Current Medical and Surgical Stroke Prevention Therapies for Patients with Carotid Artery Stenosis

2019 ◽  
Vol 16 (1) ◽  
pp. 96-103
Author(s):  
Mirza Jusufovic ◽  
Karolina Skagen ◽  
Kirsten Krohg-Sørensen ◽  
Mona Skjelland
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Recurrent Stroke ◽  
Artery Stenosis ◽  
Optimal Management ◽  
Vascular Events ◽  
Asymptomatic Carotid ◽  
Carotid Revascularization ◽  
Risks And Benefits ◽  
Asymptomatic Carotid Artery Stenosis

Carotid Artery Stenosis (CAS) is a marker of systemic atherosclerosis and patients with CAS are at high risk of vascular events in multiple vascular locations, including ipsilateral ischemic stroke. Both medical and surgical therapies have been demonstrated effective in reducing this risk. The optimal management for patients with asymptomatic carotid artery stenosis remains controversial. In patients with symptomatic CAS ≥70%, CEA has been demonstrated to reduce the risk of stroke. With the risk of recurrent stroke being particularly high in the first 2 weeks after the first event, Carotid Endarterectomy (CEA) or carotid angioplasty with stenting provides maximal benefits to patients with symptomatic CAS ≥70% if performed within this «2-week» target. Several large ongoing trials are currently comparing the risks and benefits of carotid revascularization versus medical therapy alone.

Abstract TP141: Can the Human Eye Match a Computer Algorithm in Identifying Hypoperfusion in Asymptomatic Carotid Artery Stenosis?

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Randolph S Marshall ◽  
Ronald M Lazar ◽  
James F Meschia ◽  
Philip M Meyers ◽  
E Sander Connolly ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Carotid Artery Disease ◽  
Artery Stenosis ◽  
Computer Algorithm ◽  
Automated System ◽  
Asymptomatic Carotid ◽  
Vascular Surgeon ◽  
Carotid Revascularization ◽  
Asymptomatic Carotid Artery Stenosis

Background: Perfusion weighted imaging on MRI (MRP) and computerized tomography perfusion (CTP) are increasingly required to manage large vessel disease. Computerized algorithms can quantify perfusion data, but the programs are expensive and not widely used outside acute stroke evaluation. We aimed to determine how well human observers can identify asymmetries in cerebral perfusion images compared with an automated computer algorithm. Methods: Ten clinicians experienced in treating carotid artery disease (4 vascular neurologists, 3 neuroradiologists, 1 vascular surgeon, 1 neurosurgeon, 1 interventional radiologist) were given 28 post-processed, color-coded, axial-slice MRP scans from patients in the Carotid Revascularization Endovascular versus Stenting Trial - Hemodynamics (CREST-H) study. All patients had >70%, unilateral, asymptomatic carotid artery stenosis and had varying degrees of time-to-peak (TTP) delay on the side of stenosis, ranging from 0 to 2 secs, quantified by a semi-automated system that computes quantitative perfusion maps, using deconvolution of tissue and arterial signals (Olea, Cambridge, MA). A minimum volume of 10cc was required for a given TTP delay. Clinicians were asked to determine asymmetry (y/n) and side of occlusion for each case. Number of correct responses that matched the computer output were tallied. Results: We averaged correct responses by the 10 clinicians for cases at each increment of TTP delay; (Figure). At TTP delays ≥1.5 seconds, accuracy was ≥80%. At 1.25 sec accuracy fell to 60%, and at ≤ 1 sec, accuracy was ≤50%. For TTP=0 (no asymmetry), accuracy was 71%. Conclusions: Visual impression of hemodynamic asymmetry among experienced clinicians was reasonably accurate for TTP delays ≥1.5 seconds, but declined with more subtle asymmetries. Depending on the clinical impact of TTP delays (for CREST-H: correlation with cognitive decline), experienced clinicians may perform as well as an automated algorithm.

Abstract W P103: Rates and Predictors of Five Year Survival in Asymptomatic Medicare Beneficiaries Undergoing Carotid Revascularization

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
M Fareed K Suri ◽  
Saqib A Chaudhry ◽  
Adnan I Qureshi
Keyword(s):  
Atrial Fibrillation ◽  
Renal Failure ◽  
Chronic Renal Failure ◽  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
Medicare Beneficiaries ◽  
Asymptomatic Carotid ◽  
Carotid Revascularization ◽  
Asymptomatic Carotid Artery Stenosis

Background: Current American Heart Association guidelines recommend carotid revascularization for asymptomatic patients based on co-morbid conditions and life expectancy. Objective: To determine the rates and predictors of five year survival in elderly patients with asymptomatic carotid artery stenosis who underwent either surgical or endovascular treatment. Methods: The study cohort included a representative sample of fee-for-service Medicare beneficiaries aged ≥65 years who underwent endovascular or surgical treatment for asymptomatic carotid artery stenosis with post-procedure follow-up of 3.4 (±1.7) years. The rates of 5 year survival were determined using Kaplan Meir survival methods. Cox proportional hazards analysis was used to assess the relative risk (RR) of all-cause mortality for patients in presence of selected co-morbidities including ischemic heart disease, chronic renal failure, and atrial fibrillation after adjusting for potential confounders such as age, gender, race/ethnicity and procedure type. Results: A total of 22177 patients with asymptomatic carotid artery stenosis were treated with either endovascular (n=2144) or surgical treatment (n=20033). The overall estimated 5 year survival rate was 95.3% (95% CI 95.0-95.6 %); and 95.5% and 93.8% in patients treated with surgical and endovascular treatments, respectively. After adjusting for potential confounders, relative risks of all-cause five year mortality was significantly higher among patients with atrial fibrillation (relative risk [RR] 1.9, 95% confidence interval [CI] 1.6-2.2) and those with chronic renal failure (RR 2.1, 95% CI1.7-2.6). Concurrent ischemic heart disease did not affect the all-cause mortality (RR 1.1, 95% CI0.9-1.3). Conclusion: Risks and benefits must be carefully weighed prior to carotid revascularization in elderly patients with asymptomatic carotid artery stenosis who have concurrent atrial fibrillation or chronic renal failure.

scholarly journals Long-term Risk of Stroke and Other Vascular Events in Patients With Asymptomatic Carotid Artery Stenosis

2002 ◽  
Vol 59 (7) ◽  
pp. 1162 ◽  
Author(s):  
Zurab G. Nadareishvili ◽  
Peter M. Rothwell ◽  
Vadim Beletsky ◽  
Angela Pagniello ◽  
John W. Norris
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
Vascular Events ◽  
Asymptomatic Carotid ◽  
Asymptomatic Carotid Artery Stenosis

Rates and Predictors of 5-Year Survival in a National Cohort of Asymptomatic Elderly Patients Undergoing Carotid Revascularization

Neurosurgery ◽  
2014 ◽  
Vol 76 (1) ◽  
pp. 34-41 ◽  
Author(s):  
Adnan I. Qureshi ◽  
Saqib A. Chaudhry ◽  
Mushtaq H. Qureshi ◽  
M. Fareed K. Suri
Keyword(s):  
Atrial Fibrillation ◽  
Renal Failure ◽  
Chronic Renal Failure ◽  
Relative Risk ◽  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
Asymptomatic Carotid ◽  
Carotid Revascularization ◽  
Asymptomatic Carotid Artery Stenosis

Abstract BACKGROUND: Current American Heart Association guidelines recommend carotid revascularization for asymptomatic patients on the basis of life expectancy. OBJECTIVE: To determine the rates and predictors of 5-year survival in elderly patients with asymptomatic carotid artery stenosis who underwent either carotid artery stent placement (CAS) or carotid endarterectomy (CEA). METHODS: The rates of 5-year survival were determined by use of Kaplan-Meier survival methods in a representative sample of fee-for-service Medicare beneficiaries ≥65 years of age who underwent CAS or CEA for asymptomatic carotid artery stenosis with postprocedural follow-up of 3.4 ± 1.7 years. Cox proportional hazards analysis was used to assess the relative risk of all-cause mortality for patients in the presence of selected comorbidities, including ischemic heart disease, chronic renal failure, and atrial fibrillation, after adjustment for potential confounders such as age, sex, race/ethnicity, and procedure type. RESULTS: A total of 22 177 patients with asymptomatic carotid artery stenosis were treated with either CAS (n = 2144) or CEA (n = 20 033). The overall estimated 5-year survival rate (±SE) was 95.3 ± 0.00149; it was 95.5% and 93.8% in patients treated with CEA and CAS, respectively. After adjustment for potential confounders, relative risk of all-cause 5-year mortality was significantly higher among patients with atrial fibrillation (relative risk, 1.8; 95% confidence interval, 1.5-2.1) and those with chronic renal failure (relative risk, 2.1; 95% confidence interval, 1.7-2.6). CONCLUSION: Risks and benefits must be carefully weighed before carotid revascularization in elderly patients with asymptomatic carotid artery stenosis who have concurrent atrial fibrillation or chronic renal failure.

scholarly journals Asymptomatic Carotid Artery Stenosis and the Risk of New Vascular Events in Patients With Manifest Arterial Disease

Stroke ◽  
2007 ◽  
Vol 38 (5) ◽  
pp. 1470-1475 ◽  
Author(s):  
Bertine M.B. Goessens ◽  
Frank L.J. Visseren ◽  
L. Jaap Kappelle ◽  
Ale Algra ◽  
Yolanda van der Graaf
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Arterial Disease ◽  
Artery Stenosis ◽  
Vascular Events ◽  
Asymptomatic Carotid ◽  
Asymptomatic Carotid Artery Stenosis

Oxidative injury associated with stenting of asymptomatic carotid artery stenosis

VASA ◽  
2017 ◽  
Vol 46 (4) ◽  
pp. 268-274
Author(s):  
Erhan Saraçoğlu ◽  
Ertan Vuruşkan ◽  
Yusuf Çekici ◽  
Salih Kiliç ◽  
Halil Ay ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Carotid Artery ◽  
Oxidative Damage ◽  
Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
Oxidative Stress Marker ◽  
Asymptomatic Carotid ◽  
Imaging Methods ◽  
Neurological Findings ◽  
Asymptomatic Carotid Artery Stenosis

Abstract. Background: After carotid artery stenting (CAS), neurological complications that cannot be explained with imaging methods may develop. In our study we aimed to show, using oxidative stress markers, isolated oxidative damage and resulting neurological findings following CAS in patients with asymptomatic carotid artery stenosis. Patients and methods: We included 131 neurologically asymptomatic patients requiring CAS. The neurological findings were evaluated using the modified Rankin Scale (mRS) prior to the procedure, one hour post-procedure, and two days after. Patients with elevated mRS scores but with or without typical hyperintense lesions observed on an MRI and with changes of oxidative stress marker levels at the time (Δtotal-thiol, Δtotal antioxidative status [TAS], and Δtotal oxidant status [TOS]) were evaluated. Results: In the neurological examination carried out one hour prior to the procedure, there were 92 patients with mRS = 0, 20 with mRS = 1, and 12 with mRS = 2. When Δtotal-thiol, ΔTAS, and ΔTOS values and the mRS were compared, it was observed that as the difference in oxidative parameters increased, clinical deterioration also increased proportionally (p = 0.001). Conclusions: We demonstrate a possible correlation between oxidative damage and neurological findings after CAS which could not be explained by routine imaging methods.

Revascularization for asymptomatic carotid artery stenosis improves balance and mobility

2021 ◽  
Author(s):  
Vicki L. Gray ◽  
Sarasijhaa K. Desikan. ◽  
Amir A. Khan ◽  
Dawn Barth ◽  
Siddhartha Sikdar ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
Asymptomatic Carotid ◽  
Asymptomatic Carotid Artery Stenosis
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