scholarly journals Approach To Unstable Plaque In Carotid Disease

2017 ◽  
pp. 29
Author(s):  
Mojdeh Ghabaee
Keyword(s):  
Stroke Risk ◽  
Early Recognition ◽  
Carotid Artery Disease ◽  
Unstable Plaque ◽  
Prognostic Information ◽  
Carotid Disease ◽  
Luminal Stenosis ◽  
Duplex Doppler ◽  
Artery Disease ◽  
Aggressive Interventions

Risk of cerebral infarction due to thrombo emboli originating  from carotid artery disease estimated to be near 15%, and this risk  is closely associated with the severity of luminal stenosis. But at the same time characteristics  of the plaque should be taken into account for therapeutic planning when the patient is asymptomatic and the diameter of the stenosis does not reach the threshold of 70%. Search for markers of plaque vulnerability, instability, or thromboembolic potential as complementary to the degree of the luminal stenosis in stroke risk prediction should be considered .These morphologic features of carotid plaques are increasingly believed to be one of those markers that could carry further prognostic information, and early recognition of these plaques features may identify a high-risk subgroup of patients who might particularly benefit from aggressive interventions with aggressive medical treatment.Color and duplex Doppler sonography  evaluates both  morphologic and hemodynamic   abnormalitie of carotid. Echogensity, degree of stenosis and plaque surface features are essential parameters of morphological abnormality.        

Advances in Management of Carotid Atherosclerosis

1997 ◽  
Vol 12 (2) ◽  
pp. 55-65
Author(s):  
Marc D. Malkoff ◽  
Linda S. Williams ◽  
Jose Biller
Keyword(s):  
Magnetic Resonance Angiography ◽  
Carotid Artery ◽  
Carotid Stenosis ◽  
Carotid Atherosclerosis ◽  
Stroke Risk ◽  
Carotid Artery Disease ◽  
Carotid Angioplasty ◽  
Conventional Angiography ◽  
Artery Disease ◽  
Experimental Treatments

Carotid artery stenosis is a common and potentially treatable cause of stroke. Stroke risk is increased as the degree of carotid stenosis increases, as well as in patients with neurological symptoms referable to the stenosed carotid artery. Carotid stenosis can be quantified by ultrasound imaging, magnetic resonance angiography, or conventional angiography. Medical treatment with platelet antiaggregants reduces stroke risk in some patients; other patients are best treated with carotid endarterectomy. Experimental treatments for carotid stenosis, including carotid angioplasty with or without stenting, are under investigation. We summarize the current literature and provide treatment recommendations for patients with atherosclerotic carotid artery disease.

scholarly journals Carotid or Coronary Intervention which is to be done First?

2016 ◽  
Vol 01 (04) ◽  
pp. 095-097
Author(s):  
Ravikiran M. ◽  
Jabeen Afshan ◽  
Nemani Lalita
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Surgery ◽  
Carotid Artery Disease ◽  
Artery Bypass ◽  
Significant Coronary Artery Disease ◽  
Coronary Intervention ◽  
Carotid Disease ◽  
The Past ◽  
Percutaneous Coronary ◽  
Artery Disease

AbstractIn carotid artery disease patients with concomitant significant coronary artery disease (CAD - especially left main diseases – LMCA), the risk of perioperative myocardial infarction and early and late death are increased. Conversely, in patients undergoing coronary artery bypass surgery (CABG), uncorrected severe carotid disease increases the risk of adverse neurologic events [1]. The optimal management of these co-existing conditions and the timing and sequence of correcting them remain controversial. Over the past 2 decades, staged carotid revascularisation followed by CABG, staged CABG followed by carotid revascularisation, or combined coronary and carotid revascularisation simultaneously in one operative setting have each been advocated. Our patient presented with both carotid and significant LMCA CAD, first we have done carotid intervention followed one week later by LMCA percutaneous coronary intervention (PCI).

scholarly journals Stratifying risk: asymptomatic carotid disease

2012 ◽  
Vol 11 (1) ◽  
pp. 43-52 ◽  
Author(s):  
Rafael D. Malgor ◽  
Emily A. Wood ◽  
Otavio A. Iavarone ◽  
Nicos Labropoulos
Keyword(s):  
Carotid Artery ◽  
Critical Analysis ◽  
Carotid Artery Disease ◽  
Plaque Morphology ◽  
Carotid Disease ◽  
Asymptomatic Carotid ◽  
Plaque Instability ◽  
Artery Disease ◽  
Healthcare Expenses ◽  
Annual Risk

Stroke generates significant healthcare expenses and it is also a social and economic burden. The carotid artery atherosclerotic plaque instability is responsible for a third of all embolic strokes. The degree of stenosis has been deliberately used to justify carotid artery interventions in thousands of patients worldwide. However, the annual risk of stroke in asymptomatic carotid artery disease is low. Plaque morphology and its kinetics have gained ground to explain cerebrovascular and retinal embolic events. This review provides the readers with an insightful and critical analysis of the risk stratification of asymptomatic carotid artery disease in order to assist in selecting potential candidates for a carotid intervention.

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.

Asymptomatic Cervical Carotid Stenosis

2019 ◽  
pp. 145-154
Author(s):  
Kunal Vakharia ◽  
Sabareesh K. Natarajan ◽  
Hussain Shallwani ◽  
Elad I. Levy
Keyword(s):  
Carotid Artery ◽  
Carotid Stenosis ◽  
Stroke Risk ◽  
Surgical Intervention ◽  
Carotid Artery Disease ◽  
Endovascular Management ◽  
Lifestyle Modifications ◽  
Asymptomatic Carotid ◽  
Artery Disease ◽  
Angioplasty And Stenting

Abstract: This chapter discusses the evaluation and management of asymptomatic carotid stenosis. Surgical and endovascular management of carotid artery disease continues to progress. With lifestyle modifications and medical management, the stroke risk without surgical intervention has been decreased; however, in patients with significant carotid stenosis, surgical intervention has still been shown to decrease the stroke risk by nearly half. A thorough understanding of the arterial and venous anatomy is essential for surgical planning. Carotid endarterectomy for asymptomatic carotid artery disease has been validated through prospective clinical trials to help dramatically reduce the risk of stroke. Endovascular management through carotid artery angioplasty and stenting is another option that continues to undergo evaluation in the asymptomatic patient population.

scholarly journals Moving Beyond Luminal Stenosis: Imaging Strategies for Stroke Prevention in Asymptomatic Carotid Stenosis

2015 ◽  
Vol 39 (5-6) ◽  
pp. 253-261 ◽  
Author(s):  
Ajay Gupta ◽  
Randolph S. Marshall
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Carotid Stenosis ◽  
Randomized Trials ◽  
Stroke Risk ◽  
Plaque Composition ◽  
Asymptomatic Carotid Stenosis ◽  
Carotid Disease ◽  
Asymptomatic Carotid ◽  
Luminal Stenosis

Background: With progressive improvements in medical therapy and resultant reductions in stroke risk, luminal stenosis criteria are no longer adequate to inform decisions to pursue surgical revascularization in patients with asymptomatic carotid artery stenosis. Summary: In this evidence-based review, we discuss the imaging-based risk stratification strategies that take into account factors beyond luminal stenosis measurements, including cerebral hemodynamics and plaque composition. The existing literature lends support to the use of certain imaging tests in patients with asymptomatic carotid stenosis including cerebrovascular reserve testing, MRI of plaque composition, ultrasound of plaque echolucency, and transcranial Doppler evaluation for microemboli. The highest quality evidence thus far in the literature includes only systematic reviews and meta-analyses of cohort studies with no randomized trials having yet been performed to show how these newer imaging biomarkers could be used to inform treatment decisions in asymptomatic carotid stenosis. Beyond the need for randomized trials, there are additional important steps needed to improve the relevance of evidence supporting risk assessment strategies. Imaging studies evaluating the risk of stroke in carotid disease should clearly define asymptomatic versus symptomatic disease, use uniform definitions of clearly defined outcome measures such as ipsilateral stroke, ensure that imaging interpretations are performed in a manner blinded to treatments and other risk factors, and include cohorts which are on modern intensive medical therapy. Such studies of risk stratification for asymptomatic carotid stenosis will be most valuable if they can integrate multiple high-risk features (including clinical risk factors) into a multi-factorial risk assessment strategy in a manner that is relatively simple to implement and generalizable across a wide range of practice settings. Key Messages: Together, modern imaging strategies allow for a more mechanistic assessment of stroke risk in carotid disease compared to luminal stenosis measurements alone, which, with further validation in randomized controlled trials, may improve current efforts at stroke prevention in asymptomatic carotid stenosis.

scholarly journals 664 Factors and Outcomes Associated with Delays in Carotid Endarterectomy in Symptomatic Patients

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Hussain
Keyword(s):  
Carotid Endarterectomy ◽  
Surgical Outcomes ◽  
Retrospective Cohort ◽  
Stroke Risk ◽  
Adverse Outcome ◽  
Carotid Artery Disease ◽  
Index Event ◽  
Factors Associated ◽  
Artery Disease ◽  
Significant Factors

Abstract Introduction Carotid artery disease (CAD) contributes to 20% of ischaemic stroke. Carotid endarterectomy (CEA) reduces stroke risk significantly if performed within 14 days of the index event in symptomatic patients. Studies report delayed CEA is common in practice, however underlying reasons are poorly understood. The aim is to assess factors associated with delayed CEA, and to compare outcomes between timely and delayed CEA. Method This retrospective cohort study included 24 symptomatic CAD patients planned for CEA between October 2018 and December 2019 in a tertiary vascular unit. Time from index event to CEA was measured in “timely” (≤14 days) and “delayed” (>14 days) cohorts and causes for delay were explored. Univariate logistic regression was performed to assess factors associated with delay. Surgical outcomes at 30-days and 1-year were compared between cohorts. Results Overall, 58.3% (n = 14/24) patients underwent delayed CEA. Median time from index event to CEA was 10.5 (IQR 7.5-12) and 22 (IQR 16-32) days in timely and delayed cohorts respectively (P < 0.0001). The main cause of delay was deterioration in patient condition (50%, n = 7/14). In 35.7% (n = 5/14) reasons were unclear. No statistically significant factors were associated with a delay. All surgical outcomes, including 30-day mortality (0%, n = 0/10 vs 7.1%, n = 1/14;P>0.9999) and all-stroke (0%, n = 0/10 vs 14.3%, n = 2/14;P=0.4928), were not statistically significant between timely and delayed cohorts respectively. Conclusions A substantial proportion of patients undergo delayed CEA, with inconclusive associated factors. Those undergoing a delayed CEA did not comparatively have an adverse outcome, but numbers in our study were limited. A larger scale study with increased power is required.

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