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. 

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.

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.

scholarly journals CEREBRAL ISCHAEMIA AND STROKE;

2017 ◽  
Vol 24 (12) ◽  
pp. 1823-1827
Author(s):  
Sibghat Ullah Khan ◽  
Naveed Aslam Lashari ◽  
Nadia Irum Lakho ◽  
Ambreen Faisal ◽  
Aamir Hussain
Keyword(s):  
Cerebral Ischemia ◽  
Carotid Artery ◽  
Cerebral Ischaemia ◽  
Carotid Artery Stenosis ◽  
Carotid Artery Disease ◽  
Artery Stenosis ◽  
Colour Doppler ◽  
Doppler Examination ◽  
Artery Disease ◽  
Carotid Doppler

Introduction: Colour Doppler sonography is a well-established widely available,noninvasive, cost effective and a reliable method for assessing cerebrovascular circulation.It has become a valuable completion of the sonographic workup in patients with cerebralischaemia and infarction. Its accuracy is close to angiography. Objectives: To determine thefrequency of significant carotid artery stenosis in patients of cerebral ischaemia/stroke and itscharacterized sonographic appearance of plaque. Study Design: Cross sectional study, basedon nonprobability convenience sample technique. Setting: Department of Radiology, CombinedMilitary Hospital Lahore, using Colour and Power Doppler Ultrasound machine ALOKA SSD-5500. Period: 14 October 2006 to 15 March 2007. Methodology: Total of 50 diagnosed patientsof either gender, aged 30 to 70 years with cerebral ischaemia and stroke were included in thestudy. Carotid Doppler examination was conducted in each patient and findings were recorded.Results: Among 50 patients who underwent carotid Doppler examination for diagnosis ofclinically significant carotid artery stenosis, 35 patients had carotid plaques. 08 patients werediagnosed to have more than 70 % stenosis, 07 patients with more than 50 % and 20 patientsless than 50 % carotid artery stenosis. 15 patients did not show any carotid artery disease.12 patients had bilateral stenosis while 23 had unilateral disease. Mean age of the patientswith and without carotid artery disease was 52 ± 7.87 years. Conclusion: Majority of patientswith Cerebral ischemia/stroke showed carotid artery stenosis on colour Doppler ultrasound.Common age group who developed cerebral ischemia/stroke was above 50years.

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

scholarly journals Cervical carotid artery disease in sickle cell anemia: clinical and radiological features

Blood ◽  
2011 ◽  
Vol 118 (23) ◽  
pp. 6192-6199 ◽  
Author(s):  
Paul T. Telfer ◽  
Jane Evanson ◽  
Paul Butler ◽  
Claire Hemmaway ◽  
Chenya Abdulla ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Sickle Cell ◽  
Internal Carotid ◽  
Carotid Artery Disease ◽  
Vascular Lesion ◽  
Nontreated Patient ◽  
Artery Disease ◽  
Neck Vessels ◽  
Carotid Doppler ◽  
Radiologic Features

AbstractCervical internal carotid artery (cICA) occlusion is a recognized cause of acute ischemic stroke (AIS) in sickle cell disease (SCD), but the associated clinical and radiologic features are not well described. We reviewed data on cervical magnetic resonance angiography (cMRA) performed prospectively in 67 patients (55 children) for indications including transcranial Doppler (TCD) abnormalities, AIS, or previous AIS. cICA lesions were seen in 10 (15%) patients, including 4 of 7 patients presenting with AIS, and appear to have been missed on first presentation in 4 of 10 patients with previous AIS. Radiologic features in 7 patients were consistent with dissection. In 2 patients, there was strong clinical and radiologic evidence for thromboembolic AIS, and this was also considered possible in 4 other patients. Three of the 4 AIS patients were anticoagulated acutely, and the nontreated patient had recurrent, probably thromboembolic, AIS. TCD findings were variable, but in 4 patients there were high velocities in the cerebral vessels contralateral to the cICA stenosis. We suggest that all patients with AIS should have cMRA during acute evaluation to identify cICA occlusions that may require anticoagulation. Routine screening of children with SCD should also include evaluation of neck vessels by carotid Doppler followed by cMRA if a cervical vascular lesion is suspected.

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