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Deaths Following Cardiac Surgery and Invasive Interventions
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
Cardiac surgery continues to be associated with significant adverse cerebral outcomes, ranging from stroke to cognitive decline. This is primarily caused by cerebral embolism and hypoperfusion, exacerbated by ischemia/reperfusion injury. The aetiology of post-operative stroke in cardiac surgery patients is multifactorial, with embolism as the predominant cause, while intraoperative hypotension and haemorrhage are less frequent. Embolism is attributed mainly to manipulation of the atherosclerotic aorta, release of gaseous or particulate matter from the cardiopulmonary bypass pump, post-operative AF and minimally invasive procedures. Left ventricular ejection fraction and aortic cross-clamp time are significantly correlated with post-operative neurological complications. There was a significant correlation between the presence of preoperative carotid disease (as proven by pre- and post-operative carotid ultrasonography) and post-operative neurological events. This dreaded complication can follow prolonged bypass surgery and aortic arch surgery with generalized hypoxic brain damage (Fig. 9.25). Coexistent carotid and coronary artery diseases are common and these patients remain at a high risk for peri-operative stroke or myocardial infarction after coronary bypass surgery. Intracerebral haemorrhage can follow use of anticoagulation therapy, with ECMO and LVAD use.
Stroke and Transient Ischemic Attacks of the Brain and Eye
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
However, there are limitations. Doppler test results and diagnostic criteria are influenced by several factors, such as the equipment, the specific laboratory, and the technologist performing the test. In addition, factors such as contralateral occlusive disease have been associated with increased carotid volume flow that may result in an overestimation of the severity of stenosis. Carotid ultrasonography is less sensitive for dissection; it typically demonstrates very poor flow in the artery, giving a “to-and-fro” high-resistance signal. Occasionally, the line of the dissection and a double lumen can be imaged. Another limitation of carotid ultrasound is that it evaluates only relatively short segments of the common carotid, carotid bifurcation, and proximal ICA.
Current imaging strategies in cardio-oncology
Published in Susan F. Dent, Practical Cardio-Oncology, 2019
Mirela Tuzovic, Melkon Hacobian, Eric H. Yang
In 2016, the Society of Cardiovascular Angiography and Interventions (SCAI) released an expert consensus statement, which provided recommendations on pharmacologic and interventional management of cancer patients with cardiotoxicity, and/or preexisting or acquired atherosclerotic cardiovascular disease (ASCVD) (2). In addition, it also gave expert opinion recommendations on patients receiving specific kinds of radiation therapy that may affect the extracardiac vasculature. Although data on long-term event rates are limited, ABIs and carotid ultrasonography was advised—every 5 years for the latter posttreatment—particularly in patients at elevated ASCVD risk and who received radiation therapy to the neck area (i.e., lymphoma, head and neck cancers). Chemotherapy agents such as cisplatin, nilotinib, and ponatinib were considered to be high risk agents for arterial/venous thrombotic disease. The SCAI document advises consideration of noninvasive imaging modalities such as carotid ultrasound, as well as MRI for cerebrovascular disease and CT aortography for peripheral arterial disease assessment in patients who received agents such as nilotinib and ponatinib.
The role of carotid ultrasound in patients with non-lateralizing neurological complaints
Published in Hospital Practice, 2023
Shweta Varade, Abinayaa Ravichandran, Erafat Rehim, Hussam Yacoub, Rose Duncan, Hope Kincaid, Megan C. Leary, John Castaldo
Despite the low cost, The AHA/ASA guidelines for primary prevention of ischemic stroke do not recommend routine screening of the general population for asymptomatic carotid stenosis, citing lack of cost-effectiveness, the potential adverse impact of false-positive and false-negative results in the general population, and the small absolute benefit of intervention [5]. Screening asymptomatic individuals for carotid artery stenosis is not recommended by the United States Preventive Services Task Force either, noting that there is ‘no direct evidence that screening adults with duplex ultrasonography for asymptomatic stenosis reduces stroke’ [6]. Additionally, the Journal of the American College of Cardiology Expert Consensus Panel reported that carotid ultrasonography is not recommended for routine screening of asymptomatic patients with no clinical manifestations or risk factors for atherosclerosis [7].
No progression of subclinical atherosclerosis in HIV-infected patients starting an initial regimen including tenofovir alafenamide/emtricitabine plus raltegravir, dolutegravir or elvitegravir/cobicistat during a two-year follow-up
Published in Infectious Diseases, 2020
Leonardo Calza, Marco Borderi, Vincenzo Colangeli, Aurora Borioni, Simona Coladonato, Bianca Granozzi, Pierluigi Viale
Carotid ultrasonography was made within one month after the beginning of cART and within one month after the end of the 24-month follow-up. The ultrasound investigation of the extracranial carotid arteries (common, internal and external arteries) was performed in our Hospital by the same physician using a Philips HDI 5000 power colour-Doppler with 7.5-MHz probes (Koninklijke Philips Electronics, Eindhoven, the Netherlands). In each ecographic evaluation, the patients were placed in a supine position after at least 10 min of acclimatization in a comfortable room. The common carotid, the bifurcation and at least the first 2 cm of the internal carotid arteries were evaluated in the short and long axis during the tele-diastolic phase. During the investigation, the head of the patient was hyper-extended and extra-rotated from the opposite side. The morphological investigation of the carotid lesions was performed using both ultrasonography and the ultrasound power colour-Doppler to better characterize the profile of the lesion and the IMT. Subclinical atherosclerosis was defined as an IMT ≥0.9 mm at any site, and the presence of carotid plaque was defined as an IMT ≥1.2 mm at any site, in conformity with the guidelines of the European Society of Cardiology [27].
Prognostic impact of increased pulse pressure/stroke index in a registry of hypertensive patients: the Campania Salute Network
Published in Blood Pressure, 2019
Costantino Mancusi, Maria Angela Losi, Raffaele Izzo, Eva Gerdts, Grazia Canciello, Maria Immacolata Arnone, Bruno Trimarco, Giovanni de Simone, Nicola De Luca
Carotid ultrasonography was performed using a commercially available ultrasound scanner equipped with a 7.5-MHz high-resolution transducer with an axial resolution of 0.1 mm. B-mode ultrasonography was performed with subjects in the supine position with the head turned away from the sonographer and the neck extended in mild rotation. Images were recorded on super video home system tapes for off-line analysis. The standardized comprehensive scanning and reading protocol has been previously published [27]. The maximal arterial intima media thickness (IMT) was estimated offline in up to 12 arterial walls, including the right and the left, near and far distal common carotid (1 cm), bifurcation and proximal internal carotid artery, according to European Society of Hypertension/European Society of Cardiology guidelines [17]. The average and the maximum IMT was reported in the individual patient. According to previous studies [28], carotid plaque was defined as IMT ≥1.5 mm.