Carotid Artery Plaque Echomorphology and its Association with Histopathological Characteristics May Predict Symptomatic Disease

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

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Abstract OBJECTIVE: The aim was to determine the clinical impact of routine cardiology consultation before carotid endarterectomy (CEA) in neurologically asymptomatic patients, in terms of early and long term cardiovascular events. METHODS: A single centre retrospective review of consecutive patients receiving CEA from 2007 to 2017 for asymptomatic carotid stenosis was performed. Two groups were compared: patients operated on from 2007 to 2012 received a pre-operative cardiology consultation only in selected cases (group A); from 2012 to 2017 patients received a routine pre-operative cardiology consultation (...
Source: PubMed: Eur J Vasc Endovasc ... - Category: Surgery Authors: Tags: Eur J Vasc Endovasc Surg Source Type: research
CONCLUSIONS: The presence of one or more prognostic factors as well as the various risk prediction models can guide selection of ACS patient subgroups for which a prophylactic CEA should or should not be offered. Decisions to offer prophylactic CEA should weigh in factors like surgeon's experience and hospital expertise/volume. Asymptomatic patients not expected to live long enough to benefit from the procedure should not be considered for CEA, but should be offered best medical treatment. PMID: 31814375 [PubMed - as supplied by publisher]
Source: International Angiology - Category: Cardiology Tags: Int Angiol Source Type: research
Introduction: Randomised trials have shown that successful carotid endarterectomy (CEA) approximately halves 5-year stroke risk among patients with tight asymptomatic carotid artery stenosis. The benefits of CEA with current medical therapies (including higher dose statins) are unclear. A reliable estimation of stroke risks requires follow up of a large cohort of patients with unoperated asymptomatic carotid stenosis and this report describes the design and characteristics of patients being recruited to this UK Carotid Cohort Study.
Source: European Journal of Vascular and Endovascular Surgery - Category: Surgery Authors: 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
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
Publication date: June 2018Source: Surgery (Oxford), Volume 36, Issue 6Author(s): A. Ross NaylorAbstractThe most common single cause of ischaemic carotid territory stroke is thromboembolism from stenoses in the extracranial internal carotid artery (ICA). In the majority, embolism is preceded by an acute change in plaque morphology predisposing the patient to overlying thrombus formation and embolization. The management of patients with carotid artery disease mandates risk factor modification, antiplatelet and statin therapy in everyone. There is grade A, level I evidence that recently symptomatic patients with 50–99%...
Source: Surgery (Oxford) - Category: Surgery Source Type: research
Only patients with a high risk of stroke on optimal medical therapy (OMT) will benefit from carotid revascularisation. However, for a large range of patients there is neither clear benefit nor harm from carotid endarterectomy (CEA). Over the past decade, atherosclerotic plaques harvested during CEA have shown a time dependent change in plaque composition characterised by a decrease in features currently believed to be the cause of plaque instability,1 whereas medical therapy has improved with more widespread use of statins, more active lowering of blood pressure, and more effective antiplatelet regimens.
Source: European Journal of Vascular and Endovascular Surgery - Category: Surgery Authors: Tags: Invited Commentary Source Type: research
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