Asymptomatic Carotid Bruit/Carotid Artery Stenosis

2016 ◽  
Author(s):  
Ali F AbuRahma ◽  
Patrick A. Stone
Keyword(s):  
Carotid Artery ◽  
Carotid Stenosis ◽  
Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
Asymptomatic Carotid Stenosis ◽  
Asymptomatic Carotid ◽  
Severe Stenosis ◽  
History Of ◽  
Artery Disease ◽  
The Right

Stroke used to be the third leading cause of death in the United States, behind coronary artery disease and cancer. However, a 2011 report states that stroke has now dropped to the fourth leading cause of death. Nearly 80% of strokes are ischemic, but only 15% of stroke patients have warning transient ischemic attacks. The management of patients with asymptomatic carotid stenosis is controversial; in this review, a stepwise approach to the management of asymptomatic carotid bruit/extracranial carotid artery stenosis is provided. Specifically, this review covers clinical evaluation, carotid bruits, vascular risk evaluation, imaging modalities, natural history of asymptomatic carotid artery disease, carotid plaque progression, natural history of asymptomatic carotid stenosis with evidence of clinically silent cerebral emboli, recommendations for carotid intervention/medical therapy, level 1 evidence supporting carotid endarterectomy in asymptomatic patients, and decision making for medical therapy alone versus intervention. Figures show color Doppler image with Doppler sampling from the right common carotid artery (CCA) and internal carotid artery (ICA), color duplex image with Doppler sampling of the distal left CCA and proximal ICA, color duplex ultrasound image of a plaque at the carotid bifurcation, magnetic resonance angiography showing severe stenosis of the right ICA and occluded left ICA, computed tomographic angiography showing severe stenosis of the left ICA with calcification, diagram for management of patients with both carotid stenosis and coronary artery disease, and protocol of management of asymptomatic bruit/carotid artery stenosis. Tables list the annual risk of stroke, prevalence of carotid stenosis in patients with bruits and in healthy volunteers, duplex velocity criteria for carotid stenosis, consensus criteria, validation of consensus criteria: duplex ultrasonography versus angiographic stenosis, risk factors for stroke, ranking of modifiable stroke risk factors, asymptomatic randomized trials comparing medical with medical and surgical treatment (stenosis > 60%), and a summary of specialty/societal guidelines. This review contains 7 highly rendered figures, 9 tables, and 91 references

Asymptomatic Carotid Bruit/Carotid Artery Stenosis

2016 ◽  
Author(s):  
Ali F AbuRahma ◽  
Patrick A. Stone
Keyword(s):  
Carotid Artery ◽  
Carotid Stenosis ◽  
Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
Asymptomatic Carotid Stenosis ◽  
Asymptomatic Carotid ◽  
Severe Stenosis ◽  
History Of ◽  
Artery Disease ◽  
The Right

Stroke used to be the third leading cause of death in the United States, behind coronary artery disease and cancer. However, a 2011 report states that stroke has now dropped to the fourth leading cause of death. Nearly 80% of strokes are ischemic, but only 15% of stroke patients have warning transient ischemic attacks. The management of patients with asymptomatic carotid stenosis is controversial; in this review, a stepwise approach to the management of asymptomatic carotid bruit/extracranial carotid artery stenosis is provided. Specifically, this review covers clinical evaluation, carotid bruits, vascular risk evaluation, imaging modalities, natural history of asymptomatic carotid artery disease, carotid plaque progression, natural history of asymptomatic carotid stenosis with evidence of clinically silent cerebral emboli, recommendations for carotid intervention/medical therapy, level 1 evidence supporting carotid endarterectomy in asymptomatic patients, and decision making for medical therapy alone versus intervention. Figures show color Doppler image with Doppler sampling from the right common carotid artery (CCA) and internal carotid artery (ICA), color duplex image with Doppler sampling of the distal left CCA and proximal ICA, color duplex ultrasound image of a plaque at the carotid bifurcation, magnetic resonance angiography showing severe stenosis of the right ICA and occluded left ICA, computed tomographic angiography showing severe stenosis of the left ICA with calcification, diagram for management of patients with both carotid stenosis and coronary artery disease, and protocol of management of asymptomatic bruit/carotid artery stenosis. Tables list the annual risk of stroke, prevalence of carotid stenosis in patients with bruits and in healthy volunteers, duplex velocity criteria for carotid stenosis, consensus criteria, validation of consensus criteria: duplex ultrasonography versus angiographic stenosis, risk factors for stroke, ranking of modifiable stroke risk factors, asymptomatic randomized trials comparing medical with medical and surgical treatment (stenosis > 60%), and a summary of specialty/societal guidelines.   This review contains 7 highly rendered figures, 9 tables, and 91 references

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.

scholarly journals Impairments in Brain Perfusion, Metabolites, Functional Connectivity, and Cognition in Severe Asymptomatic Carotid Stenosis Patients: An Integrated MRI Study

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Tao Wang ◽  
Feng Xiao ◽  
Guangyao Wu ◽  
Jian Fang ◽  
Zhenmeng Sun ◽  
...  
Keyword(s):  
Executive Function ◽  
Carotid Artery ◽  
Carotid Stenosis ◽  
Carotid Artery Stenosis ◽  
Anterior Part ◽  
Brain Perfusion ◽  
Posterior Cingulate Cortex ◽  
Artery Stenosis ◽  
Asymptomatic Carotid Stenosis ◽  
Asymptomatic Carotid

Carotid artery stenosis without transient ischemic attack (TIA) or stroke is considered as “asymptomatic.” However, recent studies have demonstrated that these asymptomatic carotid artery stenosis (aCAS) patients had cognitive impairment in tests of executive function, psychomotor speed, and memory, indicating that “asymptomatic” carotid stenosis may not be truly asymptomatic. In this study, when 19 aCAS patients compared with 24 healthy controls, aCAS patients showed significantly poorer performance on global cognition, memory, and executive function. By utilizing an integrated MRI including pulsed arterial spin labeling (pASL) MRI, Proton MR Spectroscopy (MRS), and resting-state functional MRI (R-fMRI), we also found that aCAS patients suffered decreased cerebral blood flow (CBF) mainly in the Left Frontal Gyrus and had decreased NAA/Cr ratio in the left hippocampus and decreased connectivity to the posterior cingulate cortex (PCC) in the anterior part of default mode network (DMN).

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.

scholarly journals Comparison of different carotid stent designs in endovascular therapy of severe carotid artery stenosis

2020 ◽  
Vol 4 (1) ◽  
pp. 2514183X2093241
Author(s):  
Philipp Gruber ◽  
Jatta Berberat ◽  
Timo Kahles ◽  
Javier Anon ◽  
Michael Diepers ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Stenosis ◽  
Carotid Artery Stenosis ◽  
Recurrent Stroke ◽  
Artery Stenosis ◽  
High Grade ◽  
Carotid Stent ◽  
Asymptomatic Carotid ◽  
Stent System ◽  
Elective Patients

Background: One of the major periprocedural risks of carotid artery stenting is embolism caused either by plaque debris or by local thrombus forming. Double-layer micromesh stent design has shown to lower the chance of debris embolism but might have a slightly higher risk of local thrombus forming. Thus, we compared two different stent designs regarding safety and outcome profile in elective patients with high-grade carotid artery stenosis using a self-expanding, double-layer micromesh carotid stent system (DLCS) or a self-expanding hybrid carotid stent system (HCS). Methods: A single-center, open-label, retrospective cohort study of 67 consecutive, elective patients with high-grade symptomatic and asymptomatic carotid stenosis was executed at a comprehensive stroke center. Outcome measures were reocclusion rate, periprocedural symptomatic ischemic events, as well as other periprocedural complications, and recurrent stroke and mortality at 30 days’ follow-up. Results: Thirty-two patients (24% women, median age 75 years (interquartile range (IQR) 71–80) were treated with DLCS, and 35 patients (29% women, median age 71 years (IQR 63–76) years) with HCS. In both groups, pretreatment carotid stenosis degree was similar (median NASCET of 80%). Successful deployment was achieved in all cases without technical failure, and both groups did not differ in reocclusion rates, recurrent stroke, and mortality within 30 days. Conclusions: DCLS and HCS revealed to have similar safety and outcome profile in elective patients with high-grade symptomatic as well as asymptomatic carotid artery stenosis.

Sign in / Sign up

Export Citation Format

Share Document