scholarly journals One-Year Progression of Moderate Asymptomatic Carotid Stenosis Predicts the Risk of Vascular Events

Stroke ◽  
2013 ◽  
Vol 44 (3) ◽  
pp. 792-794 ◽  
Author(s):  
Simona Balestrini ◽  
Francesca Lupidi ◽  
Clotilde Balucani ◽  
Claudia Altamura ◽  
Fabrizio Vernieri ◽  
...  
Keyword(s):  
Carotid Stenosis ◽  
Asymptomatic Carotid Stenosis ◽  
Vascular Events ◽  
Asymptomatic Carotid ◽  
One Year

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

Multimodal ultrasound parameters aided carotid plaque risk stratification in patients with asymptomatic carotid stenosis

2021 ◽  
pp. 028418512198918
Author(s):  
Yi Li ◽  
Shuai Zheng ◽  
Jinghan Zhang ◽  
Fumin Wang ◽  
Wen He
Keyword(s):  
Risk Stratification ◽  
Carotid Stenosis ◽  
Carotid Plaque ◽  
Regression Analyses ◽  
Asymptomatic Carotid Stenosis ◽  
Vascular Events ◽  
Asymptomatic Carotid ◽  
Asymptomatic Patients ◽  
Proximal Internal Carotid Artery ◽  
Multivariable Regression

Background Risk stratification of asymptomatic carotid plaque remains an issue in stroke prevention in clinical practice. Purpose To investigate whether a multimodal ultrasound (MMU) model would help plaque risk stratification in patients with asymptomatic carotid stenosis. Material and Methods A prospective study was conducted of symptomatic and asymptomatic patients with > 50% proximal internal carotid artery (ICA) stenosis. All patients underwent MMU examination. Multivariable regression analyses were performed to identify parameters associated with ischemic vascular events (IVE). These parameters were used to develop a scoring nomogram to assess the probability of IVE. We elaborated the diagnostic performance of the MMU nomogram using receiver operating characteristic (ROC) curves. Results From December 2018 to December 2019, 98 patients (75 men, mean age 67 ± 8 years) were included; 50 were symptomatic and 48 were asymptomatic. Multivariable regression analyses revealed that plaque surface morphology (PSM) (odds ratio [OR] 2.99, 95% confidence interval [CI] 1.26–7.12, P = 0.013), intraplaque neovascularization (IPN) grades (OR 3.23, 95% CI 1.77–5.89, P<0.001), and carotid stenosis degree (CSD) (OR 4.12, 95% CI 1.47–11.55, P = 0.007) were independently associated with IVE. For the nomogram, the area under the ROC curve was 0.85 (95% CI 0.77–0.92) and the Hosmer-Lemeshow test P value was 0.822. Conclusions In patients with proximal ICA > 50%, PSM, IPN grades, and CSD were independent variables associated with IVE. The MMU nomogram provided favorable value to risk stratification of IVE. Future large-scale studies with long-term follow-up are needed to validate these findings.

scholarly journals Angioplasty in asymptomatic carotid artery stenosis vs. endarterectomy compared to best medical treatment: One-year interim results of SPACE-2

2019 ◽  
Vol 15 (6) ◽  
pp. 638-649 ◽  
Author(s):  
T Reiff ◽  
HH Eckstein ◽  
U Mansmann ◽  
O Jansen ◽  
G Fraedrich ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Stenosis ◽  
Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
Asymptomatic Carotid Stenosis ◽  
Asymptomatic Carotid ◽  
Best Medical Treatment ◽  
Asymptomatic Carotid Artery Stenosis ◽  
One Year ◽  
The One

Background Treatment of individuals with asymptomatic carotid artery stenosis is still handled controversially. Recommendations for treatment of asymptomatic carotid stenosis with carotid endarterectomy (CEA) are based on trials having recruited patients more than 15 years ago. Registry data indicate that advances in best medical treatment (BMT) may lead to a markedly decreasing risk of stroke in asymptomatic carotid stenosis. The aim of the SPACE-2 trial (ISRCTN78592017) was to compare the stroke preventive effects of BMT alone with that of BMT in combination with CEA or carotid artery stenting (CAS), respectively, in patients with asymptomatic carotid artery stenosis of ≥70% European Carotid Surgery Trial (ECST) criteria. Methods SPACE-2 is a randomized, controlled, multicenter, open study. A major secondary endpoint was the cumulative rate of any stroke (ischemic or hemorrhagic) or death from any cause within 30 days plus an ipsilateral ischemic stroke within one year of follow-up. Safety was assessed as the rate of any stroke and death from any cause within 30 days after CEA or CAS. Protocol changes had to be implemented. The results on the one-year period after treatment are reported. Findings It was planned to enroll 3550 patients. Due to low recruitment, the enrollment of patients was stopped prematurely after randomization of 513 patients in 36 centers to CEA (n = 203), CAS (n = 197), or BMT (n = 113). The one-year rate of the major secondary endpoint did not significantly differ between groups (CEA 2.5%, CAS 3.0%, BMT 0.9%; p = 0.530) as well as rates of any stroke (CEA 3.9%, CAS 4.1%, BMT 0.9%; p = 0.256) and all-cause mortality (CEA 2.5%, CAS 1.0%, BMT 3.5%; p = 0.304). About half of all strokes occurred in the peri-interventional period. Higher albeit statistically non-significant rates of restenosis occurred in the stenting group (CEA 2.0% vs. CAS 5.6%; p = 0.068) without evidence of increased stroke rates. Interpretation The low sample size of this prematurely stopped trial of 513 patients implies that its power is not sufficient to show that CEA or CAS is superior to a modern medical therapy (BMT) in the primary prevention of ischemic stroke in patients with an asymptomatic carotid stenosis up to one year after treatment. Also, no evidence for differences in safety between CAS and CEA during the first year after treatment could be derived. Follow-up will be performed up to five years. Data may be used for pooled analysis with ongoing trials.

Abstract P564: Hypertriglyceridemia as a Treatment Target in Asymptomatic Carotid Stenosis

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Seemant Chaturvedi ◽  
Tanya N Turan ◽  
Jenifer H Voeks ◽  
Jeffrey Goldstein ◽  
Philip A Teal ◽  
...  
Keyword(s):  
Carotid Stenosis ◽  
Lipid Profiles ◽  
Pharmacologic Treatment ◽  
Asymptomatic Carotid Stenosis ◽  
Vascular Events ◽  
Asymptomatic Carotid ◽  
Chi Square ◽  
Treatment Target ◽  
Carotid Revascularization ◽  
Baseline Factors

Background: Data from the CDC show that approximately one-quarter of adults have elevated triglyceride (TG) levels. Recent trials have demonstrated that pharmacologic treatment of high TG levels, in patients already on statin therapy, reduces the rate of major vascular events such as myocardial infarction and stroke (REDUCE-IT trial). We sought to assess how often patients with asymptomatic carotid stenosis (CS) have elevated TG levels and factors associated with high TG values. Methods: Patients enrolled in the Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial (CREST 2) were analyzed. Baseline lipid profiles were evaluated to determine high TG treatment eligibility as per the REDUCE-IT trial. We also evaluated baseline use of pharmacologic treatment for high TG levels. Demographic factors and baseline medical conditions were studied in relation to high (>150 mg/dl) TG values. Chi square and t tests were used to assess baseline factors and abnormal TG values. Results: As of August 10, 2020, 1655 of 1689 randomized patients (mean age 69.7 years, 61% men) had baseline lipid profiles suitable for analysis. Treatment eligibility according to REDUCE-IT (LDL 41-100 mg/dl, TG>150 mg/dl) was present in 21% (345) of subjects. In these patients, the median TG value was 205 (IQR 93) mg/dl. Fibrate medications were used at baseline in 4.5% of patients. Analysis of demographic and medical history factors and TG values greater than 150 mg/dl is found in the Table. There was significant positive correlation between baseline hemoglobin A1C and triglyceride values (p<0.0001) Conclusions: One in five patients in CREST 2 has TG values that potentially justify pharmacologic treatment. Elevated TG levels are most correlated with diabetes, hypertension, obesity, decreased physical activity, and heart disease. Clinicians should investigate treatment of elevated TG levels as a component of intensive medical therapy for stroke prevention.

Abstract 3171: Low Stroke Incidence In Asymptomatic Carotid Stenosis Under Optimal Risk Factor Control.

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Maria C Zurru ◽  
Laura Brescacin ◽  
Claudia Alonzo ◽  
Gabriela Orzuza ◽  
Fabiana Ortega ◽  
...  
Keyword(s):  
Risk Factor ◽  
Carotid Stenosis ◽  
Doppler Ultrasonography ◽  
Vascular Risk Factor ◽  
Vascular Risk ◽  
Asymptomatic Carotid Stenosis ◽  
Vascular Events ◽  
Asymptomatic Carotid ◽  
Risk Factor Control

Background: benefits of interventional procedures for the treatment of asymptomatic carotid stenosis (ACS) are still under debate. Our objective was to evaluate the risk of vascular events in a cohort of patients with ACS under optimal medical treatment. Methods: patients with ACS ≥50% were prospectively evaluated. Data on demographic and vascular risk factor profile and control under pharmacological treatment were collected. Severity of carotid stenosis was confirmed by at least two methods (Doppler ultrasonography, angioresonance, angiotomography or digital angiography) and evolution over time was evaluated by Doppler ultrasonography performed by the same operator, blinded to clinical data. Primary end-points were coronary events and ispsilateral ischemic stroke (IIS). Results: ninety two patients were included between January 2007 and December 2010. Mean age was 72±8 years, 35% were women. Mayor vascular risk factors were: hypertension (97%), dyslipidemia (90%), obesity (40%), diabetes (30%), smoking or former smoking (51%), history of coronary heart disease (37%) and peripheral vascular disease (32%). Average follow-up was 667±509 days (range 180-1870 days). Table 1 shows vascular risk factor control during follow-up. One IIS (1.08%; 95% CI 0.19-5.9; 5.8/1000 person/year) and 2 acute myocardial infarction (2.17%; 95% CI 0.6-7.5; 11.73/1000 person/year) were observed. Eighteen percent of patients had stenosis 50-70%, 68% between 70-90% and 13% ≥ 90%. After one year most of patients showed no changes in stenosis severity (76%), 5.56% had progression and 6.52% had regression; 14.1% had no control. Conclusion: optimal pharmacological treatment was related to a very low incidence of vascular events. These data reassert the efficacy of intensive medical treatment in delaying atherosclerotic plaque progression and carotid disease complications.

scholarly journals The analysis of the connection between plaque morphology of the asymptomatic carotid stenosis and ischemic brain lesions

2013 ◽  
Vol 70 (11) ◽  
pp. 993-998 ◽  
Author(s):  
Djordje Milosevic ◽  
Janko Pasternak ◽  
Vladan Popovic ◽  
Dragan Nikolic ◽  
Pavle Milosevic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Carotid Stenosis ◽  
Carotid Plaque ◽  
Brain Infarction ◽  
Statistical Significance ◽  
Brain Parenchyma ◽  
Plaque Morphology ◽  
Asymptomatic Carotid Stenosis ◽  
Asymptomatic Carotid ◽  
Silent Brain Infarction

Background/Aim. A certain percentage of patients with asymptomatic carotid stenosis have an unstable carotid plaque. For these patients it is possible to register by modern imaging methods the existence of lesions of the brain parenchyma - the silent brain infarction. These patients have a greater risk of ischemic stroke. The aim of this study was to analyze the connection between the morphology of atherosclerotic carotid plaque in patients with asymptomatic carotid stenosis and the manifestation of silent brain infarction, and to analyze the influence of risk factors for cardiovascular diseases on the occurrence of silent brain infarction and the morphology of carotid plaque. Methods. This retrospective study included patients who had been operated for high grade (> 70%) extracranial atherosclerotic carotid stenosis at the Clinic for Vascular and Transplantation Surgery of the Clinical Center of Vojvodina over a period of 5 years. The patients analyzed had no clinical manifestation of cerebrovascular insufficiency of the carotid artery territory up to the time of operation. The classification of carotid plaque morphology was carried out according to the Gray-Weale classification, after which all the types were subcategorized into two groups: stable and unstable. Brain lesions were verified using preoperative imaging of the brain parenchyma by magnetic resonance. We analyzed ipsilateral lesions of the size > or = 3 mm. Results. Out of a 201 patients 78% had stable plaque and 22% unstable one. Unstable plaque was prevalent in the male patients (male/female ratio = 24.8% : 17.8%), but without a statistically significant difference (p > 0.05). The risk factors (hypertension, nicotinism, hyperlipoproteinemia, and diabetes mellitus) showed no statistically significant impact on carotid plaque morphology and the occurrence of silent brain infarction. Silent brain infarction was detected in 30.8% of the patients. Unstable carotid plaque was found in a larger percentage of patients with silent brain infarction (36.4% : 29.3%) but without a significant statistical difference (p > 0.05). Conclusions. Even though silent brain infarction is more frequent in patients with unstable plaque of carotid bifurication, the difference is of no statistical significance. The effects of the number and type of risk factors bear no statistical significance on the incidence of morphological asymptomatic carotid plaque.

scholarly journals COATED-PLATELETS ENHANCE TIA/STROKE RISK PREDICTION IN ASYMPTOMATIC CAROTID STENOSIS PATIENTS FOLLOWED WITH CAROTID DOPPLER SURVEILLANCE

2021 ◽  
Vol 77 (18) ◽  
pp. 1817
Author(s):  
Mohamad Khattab ◽  
Arleen Ramirez-Jimenez ◽  
Andrea Vincent ◽  
George Dale ◽  
Calin Prodan ◽  
...  
Keyword(s):  
Carotid Stenosis ◽  
Risk Prediction ◽  
Stroke Risk ◽  
Asymptomatic Carotid Stenosis ◽  
Asymptomatic Carotid ◽  
Carotid Doppler
Sign in / Sign up

Export Citation Format

Share Document