scholarly journals Is Carotid Endarterectomy Effective and Safe in Asymptomatic Patients with Carotid Stenosis?

2003 ◽  
Vol 22 (2) ◽  
pp. 153-154
Author(s):  
Cristina Cusi ◽  
Livia Candelise
Keyword(s):  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Asymptomatic Patients

scholarly journals The prognostic value of the serum inflammatory biomarkers in patients with carotid atherosclerosis

2021 ◽  
pp. 26-33
Author(s):  
Olga Dubenko ◽  
Tetyana Litovchenko ◽  
Victoria Anysienkova ◽  
Maryna Nessonova ◽  
Liudmyla Kovalenko
Keyword(s):  
Ischemic Stroke ◽  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Prognostic Value ◽  
Enzyme Linked Immunosorbent Assay ◽  
Control Group ◽  
Operating Characteristics ◽  
Asymptomatic Group ◽  
Logistic Regression Models ◽  
Asymptomatic Patients

20 % of ischemic stroke appear to originate from carotid artery atherosclerotic disease. Serum biomarkers reflecting the activity of atherosclerotic process and may help for estimate risk of acute cerebrovascular events. Several serum inflammatory markers have been proposed for risk assessment, but their prognostic role less known. The aim of this study is to clarify the prognostic value of biomarkers of atherosclerosis lipoprotein-associated phospholipase A2 (Lp-PLA2) and E-selectin in patients with symptomatic and asymptomatic carotid stenosis. Materials and methods. The study involved 106 patients with atherosclerotic carotid stenosis >50 % (74 men and 32 women, mean age 62.6±0.9) from which 76 symptomatic (35 with acute ipsilateral atherothrombotic stroke and 41 after carotid endarterectomy) and 30 asymptomatic patients. The control group consisted of age- and sex-matched 20 healthy subjects. The level of serum Lp-PLA2 and E-selectin was determined using a commercially available enzyme-linked immunosorbent assay kit. Results. The level of Lp-PLA 2 was in general significantly higher (p<0.05) in patients groups than in the control group and most high Lp-PLA2 concentration was in groups of symptomatic patients who underwent carotid endarterectomy. The level of E-selectin in the study patients was significantly higher than in the control group (p<0.05). The correlation of Lp-PLA 2 with E-selectin was significant for total patients (R=0.365664, p=0.00085) and group after carotid endarterectomy (R=0.429143, p=0.01796), but not for asymptomatic group (p>0.05). Receiver Operating Characteristics curves of logistic regression models which takes into joint both indicators was specificity and sensitive for predicting the occurrence of ischemic stroke. Conclusion. Conducted study show that the levels of Lp-PLA 2 and E-selectin have a significant impact on the development of stroke in patients with atherosclerotic carotid stenosis and can be used to predict it. A multidimensional model of the dependence of the probability of stroke on a linear combination of Lp-PLA 2 and E-selectin allows to obtaining significantly higher characteristics of the accuracy of stroke prediction than models with each factor alone.

Early results of carotid endarterectomy versus carotid stenting: Outcomes from a Mediterranean country

Vascular ◽  
2019 ◽  
Vol 27 (5) ◽  
pp. 468-474
Author(s):  
Ricardo Castro-Ferreira ◽  
Alberto Freitas ◽  
Sérgio M Sampaio ◽  
Paulo G Dias ◽  
Armando Mansilha ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Hospital Mortality ◽  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Carotid Artery Stenting ◽  
Public Hospitals ◽  
Hospital Length Of Stay ◽  
Mediterranean Country ◽  
Main Diagnosis ◽  
Asymptomatic Patients

Introduction and objectives Which is the best carotid stenosis treatment remains a controversial issue. To present day, no study has compared the results of carotid artery stenting versus carotid endarterectomy in Portugal. We aim to provide real life numbers regarding the outcomes of both procedures in Portuguese public hospitals. Methods Every patient registered between 2005 and 2015 with the main diagnosis of carotid stenosis and submitted to carotid endarterectomy or carotid artery stenting was included. The information was obtained through the Central National Healthcare Administrative database, a mandatory registry for hospital refunding. Primary outcomes were hospital mortality and stroke. Patient demographics, comorbidities and hospital length of stay were also evaluated. Results The study included 6094 patients: 1399 were symptomatic (mention of prior stroke) and 4695 asymptomatic. Carotid artery stenting was performed on 22% of the symptomatic and 18% of the asymptomatic patients. In the symptomatic patients, the in-hospital mortality was significantly higher in those submitted to stenting (3.6% vs. 1.6% in carotid endarterectomy, p = 0.025). No significant differences in outcomes were observed in the asymptomatic group (mortality 0.9% vs. 0.8%, p = 0.852; stroke rate of 2.6% vs. 2.3%, p = 0.652 – carotid artery stenting vs. carotid endarterectomy). In both groups, there was an important increase in the proportion of stenting between 2005 and 2012, followed by a gradual decline until 2015. Conclusion Despite its increasing frequency, a higher early mortality was documented for CAS in symptomatic patients. No worse outcome was observed in asymptomatic patients.

scholarly journals Ultrasonografic monitoring of hemodynamic parameters in symptomatic and asymptomatic patients with high-grade carotid stenosis prior and following carotid endarterectomy

2012 ◽  
Vol 69 (5) ◽  
pp. 399-404 ◽  
Author(s):  
Anka Mitrasinovic ◽  
Jovo Kolar ◽  
Sandra Radak ◽  
Dragoslav Nenezic ◽  
Ivana Kupresanin ◽  
...  
Keyword(s):  
Blood Flow ◽  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Diagnostic Tool ◽  
Doppler Ultrasonography ◽  
Resistance Index ◽  
Peak Systolic Velocity ◽  
Hemodynamic Parameters ◽  
Diagnostic Modality ◽  
Asymptomatic Patients

Background/Aim. Doppler ultrasonography is now a reliable diagnostic tool for noninvasive examination of the morphology and hemodynamic parameters of extracranial segments of blood vessels that participate in the brain vascularisation. This diagnostic modality in recent years become the only diagnostic tool prior to surgery. The aim of the study was to determine hemodynamic status in symptomatic and asymtomatic patients with severe carotid stenosis prior to and after carotid endarterectomy (CEA). Methods. A total of 124 symptomatic and 94 asymptomatic patients who had underwent CEA at the Clinic for Cardiovasculare Disease ?Dedinje? in Belgrade were included in this study. Doppler ultrasonography examinations were performed one day before CEA and seven days after it. The peak systolic velocity (PSV), end-dyastolic velocity (EDV), time-averaged maximum blood flow velocity (MV), resistance index (RI) and the blood flow volume (BFV) of the ipsilateral and the contralateral internal carotid artery (ICA) were measured. Results. Diabetes was the only risk factor found significantly more frequent in symptomatic patients. There were significantly more occluded contralateral ICAs in the group of symptomatic patients. There was a significant increase in PSV, EDV, MV and BFV of the ipsilateral ICA after CEA and a significant decrease in PSV, EDV, MV and BFV of the contralateral ICA after CEA. RI is the only hemodynamic parameter without significant changes after CEA in both groups of patients. Comparing the values of hemodynamic parameters after CEA between the group of symptomatic and the group of asymptomatic patients no significant differences were found. Conclusion. The occlusion of the contralateral ICA is an important factor differentiating between symptomatic and asymptomatic patients with severe carotid stenosis. Successful surgery provides good recovery of cerebral hemodynamics in both symtomatic and asymptomatic patients.

Carotid Endarterectomy for Asymptomatic Carotid Stenosis

2017 ◽  
Author(s):  
Michael E. Hochman
Keyword(s):  
Vascular Surgery ◽  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Study Design ◽  
Clinical Case ◽  
Asymptomatic Carotid Stenosis ◽  
Asymptomatic Carotid ◽  
Asymptomatic Patients ◽  
Study Intervention

This chapter provides a summary of the landmark surgical study known as the ACST trial, which compared surgical versus nonsurgical treatment for asymptomatic carotid stenosis. Is carotid endarterectomy (CEA) beneficial in asymptomatic patients with severe carotid stenosis? Starting with that question, the chapter describes the basics of the study, including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a relevant clinical case involving vascular surgery.

scholarly journals Carotid Stenting in Asymptomatic Carotid Stenosis: The Calgary Experience

2010 ◽  
Vol 37 (5) ◽  
pp. 568-573 ◽  
Author(s):  
N. Shobha ◽  
M. A. Almekhlafi ◽  
A. Pandya ◽  
P. L. Couillard ◽  
W. F. Morrish ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Medical Center ◽  
Carotid Stenting ◽  
Minor Stroke ◽  
Safe Procedure ◽  
Asymptomatic Group ◽  
Symptomatic Group ◽  
Asymptomatic Patients

Background:Although carotid endarterectomy is considered the ‘gold standard’ for standard risk symptomatic patients, the treatment of choice for asymptomatic patients remains controversial. Carotid stenting has demonstrated real-world outcomes consistent with established guidelines for carotid endarterectomy in asymptomatic high-surgical risk patients in recent prospective multicenter trials. We describe our experience with asymptomatic patients who underwent carotid stenting at our center in a routine clinical setting.Methods:This is a retrospective, longitudinal cohort study of patients who underwent carotid angioplasty and stenting at the Foothills Medical Center, Calgary, Canada between 1997 and 2007. The qualifying events were categorized as symptomatic and asymptomatic. The procedures were performed by four experienced neurointerventionists. The primary outcome was stroke or death at 30-day follow- up.Results:243 patients underwent 255 carotid stenting procedures. Their ages ranged from 50 to 83 years; the mean age was 72.0 ± 9.3 years; 67(26.3%) were women. Forty one patients (16.1%) were asymptomatic; 214 patients (83.9%) were symptomatic. The patients in the asymptomatic group were significantly younger - 66.0 ± 8.8 years compared to patients in the symptomatic group 73.2 ± 8.9 years (p<0.0001). Intraprocedurally one minor stroke (2.4%) occurred in the asymptomatic group. At 30-day follow-up, no deaths or further strokes were noted in the asymptomatic group; while eight deaths, six major and seven minor strokes occurred in the symptomatic group (p=0.22).Conclusion:Carotid stenting appears to be a safe procedure in asymptomatic patients with severe carotid stenosis in routine clinical settings as witnessed in this single center study.

scholarly journals Clinical significance of internal carotid artery restenosis following carotid endarterectomy

2012 ◽  
Vol 140 (7-8) ◽  
pp. 528-532 ◽  
Author(s):  
Djordje Radak ◽  
Slobodan Tanaskovic ◽  
Srdjan Babic ◽  
Nikola Aleksic
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Clinical Significance ◽  
Internal Carotid ◽  
Neointimal Hyperplasia ◽  
Carotid Angioplasty ◽  
Atherosclerotic Lesions ◽  
Asymptomatic Patients

Carotid endarterectomy has been established as the preferred treatment for symptomatic and asymptomatic high-grade carotid stenosis. Internal carotid artery restenosis is defined as a specific entity with a great clinical significance in carotid surgery due to accompanied increased future cerebral ischemic events risk. Carotid restenosis is the result of neointimal hyperplasia in the early postoperative period (within 36 months) or recurrent atherosclerotic lesions at a later date. While the restenotic lesions caused by neointimal hyperplasia are determined by ultrasound as smooth lesions, atherosclerotic carotid stenosis has almost the same ultrasound and angiographic characteristics as primary atherosclerotic lesions. Some authors believe that patients with internal carotid artery restenosis have insignificant risk of stroke or progression to total occlusion, and suggest conservative treatment only. On the other hand, many surgeons have more aggressive attitude towards the treatment of asymptomatic carotid stenosis and indicate surgical treatment in asymptomatic patients with carotid restenosis above 80%. The aim of our paper was to present a review of literature available data concerning etiology, pathophysiology, clinical significance and treatment of carotid restenosis following endarterectomy. Numerous studies have reported satisfactory results of redo endarterectomy and carotid angioplasty as treatment options of carotid restenosis. Carotid angioplasty for primary atherosclerotic lesions treatment is accompanied by a high carotid restenosis rate and therefore its role in primary carotid symptomatic and asymptomatic stenosis treatment is still the issue of numerous debates and the subject of extensive ongoing clinical studies worldwide.

Carotid Endarterectomy: The Gold Standard

1996 ◽  
Vol 3 (1) ◽  
pp. 10-15 ◽  
Author(s):  
Christopher K. Zarins
Keyword(s):  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Gold Standard ◽  
Surgical Complication ◽  
Complication Rates ◽  
Asymptomatic Patients ◽  
Related Risk ◽  
Investigational Therapies ◽  
Angioplasty And Stenting ◽  
Stroke Death

Carotid endarterectomy has been firmly established as the gold standard of therapy for symptomatic and asymptomatic patients with severe carotid stenosis, provided surgical complication rates are within prescribed limits. The procedure-related risk of stroke/death should be < 3% in asymptomatic patients and < 6% in symptomatic patients. New investigational therapies such as balloon angioplasty and stenting for carotid stenosis should be evaluated against the same standard.

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