Calcification in original plaque and restenosis following carotid artery stenting.

Calcification in original plaque and restenosis following carotid artery stenting. Surg Neurol Int. 2017;8:279 Authors: Katano H, Nishikawa Y, Yamada H, Mase M Abstract Background: The relationship between calcification in primary plaque and recurrent stenosis after carotid artery stenting (CAS) is not established, but an inverse association with restenosis following carotid endarterectomy (CEA) has been suggested. Methods: We retrospectively analyzed 75 plaques of 109 consecutive CAS with regard to calcification, using the calcium score and shape, location, and other characteristics of original plaques together with stenting-related factors. CAS was performed in a standard fashion with an embolic protection device. Greater-than-moderate restenosis (≥50%) was assessed by peak systolic velocity (PSV) with duplex ultrasonography (≥130 cm/s, internal/common carotid or distal/proximal PSV ratio ≥2.0). Results: Univariate analysis revealed percentages of dyslipidemia treated with statins (P = 0.03), calcification in distal ICA (P = 0.02), and immediate residual stenosis (P = 0.02) were significantly higher in patients with greater-than-moderate restenosis, whereas calcification in carotid bulb and usage of open-cell stent were rather less frequent (P
Source: Surgical Neurology International - Category: Neurosurgery Tags: Surg Neurol Int Source Type: research

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Introduction - A number of ultrasonic texture features which include severity of stenosis, grey scale median (GSM), plaque area (PA), juxtaluminal plaque area (JBA) and discrete white area (DWA) have been shown to be independent predictors of future strokes in carotid disease patients. The primary aim of the present study was to determine the association between histological features and ultrasonic plaque texture features after carotid endarterectomy. Secondary aim was to assess the association between statin therapy and symptomatic disease or other histological features.
Source: European Journal of Vascular and Endovascular Surgery - Category: Surgery Authors: Source Type: research
This study aimed to define associations between ER and local risk factors, including CA geometry and traditional systemic risk factors for ischemic events, to determine whether ER could serve as a clinical marker of carotid vulnerable plaque. METHODS: The authors retrospectively analyzed 66 patients with CA stenosis who were scheduled to undergo carotid endarterectomy or CA stenting. They calculated ER ratios in the internal CA (ICA) from long-axis MR images and as the maximal distance between the lumen and the outer borders of the plaque perpendicular to the axis of the ICA/the maximal luminal diameter of the distal ...
Source: Journal of Neurosurgery - Category: Neurosurgery Authors: Tags: J Neurosurg Source Type: research
CONCLUSIONS: In comparison with available stroke therapies, mechanical thrombectomy stands out as the most effective acute intervention in patients with emergent large-vessel occlusions. Understanding how the number needed to treat is derived and its implications helps provide perspective to clinical trial data, identify health-care resource priorities, and improve communication with patients, health-care providers, and additional key stakeholders. PMID: 31248312 [PubMed - as supplied by publisher]
Source: Interventional Neuroradiology - Category: Radiology Tags: Interv Neuroradiol Source Type: research
Authors: Alves-Ferreira J, Rocha-Neves J, Dias-Neto M, F Braga S Abstract Objetives: Carotid endarterectomy (CEA) is an established treatment for carotid stenosis (CS). However, this procedure is not risk-free and it is insufficient to control disseminated atherosclerosis. Our aim was to determine long-term cardiovascular (CV) morbidity and mortality after CEA and identify associated risk predictors. DESIGN: Consecutive cohorts of CEAs performed between 2010-2018 in two Portuguese hospitals were retrospectively analysed. The major end-points were acute myocardial infarction (AMI), stroke, all-cause death and ma...
Source: Scandinavian Cardiovascular Journal - Category: Cardiology Tags: Scand Cardiovasc J Source Type: research
Conclusions: Embolism associated with asymptomatic carotid stenosis shows circadian variation with highest rates 4–6 h before midday. This corresponds with peak circadian incidence of stroke and other vascular complications. These and ASED Study results show that monitoring frequency, duration, and time of day are important in ES detection. Introduction Transcranial Doppler (TCD) detected microembolism in the ipsilateral middle cerebral artery (MCA) may help stratify the risk of stroke and other arterial disease complications in persons with advanced (≥60%) asymptomatic carotid stenosis. If so, this techniqu...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
Ahmed Mohamed Elhfnawy1*, Peter U. Heuschmann2, Mirko Pham3†, Jens Volkmann1† and Felix Fluri1,4 1Department of Neurology, University Hospital Würzburg, Würzburg, Germany 2Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany 3Institute of Diagnostic and Interventional Neuroradiology, University Hospital of Würzburg, Würzburg, Germany 4Department of Neurology, Kantonssptial St. Gallen, St. Gallen, Switzerland Background and Purpose: Internal carotid artery stenosis (ICAS)≥70% is a leading cause of ischemic cerebrovascular event...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
We have recently published that three main predictors for carotid restenosis (CR) within 1 year after carotid endarterectomy (CEA) are increased high-sensitivity C-reactive protein before CEA (6 hours), increased fibrinogen 48 hours after surgery, and not taking aspirin after CEA. A Fisher equation incorporating these predictors was created to predict CR after CEA implemented in a computer program, the carotid restenosis risk rate (3R) calculator. This program calculates whether the patient is at low or high risk for CR and displays recommended therapeutic algorithms consisting of aspirin, clopidogrel, cilostazol, and statins.
Source: Journal of Vascular Surgery - Category: Surgery Authors: Source Type: research
As the population ages, surgical decision-making in vascular surgery has become more complex. Older patients may not have been offered vascular surgical intervention in the past because of prohibitive physiologic demands and poor health. Patients now have more aggressive management of vascular risk factors with medications, such as statin therapy, and less invasive endovascular or hybrid treatment options. Outcomes in elderly patients may not be comparable with younger patients for entities such as aortic aneurysm repair, carotid endarterectomy, or lower extremity revascularization. Despite this, desirable outcomes can be ...
Source: Clinics in Geriatric Medicine - Category: Geriatrics Authors: Source Type: research
The optimal management of patients with asymptomatic carotid stenosis (ACS) is controversial. The study by Klarin et  al1 provides important novel information that challenges the theory claiming that medical treatment (MT) alone is adequate for the management of all patients with ACS and that prophylactic carotid endarterectomy is not justified in any of these patients.2 Klarin et al1 showed that 112 of 219 pat ients (50%) with radiographically confirmed first-ever carotid-related strokes did actually receive antiplatelet therapy before their stroke, and 121 of 219 patients (55%) received lipid-low...
Source: Journal of Vascular Surgery - Category: Surgery Authors: Tags: Letter to the Editor Source Type: research
We sought to establish the rates of statin use in patients with carotid artery disease and to examine the association between statin therapy and clinical outcomes among an older population after carotid revascularization.
Source: Journal of Vascular Surgery - Category: Surgery Authors: Source Type: research
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