Carotid Artery Calcifications are a Risk Indicator for Both Stroke and Myocardial Infarction

2013 ◽  
Vol 13 (1) ◽  
pp. 37
Author(s):  
Arthur H. Friedlander
Keyword(s):  
Myocardial Infarction ◽  
Carotid Artery ◽  
Risk Indicator

Cerebral vasoconstriction following CEA and the role of conventional cerebral angiography

2020 ◽  
pp. 10.1212/CPJ.0000000000000941
Author(s):  
Azam S. Tolla ◽  
Muhammad U. Farooq ◽  
Bradly Haveman-Gould ◽  
Ghassan Naisan ◽  
Philip B. Gorelick
Keyword(s):  
Myocardial Infarction ◽  
Carotid Artery ◽  
Cerebral Hyperperfusion Syndrome ◽  
Carotid Revascularization ◽  
Cerebral Vasoconstriction ◽  
Cerebral Hyperperfusion ◽  
Delayed Complication ◽  
Reduce Risk ◽  
Revascularization Procedures

Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are established cerebrovascular procedures to reduce risk of stroke. Complications include stroke, myocardial infarction, and death. A delayed complication following carotid revascularization is cerebral hyperperfusion syndrome (CHS), which can manifest as intracerebral hemorrhage (ICH)[1]. A less common delayed complication of carotid revascularization procedures is reversible cerebral vasoconstriction syndrome (RCVS).

Abstract 3118: Combined Assessment of Intima-Media Thickness and Echolucency of an Atherosclerotic Plaque in Carotid Artery has an Additive Value on Prediction of Future Coronary Events in Patients with Coronary Artery Disease and Carotid Atherosclerosis

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Mitsumasa Hirano ◽  
Takamitsu Nakamura ◽  
Yoshinobu Kitta ◽  
Isao Takishima ◽  
Aritaka Makino ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Carotid Artery ◽  
Unstable Angina ◽  
Cardiac Death ◽  
Intima Media Thickness ◽  
Ultrasound Assessment ◽  
Coronary Events ◽  
Artery Disease

Single ultrasound assessment of either intima-media thickness (IMT) or plaque echolucency of carotid artery is considered a surrogate for systemic atherosclerotic burden and provides prognostic information for coronary events. The assessment of IMT and plaque echolucency of carotid artery has the advantage of obtaining structural and compositional information on atherosclerotic plaques in a single session. This study examined the hypothesis that the combined ultrasound assessment of IMT and echolucency in a carotid artery may have an additive effect on the prediction of coronary events in patients with coronary artery disease (CAD). Ultrasound assessment of carotid IMT and plaque echolucency with integrated backscatter (IBS) analysis (intima-media IBS value minus adventitia IBS) was performed in 411 patients with CAD and carotid plaques (IMT ≥ 1.1 mm). The plaque with the greatest axial thickness in carotid arteries was the target for measurement of maximum IMT (plaque-IMTmax) and echolucency (lower IBS reflects echolucent plaque). All patients were prospectively followed up for 70 months or until the occurrence of one of the following coronary events: cardiac death, nonfatal myocardial infarction, or unstable angina pectoris requiring revascularization. During follow-up, 49 coronary events occurred (cardiac death in 2, myocardial infarction in 10, unstable angina in 37). In a multivariate Cox hazards analysis, plaque-IMTmax and plaque echolucency (lower IBS value) were significant predictors of coronary events (HR; 1.82 and 0.85, 95% CI 1.2 – 2.9 and 0.80 – 0.91, respectively, both p < 0.01) independently of age, LDL-C levels, and diabetes. When outcomes were stratified according to plaque-IMTmax and plaque echolucency in combination or alone, the combination of plaque-IMTmax and plaque echolucency was the strongest predictor of events, followed by plaque echolucency and plaque-IMTmax, on the basis of the c -statistic (area under the ROC curve; 0.80, 0.73, and 0.71, respectively). Combined ultrasound assessment of IMT and echolucency of carotid plaque had an additive value on the prediction of coronary events, and these simultaneous ultrasound measurements may be useful for risk stratification in CAD.

Abstract 13769: Assessing the Risk for Cardiovascular Diseases According to Lipoprotein(a) Levels

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Narek A Tmoyan ◽  
Marat V Ezhov ◽  
Olga I Afanasieva ◽  
Uliana V Chubykina ◽  
Elena A Klesareva ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cardiovascular Diseases ◽  
Carotid Artery ◽  
Lower Extremity ◽  
Carotid Artery Disease ◽  
Lipoprotein A ◽  
Artery Disease ◽  
Lower Extremity Artery Disease

Introduction: There is no common opinion about threshold lipoprotein(a) [Lp(a)] concentration for atherosclerotic cardiovascular diseases (ASCVD) risk. Different clinical guidelines and consensus documents postulated cut-off Lp(a) level as 30 mg/dL or 50 mg/dL. We assessed the concentration of Lp(a) that associated with ASCVD of different locations. Methods: The study included 1224 patients with ASCVD. Lp(a) concentration was measured by enzyme-linked immunosorbent assay in serum. Patients were divided into 3 groups: group I - Lp(a)<30 mg/dL, group II - 30≤Lp(a)<50 mg/dL, group III - Lp(a)≥50 mg/dL (table). Results: Coronary heart disease, carotid artery disease, lower extremity artery disease, myocardial infarction and ischemic stroke were diagnosed in 61%; 34%; 23%; 42% and 11% patients, respectively. Lower extremity artery disease, carotid artery disease and myocardial infarction were more frequent in patients with Lp(a) concentration from 30 to 50 mg/dL compared to patients with Lp(a) <30 mg/dL: 36%, 41%, 48% vs. 17%, 30%, 36% respectively, p<0.01 for all. Subjects with Lp(a) 30-50 mg/dL (n=182, 15%) had a greater odds ratio of lower extremity artery disease, carotid artery disease and myocardial infarction compared to patients with Lp(a) <30 mg/dL (table). ROC analysis demonstrated that Lp(a) cut-off levels for lower extremity artery disease, carotid artery disease, coronary heart disease and myocardial infarction were 26; 21; 37 and 36 mg/dL, respectively. Conclusions: Our results demonstrate that in case of Lp(a) cut-off level of 50 mg/dL about 15% of patients are underestimated for the risk of ASCVD. Lp(a) cut-off level for ASCVD is between 20 and 40 mg/dL regarding the atherosclerosis location.

scholarly journals Carotid Endarterectomy Versus Stenting: A Meta-Analysis of Randomized Trials

2011 ◽  
Vol 38 (2) ◽  
pp. 230-235 ◽  
Author(s):  
Daniel Yavin ◽  
Derek J. Roberts ◽  
Michael Tso ◽  
Garnette R. Sutherland ◽  
Misha Eliasziw ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Artery Stenosis ◽  
Carotid Artery Stenting ◽  
Meta Analysis ◽  
Artery Stenosis ◽  
Cranial Neuropathy ◽  
Cardiac Complications ◽  
Lower Odds

Background:A meta-analysis of randomized controlled trials (RCTs) was conducted to update the available evidence on the safety and efficacy of carotid endarterectomy (CEA) versus carotid artery stenting (CAS) in the treatment of carotid artery stenosis.Methods:A comprehensive search was performed of MEDLINE, EMBASE, CENTRAL, bibliographies of included articles and past systematic reviews, and abstract lists of recent scientific conferences. For each reported outcome, a Mantel-Haenszel random-effects model was used to calculate odds ratios (ORs) and 95% confidence intervals (CI). The I2 statistic was used as a measure of heterogeneity.Results:Twelve RCTs enrolling 6,973 patients were included in the meta-analysis. Carotid artery stenting was associated with a significantly greater odds of periprocedural stroke (OR 1.72, 95% CI 1.20 to 2.47) and a significantly lower odds of periprocedural myocardial infarction (OR 0.47, 95% CI 0.29 to 0.78) and cranial neuropathy (OR 0.08, 95% CI, 0.04 to 0.16). The odds of periprocedural death (OR 1.11, 95% CI 0.56 to 2.18), target vessel restenosis (OR 1.95, 95% CI 0.63 to 6.06), and access-related hematoma were similar following either intervention (OR 0.60, 95% CI 0.30 to 1.21).Conclusions:In comparison with CEA, CAS is associated with a greater odds of stroke and a lower odds of myocardial infarction. While the results our meta-analysis support the continued use of CEA as the standard of care in the treatment of carotid artery stenosis, CAS is a viable alternative in patients at elevated risk of cardiac complications.

Vascular β-adrenergic receptor system is dysfunctional after myocardial infarction

2001 ◽  
Vol 280 (3) ◽  
pp. H1129-H1135 ◽  
Author(s):  
Mohamed A. Gaballa ◽  
Andrea Eckhart ◽  
Walter J. Koch ◽  
Steven Goldman
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Carotid Artery ◽  
Membrane Protein ◽  
Adrenergic Receptor ◽  
Vascular Reactivity ◽  
Diastolic Pressure ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Receptor System

We identified abnormalities in the vascular β-adrenergic receptor (β-AR) signaling pathway in heart failure after myocardial infarction (MI). To examine these abnormalities, we measured β-AR-mediated hemodynamics, vascular reactivity, and the vascular β-AR molecular signaling components in rats with heart failure after MI. Six weeks after MI, these rats had an increased left ventricular (LV) end-diastolic pressure, decreased LV systolic pressure, and decreased rate of LV pressure change (dP/d t). LV dP/d t responses to isoproterenol were shifted downward, although the responses for systemic vascular resistance were shifted upward in heart failure rats ( P < 0.05). Isoproterenol- and IBMX-induced vasorelaxations were blunted in heart failure rats ( P< 0.05) with no change in the forskolin-mediated vasorelaxation. These changes were associated with the following alterations in β-AR signaling ( P < 0.05): decreases in β-AR density (aorta: 58.7 ± 6.0 vs. 35.7 ± 1.9 fmol/mg membrane protein; carotid: 29.6 ± 5.6 vs. 18.0 ± 3.9 fmol/mg membrane protein, n = 5), increases in G protein-coupled receptor kinase activity levels (relative phosphorimage counts of 191 ± 39 vs. 259 ± 26 in the aorta and 115 ± 30 vs. 202 ± 7 in the carotid artery, n = 5), and decreases in cGMP and cAMP in the carotid artery (0.85 ± 0.10 vs. 0.31 ± 0.06 pmol/mg protein and 2.3 ± 0.3 vs. 1.2 ± 0.1 pmol/mg protein, n = 5) with no change in Gαs or Gαi in the aorta. Thus in heart failure there are abnormalities in the vascular β-AR system that are similar to those seen in the myocardium. This suggests a common neurohormonal mechanism and raises the possibility that treatment in heart failure focused on the myocardium may also affect the vasculature.

Comparison of postoperative results between carotid endarterectomy and carotid artery stenting for patients with contralateral carotid artery occlusion: A meta-analysis

Vascular ◽  
2019 ◽  
Vol 27 (6) ◽  
pp. 595-603 ◽  
Author(s):  
Wen-Qiang Xin ◽  
Yan Zhao ◽  
Tie-Zhu Ma ◽  
Yi-Kuan Gao ◽  
Wei-Han Wang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Artery Stenting ◽  
Meta Analysis ◽  
Carotid Occlusion ◽  
Cochrane Library ◽  
Post Procedure ◽  
Pubmed Database ◽  
Significant Difference

Objectives The purpose of this study was to conduct a meta-analysis to systematically compare the safety and efficacy of carotid endarterectomy and carotid artery stenting in contralateral carotid occlusion patients who needed reperfusion. Methods This study retrieved potential academic articles comparing results between carotid endarterectomy and carotid artery stenting for patients with contralateral carotid occlusion from the MEDLINE database, the PubMed database the EMBASE database, and the Cochrane Library from January 1990 to May 2018. The reference articles for the identified studies were carefully reviewed to ensure that all available documents were represented in the study. Results Four retrospective cohort study involving 6252 patients with contralateral carotid occlusion were included in our meta-analysis. During 30-day follow-up, there is significant difference in post-procedure mortality (odds ratio (OR) = 0.476, 95% confidence interval (CI) (0.306–0.740), P = 0.001); no significant differences are not found in post-procedure stroke (risk difference (RD) = 0.002, 95%CI (–0.007 to 0.011); P = 0.631), myocardial infarction (RD = 0.003, 95%CI (–0.002 to 0.008); P = 0.301), and transient cerebral ischemia (RD = 1.059, 95%CI (–0.188 to 5.964); P = 0.948). Conclusions Carotid endarterectomy was associated with a lower incidence of mortality compared to carotid artery stenting for patients with contralateral carotid occlusion. Regarding stroke, myocardial infarction, and transient ischemic attack, there was no significant difference between the two groups. More randomized controlled trials and prospective cohorts are necessary to help further clarify the ideal approach for these patients.

scholarly journals Early Outcomes in the ROADSTER 2 Study of Transcarotid Artery Revascularization in Patients With Significant Carotid Artery Disease

Stroke ◽  
2020 ◽  
Vol 51 (9) ◽  
pp. 2620-2629 ◽  
Author(s):  
Vikram S. Kashyap ◽  
Peter A. Schneider ◽  
Mazin Foteh ◽  
Raghu Motaganahalli ◽  
Rasesh Shah ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
High Risk ◽  
Carotid Artery ◽  
Death Rate ◽  
Technical Success ◽  
Protocol Population ◽  
Procedural Success ◽  
Intent To Treat ◽  
Treat Population ◽  
Stroke Death

Background and Purpose: Transcarotid artery revascularization (TCAR) is comprised of carotid artery stent placement with cerebral protection via proximal carotid artery clamping and reversal of cerebral arterial flow. The aim of the present study was to evaluate the safety and efficacy of TCAR performed by a broad group of physicians with variable TCAR experience. Methods: The ROADSTER 2 study is a prospective, open label, single arm, multicenter, postapproval registry for patients undergoing TCAR. Patients considered at high risk for complications from carotid endarterectomy with symptomatic stenosis ≥50% or asymptomatic stenosis ≥80% were included. The primary end point was procedural success, which encompassed technical success plus the absence of stroke, myocardial infarction, or death within the 30-day postoperative period. Secondary end points included technical success and individual/composite rates of stroke, death, and myocardial infarction (MI). All patients underwent independent neurological assessments before the procedure, within 24 hours, and at 30 days after TCAR. An independent clinical events committee adjudicated all major adverse events. Results: Between 2015 and 2019, 692 patients (Intent to Treat Population) were enrolled at 43 sites. Sixty cases had major protocol violations, leaving 632 patients adhering to the Food and Drug Administration-approved protocol (per-protocol population). The majority (81.2%) of operators were TCAR naïve before study initiation. Patients underwent TCAR for neurological symptoms in 26% of cases, and all patients had high-risk factors for carotid endarterectomy (anatomic-related 44%; physiological 32%; both 24%). Technical success occurred in 99.7% of all cases. The primary end point of procedural success rate in the Intent to Treat population was 96.5% (per-protocol 97.9%). The early postoperative outcomes in the Intent to Treat population included stroke in 13 patients (1.9%), death in 3 patients (0.4%), and MI in 6 patients (0.9%). The composite 30-day stroke/death rate was 2.3%, and stroke/death/MI rate was 3.2%. In the per-protocol population, there were strokes in 4 patients (0.6%), death in one patient (0.2%), and MI in 6 patients (0.9%) leading to a composite 30-day stroke/death rate of 0.8% and stroke/death/MI rate of 1.7%. Conclusions: TCAR results in excellent early outcomes with high technical success combined with low rates of postprocedure stroke and death. These results were achieved by a majority of operators new to this technology at the start of the trial. Adherence to the study protocol and peri-procedural antiplatelet therapy optimizes outcomes. Longer-term follow-up data are needed to confirm these early outcomes. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02536378.

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