Asymptomatic Carotid Artery Disease in Valvular Heart Surgery

Angiology ◽  
2011 ◽  
Vol 63 (3) ◽  
pp. 171-177 ◽  
Author(s):  
Amedeo Anselmi ◽  
Mario Gaudino ◽  
Nicola Risalvato ◽  
Giuseppe Lauria ◽  
Franco Glieca
Keyword(s):  
Cardiac Surgery ◽  
Carotid Artery ◽  
Carotid Stenosis ◽  
Heart Surgery ◽  
Carotid Artery Disease ◽  
Asymptomatic Carotid ◽  
Valvular Surgery ◽  
Artery Disease ◽  
Ischemic Attack

We evaluated the prevalence of asymptomatic carotid artery disease in patients scheduled for valvular cardiac surgery. Preoperative screening of the carotid arteries was performed. Among 1012 patients scheduled for valvular cardiac surgery, 267 (26.4%) had carotid stenosis graded >50%; 37 had carotid stenosis >70% and underwent combined valvular surgery and carotid endarterectomy (CEA); and 230 (86%) had carotid stenosis >50% to ≤69% and received valvular cardiac surgery under hypothermic cardiopulmonary bypass. Operative mortality and the rate of perioperative adverse neurological events were comparable among the groups. During 6.8 years of follow-up, patients with carotid stenosis not exceeding 69% at the time of surgery had CEA more frequently ( P < .05) and stroke/transient ischemic attack ([TIA] P < .05) versus patients treated with combined surgery. The prevalence of asymptomatic carotid stenosis is not negligible in patients undergoing isolated valvular surgery. Combined valvular and carotid surgery is safe and reduces the incidence of CEA and stroke/TIA during follow-up.

29 ASYMPTOMATIC CAROTID ARTERY DISEASE IN VALVULAR HEART SURGERY

2011 ◽  
Vol 12 (1) ◽  
pp. 7
Author(s):  
A. Anselmi ◽  
M. Morelli ◽  
C. Pragliola ◽  
N. Pavone ◽  
V. Tsiopoulos ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Heart Surgery ◽  
Carotid Artery Disease ◽  
Asymptomatic Carotid ◽  
Artery Disease

scholarly journals The role of monocyte to HDL ratio in predicting clinically significant carotid stenosis in patients with asymptomatic carotid artery disease

2020 ◽  
Vol 66 (8) ◽  
pp. 1043-1048
Author(s):  
Mustafa Yurtdaş ◽  
Yalin Tolga Yaylali ◽  
Mahmut Özdemir
Keyword(s):  
Carotid Artery ◽  
Carotid Stenosis ◽  
Carotid Artery Disease ◽  
Monocyte Count ◽  
Asymptomatic Carotid ◽  
Markers Of Inflammation ◽  
Group 2 ◽  
Clinically Significant ◽  
Artery Disease ◽  
Group 1

SUMMARY OBJECTIVE Monocyte count to HDL-C Ratio (MHR) and Fibrinogen to Albumin Ratio (FAR) have recently emerged as markers of inflammation in atherosclerotic diseases. Our goal was to investigate the relationships of MHR and FAR with the severity of carotid artery stenosis (CAS) in patients with asymptomatic carotid artery disease. METHODS This retrospective study consisted of 300 patients with asymptomatic CAS. Pre-angiographic MHR, FAR, and high-sensitive C-reactive protein (hsCRP) were measured. Carotid angiography was performed in patients with ≥50% stenosis on carotid ultrasonography. Patients were first split into 2 groups based on the degree of CAS and then tertiles (T) of MHR. RESULTS 96 patients had clinically insignificant CAS (<50%) (Group-1), and 204 patients had clinically significant CAS (≥50%) (Group-2). Group-2 had higher MHR, FAR, and hsCRP than group-1. Patients in T3 had higher MHR, FAR, and hsCRP than in T1 and T2. MHR, FAR, and hsCRP were correlated with each other (p<0.001, for all). MHR, FAR, and hsCRP were independent predictors of significant CAS. MHR better predicted a significant CAS than FAR and hsCRP (p<0.05). CONCLUSION Pre-angiographic MHR may be a better predictor than FAR and hsCRP in identifying a clinically significant carotid stenosis in patients with asymptomatic CAS. Patients with asymptomatic CAS and a high level of MHR should be followed-up closely to supervise risk-factor control and intensify treatment.

Mid-Term Follow Up of Untouched Asymptomatic Carotid Artery Disease During Coronory Artery Bypass Operation

2012 ◽  
Vol 21 (1) ◽  
pp. 29-33
Author(s):  
M.Onur Hanedan ◽  
Ertekin Utku Ünal ◽  
Garip Altıntaş ◽  
Anıl Özen ◽  
Aytaç Çalışkan ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Disease ◽  
Artery Bypass ◽  
Bypass Operation ◽  
Asymptomatic Carotid ◽  
Artery Disease

Patterns of Failure of Aspirin Treatment in Symptomatic Atherosclerotic Carotid Artery Disease

Neurosurgery ◽  
1990 ◽  
Vol 26 (4) ◽  
pp. 565-569 ◽  
Author(s):  
Douglas Chyatte ◽  
Terence L. Chen
Keyword(s):  
Carotid Artery ◽  
Treatment Failure ◽  
Carotid Stenosis ◽  
Carotid Artery Disease ◽  
Medical Center ◽  
Neurological Symptoms ◽  
Veterans Administration ◽  
Artery Disease ◽  
Ischemic Attack ◽  
Common Manifestation

Abstract Over a 24-month period, 291 patients were consecutively admitted to the West Haven Veterans Administration Medical Center with new ischemic neurological symptoms. Of these, 90 patients (31%) developed ischemic neurological symptoms while taking aspirin (aspirin treatment failure). Of those in whom aspirin treatment failed. 66 patients had ischemic symptoms in the distribution of the carotid artery. Aspirin treatment failed in 21 patients with severe carotid stenosis (&gt;75% stenosis). Eleven of these 21 patients had cerebral infarctions while taking aspirin, and 7 of these 11 infarcts occurred without the prior warning of transient ischemic attacks. Aspirin treatment failed in 45 patients with lesser degrees of carotid stenosis. Transient ischemic attack without permanent ischemia was the most common manifestation of failure in these patients. Infarction occurred in only 12 of these 45 patients and in only 4 patients did infarction occur without warning. We conclude that patients with symptomatic high-grade carotid stenosis (&gt;75%) in whom aspirin treatment failed are likely to suffer an infarct without warning as the first sign of treatment failure (P&lt; 0.033). We suggest that this subgroup of patients should be considered for alternative forms of therapy.

Asymptomatic Cervical Carotid Stenosis

2019 ◽  
pp. 145-154
Author(s):  
Kunal Vakharia ◽  
Sabareesh K. Natarajan ◽  
Hussain Shallwani ◽  
Elad I. Levy
Keyword(s):  
Carotid Artery ◽  
Carotid Stenosis ◽  
Stroke Risk ◽  
Surgical Intervention ◽  
Carotid Artery Disease ◽  
Endovascular Management ◽  
Lifestyle Modifications ◽  
Asymptomatic Carotid ◽  
Artery Disease ◽  
Angioplasty And Stenting

Abstract: This chapter discusses the evaluation and management of asymptomatic carotid stenosis. Surgical and endovascular management of carotid artery disease continues to progress. With lifestyle modifications and medical management, the stroke risk without surgical intervention has been decreased; however, in patients with significant carotid stenosis, surgical intervention has still been shown to decrease the stroke risk by nearly half. A thorough understanding of the arterial and venous anatomy is essential for surgical planning. Carotid endarterectomy for asymptomatic carotid artery disease has been validated through prospective clinical trials to help dramatically reduce the risk of stroke. Endovascular management through carotid artery angioplasty and stenting is another option that continues to undergo evaluation in the asymptomatic patient population.

scholarly journals Management of significant atherosclerotic carotid artery disease: review of literature

2021 ◽  
Vol 8 (12) ◽  
pp. 3758
Author(s):  
Sibasankar Dalai ◽  
Aravind V. Datla
Keyword(s):  
Carotid Artery ◽  
Carotid Stenosis ◽  
Carotid Artery Disease ◽  
Treatment Options ◽  
Technological Advances ◽  
Computed Tomography Angiogram ◽  
Digital Subtraction Angiogram ◽  
Artery Disease ◽  
Ischemic Attack ◽  
Carotid Doppler

Stroke is the third leading cause of death and disability in the world. Carotid artery stenosis due to atherosclerosis accounts for 20 to 30% of all strokes. The patients can be asymptomatic or present with a transient ischemic attack or stroke. Diagnosis is based primarily on imaging modalities like carotid Doppler, CT (Computed tomography) angiogram, MR (Magnetic resonance) angiogram or DSA (Digital subtraction angiogram). Treatment options include optimal medical therapy, carotid endarterectomy-touted as the gold standard for treating significant carotid stenosis; and carotid artery stenting, whose safety and efficacy have undergone significant improvements due to technological advances in the field. We presented a review of the literature outlining the various aspects of atherosclerotic carotid stenosis and the findings of several randomized controlled trials conducted to settle the debate between endarterectomy and stenting for carotid stenosis. 

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.

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