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Endarterectomy for Asymptomatic Carotid Artery Stenosis
Published in Juan Carlos Jimenez, Samuel Eric Wilson, 50 Landmark Papers Every Vascular and Endovascular Surgeon Should Know, 2020
Juan Carlos Jimenez, Samuel Eric Wilson
Research Question/Objective To determine whether the addition of carotid endarterectomy to aggressive medical management can reduce the incidence of cerebral infarction in patients with asymptomatic carotid artery stenosis.
Clinical specialties
Published in Andrew Schofield, Paul Schofield, The Complete SAQ Study Guide, 2019
Andrew Schofield, Paul Schofield
A 73-year-old man is seen in A&E. He had experienced slurred speech and weakness on his left side. The symptoms lasted 50 minutes before resolving. On examination, he is in atrial fibrillation. You believe he may have had a TIA. What scoring system can be used to determine the risk of stroke in the days following a transient ischaemic attack? (1)Name three of the paramameters used in the scoring system above. (3)What operation may be performed on someone with carotid artery stenosis? (1)Name three risk factors for an ischaemic stroke. (3)The same patient is seen in clinic soon after his attendance at A&E and is still in AF. He is started on warfarin.What is the mechanism of action of warfarin? (2)
Cerebrovascular disease in the elderly patient
Published in Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich, Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
The management of asymptomatic carotid artery stenosis remains controversial. The Asymptomatic Carotid Atherosclerosis Study documented a significant benefit of CEA, compared with medical therapy with aspirin 650 mg twice daily in patients with >60% stenosis of the ICA (76). The difference was small, with a 10% risk of stroke in the medical group compared with a 5% risk of stroke in the surgical group over 5 years. Furthermore, the results did not diverge until the fifth year of follow-up. In elderly patients, an immediate risk of complication from carotid surgery may outweigh a risk of stroke 5 years in the future. Another trial demonstrated a higher 16% reduction in stroke with CEA in patients with significant asymptomatic stenosis (77). Currently, CREST 2 is attempting to determine how maximal medical therapy compares to CEA and CAS plus maximal medical therapy for asymptomatic carotid artery stenosis (78).
The influence of the elastic modulus of the plaque in carotid artery on the computed results of FFRCT
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2020
Kesong Xu, Long Yu, Jun Wan, Shengzhang Wang, Haiyan Lu
The carotid artery is one of the major blood vessels that supply the blood flow to the brain. Carotid artery stenosis is one of the most dangerous cardiovascular diseases and an important factor in causing cerebral infarction. Atherosclerosis is the leading cause of carotid artery stenosis in middle-aged and elderly people (Fabris et al. 1994; Stroud et al. 2002). However, currently there is a lack of effective means to evaluate the risk degree of carotid artery stenosis in clinical practice. Generally, the stenosis rate of carotid artery calculated by using medical image data is used to assess the risk degree of carotid artery stenosis (Augst et al. 2003). However, this method reflects hardly the actual blood supply from the carotid artery to the brain. To achieve functional assessment for carotid artery stenosis, the researchers managed to use the blood fraction flow reserve (FFR) (Huang et al. 2015). FFR is widely used clinically to evaluate the degree of coronary artery stenosis, which can reflect the ratio of the current blood flow that the artery can provide to the downstream compared to that it can provide when the artery is completely healthy. The flow ratio can be approximated by the ratio of the downstream pressure to the upstream pressure of the stenosis, and its approximate calculation formula is
Clinical efficacy and safety of statin treatment after carotid artery stenting
Published in Artificial Cells, Nanomedicine, and Biotechnology, 2019
Lingya Qiao, Shibo Wang, Qiang Jia, Ji Bian, Yimu Fan, Xiaolin Xu
Stroke represents a leading reason of deaths and disability, posing a great threat to human health around the world [1]. Approximate 7% of stroke cases could be attributed to carotid artery stenosis [2]. The prevalence of carotid artery stenosis is up to 1% in general population, and its morbidity sharply increases with population ageing, obesity, diabetes mellitus, smoking, hypertension, family history, etc. [3,4]. Timely diagnosis and treatment of carotid artery stenosis could significantly prevent the occurrence of stroke [5]. Carotid artery endarterectomy (CEA) and carotid artery stenting (CAS) are two common treatments for carotid artery stenosis. Compared to CEA, CAS is minimally invasive, so the latter is accepted as an alternative to CEA, especially among those with high surgical risk [6,7]. However, growing evidence have demonstrated that CAS treatment is related to high risk of stroke, restenosis, mortality, as well as perioperative complications, like contrast-induced nephropathy (CIN) [8–11].
ECAS progression score: a web-based model to predict progression of extracranial carotid artery stenosis
Published in Neurological Research, 2019
Ruijun Ji, Kai Yu, Guoyang Li, Xinyu Liu, Yinglin Yan, Suying Gao, Hongna Yang, Shangmin Qin, Fang Li, Guangbo Zhang, Bo Yang, Yan He, Yongna Zhao, Enjing Li, Lihua Xu, Na Zhang, Dongna Fan, Dongliang Liu
Although carotid artery stenosis is a risk factor for stroke, not every carotid stenosis carries the same risk and clinicians should strive to assess and treat them accordingly [37]. With some investigators already calling for more targeted strategies for intervention in severe asymptomatic disease and randomized trials in revascularization [38,39], upstream evaluation of asymptomatic carotid artery disease will likely need to follow suit [37]. We recommend to evaluate the potential risk of stroke for patients with ECAS by combined parameters rather than the only degree of stenosis. Although some emerging modalities are not currently part of routine practice, they could be promising tools used to estimate the individual risk of stroke in the coming future. For example, neovascularization of carotid plaque can be identified with contrast-enhanced ultrasound [40,41], which was shown to be associated with a higher risk of ipsilateral stroke. Microembolic signals detected by transcranial Doppler have been shown to discriminate patients at higher risk of stroke [42]. High-resolution magnectic resonance imaging can accurately demonstrate lipid-rich necrotic core, intra-plaque hemorrhage and thinning or rupture of the fibrous cap [43,44]. Integrating relevant information on degree of stenosis, risk of progression, plaque texture, neovascularity and microembolic signals might be helpful for identifying higher risk patients for either more intensive surveillance or even earlier intervention.