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.

scholarly journals Carotid Artery Disease and Stroke: Assessing Risk with Vessel Wall MRI

2012 ◽  
Vol 2012 ◽  
pp. 1-13 ◽  
Author(s):  
William S. Kerwin
Keyword(s):  
Risk Factors ◽  
Carotid Artery ◽  
Vessel Wall ◽  
Carotid Arteries ◽  
Carotid Atherosclerosis ◽  
Carotid Artery Disease ◽  
Size Composition ◽  
Clinical Role ◽  
Additional Risk ◽  
Artery Disease

Although MRI is widely used to diagnose stenotic carotid arteries, it also detects characteristics of the atherosclerotic plaque itself, including its size, composition, and activity. These features are emerging as additional risk factors for stroke that can be feasibly acquired clinically. This paper summarizes the state of evidence for a clinical role for MRI of carotid atherosclerosis.

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.

Association between Pre-Existing Coronary Artery Disease and 5-Year Mortality in Stroke Patients with High-Grade Carotid Artery Stenosis

2020 ◽  
pp. 1-7
Author(s):  
Ching-I Wu ◽  
Chia-Lun Wu ◽  
Feng-Chieh Su ◽  
Shun-Wen Lin ◽  
Wen-Yi Huang
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Significant Risk ◽  
Cox Proportional Hazards Model ◽  
Artery Stenosis ◽  
High Grade ◽  
Increased Risk ◽  
Artery Disease

<b><i>Background:</i></b> The coincidence of coronary artery disease (CAD) and carotid artery stenosis (CAS) was observed. However, the association between pre-existing CAD and ischemic stroke (IS) outcome in patients with high-grade CAS remains unclear. We aimed to investigate the association between pre-existing CAD and outcomes of acute IS patients with high-grade CAS. <b><i>Methods:</i></b> From January 1, 2007, to April 30, 2012, we enrolled 372 acute IS patients with high-grade CAS and prospectively observed them for 5 years. Demographic features, vascular risk factors, comorbidities, and outcomes were compared between patients with and without pre-existing CAD. <b><i>Results:</i></b> Among 372 individuals, 75 (20.2%) patients had pre-existing CAD and 297 (79.8%) patients did not have pre-existing CAD. The prevalence rates of hypertension, congestive heart failure, chronic kidney disease, and gout in patients with pre-existing CAD were significantly higher than in those without pre-existing CAD (<i>p</i> = 0.017, <i>p</i> &#x3c; 0.001, <i>p</i> = 0.002, and <i>p</i> &#x3c; 0.001, respectively). The multivariate Cox proportional hazards model revealed that pre-existing CAD was a significant risk factor for a 5-year all-cause mortality in acute IS patients with high-grade CAS (hazard ratio = 2.26; 95% confidence interval = 1.35–3.79; <i>p</i> = 0.002). <b><i>Conclusion:</i></b> Pre-existing CAD was associated with an increased risk of 5-year mortality in acute IS patients with high-grade CAS. Intensive treatment for the pre-existing CAD may reduce long-term mortality in acute IS patients with high-grade CAS.

Contrast Enhanced Ultrasound: Visualization of Far Field and Classification of Plaque in the Extracranial Carotid Arteries

2018 ◽  
Vol 42 (3) ◽  
pp. 109-115 ◽  
Author(s):  
Paige L. Rowland ◽  
Michelle Colpitts ◽  
Angela Malone ◽  
Munis Raza ◽  
Lenora L. Eberhart ◽  
...  
Keyword(s):  
Image Quality ◽  
Carotid Artery ◽  
Carotid Arteries ◽  
Carotid Artery Disease ◽  
Plaque Morphology ◽  
Far Field ◽  
Contrast Enhanced Ultrasound ◽  
Contrast Imaging ◽  
Contrast Enhanced ◽  
Artery Disease

Ultrasound stratification for the degree of carotid artery disease based solely on lumen reduction has poorly predicted patient outcomes. This pilot study focused on patients with moderate carotid artery stenosis. Our purpose was to use contrast imaging with ultrasound to improve carotid field. A total of 10 patients diagnosed with moderate carotid artery stenosis were rescanned with an administration of a contrast imaging agent. Two-dimensional (2D) imaging, color, and Doppler were utilized to scan the patients. The 20 carotid arteries were blindly read by 2 experienced physicians. Visualization of far field, quality of Doppler envelope, plaque morphology, and overall image quality were semi-quantifiably assessed. With the use of a contrast imaging agent, there was a reduction in interphysician interpretation variability. The Kappa coefficient yielded an increase in agreement for postcontrast imaging in the majority of variables. The Doppler envelope showed improvement from precontrast (0.06) to postcontrast (0.63). The visualization of the far fields demonstrated a significant increase in agreement (0.77, 0.71, and 0.67) postcontrast. Plaque morphology demonstrated enhancement in characterization with contrast (–0.09 to 0.66). In this study, contrast-enhanced ultrasound (CEUS) was found to increase overall image quality. Improved interpretation can enhance risk stratification and with further exploration could be used to guide treatment plans for patients with asymptomatic moderate carotid artery disease.

scholarly journals Left-sided carotid arteries have a higher prevalence of intraplaque hemorrhage than right-sided: An asymmetric conundrum

2020 ◽  
Vol 33 (6) ◽  
pp. 494-500
Author(s):  
Anthony S Larson ◽  
Waleed Brinjikji ◽  
Luis Savastano ◽  
Eugene Scharf ◽  
John Huston ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Arteries ◽  
Carotid Artery Disease ◽  
Underlying Mechanism ◽  
Intraplaque Hemorrhage ◽  
Asymmetric Distribution ◽  
Anterior Circulation ◽  
Asymptomatic Patients ◽  
Left And Right ◽  
Artery Disease

Purpose To assess whether an asymmetry exists in the prevalence of carotid artery intraplaque hemorrhage (IPH) between right- and left-sided arteries. Materials and methods The records of all patients with atherosclerotic carotid artery disease that underwent neck magnetic resonance angiography imaging with high-resolution plaque sequences between 2017 and 2020 at our institution were retrospectively reviewed. The prevalence of stenosis and IPH was determined for all patients and compared between the left and right carotid arteries of those with unilateral anterior circulation ischemic strokes. Multiple regression analysis was performed to determine potential independent associations of IPH laterality with ischemic strokes. Results A total of 368 patients were included overall and 241 were male (65.4%). There were a total of 125 asymptomatic patients and 211 patients with unilateral anterior circulation ischemic strokes. Of patients with ischemic strokes, 55.5% had left-sided strokes compared with 44.5% who had right-sided strokes ( p = 0.03). Patients with left-sided strokes had a higher prevalence of ipsilateral IPH than those with right-sided strokes (64.1% versus 36.2%, p < 0.0001), despite similar degrees of stenosis. Both age (odds ratio (OR): 1.0; 95% confidence interval (CI): 1.0–1.1; p = 0.007) and the presence of left-sided IPH (OR: 3.2; 95% CI: 1.5–6.8; p = 0.003) were independently associated with unilateral ischemic strokes. Conclusions Left-sided plaques more frequently have IPH and may be more likely to result in ipsilateral ischemic strokes compared with right-sided plaques. The underlying mechanism of asymmetric distribution of IPH between right and left carotids remains unclear.

Carotid Artery Disease

1985 ◽  
Vol 11 (1) ◽  
pp. 37-39 ◽  
Author(s):  
David R. Campbell
Keyword(s):  
Carotid Artery ◽  
Carotid Arteries ◽  
Carotid Artery Disease ◽  
Definitive Diagnosis ◽  
Noninvasive Techniques ◽  
Artery Disease

Because macroangiopathy is a ma jor complication of diabetes, evalua tion of the carotid arteries for possible obstruction is of primary importance. Patients with transient ischemic at tacks, a precursor of strokes, are liable to have either a mechanical reduction of flow secondary to stenosis or a re lease of emboli from extracranial plaques. After a definitive diagnosis by angiogram, dissection of a tight lesion is indicated. Asymptomatic bruits should be evaluated by noninvasive techniques for possible prophylactic endarterectomy.

Abstract WP233: Validation of Multi-parametric Ultrasonography Criteria With Catheter Angiography in Internal Carotid Artery Disease: a Multicenter Study

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Kristian Barlinn ◽  
Henning Rickmann ◽  
Ali Rabahi ◽  
Hagen H Kitzler ◽  
Andrij Abramyuk ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Arteries ◽  
Internal Carotid ◽  
Carotid Artery Disease ◽  
False Negative ◽  
Catheter Angiography ◽  
True Negative ◽  
Artery Disease ◽  
Extracranial Ica

Introduction: Novel multi-parametric criteria for duplex ultrasonography (DUS) grading of extracranial internal carotid artery (ICA) steno-occlusive disease have been recently introduced by the German ultrasound expert panel (DEGUM). We sought to determine diagnostic accuracy of the DEGUM criteria against the gold standard catheter angiography. Methods: We prospectively enrolled consecutive patients who routinely underwent diagnostic or therapeutic catheter angiography of the extracranial carotid arteries in four German study sites. Internal carotid artery disease was graded according to the DEGUM multi-parametric criteria for DUS. On angiography, extracranial ICA disease was graded using the NASCET approach. Ultrasonography and endovascular raters were blinded to clinical data and any other imaging modalities. To correspond to clinically relevant NASCET groups, all stenosis measurements were stratified into ranges: normal, mild (1-49%), moderate (50-69%), severe (70-99%) and occlusion. Results: We studied 130 patients who underwent both DUS and catheter angiography for assessment of carotid arteries (mean age, 64±11 years; 67% men; median time between DUS and angiography, 1 day [interquartile range, 2.5]). To date, fifty-two carotid artery pairs were independently rated and available for comparative analysis. Compared with catheter angiography, DUS had the following positive (PPV) and negative predictive values (NPV): PPV 50% and NPV 72% (3 true positive, 3 false positive, 33 true negative, 13 false negative) for detection of moderate, and PPV 57% and NPV 77% (20 true positive, 15 false positive, 13 true negative, 4 false negative) for detection of severe stenosis. Conclusions: Our preliminary data indicate that the novel DEGUM multi-parametric ultrasonography criteria do not eliminate the need for a confirmatory test for identification of clinically relevant grades of extracranial ICA disease.

scholarly journals Toll-like receptor 2 and 4 stimulation elicits an enhanced inflammatory response in human obese patients with atherosclerosis

2011 ◽  
Vol 121 (5) ◽  
pp. 205-214 ◽  
Author(s):  
Vincent P.W. Scholtes ◽  
Dik Versteeg ◽  
Jean-Paul P.M. de Vries ◽  
Imo E. Hoefer ◽  
Arjan H. Schoneveld ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Carotid Artery ◽  
Cardiovascular Risk Factors ◽  
Carotid Artery Disease ◽  
Innate Immune ◽  
Obese Patients ◽  
Cd11b Expression ◽  
Activation Marker ◽  
Artery Disease

The innate immune response elicited by activation of TLRs (Toll-like receptors) plays an important role in the pathogenesis of atherosclerosis. We hypothesized that cardiovascular risk factors are associated with the activation status of the innate immune system. We therefore assessed the responsiveness of TLRs on circulating cells in two groups of patients with established atherosclerosis and related this to the presence of cardiovascular risk factors. TNF (tumour necrosis factor)-α release induced by TLR2 and TLR4 activation was measured in patients with established coronary [PCI (percutaneous coronary intervention) study, n=78] or carotid artery disease [CEA (carotid endarterectomy) study, n=104], by stimulating whole blood samples with lipopolysaccharide (TLR4 ligand) and Pam3CSK4 [tripalmitoylcysteinylseryl-(lysyl)4; TLR2 ligand]. As an early activation marker, CD11b expression was measured by flow cytometry on CD14+ cells. Obesity was the ‘only’ risk factor that correlated with the TLR response. In both studies, obese patients had significantly higher TNF-α levels after stimulation of TLR2 compared with non-obese patients [16.9 (7.7–49.4) compared with 7.5 (1.5–19.2) pg/ml (P=0.008) in coronary artery disease and 14.6 (8.1–28.4) compared with 9.5 (6.1–15.7) pg/ml (P=0.015) in carotid artery disease; values are medians (interquartile range)]. Similar results were obtained following TLR4 stimulation. The enhanced inflammatory state in obese patients was also confirmed by a significant increased expression of the activation marker CD11b on circulating monocytes. In conclusion, obesity is associated with an enhanced TLR response in patients suffering from established atherosclerotic disease.

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