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Discharge prescription patterns for antiplatelet and statin therapy following carotid endarterectomy: an analysis of the vascular quality initiative
Conclusions Although statin use has substantially improved following CEA, more than half of individuals not on a statin preprocedure remained this way at discharge. In addition, DAPT at discharge was frequent, a quarter of whom were on SAPT preprocedure. Further efforts are needed to improve rates of new statin prescriptions, ensure appropriate APT intensity at discharge and determine how different discharge APT regimens impact outcomes.
Source: BMJ Open - July 25, 2023 Category: General Medicine Authors: Eppler, M., Singh, N., Ding, L., Magee, G., Garg, P. Tags: Open access, Cardiovascular medicine Source Type: research

Investigation of Combined Carotid Endarterectomy and Coronary Artery Bypass Graft Surgery Outcomes and Adverse Event Risk Factors in the Vascular Quality Initiative
CONCLUSIONS: Combined CEA and CABG provides excellent long-term mortality prevention in patients with co-existing severe coronary and carotid atherosclerosis. Simultaneous CEA and CABG provides equivalent stroke prevention and long-term survival to both a cohort of patients undergoing coronary revascularization within 5 years of CEA and patients undergoing isolated CEA or CABG in the literature. The two most impactful modifiable risk factors towards long-term stroke and mortality prevention for patients undergoing simultaneous CEA-CABG are patch placement at CEA site and adherence to statin medication therapy.PMID:37303074...
Source: Atherosclerosis - June 11, 2023 Category: Cardiology Authors: Ashley Penton Jonathan Lin Grant Kolde Matthew DeJong Matthew Blecha Source Type: research

Modern Treatment of Asymptomatic Carotid Stenosis —The Importance of Both Medical Therapy and Carotid Endarterectomy
Each year there are approximately 700  000 new ischemic strokes in the US, and 10% to 15% of them are caused by thromboembolism from a previously asymptomatic carotid stenosis (ACS). Three large randomized clinical trials, published in the 1990s and early 2000s, have demonstrated a significant benefit of carotid endarterectomy (CEA) i n preventing stroke in patients with severe ACS compared with medical therapy alone. They showed a 50% relative risk reduction in 5-year stroke rate and an approximately 1% per year absolute stroke risk reduction. Over the course of the past 2 decades, there has been significant improvement...
Source: JAMA Surgery - June 8, 2022 Category: Sports Medicine Source Type: research

Prognostic factors of long-term survival to guide selection of asymptomatic patients for carotid endarterectomy.
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 - December 11, 2019 Category: Cardiology Tags: Int Angiol Source Type: research

Asymptomatic Carotid Stenosis Is Associated With Circadian and Other Variability in Embolus Detection
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 t...
Source: Frontiers in Neurology - April 15, 2019 Category: Neurology Source Type: research

High-grade carotid artery stenosis: A forgotten area in cardiovascular risk management
Conclusions The clinical event rate was high in patients with high-grade CAS and the management of cardiovascular risk was deficient in all aspects.
Source: European Journal of Preventive Cardiology - August 10, 2016 Category: Cardiology Authors: Good, E., Länne, T., Wilhelm, E., Perk, J., Jaarsma, T., de Muinck, E. Tags: Original scientific papers Source Type: research

Effects of Statins on Early and Late Clinical Outcomes of Carotid Endarterectomy and the Rate of Post-Carotid Endarterectomy Restenosis
Statins have no effect on post-carotid endarterectomy (CEA) restenosis but are associated with decreased death rates in patients with diabetes trending to lower both death and stroke rates in diabetic patients with hypercholesterolemia.
Source: Journal of Vascular Surgery - November 22, 2015 Category: Surgery Authors: A.F. AbuRahma, M. Srivastava, P.A. Stone Tags: Abstract Source Type: research

Life‐threatening coronary disease is prevalent in patients with stenosing carotid artery disease
ConclusionsEndarterectomized carotid patients have a high risk of acute myocardial infarction and death, and need an intensified cardiovascular disease‐risk‐lowering treatment. Although asymptomatic, the evaluation of prognostically significant myocardial ischemia should be considered in these high‐risk patients. Eventually, a clinical trial is needed to address whether carotid patients would benefit from early intervention.
Source: International Journal of Stroke - August 26, 2015 Category: Neurology Authors: Krista Nuotio, Lauri Soinne, Helena Hänninen, Jani Saksi, Jarno Tuimala, Antti Jula, Petri T. Kovanen, Markku Kaste, Petra Ijäs, Perttu J. Lindsberg Tags: Research Source Type: research

Life ‐threatening coronary disease is prevalent in patients with stenosing carotid artery disease
ConclusionsEndarterectomized carotid patients have a high risk of acute myocardial infarction and death, and need an intensified cardiovascular disease‐risk‐lowering treatment. Although asymptomatic, the evaluation of prognostically significant myocardial ischemia should be considered in these high‐risk patients. Eventually, a clinical trial is needed to address whether carotid patients would benefit from early intervention.
Source: International Journal of Stroke - August 25, 2015 Category: Neurology Authors: Krista Nuotio, Lauri Soinne, Helena H änninen, Jani Saksi, Jarno Tuimala, Antti Jula, Petri T. Kovanen, Markku Kaste, Petra Ijäs, Perttu J. Lindsberg Tags: Research Source Type: research

Comparative Review of the Treatment Methodologies of Carotid Stenosis
Int J AngiolDOI: 10.1055/s-0035-1545073The treatment of carotid stenosis entails three methodologies, namely, medical management, carotid angioplasty and stenting (CAS), as well as carotid endarterectomy (CEA). The North American Symptomatic Carotid Endarterectomy Trial (NASCET) and European Carotid Surgery Trial (ECST) have shown that symptomatic carotid stenosis greater than 70% is best treated with CEA. In asymptomatic patients with carotid stenosis greater than 60%, CEA was more beneficial than treatment with aspirin alone according to the Asymptomatic Carotid Atherosclerosis (ACAS) and Asymptomatic Carotid Stenosis Tr...
Source: International Journal of Angiology - May 18, 2015 Category: Cardiology Authors: Bae, ConeySzuchmacher, MauricioChang, John B. Tags: Review Article Source Type: research

Discussion
DR ERIC ENDEAN (Lexington, KY): The authors have presented a provocative study that has investigated the early and late effect of statins on patients undergoing carotid endarterectomy. The authors retrospectively evaluated 500 patients, 60% of whom were taking statins and 40% without statins. Interestingly, among the patients taking statins, they found a higher incidence of diabetes and, as would be expected, hypercholesterolemia. To the author's credit, there was a low incidence of stroke, MI, and death.
Source: Journal of the American College of Surgeons - March 21, 2015 Category: Surgery Tags: Southern surgical association article Source Type: research

Stroke Prevention - Medical and Lifestyle Measures
Background: According to the World Health Organization, stroke is the ‘incoming epidemic of the 21st century'. In light of recent data suggesting that 85% of all strokes may be preventable, strategies for prevention are moving to the forefront in stroke management. Summary: This review discusses the risk factors and provides evidence on the effective medical interventions and lifestyle modifications for optimal stroke prevention. Key Messages: Stroke risk can be substantially reduced using the medical measures that have been proven in many randomized trials, in combination with effective lifestyle modifications. The glob...
Source: European Neurology - January 6, 2015 Category: Neurology Source Type: research

Effect of Statins on Early and Late Clinical Outcomes of Carotid Endarterectomy and the Rate of Post-Carotid Endarterectomy Restenosis
A retrospective analysis of prospectively collected data on 500 consecutive CEAs followed routinely at 1, 6, and 12 months and every year thereafter. Statins significantly lowered death rates in diabetics and tended to lower both death and stroke rates in diabetics and patients with hypercholesterolemia. Statins had no effect on post-CEA restenosis.
Source: Journal of the American College of Surgeons - December 15, 2014 Category: Surgery Authors: Ali F. AbuRahma, Mohit Srivastava, Patrick A. Stone, Bryan K. Richmond, Zachary AbuRahma, Will Jackson, L Scott Dean, Albeir Y. Mousa Source Type: research

Treatment with betablockers is associated with higher grey-scale median in carotid plaques
Conclusions: These results suggest the use of standardized ultrasound techniques as an important tool in evaluating the effect of anti-atherosclerotic medications and underline the need of.further prospective randomized studies on larger patient cohorts in order to confirm these results.
Source: BMC Cardiovascular Disorders - August 30, 2014 Category: Cardiology Authors: Giuseppe AsciuttoNuno DiasAna PerssonJan NilssonIsabel Gonçalves 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

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