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 (>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 (>75%) in whom aspirin treatment failed are likely to suffer an infarct without warning as the first sign of treatment failure (P< 0.033). We suggest that this subgroup of patients should be considered for alternative forms of therapy.

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.

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. 

Advances in Management of Carotid Atherosclerosis

1997 ◽  
Vol 12 (2) ◽  
pp. 55-65
Author(s):  
Marc D. Malkoff ◽  
Linda S. Williams ◽  
Jose Biller
Keyword(s):  
Magnetic Resonance Angiography ◽  
Carotid Artery ◽  
Carotid Stenosis ◽  
Carotid Atherosclerosis ◽  
Stroke Risk ◽  
Carotid Artery Disease ◽  
Carotid Angioplasty ◽  
Conventional Angiography ◽  
Artery Disease ◽  
Experimental Treatments

Carotid artery stenosis is a common and potentially treatable cause of stroke. Stroke risk is increased as the degree of carotid stenosis increases, as well as in patients with neurological symptoms referable to the stenosed carotid artery. Carotid stenosis can be quantified by ultrasound imaging, magnetic resonance angiography, or conventional angiography. Medical treatment with platelet antiaggregants reduces stroke risk in some patients; other patients are best treated with carotid endarterectomy. Experimental treatments for carotid stenosis, including carotid angioplasty with or without stenting, are under investigation. We summarize the current literature and provide treatment recommendations for patients with atherosclerotic 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.

Carotid Plaque Mast Cells Associate with Atherogenic Serum Lipids, High Grade Carotid Stenosis and Symptomatic Carotid Artery Disease

2005 ◽  
Vol 19 (5) ◽  
pp. 291-301 ◽  
Author(s):  
Erno M.P. Lehtonen-Smeds ◽  
Mikko Mäyränpää ◽  
Perttu J. Lindsberg ◽  
Lauri Soinne ◽  
Eija Saimanen ◽  
...  
Keyword(s):  
Mast Cells ◽  
Carotid Artery ◽  
Carotid Stenosis ◽  
Carotid Plaque ◽  
Serum Lipids ◽  
Carotid Artery Disease ◽  
High Grade ◽  
Symptomatic Carotid ◽  
Artery Disease

Intracranial carotid artery disease in patients with recent neurological symptoms: high prevalence on CTA

2012 ◽  
Vol 55 (2) ◽  
pp. 179-185 ◽  
Author(s):  
Henk A. Marquering ◽  
Paul J. Nederkoorn ◽  
Leslie Bleeker ◽  
René van den Berg ◽  
Charles B. Majoie
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Disease ◽  
Neurological Symptoms ◽  
High Prevalence ◽  
Artery Disease
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