carotid stenosis. Presence of deep white matter hyperintensity, FLAIR vessel sign and GRE vessel sign were more frequently observed in symptomatic carotid stenosis. Patients with symptomatic carotid stenosis had increased cerebral blood flow, cerebral blood volume (CBV), and delayed time to peak when compared to the asymptomatic stenosis. Multivariate analysis revealed length of plaque (>20mm), deep white matter hyperintensity and increased CBV were associated with symptomatic carotid stenosis (Odd ratio [OR]=2.339, 95% confidence interval [CI] 1.312-4.169, P=0.004; OR=2.315, 95% CI 1.160-4.619, P=0.017; OR=2.242, 95% CI 1.127-4.463, P=0.021, respectively). Conclusion: Plaque burden, deep white matter hyperintensity, and increased CBV were independent predictors of symptom development in carotid stenosis. Multimodal imaging may be useful to identify high risk patients of ischemic stroke among asymptomatic carotid stenosis.

After Successful Endarterectomy for Symptomatic Carotid Stenosis, Should Any Contralateral but Asymptomatic Carotid Stenosis Be Operated on as Well?

1997 ◽  
Vol 7 (1) ◽  
pp. 34-42 ◽  
Author(s):  
D.W.J. Dippel ◽  
P.J. Koudstaal ◽  
H. van Urk ◽  
J.D.F. Habbema ◽  
J. van Gijn ◽  
...  
Keyword(s):  
Carotid Stenosis ◽  
Asymptomatic Carotid Stenosis ◽  
Asymptomatic Carotid ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis

scholarly journals Carotid revascularization and medical management for asymptomatic carotid stenosis – Hemodynamics (CREST-H): Study design and rationale

2018 ◽  
Vol 13 (9) ◽  
pp. 985-991 ◽  
Author(s):  
Randolph S Marshall ◽  
Ronald M Lazar ◽  
David S Liebeskind ◽  
E Sander Connolly ◽  
George Howard ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
White Matter ◽  
Carotid Stenosis ◽  
Medical Management ◽  
Cerebral Microbleeds ◽  
White Matter Hyperintensity ◽  
Asymptomatic Carotid Stenosis ◽  
Asymptomatic Carotid ◽  
Carotid Revascularization ◽  
One Year

Rationale For patients with asymptomatic high-grade carotid stenosis, clinical investigations have focused on preventing cerebral infarction, yet stenosis that reduces cerebral blood flow may independently impair cognition. Whether revascularization of a hemodynamically significant carotid stenosis can alter the course of cognitive decline has never been investigated in the context of a randomized clinical trial. Hypothesis Among patients randomized in the Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis (CREST-2) trials, the magnitude of treatment differences (revascularization versus medical management alone) with regard to cognition will differ between those with flow impairment compared to those without flow impairment. Sample size We will enroll approximately 500 patients from CREST-2, of which we anticipate 100 will have hemodynamic impairment. We estimate 93% power to detect a clinically meaningful treatment difference of 0.5 SD. Methods and design We will use perfusion-weighted magnetic resonance imaging to stratify by hemodynamic status. Linear regression will compare treatment differences, controlling for baseline cognitive status, age, depression, prior cerebral infarcts, silent infarction, white matter hyperintensity volume, and cerebral microbleeds. Study outcomes The primary outcome is change in cognition at one year. Secondary outcomes include silent infarction, change in white matter hyperintensity volume, number of cerebral microbleeds, and cortical thickness over one year. Discussion If cognitive impairment can be shown to be reversible by revascularization, then we can redefine “symptomatic carotid stenosis” to include cognitive impairment and identify a new population of patients likely to benefit from revascularization. Trial Registration US National Institutes of Health (NIH) clinicaltrials.gov NCT03121209

scholarly journals Simultaneous assessment of plaque morphology, cerebral micro-embolic signal status and platelet biomarkers in patients with recently symptomatic and asymptomatic carotid stenosis

2019 ◽  
Vol 40 (11) ◽  
pp. 2201-2214
Author(s):  
Stephen J Murphy ◽  
Soon T Lim ◽  
Justin A Kinsella ◽  
Sean Tierney ◽  
Bridget Egan ◽  
...  
Keyword(s):  
Carotid Stenosis ◽  
Transcranial Doppler Ultrasound ◽  
Plaque Morphology ◽  
Asymptomatic Carotid Stenosis ◽  
Asymptomatic Carotid ◽  
Symptomatic Carotid ◽  
Reticulated Platelets ◽  
Asymptomatic Patients ◽  
Symptomatic Carotid Stenosis ◽  
Simultaneous Assessment

The relationship between plaque morphology, cerebral micro-embolic signals (MES) and platelet biomarkers in carotid stenosis patients warrants investigation. We combined data from two prospective, observational studies to assess carotid plaque morphology and relationship with cerebral MES and platelet biomarkers in patients with recently symptomatic (≤4 weeks of transient ischaemic attack (TIA)/ischaemic stroke) versus asymptomatic carotid stenosis. Plaque morphology on ultrasound was graded with Grey-Scale Median (GSM) and Gray–Weale (GW) scoring. Bilateral transcranial Doppler ultrasound classified patients as ‘MES+ve’ or ‘MES-ve’. Full blood counts were analysed and flow cytometry quantified CD62P and CD63 expression, leucocyte-platelet complexes and reticulated platelets. Data from 42 recently symptomatic carotid stenosis patients were compared with those from 36 asymptomatic patients. There were no differences in median GSM scores between symptomatic and asymptomatic patients (25 vs. 30; P = 0.31) or between MES+ve vs. MES-ve symptomatic patients (36 vs. 25; P = 0.09). Symptomatic patients with GSM-echodense plaques (GSM ≥25) had higher platelet counts (228 vs. 191 × 109/L), neutrophil–platelet (3.3 vs. 2.7%), monocyte–platelet (6.3 vs. 4.55%) and lymphocyte–platelet complexes (2.91 vs. 2.53%) than ‘ asymptomatic patients with GSM-echodense plaques’ ( P ≤ 0.03). Recently, symptomatic carotid stenosis patients with ‘GSM-echodense plaques’ have enhanced platelet production/secretion/activation compared with their asymptomatic counterparts. Simultaneous assessment with neurovascular imaging and platelet biomarkers may aid risk-stratification in carotid stenosis.

scholarly journals Identification, risk stratification and prognostication of stroke by detection of intra-carotid plaque hemorrhage

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
H Maqsood ◽  
S Younus ◽  
M Saim ◽  
S Qazi ◽  
A Basit ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Carotid Artery ◽  
Carotid Stenosis ◽  
Resonance Imaging ◽  
Asymptomatic Carotid Stenosis ◽  
Asymptomatic Carotid ◽  
Symptomatic Carotid ◽  
Atherosclerotic Stenosis ◽  
Symptomatic Carotid Stenosis

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Atherosclerotic stenosis of the internal carotid artery is present in 1% to 2% of the adult population and is the cause of  10% to 15% of ischemic strokes. Intra-plaque hemorrhage (IPH) in carotid stenosis increases the risk of cerebrovascular events. Magnetic resonance imaging can be used to detect pathologies like IPH and necrosis in carotid stenosis. Purpose : This study sought to compare the risk of stroke between patients with carotid artery disease with and without the presence of intraplaque hemorrhage (IPH) on magnetic resonance imaging. Methods : In this meta-analysis we gathered the data from 10 original cohort studies including 631 patients with symptomatic carotid stenosis and 157 patients with asymptomatic carotid stenosis. Primary outcome was the hazards of ipsilateral ischemic stroke which were compared between patients with and without IPH. Results : IPH was present in 57.1% of patients with symptomatic carotid stenosis and 24.7% of patients with asymptomatic carotid stenosis. During 1,334 observed person-years, 74 ipsilateral strokes occurred. Presence of IPH at baseline increased the risk of ipsilateral stroke both in symptomatic (hazard ratio [HR]: 11.7; 95% confidence interval [CI]: 4.7 to 22.8) and asymptomatic (HR: 6.8; 95% CI: 0.9 to 45.4) patients. Multivariate analysis identified IPH (HR: 11.7; 95% CI: 5.3 to 26.4) and severe degree of stenosis (HR: 3.8; 95% CI: 02 to 8.2) as independent predictors of ipsilateral stroke. Conclusion : Our study concludes that IPH is common in patients with carotid artery stenosis and is a stronger predictor of stroke. Magnetic resonance imaging is the modality that can help in identification of patients with carotid disease who would benefit from revascularization.

Surgical Treatment of Carotid Artery Stenotic Disease

2003 ◽  
Vol 16 (1) ◽  
pp. 31-37
Author(s):  
G. Lanza
Keyword(s):  
Surgical Treatment ◽  
Carotid Artery ◽  
Carotid Stenosis ◽  
Endovascular Procedures ◽  
Controlled Trials ◽  
Carotid Surgery ◽  
Asymptomatic Carotid Stenosis ◽  
Asymptomatic Carotid ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis

Starting from historical considerations, the evolution of carotid surgery is analyzed from its origin, when indications and methods used to rely on the insights of operators to date when indications, influenced by improvements in diagnostic and therapeutic techniques, must match the evidence coming from controlled trials. Current indications are herein produced for symptomatic carotid stenosis, which are considered standard, for asymptomatic carotid stenosis and endovascular procedures, which have yet to be defined. Also indications for carotid surgery in emergency are provided, a chapter which has recently been rediscovered and proposed with good results.

scholarly journals Circulating microRNAs in Symptomatic and Asymptomatic Carotid Stenosis

2021 ◽  
Vol 12 ◽  
Author(s):  
Gerrit M. Grosse ◽  
Anselm A. Derda ◽  
Ricarda D. Stauss ◽  
Lavinia Neubert ◽  
Danny D. Jonigk ◽  
...  
Keyword(s):  
Carotid Stenosis ◽  
Transcranial Doppler Ultrasound ◽  
Plaque Vulnerability ◽  
Asymptomatic Carotid Stenosis ◽  
Asymptomatic Carotid ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis ◽  
Pre Treatment

Background: Specific microRNAs (miRs) have been implicated in the pathophysiology of atherosclerosis and may represent interesting diagnostic and therapeutic targets in carotid stenosis. We hypothesized that the levels of specific circulating miRs are altered in patients with symptomatic carotid stenosis (sCS) in comparison to those in patients with asymptomatic carotid stenosis (aCS) planned to undergo carotid endarterectomy (CEA). We also studied whether miR levels are associated with plaque vulnerability and stability over time after CEA.Methods: Circulating levels of vascular-enriched miR-92a, miR-126, miR-143, miR-145, miR-155, miR-210, miR-221, miR-222, and miR-342-3p were determined in 21 patients with sCS and 23 patients with aCS before CEA and at a 90-day follow-up. Transcranial Doppler ultrasound for detection of microembolic signals (MES) in the ipsilateral middle cerebral artery was performed prior to CEA. Carotid plaques were histologically analyzed.Results: Mean levels of miRs were not considerably different between groups and were only marginally higher in sCS than aCS concerning miR-92a, miR-210, miR-145, and miR-143 with the best evidence concerning miR-92a. After adjustment for vascular risk factors and statin pre-treatment, the effect sizes remained essentially unchanged. At follow-up, however, these modest differences remained uncorroborated. There were no relevant associations between miR-levels and MES or histological plaque vulnerability features.Conclusions: This study does not provide evidence for strong associations between specific circulating miRs and symptomatic state in a collective of comprehensively characterized patients with carotid stenosis. Further work is needed to elucidate the role of circulating miRs as targets in advanced carotid atherosclerosis.

Carotid Artery Atherosclerotic Disease

2003 ◽  
Vol 16 (1) ◽  
pp. 27-30
Author(s):  
D. Inzitari
Keyword(s):  
Ischemic Stroke ◽  
Carotid Stenosis ◽  
Surgical Procedure ◽  
Number Needed To Treat ◽  
Asymptomatic Carotid Stenosis ◽  
Asymptomatic Carotid ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis ◽  
History Of ◽  
The Moment

Carotid endarterectomy represents one of the main strategies for primary and secondary prevention of atherothrombotic ischemic stroke. ECST and NASCET studies on symptomatic carotid stenosis showed a significantly higher benefit of surgical compared to medical therapy to reduce the risk of ischemic stroke in case of severe stenosis, (over 70% in NASCET study and over 85% in ECST study) with a Number Needed to Treat, NNT, at 2 years of 8. For moderate stenosis (50–69% in the NASCET study) there was a smaller benefit (NNT = 20), while there was no benefit for stenosis < 50%. The ACAS study on asymptomatic carotid stenosis showed a higher benefit of surgical therapy for stenosis over 60% (NNT at 2 years of 67). The application of these results to clinical practice depends on the reproducibility of the same conditions mainly in terms of perioperative risk. Moreover, data on the natural history of asymptomatic carotid stenosis showed that only 50% of the ischemic events at follow-up were related to the stenosis itself. This could indicate that the real benefit of the surgical procedure could be less than that reported by the clinical trials. The plaque composition, to be evaluated by emerging ultrasonographic and magnetic resonance techniques, is assuming increasing relevance as a further criterion to establish the indication for the surgical procedure. At the moment, however, no evidence exists on this matter.

Asymptomatic Carotid Stenosis is Associated with Gray and White Matter Damage

2015 ◽  
Vol 10 (8) ◽  
pp. 1197-1203 ◽  
Author(s):  
Wagner M. Avelar ◽  
Anelyssa D'Abreu ◽  
Ana C. Coan ◽  
Fabrício Oliveira Lima ◽  
Rachel Guimarães ◽  
...  
Keyword(s):  
White Matter ◽  
Carotid Stenosis ◽  
Asymptomatic Carotid Stenosis ◽  
White Matter Damage ◽  
Asymptomatic Carotid

scholarly journals Atherosclerotic lesions of brachiocephalic arteries and issues of surgical correction of symptomatic and asymptomatic carotid stenosis

2018 ◽  
Vol 177 (5) ◽  
pp. 17-20
Author(s):  
N. I. Glushkov ◽  
M. A. Ivanov ◽  
A. S. Artemova ◽  
A. Yu. Apresyan ◽  
A. D. Gorovaya ◽  
...  
Keyword(s):  
Carotid Stenosis ◽  
Metabolic Disorders ◽  
Carotid Arteries ◽  
Atherosclerotic Lesion ◽  
Control Group ◽  
Asymptomatic Carotid ◽  
Symptomatic Carotid ◽  
Atherosclerotic Lesions ◽  
Symptomatic Carotid Stenosis ◽  
Brachiocephalic Arteries

The objective of the study was to evaluate the results of carotid endarterectomy in patients with symptomatic and asymptomatic course of hemodynamically significant stenosis of carotid arteries.Material and methods. The work was based on observations of 88 patients: the main group included 28 patients with asymptomatic lesion, the control group – 60 patients with symptomatic critical carotid stenosis.Results. There was a predominance of contralateral carotid stenosis, changes in vertebral arteries in the control group. Features of atherosclerotic lesion of carotid arteries associated with the severity of metabolic disorders, perioperative fluctuations of hemodynamics, time of clamping of carotid arteries.Conclusion. Aggressive course of symptomatic carotid stenosis requires correction of metabolic disorders in the perioperative and in the distant periods, as well as monitoring of hemodynamic abnormalities.

Sign in / Sign up

Export Citation Format

Share Document