Abstract T MP26: Progression Of Asymptomatic Carotid Stenosis: Incidence Of Symptoms And Predictive Factors

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Tarun Singh ◽  
Christopher L Kramer ◽  
Giuseppe Lanzino ◽  
Alejandro A Rabinstein
Keyword(s):  
Carotid Stenosis ◽  
Medical Therapy ◽  
Previous History ◽  
Multivariate Logistic Regression Analysis ◽  
Asymptomatic Carotid ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis ◽  
Bilateral Carotid

Background: Given the uncertainty regarding clinical applicability of early treatment trials and lack of data on long-term disease progression, we evaluated the progression of stenosis and development of symptoms on patients with asymptomatic carotid artery stenosis (ACAS) treated with contemporary medical therapy over a prolonged follow up. Methods: Retrospective review of bilateral carotid arteries from consecutive patients diagnosed with moderate or severe ACAS, at our institution between 2000 and 2001. Patient vascular risk factors and treatments, cerebrovascular imaging, ipsilateral symptoms, and revascularization were recorded. Progression of stenosis was defined by change category of stenosis. Factors associated with symptomatic carotid disease were sought using univariate and multivariate logistic regression analysis. Results: We identified 214 patients (58.8% men; median age 70 years) and collected data on 349 vessels. Severe stenosis (>70%) upon diagnosis was present in 92(26.4%) vessels. All patients were on antithrombotics, 97% on antihypertensives, and 95% on statins. Median length of follow up was 13 years (range 5-14) and the mean number of time points with follow-up imaging was 8.1±3.9. Progression of stenosis was observed in 237(67.9%) vessels. 72(20.6%) patients developed symptomatic carotid stenosis (TIA in 14.4%, non-disabling stroke in 4%, and disabling stroke in 2.2%). Median time to appearance of first symptom was 6 years (range 1-13). Revascularization procedures were performed in 118(33.8%) vessels, including 73(61.9%) vessels which had become symptomatic. On multivariate analysis, baseline stenosis (OR 1.65, 95%CI 1.12-2.44), intracranial stenosis > 50% (OR 2.87, 95%CI 1.46-5.62), plaque ulceration (OR 3.41, 95%CI 1.34-8.69), silent infarction (OR 4.25, 95%CI 2.30-7.83), and previous history of TIA/stroke (OR 2.73, 95%CI 1.14-6.54) were associated with development of TIA/stroke ipsilateral to the carotid stenosis. Conclusions: There is a substantial rate of progression of stenosis in patients with asymptomatic carotid atherosclerosis over time despite adequate medical therapy. Over long-term follow up, one in five patients with ACAS developed ipsilateral TIA/stroke.

Abstract P566: Identifying Sex-Specific Differences in the Carotid Revascularization Literature: Findings From a Scoping Review

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Vignan Yogendrakumar ◽  
Michel C Shamy ◽  
Brian Dewar ◽  
Dean Fergusson ◽  
Dar Dowlatshahi ◽  
...  
Keyword(s):  
Carotid Stenosis ◽  
Medical Therapy ◽  
Scoping Review ◽  
Sufficient Information ◽  
Significant Heterogeneity ◽  
Long Term Outcomes ◽  
Carotid Revascularization ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis

Background and Purpose: No systematic review of the literature has dedicated itself to looking at the management of symptomatic carotid stenosis in women. In this scoping review, we aimed to identify all randomized controlled trials (RCTs) that reported sex-specific outcomes for patients who underwent carotid revascularization, and determine whether sufficient information is reported within these studies to assess women’s short and long-term outcomes. Methods: We systematically searched Medline, Embase, Pubmed, and Cochrane libraries for RCTs published between 1991 and 2020 that included women and compared either endarterectomy with stenting, or any revascularization (endarterectomy or stenting) with medical therapy in patients with symptomatic high grade (greater than 50%) carotid stenosis. Results: From 1,537 references examined, 27 eligible studies were identified. Sex-specific outcomes were reported in 13 studies. Baseline patient characteristics of enrolled women were reported in 2 of those 13 studies. Common outcomes reported included stroke and death, however there was significant heterogeneity in the reporting of both periprocedural and long-term outcomes. Sex-specific differences relating to the degree of stenosis and time from index event to treatment were limited to studies comparing endarterectomy to medical therapy. Adverse events were not reported by sex. Conclusions: Half of the previously published RCTs and systematic reviews report sex-specific outcomes. Detailed analysis on the benefits of carotid artery intervention for women with symptomatic stenosis is limited . Further analysis with individual patient data and a network meta-analysis is the necessary next step to better assess the treatment effects of carotid management in women.

scholarly journals Identifying sex-specific differences in the carotid revascularisation literature: findings from a scoping review

2021 ◽  
pp. svn-2020-000744
Author(s):  
Vignan Yogendrakumar ◽  
Michel Shamy ◽  
Brian Dewar ◽  
Dean A Fergusson ◽  
Dar Dowlatshahi ◽  
...  
Keyword(s):  
Carotid Stenosis ◽  
Medical Therapy ◽  
Scoping Review ◽  
Sufficient Information ◽  
Significant Heterogeneity ◽  
Long Term Outcomes ◽  
Symptomatic Carotid ◽  
Female Patients ◽  
Symptomatic Carotid Stenosis

ObjectiveNo systematic review of the literature has dedicated itself to looking at the management of symptomatic carotid stenosis in female patients. In this scoping review, we aimed to identify all randomised controlled trials (RCTs) that reported sex-specific outcomes for patients who underwent carotid revascularisation, and determine whether sufficient information is reported within these studies to assess short-term and long-term outcomes in female patients.Design, setting and participantsWe systematically searched Medline, Embase, Pubmed and Cochrane libraries for RCTs published between 1991 and 2020 that included female patients and compared either endarterectomy with stenting, or any revascularisation (endarterectomy or stenting) with medical therapy in patients with symptomatic high-grade (>50%) carotid stenosis.ResultsFrom 1537 references examined, 27 eligible studies were identified. Sex-specific outcomes were reported in 13 studies. Baseline patient characteristics of enrolled female patients were reported in 2 of those 13 studies. Common outcomes reported included stroke and death, however, there was significant heterogeneity in the reporting of both periprocedural and long-term outcomes. Sex-specific differences relating to the degree of stenosis and time from index event to treatment are largely limited to studies comparing endarterectomy to medical therapy. Adverse events were not reported by sex.ConclusionsOnly half of the previously published RCTs and systematic reviews report sex-specific outcomes. Detailed analyses on the results of carotid artery intervention for female patients with symptomatic stenosis are limited.

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.

scholarly journals Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): a randomised controlled trial with cost-effectiveness analysis

2016 ◽  
Vol 20 (20) ◽  
pp. 1-94 ◽  
Author(s):  
Roland L Featherstone ◽  
Joanna Dobson ◽  
Jörg Ederle ◽  
David Doig ◽  
Leo H Bonati ◽  
...  
Keyword(s):  
Relative Risk ◽  
Carotid Artery ◽  
Carotid Stenosis ◽  
Health Technology ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis ◽  
Randomised Controlled ◽  
Stroke Death

BackgroundCarotid artery stenting (CAS) is an alternative to carotid endarterectomy (CEA) for the treatment of carotid stenosis, but safety and long-term efficacy were uncertain.ObjectiveTo compare the risks, benefits and cost-effectiveness of CAS versus CEA for symptomatic carotid stenosis.DesignInternational, multicentre, randomised controlled, open, prospective clinical trial.SettingHospitals at 50 centres worldwide.ParticipantsPatients older than 40 years of age with symptomatic atheromatous carotid artery stenosis.InterventionsPatients were randomly allocated stenting or endarterectomy using a computerised service and followed for up to 10 years.Main outcome measuresThe primary outcome measure was the long-term rate of fatal or disabling stroke, analysed by intention to treat (ITT). Disability was assessed using the modified Rankin Scale (mRS). A cost–utility analysis estimating mean costs and quality-adjusted life-years (QALYs) was calculated over a 5-year time horizon.ResultsA total of 1713 patients were randomised but three withdrew consent immediately, leaving 1710 for ITT analysis (853 were assigned to stenting and 857 were assigned to endarterectomy). The incidence of stroke, death or procedural myocardial infarction (MI) within 120 days of treatment was 8.5% in the CAS group versus 5.2% in the CEA group (72 vs. 44 events) [hazard ratio (HR) 1.69, 95% confidence interval (CI) 1.16 to 2.45;p = 0.006]. In the analysis restricted to patients who completed stenting, age independently predicted the risk of stroke, death or MI within 30 days of CAS (relative risk increase 1.17% per 5 years of age, 95% CI 1.01% to 1.37%). Use of an open-cell stent conferred higher risk than a closed-cell stent (relative risk 1.92, 95% CI 1.11 to 3.33), but use of a cerebral protection device did not modify the risk. CAS was associated with a higher risk of stroke in patients with an age-related white-matter changes score of 7 or more (HR 2.98, 95% CI 1.29 to 6.93;p = 0.011). After completion of follow-up with a median of 4.2 years, the number of patients with fatal or disabling stroke in the CAS and CEA groups (52 vs. 49), and the cumulative 5-year risk did not differ significantly (6.4% vs. 6.5%) (HR 1.06, 95% CI 0.72 to 1.57;p = 0.776). Stroke of any severity was more frequent in the CAS group (15.2% vs. 9.4% in the CEA group) (HR 1.712, 95% CI 1.280 to 2.300;p < 0.001). There was no significant difference in long-term rates of severe carotid restenosis or occlusion (10.8% in the CAS group vs. 8.6% in the CEA group) (HR 1.25, 95% CI 0.89 to 1.75;p = 0.20). There was no difference in the distribution of mRS scores at 1-year, 5-year or final follow-up. There were no differences in costs or QALYs between the treatments.LimitationsPatients and investigators were not blinded to treatment allocation. Interventionists’ experience of stenting was less than that of surgeons with endarterectomy. Data on costs of managing strokes were not collected.ConclusionsThe functional outcome after stenting is similar to endarterectomy, but stenting is associated with a small increase in the risk of non-disabling stroke. The choice between stenting and endarterectomy should take into account the procedural risks related to individual patient characteristics. Future studies should include measurement of cognitive function, assessment of carotid plaque morphology and identification of clinical characteristics that determine benefit from revascularisation.Trial registrationCurrent Controlled Trials ISRCTN25337470.FundingThis project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 20. See the NIHR Journal Library website for further project information. Further funding was provided by the Medical Research Council, Stroke Association, Sanofi-Synthélabo and the European Union.

“Timing to carotid endarterectomy affects early and long term outcomes of symptomatic carotid stenosis.”

2021 ◽  
Author(s):  
Emiliano Chisci ◽  
Elisa Lazzeri ◽  
Fabrizio Masciello ◽  
Nicola Troisi ◽  
Filippo Turini ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Long Term Outcomes ◽  
Symptomatic Carotid ◽  
Symptomatic 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 Long-term outcomes of stenting and endarterectomy for symptomatic carotid stenosis: a preplanned pooled analysis of individual patient data

2019 ◽  
Vol 18 (4) ◽  
pp. 348-356 ◽  
Author(s):  
Thomas G Brott ◽  
David Calvet ◽  
George Howard ◽  
John Gregson ◽  
Ale Algra ◽  
...  
Keyword(s):  
Carotid Stenosis ◽  
Individual Patient Data ◽  
Pooled Analysis ◽  
Patient Data ◽  
Long Term Outcomes ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis

Carotid Endarterectomy for Symptomatic Carotid Stenosis

2017 ◽  
Author(s):  
Hardik A. Amin
Keyword(s):  
Vascular Surgery ◽  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Study Design ◽  
Clinical Case ◽  
Nonsurgical Treatment ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis ◽  
Study Intervention

This chapter provides a summary of the landmark surgical study known as the NASCET trial, which compared surgical versus nonsurgical treatment for patients with symptomatic carotid stenosis. 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 regarding vascular surgery.

Sign in / Sign up

Export Citation Format

Share Document