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Source: Journal of Vascular Surgery
Condition: Cholesterol
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Total 25 results found since Jan 2013.
Reduction in Early Stroke Risk in Carotid Stenosis With Transient Ischemic Attack Associated With Statin Treatment
In patients with acute symptomatic carotid stenosis, statin pretreatment is associated with reduced stroke risk. Carotid endarterectomy (CEA) in patients with associated symptoms is highly effective for secondary stroke prevention. Maximum benefit appears to be in those who undergo surgery ≤2 weeks of symptom onset; however, the safety of very early CEA has been questioned. Data from the Swedish Vascular Registry indicated an 11.5% stroke and death rate in patients undergoing CEA ≤48 hours of symptom onset. This is a fourfold increase in the odds of a poor outcome compared with those undergoing CEA from 3 to 7 days (S...
Source: Journal of Vascular Surgery - January 24, 2014 Category: Surgery Authors: Á. Merwick, G.W. Albers, E.M. Arsava Tags: Abstracts Source Type: research
The imperative need to identify stroke risk stratification models for patients with asymptomatic carotid artery stenosis
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-lowering therapy (most ...
Source: Journal of Vascular Surgery - September 20, 2018 Category: Surgery Authors: Kosmas I. Paraskevas, Jean-Baptiste Ricco Tags: Letter to the Editor Source Type: research
The effect of statin use and intensity on stroke and myocardial infarction after carotid endarterectomy
Statin use in patients with cerebrovascular disease undergoing carotid endarterectomy (CEA) has been advocated for prevention of stroke and cardiovascular events. However, the effect of statin therapy on long-term outcomes after CEA still needs to be delineated.
Source: Journal of Vascular Surgery - April 20, 2018 Category: Surgery Authors: Nkiruka Arinze, Alik Farber, Teviah Sachs, Gregory Patts, Jeffrey Kalish, Angela Kuhnen, George Kasotakis, Jeffrey J. Siracuse Tags: Clinical paper Source Type: research
Females are Less Likely to Receive Best Medical Therapy for Stroke Prevention Before and After Carotid Revascularization than Males
Current professional guidelines recommend best medical therapy (BMT) with statin agents and antiplatelet therapy for primary and secondary stroke prevention in patients with carotid artery stenosis. We aimed to assess the association of patient sex with preoperative BMT in patients undergoing carotid revascularization.
Source: Journal of Vascular Surgery - October 11, 2022 Category: Surgery Authors: Sanuja Bose, David P. Stonko, Georgina M. Pappas, Laura M. Drudi, Michael C. Stoner, Caitlin W. Hicks Source Type: research
Statins Reduce Neurologic Injury in Asymptomatic Carotid Endarterectomy Patients
This study defined neurologic injury after CEA as both clinical stroke and significant cognitive dysfunction. Agreeing to participate in the study were 328 asymptomatic patients with carotid stenosis scheduled for elective CEA. Patients were evaluated for perioperative stroke and cognitive dysfunction. Cognitive dysfunction was determined by a battery of neuropsychometric tests performed preoperatively and 1 day postoperatively (Heyer EJ et al, Arch Neurol 2002;59:217-22). Patients taking a statin medication at the time of their CEA had a lower incidence of clinical stroke (0.0% vs 3.1%; P = .02) and a lower incidence of c...
Source: Journal of Vascular Surgery - June 30, 2013 Category: Surgery Authors: E.J. Heyer, J.L. Mergeche, S.S. Bruce Tags: Abstracts Source Type: research
Best evidence for medical therapy for carotid artery stenosis
This article presents and summarizes the evidence supporting best medical treatment for carotid artery stenosis.
Source: Journal of Vascular Surgery - October 1, 2013 Category: Surgery Authors: Jason Constantinou, Parveen Jayia, George Hamilton Tags: Evidence summary Source Type: research
Invited commentary
There has been recent renewed scrutiny into the appropriateness of performing prophylactic interventions on patients with severe asymptomatic carotid artery atherosclerotic plaque to prevent future strokes. Prophylactic carotid endarterectomy (CEA) has been demonstrated in several randomized, prospective trials to provide superior stroke prevention compared with contemporaneous medical therapies in patients with severe carotid artery stenosis. However, ongoing current discussions have focused on the premise that the incidence of ischemic stroke may be decreasing and the hypothesis that improved pharmacologic therapies, suc...
Source: Journal of Vascular Surgery - June 30, 2013 Category: Surgery Authors: Caron B. Rockman Tags: Clinical research studies Source Type: research
Durability of eversion carotid endarterectomy
Conclusions: The results of this study show that eversion CEA can be performed in symptomatic and asymptomatic patients with an extremely low perioperative stroke/death risk and a negligible incidence of late restenosis/occlusion, thus assuring a persistently good protection against the risk of cerebral ischemia.
Source: Journal of Vascular Surgery - January 13, 2014 Category: Surgery Authors: Enzo Ballotta, Antonio Toniato, Giuseppe Da Giau, Renata Lorenzetti, Anna Da Roit, Claudio Baracchini Tags: Clinical research studies Source Type: research
Carotid endarterectomy for symptomatic low-grade carotid stenosis
Conclusions: This study shows that CEA is a safe, effective, and durable treatment for patients with symptomatic low-grade carotid stenosis associated with unstable plaque. Patients had excellent protection against further ischemic events and survived long enough to justify the initial surgical risk. Plaque instability seems to play a major part in the onset of ischemic events, regardless the entity of lumen narrowing.
Source: Journal of Vascular Surgery - August 19, 2013 Category: Surgery Authors: Enzo Ballotta, Annalisa Angelini, Franco Mazzalai, Giacomo Piatto, Antonio Toniato, Claudio Baracchini Tags: Clinical research studies Source Type: research
Invited commentary
Although carotid endarterectomy and stenting for symptomatic significant carotid artery stenosis are widely accepted for stroke prevention, their use for asymptomatic stenosis is more controversial. With the advances in medical therapy, particularly the use of statins, and with an annual stroke risk of 1% to 2% for asymptomatic disease, justifying these interventions in these patients is more difficult. What is more disturbing is that ∼90% of all carotid endarterectomy and stenting procedures in the United States are performed on asymptomatic patients and that many were felt to be unnecessary, resulting in a cost of>$2 billion annually.
Source: Journal of Vascular Surgery - April 20, 2018 Category: Surgery Authors: Ali F. AbuRahma Tags: From bench to bedside Source Type: research
Progression of asymptomatic carotid stenosis despite optimal medical therapy
Background: Despite level 1 evidence in support of carotid endarterectomy vs medical therapy in selected asymptomatic patients, an alternative posture is that optimal medical therapy (OMT) has not been adequately studied and that such OMT has reduced stroke risk in asymptomatic patients to levels wherein carotid endarterectomy is no longer justified. The goal of this study was to determine the natural history of patients with asymptomatic moderate (50%-69%) carotid artery stenosis (AMCAS) in a contemporary cohort as a function of their associated medical therapy.Methods: Patients with AMCAS determined by duplex ultrasound ...
Source: Journal of Vascular Surgery - June 30, 2013 Category: Surgery Authors: Mark F. Conrad, Valy Baloum, Shankha Mukhopadhyay, Ashu Garg, Virendra I. Patel, Richard P. Cambria Tags: Clinical research studies Source Type: research
Cardiovascular Effects of Intensive Lifestyle Intervention in Type 2 Diabetes
In this study, conducted in 16 centers in the United States, 5145 overweight or obese patients with type 2 diabetes were randomly assigned to participate in an intensive lifestyle intervention that promoted weight loss through decreased caloric intake and increased physical activity, the intervention group, or receive diabetes support and education only, the control group. The primary outcome was a composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for angina occurring over a maximum follow-up of 13.5 years. At a median follow-up of 9.6 years, the trial was st...
Source: Journal of Vascular Surgery - October 1, 2013 Category: Surgery Authors: The Look AHEAD Research Group Tags: Abstracts Source Type: research
A Risk Prediction Model for Determining Appropriateness of CEA in Patients With Asymptomatic Carotid Artery Stenosis
A scoring system based on the probability of long-term survival can be used to determine patients most likely to benefit from carotid endarterectomy (CEA). There is considerable controversy about which patients with asymptomatic carotid stenosis, even high-grade asymptomatic carotid stenosis, are most likely to benefit from a prophylactic CEA. Indeed, there are those who believe that asymptomatic carotid stenosis may be best treated with carotid artery stenting and those who also contend that with modern medical therapy, asymptomatic carotid stenosis may be best treated with medical therapy alone. Although it seems intuit...
Source: Journal of Vascular Surgery - March 24, 2014 Category: Surgery Authors: M.F. Conrad, J. Kang, S. Mukhopadhyay Tags: Abstracts Source Type: research
