scholarly journals SS25. The Association between Shear Rate and Symptomatic Carotid Disease Is a Better Predictor than Velocity or Diameter in Severe Carotid Stenosis

2018 ◽  
Vol 67 (6) ◽  
pp. e171
Author(s):  
Nizar Hariri ◽  
Todd Russell ◽  
Gregory Kasper ◽  
Fedor Lurie
Keyword(s):  
Shear Rate ◽  
Carotid Stenosis ◽  
Carotid Disease ◽  
Symptomatic Carotid

scholarly journals LO012: High-risk investigation findings for symptomatic carotid disease in ED TIA patients

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S34-S34
Author(s):  
N. Motamedi ◽  
K. Abdulaziz ◽  
M. Sharma ◽  
J.J. Perry
Keyword(s):  
Platelet Count ◽  
Blood Glucose ◽  
High Risk ◽  
Carotid Stenosis ◽  
Univariate Analysis ◽  
Carotid Disease ◽  
Multicenter Cohort Study ◽  
Symptomatic Carotid ◽  
Acute Infarction ◽  
Large Vessel Disease

Introduction: About 20% of TIAs are due to large vessel disease. Carotid stenosis >50% which is causing a TIA or stroke needs to be definitely managed quickly in order to benefit. Alternatively, dual antiplatelet therapy may be considered. The objective of this study was to determine high-risk diagnostic findings associated with symptomatic carotid disease in ED patients with TIA to indicate patients requiring urgent carotid imaging. Methods: We performed a prospective Canadian multicenter cohort study, at 13 academic sites, of ED patients with TIA or non-disabling stroke from 2006-2014. Study research nurses recorded imaging findings on standardized data collection forms from the final reports of all imaging tests ordered in the ED on prospectively enrolled patients by treating emergency physicians. Symptomatic carotid disease was defined as carotid stenosis 50-99% or carotid dissection and was adjudicated by stroke neurology to be the etiology of the index event. Patients were followed by medical review and telephone up to 90 days. Univariate analysis was conducted for investigation results with our primary outcome. Results: The cohort included 305 patients with and 5,277 without symptomatic carotid disease. Positive predictors of symptomatic carotid disease included platelet count over 400 x 109/L (15.3% vs 7.6%; p=0.0095), blood glucose >15 mmol/L (11.4% vs 4.4%; p<0.0001), CT evidence of acute infarction (9.8% vs 4.1%; p<0.0001), CT evidence of old infarction (35.7% vs 24.1%; p<0.0001), and CT evidence of any infarct (43.3% vs 26.7%; p<0.0001). There were no negative predictors of symptomatic carotid disease. Conclusion: High-risk investigation findings suggestive of symptomatic carotid disease in ED TIA patients include platelet count over 400 x 109/L, blood glucose >15 mmol/L, CT evidence of any infarction. Patients with any of these findings should be considered for rapid carotid imaging.

scholarly journals LO010: Clinical assessment of transient ischemic attack patients for symptomatic carotid disease in the emergency department

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S33-S33
Author(s):  
N. Motamedi ◽  
K. Abdulaziz ◽  
M. Sharma ◽  
J.J. Perry
Keyword(s):  
Carotid Stenosis ◽  
Clinical Features ◽  
Univariate Analysis ◽  
Disease Diagnosis ◽  
Older Age ◽  
Carotid Disease ◽  
Multicenter Cohort Study ◽  
Symptomatic Carotid ◽  
History Of ◽  
Male Sex

Introduction: TIAs precede about 30% of strokes, with 4-10% having a stroke within 90 days of their TIA. In patients with a TIA due to symptomatic carotid disease, diagnosis and treatment within 2 weeks has been shown to have much better outcomes, while delay beyond 12 weeks no longer reduces subsequent stroke risk. The objective of this study was to determine the clinical findings associated with symptomatic critical disease following an ED visit for TIA to indicate patients requiring prompt carotid imaging. Methods: We performed a prospective Canadian multicenter cohort study, at 13 academic sites, of ED patients with TIA or non-disabling stroke from 2006-2014. Treating ED physicians indicate clinical features on standardized data collection forms. Symptomatic carotid disease was carotid stenosis 50-99%, or carotid dissection, adjudicated by stroke neurology to be the etiology of the index event. Patients were followed by medical review and telephone up to 90 days. Univariate analysis was conducted for clinical features associated with patients who were eventually found to have symptomatic carotid disease as a cause for their TIA. Results: The cohort included 305 patients with and 5,277 without symptomatic carotid disease. Positive predictors of symptomatic carotid disease included older age (74.0 yrs vs 68.0 yrs p<0.0001), male sex (62.9% vs 47.9%; p<0.0001), history of weakness (63.3% vs 41.4%; p<0.0001), language disturbance (52.1% vs 40.0%; p<0.0001), weakness on physical exam (25.5% vs 17.1%; p=0.0002), history of hypertension (74.8% vs 59.5%; p<0.0001), and known history of carotid stenosis (18.9% vs 3.1%; p<0.0001). Negative predictors of symptomatic carotid disease included first ever TIA (56.8% vs 68.8%; p<0.0001), history of altered sensation (39.4% vs 45.8%; p=0.0322), lightheadedness (13.0% vs 22.4%; p=0.0002), and vertigo (3.6% vs 12.7%; p<0.0001). Conclusion: TIA patients with older age, male sex, weakness, language disturbance or history of carotid stenosis need to be promptly imaged to assess for symptomatic carotid disease.

Current Status of Carotid Endarterectomy for Atheromatous Disease

Neurosurgery ◽  
1983 ◽  
Vol 13 (6) ◽  
pp. 718-723 ◽  
Author(s):  
Christopher M. Loftus ◽  
Donald O. Quest
Keyword(s):  
Surgical Treatment ◽  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Neurological Deficit ◽  
Carotid Occlusion ◽  
Current Status ◽  
Carotid Surgery ◽  
Transient Ischemic Attacks ◽  
Carotid Disease ◽  
Symptomatic Carotid

Abstract The authors discuss the indications for both elective and emergency carotid endarterectomy. Reports on the surgical treatment of asymptomatic bruit and contralateral carotid stenosis are reviewed. The results of endarterectomy for symptomatic carotid disease, including transient ischemic attacks, acute neurological deficit, and complete carotid occlusion, are discussed. The complications and risks of carotid surgery are also presented.

scholarly journals Completeness of Circle of Willis in asymptomatic and symptomatic extracranial carotid disease

2016 ◽  
Vol 69 (11-12) ◽  
pp. 351-355 ◽  
Author(s):  
Vladimir Manojlovic ◽  
Vladan Popovic ◽  
Dragan Nikolic ◽  
Djordje Milosevic ◽  
Janko Pasternak ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Carotid Stenosis ◽  
Circle Of Willis ◽  
Control Group ◽  
Collateral Flow ◽  
Cerebral Lesions ◽  
Carotid Disease ◽  
Asymptomatic Group ◽  
Symptomatic Carotid ◽  
Group I

Introduction. This research has been aimed at determining whether incomplete Circle of Willis in patients with significant extracranial carotid stenosis is associated with a higher incidence of neurological symptomatology and/or ischemic cerebral lesions. Material and Methods. The research was conducted as a prospective study which comprised 211 patients who underwent surgical treatment of extracranial carotid disease at the Department of Vascular Surgery in Novi Sad and 102 patients in the control group. Each patient underwent preoperative magnetic resonance imaging and magnetic resonance angiography with visualization of cerebral parenchyma, extracranial and intracranial cerebral circulation. Assessment of Circle of Willis morphology was performed by 3D time-of-flight magnetic resonance angiogram sequence analysis. The patients were divided into two groups: group I - the patients with complete Circle of Willis and group II - the patients with incomplete Circle of Willis i.e. with the disruption of anterior and/or ipsilateral posterior circulation - regarding the side of significant carotid stenosis. Results. Out of 211 patients who were operated during a two-year period, 133 had the complete Circle of Willis, while 78 patients had the incomplete Circle of Willis. Out of 111 patients with symptomatic carotid disease or silent cerebral infarction, 52.5% (58) had the complete Circle of Willis and 47.5% (53) had the incomplete Circle of Willis. It was shown to be statistically different (P = 0.0146) in relation with the asymptomatic group of patients (100), where the frequency of the complete Circle of Willis was 75% (75) while the insufficiency of anterior or ipsilateral posterior collateralization was found in 25% (25). In the control group there were significantly fewer cases of developed collateral flow and the complete Circle of Willis (41%) compared to the operated patients with extracranial carotid stenosis (63%) (P = 0.0003). Conclusion. Incompleteness of Circle of Willis is associated with more frequent occurrence of neurological symptomatology or ischemic lesions of brain parenchyma in operated patients with significant extracranial carotid stenosis. The control group without extracranial carotid stenosis had less developed collaterals of Circle of Willis compared to extracranial carotid patients.

scholarly journals P.065 Physician Approaches to Anti-thrombotic Therapies for Acutely Symptomatic Carotid Stenosis: Insights from the Hot Carotid Qualitative Study

2021 ◽  
Vol 48 (s3) ◽  
pp. S37-S37
Author(s):  
B Beland ◽  
A Ganesh ◽  
G Jewett ◽  
DJ Campbell ◽  
M Varma ◽  
...  
Keyword(s):  
Carotid Stenosis ◽  
Antiplatelet Therapy ◽  
Qualitative Content Analysis ◽  
Recurrent Stroke ◽  
Stroke Care ◽  
Plaque Morphology ◽  
Structured Interviews ◽  
Carotid Disease ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis

Background: Whereas the beneficial effect of antiplatelet therapy for recurrent stroke prevention is well-established, uncertainties remain regarding the optimal anti-thrombotic regimen for acutely symptomatic carotid stenosis (“hot carotid”), particularly as patients await revascularization. We sought to explore the approaches of stroke physicians to peri-procedural anti-thrombotic management of patients with “hot carotids”. Methods: We conducted semi-structured interviews regarding “hot carotid” management with purposive sampling of 20 stroke physicians from 14 centres in North America, Europe, Asia, and Australia. We identified key themes using conventional qualitative content analysis. Results: Important themes revealed from our discussion included limitations of existing clinical trial evidence, competing surgeon versus neurologist/internist preferences, and single vs dual antiplatelet therapy (DAPT) while awaiting revascularization. Areas of uncertainty included the management of stroke while on aspirin, implications of non-stenotic features of carotid disease (intraluminal thrombus, plaque morphology), the role of newer anti-platelet agents or anticoagulants, platelet aggregation testing, and how soon to start DAPT. Conclusions: Our qualitative analysis revealed themes that were important to stakeholders in stroke care. Teams designing international trials will have to accommodate identified variations in anti-thrombotic practice patterns and take into consideration areas of uncertainty, such as newer anti-thrombotic agents, and the implication of non-stenotic features of carotid disease.

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