scholarly journals Prevalence of carotid artery disease in patients with metabolic syndrome

2020 ◽  
Vol 12 ◽  
Author(s):  
Tatjana Deleva-Stoshevska
Keyword(s):  
Metabolic Syndrome ◽  
Risk Factor ◽  
Carotid Artery ◽  
Carotid Artery Disease ◽  
Significant Risk ◽  
Adequate Treatment ◽  
Effective Prevention ◽  
Linear Probe ◽  
Artery Disease ◽  
The Impact

There is a growing body of scientific evidence on the impact of metabolic syndrome (MetS) on the progression of atherosclerosis, imposing the need for research of the association of MetS with carotid artery disease (CAD) as a significant risk factor for cerebrovascular insult (CVI) and transient ischemic attack (TIA). The aim of the study was to determine the prevalence of CAD as a risk factor for CVI and TIA in subjects with MetS. Material and methods: A cross-sectional study was performed including a total of 118 subjects, 65 men, 53 women, with MetS according to NCEP ATP III criteria that were analyzed clinically, biochemically and ultrasonographically in the City General Hospital "8th September" - Skopje in the period from January 2017 to January 2018. Waist circumference, blood pressure, glycemia, triglycerides, and HDL cholesterol were determined according to standard routine protocols. The evaluation of the extracranial carotid trunk was done with a Color Doppler Duplex sonography with a linear probe of 7.5MHz. CAD assessment was performed using Ultrasound Consensus Criteria for Carotid Stenosis. An objective neurological assessment of the existence of CVI and TIA was performed by a standard protocol for neurological examination and brain CT results from medical history were reviewed. Results: The prevalence of CAD in this study was 77 subjects (65.25%), of which 35 subjects (29.66%) had symptomatic CAD, 17 subjects (48.57%) had CVI, 18 subjects (51.43%) had TIA. Regarding the degree of carotid artery stenosis (CAS) in the total number of subjects with MetS and CAD, no subjects with normal findings were registered, 16 subjects had stenosis <50% , 29 subjects had stenosis 50-69% , 23 subjects had stenosis 70-99% , while 9 subjects had occlusion. Conclusion: The results obtained in this study have shown that asymptomatic CAD is dominant in patients with MetS, which further imposed the need for timely extracranial ultrasonographic evaluation of the carotid trunk. This would achieve both effective prevention and adequate treatment of CVI and TIA, thereby reducing morbidity and mortality from cerebrovascular events which has a great health and socioeconomic significance.

An analysis of malpractice litigation in the surgical management of carotid artery disease

2020 ◽  
Vol 132 (6) ◽  
pp. 1900-1906 ◽  
Author(s):  
Jack J. Haslett ◽  
Lindsey A. LaBelle ◽  
Xiangnan Zhang ◽  
J Mocco ◽  
Joshua Bederson ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Perioperative Care ◽  
Carotid Artery Disease ◽  
Significant Risk ◽  
Search Terms ◽  
Jury Verdicts ◽  
Procedural Error ◽  
Legal Databases ◽  
The Difference ◽  
Artery Disease

OBJECTIVECarotid artery disease is a common illness that can pose a significant risk if left untreated. Treatment via carotid endarterectomy (CEA) or carotid artery stenting (CAS) can also lead to complications. Given the risk of adverse events related to treating, or failing to treat, carotid artery disease, this is a possible area for litigation. The aim of this review is to provide an overview of the medicolegal factors involved in treating patients suffering carotid artery disease and to compare litigation related to CEA and CAS.METHODSThree large legal databases were used to search for jury verdicts and settlements in cases related to untreated carotid artery disease, CEA, and CAS. Search terms included “endarterectomy,” “medical malpractice,” “carotid,” “stenosis,” “stenting,” “stent,” and combinations of those words. Three types of cases were considered relevant: 1) cases in which the primary allegation was negligence performing a CEA or perioperative care (CEA-related cases); 2) cases in which the primary allegation was negligence performing a CAS or perioperative care (CAS-related cases); and 3) cases in which the plaintiff alleged that a CEA or CAS should have been performed (failure-to-treat [FTT] cases).RESULTSOne hundred fifty-four CEA-related cases, 3 CAS-related cases, and 67 FTT cases were identified. Cases resulted in 133 verdicts for the defense (59%), 64 settlements (29%), and 27 plaintiff verdicts (12%). The average payout in cases that were settled outside of court was $1,097,430 and the average payout in cases that went to trial and resulted in a plaintiff verdict was $2,438,253. Common allegations included a failure to diagnose and treat carotid artery disease in a timely manner, treating with inappropriate indications, procedural error, negligent postprocedural management, and lack of informed consent. Allegations of a failure to timely treat known carotid artery disease were likely to lead to a payout (60% of cases involved a payout). Allegations of procedural error, specifically where the resultant injury was nerve injury, were relatively less likely to lead to a payout (28% of cases involved a payout).CONCLUSIONSBoth diagnosing and treating carotid artery disease has serious medicolegal implications and risks. In cases resulting in a plaintiff verdict, the payouts were significantly higher than cases resolved outside the courtroom. Knowledge of common allegations in diagnosing and treating carotid artery disease as well as performing CEA and CAS may benefit neurosurgeons. The lack of CAS-related litigation suggests these procedures may entail a lower risk of litigation compared to CEA, even accounting for the difference in the frequency of both procedures.

Snoring and carotid artery disease: A new risk factor emerges

2018 ◽  
Vol 129 (1) ◽  
pp. 265-268 ◽  
Author(s):  
Robert Deeb ◽  
Matthew R. Smeds ◽  
Jonathan Bath ◽  
Edward Peterson ◽  
Matthew Roberts ◽  
...  
Keyword(s):  
Risk Factor ◽  
Carotid Artery ◽  
Carotid Artery Disease ◽  
Artery Disease

scholarly journals Neck Irradiation: a Risk Factor for Occlusive Carotid Artery Disease

2002 ◽  
Vol 23 (4) ◽  
pp. 299-302 ◽  
Author(s):  
M. Halak ◽  
S. Fajer ◽  
H. Ben-Meir ◽  
Z. Loberman ◽  
B. Weller ◽  
...  
Keyword(s):  
Risk Factor ◽  
Carotid Artery ◽  
Carotid Artery Disease ◽  
Neck Irradiation ◽  
Artery Disease

COPD as a risk factor for carotid artery disease (CAD) and low-extremity artery disease (LEAD)

2020 ◽  
Author(s):  
Daniela Buklioska Ilievska ◽  
Jordan Minov ◽  
Nade Kochovska Kamchevska ◽  
Marjan Baloski ◽  
Bozidar Poposki
Keyword(s):  
Risk Factor ◽  
Carotid Artery ◽  
Carotid Artery Disease ◽  
Artery Disease

scholarly journals The Role of Intraindividual Carotid Artery Variation in the Development of Atherosclerotic Carotid Artery Disease: A Literature Review

2019 ◽  
Vol 7 (3) ◽  
pp. 82-91
Author(s):  
Shawn Stefan Albers ◽  
Andrew Stanton Kucey ◽  
Anish Engineer
Keyword(s):  
Risk Factors ◽  
Carotid Artery ◽  
Carotid Arteries ◽  
Carotid Artery Disease ◽  
Significant Risk ◽  
Anatomical Variations ◽  
Anatomic Variations ◽  
Bifurcation Angle ◽  
Increased Risk ◽  
Artery Disease

Carotid artery disease (CAD) is associated with numerous risk factors, including hypertension, hyperlipidemia, hypercholesterolemia, diabetes mellitus, and smoking. These systemic risk factors do not affect the carotid arteries equally in most patients, resulting in asymmetrical bilateral and unilateral CAD. It is unclear if anatomic variations in the carotid arteries predispose an individual to formation of atherosclerotic CAD. We wanted to assess (1) the inter-individual or intra-individual anatomical variations in the carotid arteries and (2) whether anatomical variations predispose the development of atherosclerotic CAD. PubMed and Medline were utilized to identify relevant literature for critical appraisal, summarization and documentation. Inclusion and exclusion criteria were applied to narrow results and articles were critically appraised and analyzed. Evidence suggests that a low outflow/inflow ratio, elevated bifurcation height, and bifurcation angle are associated with increased risk for CAD. Sex and age demonstrated positive correlation with the disease. Additionally, tortuosity and kinking of the carotid arteries may affect the formation of CAD but coiling of the arteries is a natural age-dependent process and does not affect CAD development. This review suggests there are anatomic variations in the carotid arteries that increase the risk of developing carotid artery disease. The most significant risk factors include a low outflow/inflow ratio, increased internal carotid artery tortuosity, elevated bifurcation height, and bifurcation angle.

Cortical Ischemic Lesion Burden Measured by DIR Is Related to Carotid Artery Disease Severity

2014 ◽  
Vol 39 (1) ◽  
pp. 23-30 ◽  
Author(s):  
Doriana Landi ◽  
Paola Maggio ◽  
Domenico Lupoi ◽  
Paola Palazzo ◽  
Claudia Altamura ◽  
...  
Keyword(s):  
Risk Factors ◽  
Carotid Artery ◽  
Disease Severity ◽  
Carotid Artery Disease ◽  
Carotid Disease ◽  
Ischemic Lesion ◽  
Cerebrovascular Risk ◽  
Artery Disease ◽  
The Impact

Background: Over time, exposure to cerebrovascular risk factors and carotid artery disease may cause multiple asymptomatic brain cortical and subcortical microinfarcts, which are commonly found at brain autopsy. So far, lack of convenient neuroimaging tools limited the investigation of grey matter ischemic damage in vivo. We applied the Double Inversion Recovery (DIR) sequence to explore the impact of carotid artery disease on intracortical ischemic lesion load in vivo, taking into account the impact of demographic characteristics and vascular risk factors. Methods: DIR was acquired in 62 patients with common cerebrovascular risk factors stratified in three groups according to carotid artery disease severity. Intracortical lesions scored on DIR (DIRlns) were classified by vascular territory, lobe and hemisphere. White matter hyperintensities (WMHs) volume was also quantified on Fluid Attenuated Inversion Recovery sequence (FLAIR). Results: Among demographic characteristics and cerebrovascular risk variables explored, General Linear Model indicated that age and carotid artery disease were significantly associated to DIRlns. After correcting for age, DIRlns load was found to be significantly dependent on carotid artery stenosis severity (F(2, 58) = 5.56, p = 0.006). A linear positive correlation between DIRlns and WMHs was found after correcting for age (p = 0.003). Conclusions: Carotid disease severity is associated with DIRlns accrual. Microembolism and impaired cerebral hemodynamics may act as physiopathological mechanisms underlying cortical ischemic damage. The role of other factors, such as small vessel disease and the possible interaction with carotid disease, remains to be further explored.

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