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Radiographic and symptomatic brain ischemia in CEA and CAS: A systematic review and meta-analysis
Conclusions: One in 5 persons with periprocedural radiographic brain ischemia during CEA and CAS had strokes and TIAs. The stable ratio of stroke and TIA to radiographic ischemia suggests that MRI ischemia could serve as a surrogate measure of periprocedural risk.
Source: Neurology - November 6, 2017 Category: Neurology Authors: Cho, S.-M., Deshpande, A., Pasupuleti, V., Hernandez, A. V., Uchino, K. Tags: MRI, All Cerebrovascular disease/Stroke ARTICLE Source Type: research

Age and the fuzzy edges of embolic stroke of undetermined source: Implications for trials
After an acute ischemic stroke, clinicians pursue further diagnostic assessment to identify the most plausible causes and tailor secondary prevention strategies. Available treatments with a high level of evidence for reducing recurrence stroke risk might include long-term oral anticoagulation in patients with a major-risk cardioembolic source (atrial fibrillation, prosthetic valves, etc), carotid endarterectomy in minor ischemic stroke related to moderate to severe internal carotid artery atherosclerotic stenosis, and best-practice medical management in those with lacunar stroke due to cerebral small vessel disease.1 Howev...
Source: Neurology - August 7, 2017 Category: Neurology Authors: Charidimou, A. Tags: Stroke in young adults, All Clinical trials, All Cerebrovascular disease/Stroke, Embolism, Infarction EDITORIALS Source Type: research

Improving practice through neurovascular board
Management of cervical internal carotid artery (ICA) stenosis remains contentious despite numerous randomized trials and observational studies over the decades since the first report of carotid endarterectomy. Rimmele et al.1 in this issue of Neurology® summarize the 53-month experience of deliberations by a Neurovascular Board at the University Medical Center, Hamburg-Eppendorf (UKE), on management of ICA disease. The multidisciplinary board of senior vascular specialists reviewed 614 cases. The board recommended revascularization in 76% of symptomatic cases and in 27% of asymptomatic cases and encouraged trial p...
Source: Neurology - July 24, 2017 Category: Neurology Authors: Meschia, J. F., Brott, T. G. Tags: Stroke prevention EDITORIALS Source Type: research

Optimal management of patients with asymptomatic carotid stenosis
Prior trials have shown that carotid endarterectomy (CEA) is superior to nonoperative management of asymptomatic carotid stenosis.1,2 More recent trials have shown surprisingly better outcomes for stroke patients managed with maximal medical therapy.3,4 As such, a number of experts have called for revisiting clinical trials of both CEA and carotid stenting for patients with symptomatic and asymptomatic carotid stenosis using modern medical therapy. Given the current substantial equipoise within the field, modern studies seem reasonable. A number of ongoing trials aim to address current areas of equipoise, but enrollment in...
Source: Neurology - May 22, 2017 Category: Neurology Authors: Starke, R. M. Tags: Stroke prevention, Other cerebrovascular disease/ Stroke, All Cerebrovascular disease/Stroke EDITORIALS Source Type: research

Body mass index and outcome after revascularization for symptomatic carotid artery stenosis
Conclusions: BMI is not associated with periprocedural risk of stroke or death; however, BMI 25–<30 is associated with lower postprocedural risk than BMI 20–<25. These observations were similar for CAS and CEA.
Source: Neurology - May 22, 2017 Category: Neurology Authors: Volkers, E. J., Greving, J. P., Hendrikse, J., Algra, A., Kappelle, L. J., Becquemin, J.-P., Bonati, L. H., Brott, T. G., Bulbulia, R., Calvet, D., Eckstein, H.-H., Fraedrich, G., Gregson, J., Halliday, A., Howard, G., Jansen, O., Roubin, G. S., Brown, M. Tags: Stroke prevention, Clinical trials Systematic review/meta analysis, Risk factors in epidemiology, Infarction ARTICLE Source Type: research

Asymptomatic carotid stenosis: Medicine alone or combined with carotid revascularization
Two positive randomized trials established carotid endarterectomy (CEA) as a superior treatment to medical management alone for the treatment of asymptomatic carotid artery stenosis. However, advances in medical therapy have led to an active and spirited debate about the best treatment for asymptomatic carotid stenosis. The Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis (CREST 2) trial aims to better define the best treatment for the average patient with severe asymptomatic carotid stenosis. Enrollment in the trial may be hampered by strong opinions on either side of the debate. It is im...
Source: Neurology - May 22, 2017 Category: Neurology Authors: Heck, D. V., Roubin, G. S., Rosenfield, K. G., Gray, W. A., White, C. J., Jovin, T. G., Matsumura, J. S., Lal, B. K., Katzen, B. T., Dabus, G., Jankowitz, B. T., Brott, T. G. Tags: Stroke prevention, Other cerebrovascular disease/ Stroke, All Cerebrovascular disease/Stroke VIEWS & amp;amp; REVIEWS Source Type: research

Early Carotid Revascularization Reduces Readmission for Recurrent Ischemic Stroke in Acute Ischemic Stroke Patients: Analysis of United States Nationwide Readmissions Database (P4.294)
Conclusions:Patients with ischemic stroke undergoing carotid revascularization during the initial hospitalization have significantly lower risk of readmission related to another ischemic strokeDisclosure: Dr. Chaudhry has nothing to disclose. Dr. Gheith has nothing to disclose. Dr. Gu has nothing to disclose. Dr. Afzal has nothing to disclose. Dr. Rahman has nothing to disclose. Dr. Riaz has nothing to disclose. Dr. Sachdeva has nothing to disclose. Dr. Sattar has nothing to disclose. Dr. Razak has nothing to disclose. Dr. Qureshi has nothing to disclose.
Source: Neurology - April 17, 2017 Category: Neurology Authors: Chaudhry, S., Gheith, T., Gu, S., Afzal, M.-R., Rahman, H., Riaz, A., Sachdeva, G., Sattar, A., Razak, A., Qureshi, A. Tags: In-Hospital Stroke Care Source Type: research

Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis: CREST-2 Update (P6.279)
Conclusions:CREST-2 is designed to identify the best approach for asymptomatic carotid stenosis. An update will be provided regarding the numbers of patients randomized, centers certified, as well as surgeons and interventionists fully approved. The CREST-2 Registry will provide the option of CAS while enhancing interventionists’ credentials for participation in CREST-2.Disclosure: Dr. Barrett has nothing to disclose. Dr. Meschia has received personal compensation in an editorial capacity for the European Journal of Neurology. Dr. Lal has nothing to disclose. Dr. Howard has received personal compensation for activiti...
Source: Neurology - April 17, 2017 Category: Neurology Authors: Barrett, K., Meschia, J., Lal, B., Howard, G., Roubin, G., Brown, R., Chaturvedi, S., Chimowitz, M., Demaerschalk, B., Howard, V., Huston, J., Lazar, R., Moore, W., Moy, C., Turan, T., Voeks, J., Brott, T. Tags: Prevention of Cerebrovascular Disease Source Type: research

Utilization of Carotid Revascularization for Ischemic Stroke/TIA: A Canadian Perspective (P5.276)
Conclusions:Use of CEA/CAS in patients with acute ischemic stroke/TIA admitted to hospitals in Canada has doubled over the last decade. Differences in utilization by age, sex and across provinces are seen.Disclosure: Dr. Najm has nothing to disclose. Dr. Lindsay has nothing to disclose. Dr. Hill has nothing to disclose. Dr. Demchuk has nothing to disclose. Dr. Menon has nothing to disclose.
Source: Neurology - April 17, 2017 Category: Neurology Authors: Najm, M., Lindsay, P., Hill, M. D., Demchuk, A., Menon, B. Tags: SubAcute Interventional Therapies in Cerebrovascular Disease Source Type: research

Pattern of Utilization of Carotid Endarterectomy in Acute Ischemic Stroke Patients Undergoing Early Carotid Endarterectomy According to Severity of Neurological Deficits and Infarct Size (P5.277)
Conclusions:CEA was performed in ischemic stroke patients with minor or moderate infarction on CT scan with an acceptable rate of recurrent stroke and death and without any adverse functional outcome.Disclosure: Dr. Ahrar has nothing to disclose. Dr. Qureshi has nothing to disclose. Dr. Saleem has nothing to disclose.
Source: Neurology - April 17, 2017 Category: Neurology Authors: Ahrar, A., Qureshi, A., Saleem, M. Tags: SubAcute Interventional Therapies in Cerebrovascular Disease Source Type: research

A Systematic Literature Review of Patients with Carotid Web and Acute Ischemic Stroke. (P5.286)
Conclusions:CW is a rare disease leading to ischemic stroke in younger patients without typical CV risk factors. CW patients in our SLR were at extremely high risk for recurrent stroke (47.8%). Aggressive secondary stroke prevention measures are indicated in this patient population, however, the optimal treatment strategies remain unclear. Carotid revascularization may be the definitive treatment for certain patients with CW, but further studies are needed as incomplete reporting and potential publication bias limit our findings.Disclosure: Dr. Dhruv has nothing to disclose. Dr. Kim has nothing to disclose. Dr. Koffel has ...
Source: Neurology - April 17, 2017 Category: Neurology Authors: Dhruv, P., Kim, J., Koffel, J., Anderson, D., Streib, C. Tags: SubAcute Interventional Therapies in Cerebrovascular Disease Source Type: research

The urgent need for contemporary clinical trials in patients with asymptomatic carotid stenosis
Asymptomatic extracranial internal carotid artery atherosclerotic stenosis increases with age and is more common in men. Studies performed more than 2 decades ago showed that carotid endarterectomy reduced the rate of stroke in carefully selected patients with asymptomatic carotid stenosis compared with medical therapy in the long term. Those trials were completed more than 20 years ago and with advances in the treatment of atherosclerotic disease, the question has been raised to as to whether endarterectomy is still of value for patients with asymptomatic narrowing. Perioperative risk of carotid revascularization procedur...
Source: Neurology - November 20, 2016 Category: Neurology Authors: Chaturvedi, S., Chimowitz, M., Brown, R. D., Lal, B. K., Meschia, J. F. Tags: Stroke prevention, All Clinical trials, All Cerebrovascular disease/Stroke VIEWS & amp;amp; REVIEWS Source Type: research

Nonstenotic carotid plaque on CT angiography in patients with cryptogenic stroke
Conclusions: Large but nonstenotic carotid artery plaque is considerably more common ipsilateral than contralateral to cryptogenic stroke, suggesting that nonstenotic plaque is an underrecognized cause of stroke. We measured plaque size using CT angiography, a method that could be easily implemented in clinical practice.
Source: Neurology - August 14, 2016 Category: Neurology Authors: Coutinho, J. M., Derkatch, S., Potvin, A. R. J., Tomlinson, G., Kiehl, T.-R., Silver, F. L., Mandell, D. M. Tags: CT, Stroke prevention, All Cerebrovascular disease/Stroke, Embolism ARTICLE Source Type: research

Systematic Review of Radiographic and Symptomatic Brain Infarcts in Carotid Artery Interventions and Cerebral Angiography (P1.230)
Conclusion: Only 1 of 10 periprocedural RBI during carotid revascularization or diagnostic angiography were symptomatic. CEA has a lower incidence of RBI compared to CAS. Disclosure: Dr. Cho has nothing to disclose. Dr. Deshpande has nothing to disclose. Dr. Pasupuleti has nothing to disclose. Dr. Diaz has nothing to disclose. Dr. Uchino has nothing to disclose.
Source: Neurology - April 3, 2016 Category: Neurology Authors: Cho, S., Deshpande, A., Pasupuleti, V., Diaz, A., Uchino, K. Tags: Carotid Disease Source Type: research

Natural History of Extracranial Carotid Stenosis in Asian Stroke Patients- A Retrospective Study (P1.182)
Conclusions- Symptomatic steno-occlusive disease of cervical carotid artery carries a high risk of subsequent vascular events and mortality despite best medical therapy. Perhaps, better methods of risk stratification and an aggressive approach towards revascularisation in eligible cases are warranted.Disclosure: Dr. Chandra has nothing to disclose. Dr. Woo has nothing to disclose. Dr. Woo has nothing to disclose. Dr. Liu has nothing to disclose. Dr. Kulkarni has nothing to disclose. Dr. Sharma has nothing to disclose.
Source: Neurology - April 3, 2016 Category: Neurology Authors: Chandra, B., Woo, J. W., Woo, R. W., Liu, R. J., Kulkarni, A., Sharma, V. Tags: Cerebrovascular Disease: Risk Factors and Prevention Source Type: research

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