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 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 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.

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.

Comparative characteristics of atherogenesis factors in patients with symptomatic and asymptomatic atherosclerotic carotid stenosis

2021 ◽  
Vol 41 (1) ◽  
pp. 70-76
Author(s):  
V. Ju. Anysienkova ◽  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Internal Carotid ◽  
Clinical Manifestations ◽  
Control Group ◽  
Clinical Group ◽  
Atherosclerotic Stenosis ◽  
Group I ◽  
Atherosclerotic Process

To study a comparative assessment of risk factors for atherogenesis in patients with different clinical manifestations of carotid atherosclerotic stenosis. The study included 106 patients (men — 74, women — 32) aged 39 to 79 years (mean age 62.6 ± 0.9), which devided to 3 clinical groups: Group I — 35 patients with acute atherothrombotic stroke with ipsilateral carotid stenosis, group II — 41 patients after acute cerebrovascular events and carotid endarterectomy, group III — 30 patients with asymptomatic atherosclerotic carotid stenosis and the control group, which consisted of 20 relatively healthy individuals. The degree of stenosis of the internal carotid arteries was highest (> 70 %) in the group of patients who underwent carotid endarterectomy. In addition in this group was prevalence younger men, compared with the group of asymptomatic stenosis and women (p = 0.00300), there was an older age of patients and moderate stenosis of 50–69 % (p = 0.00647). In patients with stenotic atherosclerosis of the internal carotid artery, there was a significant increase in the level of Lp-PLA2 compared with the control. This confirms that Lp-PLA2 can be considered as a marker of carotid atherosclerosis and influence the development of ischemic stroke. The highest level of Lp-PLA2 was observed in the clinical group of patients who underwent carotid endarterectomy after ischemic stroke and there was a tendency to a more significant increase in total cholesterol. This suggests a more aggressive course of the atherosclerotic process in patients in this group.

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 Identification, risk stratification and prognostication of stroke by detection of intra-carotid plaque hemorrhage

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
H Maqsood ◽  
S Younus ◽  
M Saim ◽  
S Qazi ◽  
A Basit ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Carotid Artery ◽  
Carotid Stenosis ◽  
Resonance Imaging ◽  
Asymptomatic Carotid Stenosis ◽  
Asymptomatic Carotid ◽  
Symptomatic Carotid ◽  
Atherosclerotic Stenosis ◽  
Symptomatic Carotid Stenosis

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Atherosclerotic stenosis of the internal carotid artery is present in 1% to 2% of the adult population and is the cause of  10% to 15% of ischemic strokes. Intra-plaque hemorrhage (IPH) in carotid stenosis increases the risk of cerebrovascular events. Magnetic resonance imaging can be used to detect pathologies like IPH and necrosis in carotid stenosis. Purpose : This study sought to compare the risk of stroke between patients with carotid artery disease with and without the presence of intraplaque hemorrhage (IPH) on magnetic resonance imaging. Methods : In this meta-analysis we gathered the data from 10 original cohort studies including 631 patients with symptomatic carotid stenosis and 157 patients with asymptomatic carotid stenosis. Primary outcome was the hazards of ipsilateral ischemic stroke which were compared between patients with and without IPH. Results : IPH was present in 57.1% of patients with symptomatic carotid stenosis and 24.7% of patients with asymptomatic carotid stenosis. During 1,334 observed person-years, 74 ipsilateral strokes occurred. Presence of IPH at baseline increased the risk of ipsilateral stroke both in symptomatic (hazard ratio [HR]: 11.7; 95% confidence interval [CI]: 4.7 to 22.8) and asymptomatic (HR: 6.8; 95% CI: 0.9 to 45.4) patients. Multivariate analysis identified IPH (HR: 11.7; 95% CI: 5.3 to 26.4) and severe degree of stenosis (HR: 3.8; 95% CI: 02 to 8.2) as independent predictors of ipsilateral stroke. Conclusion : Our study concludes that IPH is common in patients with carotid artery stenosis and is a stronger predictor of stroke. Magnetic resonance imaging is the modality that can help in identification of patients with carotid disease who would benefit from revascularization.

scholarly journals Atherosclerotic lesions of brachiocephalic arteries and issues of surgical correction of symptomatic and asymptomatic carotid stenosis

2018 ◽  
Vol 177 (5) ◽  
pp. 17-20
Author(s):  
N. I. Glushkov ◽  
M. A. Ivanov ◽  
A. S. Artemova ◽  
A. Yu. Apresyan ◽  
A. D. Gorovaya ◽  
...  
Keyword(s):  
Carotid Stenosis ◽  
Metabolic Disorders ◽  
Carotid Arteries ◽  
Atherosclerotic Lesion ◽  
Control Group ◽  
Asymptomatic Carotid ◽  
Symptomatic Carotid ◽  
Atherosclerotic Lesions ◽  
Symptomatic Carotid Stenosis ◽  
Brachiocephalic Arteries

The objective of the study was to evaluate the results of carotid endarterectomy in patients with symptomatic and asymptomatic course of hemodynamically significant stenosis of carotid arteries.Material and methods. The work was based on observations of 88 patients: the main group included 28 patients with asymptomatic lesion, the control group – 60 patients with symptomatic critical carotid stenosis.Results. There was a predominance of contralateral carotid stenosis, changes in vertebral arteries in the control group. Features of atherosclerotic lesion of carotid arteries associated with the severity of metabolic disorders, perioperative fluctuations of hemodynamics, time of clamping of carotid arteries.Conclusion. Aggressive course of symptomatic carotid stenosis requires correction of metabolic disorders in the perioperative and in the distant periods, as well as monitoring of hemodynamic abnormalities.

scholarly journals Assessment of Cognitive Functions in Patients with Carotid Stenosis Undergoing Carotid Intervention

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
S A M Helal ◽  
M H Elboulkemy ◽  
A A Abdelaziz ◽  
A N Mohamed ◽  
A A I Elbassiouny ◽  
...  
Keyword(s):  
Cerebral Infarction ◽  
Carotid Stenosis ◽  
Cognitive Functions ◽  
Intervention Group ◽  
Control Group ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis ◽  
Number Of Patients ◽  
Significant Difference

Abstract Background Symptomatic carotid stenosis is commonly defined as stenosis in the internal carotid artery, intracranial or extracranial, leading to symptoms of amaurosis fugax, transient ischemic attacks, or ischemic stroke ipsilateral to the lesion. Degree of stenosis varies among the major therapeutic trials studying treatment of carotid stenosis, but severe stenosis (70–99%) has been demonstrated to confer the highest risk for recurrent stroke or TIA. The number of people suffering from arteriosclerosis with vascular risk factors has been increasing recently due to the westernization of diet patterns and changing living environments, which has led to the increase in the number of patients with carotid stenosis (CS) or cerebral infarction. Severe CS is one of the important culprits underlying cerebral infarction, and can cause cognitive impairments due to continuous perfusion defects. Aim The aim of this study was to detect the effect of revascularization procedures on cognitive functions from baseline to 3 months follow up post-procedure in patients with CS using comprehensive psychometric tests. Methodology A prospective nonrandomized hospital based study was done at Ain Shams University hospitals. The study was conducted over 3 years from January 2015 till March 2018. Eighty patients with CS were enrolled, 34 patients underwent CAS procedure, six patients underwent CEA using standard techniques and the other 40 control patients follow up on conservative medical treatment. Decisions about whether and which method of treatment was applied (CEA, CAS, conservative) were taken independently of the study and were up to the treating physicians and patients. All CEAs and stents were performed under local anesthesia; periprocedural embolization was detected using follow up DW MRI imaging. Results Comparisons of clinical information at baseline between two groups On the basis of inclusion and exclusion criteria, a total of 80 patients were recruited into the present study and received regular follow-up. 2 were lost to follow-up from the control group (died after 2 months of study). The main determinants (age, males/ females ratio, education level, DM, HTN, dyslipidemia, ISHD, smoking, laterality and degree of stenosis by CD and DSA) were compared between patients of the two groups to make sure that both groups were homogenous with no selection bias. There was no significant difference between the two groups except for the age, total number of previous strokes as well as presence of contralateral stenosis which were more prevalent in the intervention group (p &lt; 0.05) and thus may affect their cognitive results. Conclusion that extracranial carotid intervention either CAS or CEA exerts beneficial effects on some of the cognitive functions of symptomatic CS patients at 3 months after treatment, in particular, the visual, working memory and executive functions.

Sign in / Sign up

Export Citation Format

Share Document