scholarly journals Comparison of the Values of MRI in the Differential Diagnosis of Symptomatic Carotid Stenosis and Atherosclerotic Plaque

2020 ◽  
Vol 4 (4) ◽  
Author(s):  
Junying Bi ◽  
Yanni Zeng ◽  
Jun Meng ◽  
Tiantian Zhou ◽  
Xiang Gao
Keyword(s):  
Differential Diagnosis ◽  
Carotid Artery ◽  
Carotid Stenosis ◽  
Atherosclerotic Plaque ◽  
Carotid Artery Stenosis ◽  
Gold Standard ◽  
Artery Stenosis ◽  
Symptomatic Carotid ◽  
Carotid Mri ◽  
Symptomatic Carotid Stenosis

 Objective: To evaluate the values of Carotid Magnetic Resonance Imaging (MRI) in the differential diagnosis of symptomatic carotid stenosis and atherosclerotic plaque. Methods: 56 patients with ischemic cerebrovascular disease admitted in our hospital from October 2018 to October 2019 were selected and treated with Carotid MRI and digital subtraction angiography (DSA) examinations. According to the two examination results recorded and the “gold standard” of DSA examination, values of Carotid MRI in the differential diagnosis of symptomatic carotid stenosis were evaluated. Results: According to the “gold standard” of DSA examination, the sensitivity and specificity of MRI examination for carotid stenosis were: Mild: 92.54% and 97.78%; Moderate: 85.71% and 88.78%; Severe: 100.00% and 97.8%; and complete occlusion: 100.00% and 100.00%; The proportions of intraplaque haemorrhage and ruptured fibrous cap in different degrees of carotid artery stenosis were: Mild: 30.16% and 22.22%; Moderate: 43.48% and 39.13%; And severe: 57.89% and 52.63%. Conclusion: MRI examination can evaluate the degree of symptomatic carotid artery stenosis, and show the characteristics of atherosclerotic plaque at the same time to provide a reference for early clinical differential diagnosis and treatment.

Carotid Artery Stenting May Be Losing the Battle against Carotid Endarterectomy for the Management of Symptomatic Carotid Artery Stenosis, But the Jury Is Still Out

Vascular ◽  
2009 ◽  
Vol 17 (4) ◽  
pp. 183-189 ◽  
Author(s):  
Kosmas I. Paraskevas ◽  
Dimitri P. Mikhailidis ◽  
Frank J. Veith
Keyword(s):  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Carotid Artery Stenosis ◽  
Carotid Artery Stenting ◽  
Artery Stenosis ◽  
Long Term Results ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis

Carotid artery stenting (CAS) has emerged as a potential alternative to carotid endarterectomy (CEA) for the management of carotid artery stenosis. The purpose of this article is to provide an evaluation and critical overview of the trials comparing the early and later results of CAS with CEA for symptomatic carotid stenosis. The Cochrane Controlled Trials Register, PubMed/Medline, and EMBASE databases were searched up to February 1, 2009, to identify trials comparing the long-term outcomes of CAS with CEA. The MeSH terms used were “carotid artery stenting,” “carotid endarterectomy,” “symptomatic carotid artery stenosis,” “treatment,” “clinical trial,” “randomized,” and “long-term results,” in various combinations. One single-center and three multicenter randomized studies reporting their long-term results from the comparison of CAS with CEA for symptomatic carotid stenosis were identified. All four studies independently reached the conclusion that CAS may not provide results equivalent to those of CEA for the management of symptomatic carotid stenosis. A higher incidence of recurrent stenosis and peri- and postprocedural events accounted for the inferior results reported for CAS compared with CEA. Current data from randomized studies indicate that CAS provides inferior long-term results compared with CEA for the management of symptomatic carotid artery stenosis. However, it can be argued that all of these trials were performed when both CAS equipment and CAS operators had not evolved to their current status. Given that current equipment and mature experience are required for CAS before comparing it with the current “gold standard” procedure (CEA), the results of soon-to-be reported trials (Carotid Revascularization Endarterectomy vs Stenting Trial [CREST], International Carotid Stenting Study [ICSS], or others) may alter the current impression that CAS is inferior to CEA for the treatment of symptomatic carotid stenosis.

scholarly journals Safety and Efficacy of Early Carotid Endarterectomy in Patients with Symptomatic Carotid Artery Stenosis: A Meta-Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Xiao Chen ◽  
Jing Su ◽  
Guojun Wang ◽  
Han Zhao ◽  
Shizhong Zhang ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Carotid Artery Stenosis ◽  
Meta Analysis ◽  
Postoperative Mortality ◽  
Neurological Symptoms ◽  
Artery Stenosis ◽  
Symptomatic Carotid ◽  
Postoperative Stroke

Background and Purpose. This study is aimed at assessing the differences in postoperative stroke, myocardial infarction (MI), and mortality in patients with symptomatic carotid artery stenosis (sCAS) treated with early or late carotid endarterectomy (CEA) to determine and compare the safety of different operation timing. Design. A systematic document retrieval of studies published in the past 10 years reporting periprocedural stroke/mortality/MI after carotid endarterectomy (CEA) related to the time between CEA and qualifying neurological symptoms. The application database has “PubMed, EMbase and Cochrane databases.” RevMan5.3 software provided by the Cochrane collaboration was used for meta-analysis. Results. A systematic literature search was conducted in databases. A total of 10 articles were included in this study. They were divided into early CEA and delayed CEA with operation within 48 h, 1 w, or 2 w after onset of neurological symptoms. Incidence of the postoperative stroke in patients undergoing delayed CEA (≥48 h) was significantly higher than patients with delayed CEA (<48 h) ( OR = 2.14 , 95% CI: 1.43-3.21, P = 0.0002 ). The postoperative mortality of patients after delayed CEA (≥48 h) was significantly higher than patients after early CEA (<48 h) ( OR = 1.35 , 95% CI: 1.06-1.71, P = 0.02 ). The risk of postoperative mortality of patients treated with delayed CEA (≥7 d) was significantly higher than patients after the early CEA group (<7 d) ( OR = 1.69 , 95% CI: 1.21-2.32, P = 0.001 ). Conclusion. Early CEA is safe and effective for a part of patients with symptomatic carotid stenosis, but a comprehensive preoperative evaluation of patients with carotid stenosis must be performed.

Short-term Outcome of Straight vs Tapered Carotid Stenting for Symptomatic Carotid Artery Stenosis: A Prospective Study

2018 ◽  
Vol 25 (6) ◽  
pp. 765-770 ◽  
Author(s):  
Jianlin Liu ◽  
Jianfeng Han ◽  
Lin Yang ◽  
Yanzi Li
Keyword(s):  
Myocardial Infarction ◽  
Carotid Artery ◽  
Prospective Study ◽  
Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
Short Term ◽  
Term Outcome ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis ◽  
A Prospective Study

Purpose: To investigate the short-term outcomes and complications of straight vs tapered carotid stent placement for patients with symptomatic carotid stenosis. Methods: A prospective study was conducted to examine if tapered carotid stents (TCS) performed better than straight carotid stents (SCS) in terms of complications and outcomes in patients with a unilateral, symptomatic, internal carotid artery stenosis ⩾70%. Between January 2014 and January 2016, 236 patients were screened; 88 were excluded, leaving 148 patients for 1:1 randomization to carotid artery stenting with either SCS or TCS. The data were analyzed for differences between the groups in terms of complications (hemodynamic depression, cerebral hyperperfusion syndrome, puncture site sequelae) and endpoint events (stroke, myocardial infarction, and death) at 30 days and 6 months. Results: Two patients in the TCS group underwent endarterectomy after allocation, leaving 72 patients (mean age 65.1±8.8 years; 59 men) in the TCS group for analysis vs 74 (mean age 65.0±7.9 years; 58 men) in the SCS group. The technical success was 100% in both groups. The incidence of hemodynamic depression (hypotension and bradycardia) after the procedures were higher in the SCS group (p=0.04), and the patients who underwent SCS procedures had longer hospital stays (p=0.01). There was no difference in the incidences of complications, myocardial infarction, mortality, or stroke at 30 days or 6 months between the SCS and TCS groups. The rates of restenosis (4% SCS vs 1% TCS) were similar (p=0.63); all restenoses were moderate (50%–70%). Conclusion: When compared to straight stents, tapered carotid stents significantly decreased hemodynamic complications and hospital stay.

NGAL and MMP-9/NGAL as biomarkers of plaque vulnerability and targets of statins in patients with carotid atherosclerosis

2017 ◽  
Vol 56 (1) ◽  
Author(s):  
Wolf Eilenberg ◽  
Stefan Stojkovic ◽  
Alexandra Kaider ◽  
Nicolas Kozakowski ◽  
Christoph M. Domenig ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Atherosclerotic Plaque ◽  
Carotid Artery Stenosis ◽  
Carotid Atherosclerosis ◽  
Heart Association ◽  
Statin Treatment ◽  
Artery Stenosis ◽  
Plaque Vulnerability ◽  
Symptomatic Carotid ◽  
Asymptomatic Patients

AbstractBackground:Neutrophil gelatinase associated lipocalin (NGAL) is expressed in atherosclerotic lesions and was recently implicated in the pathogenesis of cardiovascular pathologies. Statins are known to exert stabilizing effects on atherosclerotic plaque. The aims of our study were (1) to investigate the association of serum NGAL and metalloproteinase (MMP)-9/NGAL complex with the vulnerability of the atherosclerotic plaque, and (2) to reveal the effects of statin treatment on circulating NGAL and MMP-9/NGAL levels in patients with carotid artery stenosis.Methods:We examined the levels of NGAL and MMP-9/NGAL in blood samples from 136 patients with carotid artery stenosis by specific enzyme-linked immunosorbent assays.Results:Patients with vulnerable plaques, as determined by ultrasound (plaques with decreased echogenicity) and histological analysis (type VI according to the classification of American Heart Association [AHA]), displayed the highest levels of NGAL (both p<0.0001) and MMP-9/NGAL complex (p=0.0004 and p=0.004, respectively). Moreover, patients with symptomatic carotid atherosclerosis had significantly higher NGAL levels compared to asymptomatic patients (p=0.0007). The statin-treated group (n=108) demonstrated lower NGAL (73.9 vs. 128.0 μg/L, p<0.0001) and MMP-9/NGAL (28.9 vs. 40.6 μg/L, p=0.046) as compared to the non-statin group (n=28). Furthermore, in multivariate regression analysis NGAL, but not MMP-9/NGAL levels, were independently associated with symptomatic carotid artery stenosis. In addition, statin treatment was independently associated with lower NGAL levels.Conclusions:Circulating NGAL and MMP-9/NGAL are associated with plaque vulnerability in patients with carotid artery stenosis. Statin treatment could contribute to plaque stabilization by reducing circulating NGAL and MMP-9/NGAL levels.

scholarly journals Atherosclerotic plaque rupture in symptomatic carotid artery stenosis

1996 ◽  
Vol 23 (5) ◽  
pp. 755-766 ◽  
Author(s):  
Sandra Carr ◽  
Andrew Farb ◽  
William H. Pearce ◽  
Renu Virmani ◽  
James S.T. Yao
Keyword(s):  
Carotid Artery ◽  
Atherosclerotic Plaque ◽  
Carotid Artery Stenosis ◽  
Plaque Rupture ◽  
Artery Stenosis ◽  
Symptomatic Carotid ◽  
Atherosclerotic Plaque Rupture

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 A study on prevalence of carotid artery stenosis in acute ischaemic stroke patients in Amalapuram, Andhra Pradesh, India

2019 ◽  
Vol 7 (6) ◽  
pp. 2146
Author(s):  
Bonthu Mamatha Bharathi ◽  
Raveena Gullapalli
Keyword(s):  
Risk Factor ◽  
Carotid Artery ◽  
Ischaemic Stroke ◽  
Carotid Stenosis ◽  
Carotid Artery Stenosis ◽  
Acute Onset ◽  
Artery Stenosis ◽  
Doppler Study ◽  
Diastolic Velocity ◽  
Asymptomatic Patients

Background: Extra cranial carotid disease due to arteriosclerosis is usually associated with hypercholesterolemia and hyperlipidemia. Extra cranial carotid stenosis has been found to be less prevalent in black American and in Egyptians while intracranial disease is far more common Various methods includes transcranial doppler (TCD) ultrasonography, cerebral angiography, computed tomography angiography (CTA) and magnetic resonance angiography (MRA).Methods: All patients with ischaemic stroke of acute onset admitted in the medical wards of Konaseema institute of medical sciences between June 2018 and January 2019 were included in the study. All patients were subjected to CT scan brain study and colour Doppler study of extra cranial carotid arteries and vertebral arteries. Systolic and diastolic velocity of blood flow, carotid intimal medial thickness, presence of athermanous plaque and thrombus was looked for and then the percentage of stenosis of the affected arteries was calculated.Results: In the present study 0ut of 23 patients with carotid stenosis 9 patients had mild carotid stenosis, 8 patients had moderate stenosis and 6 patients had severe stenosis. Out of 23 patients with carotid stenosis the 11 patients have stenosis in the right carotid and 12 patients had stenosis in the left side. The site of stenosis is ICA in 17 patients and CCA in 6 patients.Conclusions: In present study every patient with carotid artery stenosis had one or the other risk factor for carotid atherosclerosis. In other words, there was no patient with carotid artery stenosis, without any risk factor in present study. Hence asymptomatic patients with these risk factors should be screened for carotid stenosis to prevent stroke.

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