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Complications and outcomes of carotid artery stenting in high-risk cases
In treatment of internal carotid artery stenosis, carotid artery stenting (CAS) is the standard choice for patients at risk for carotid endarterectomy (CEA). Occasionally, patients at risk of both CEA and CAS are encountered. In addition, in practice sometimes CAS is performed in patients with high risk due to patient preference and other factors. In general, symptomatic carotid artery stenosis is a risk factor for CAS1. Despite this, the American Heart Association and Stroke Association guidelines recommend CAS as an alternative to CEA for symptomatic moderate-to-severe stenosis2.
Source: Journal of Stroke and Cerebrovascular Diseases - August 31, 2023 Category: Neurology Authors: So Ozaki, Taisuke Akimoto, Yu Iida, Shigeta Miyake, Ryosuke Suzuki, Wataru Shimohigoshi, Satoshi Hori, Jun Suenaga, Nobuyuki Shimizu, Yasunobu Nakai, Katsumi Sakata, Tetsuya Yamamoto Source Type: research

Predictors of hemodynamic instability during and persistent after carotid artery stenting
Carotid artery stenting (CAS) is an alternative to carotid endarterectomy (CEA) and is widely used to treat carotid artery stenosis. CAS and CEA have been demonstrated to be equally effective and safe in both symptomatic and asymptomatic cases of carotid artery stenosis.1-3 CAS-induced hemodynamic instability (HI), manifested as bradyarrhythmia and/or hypotension, has been reported to have an incidence ranging from 7% to 76%.4-7 HI induced by CAS may increase the risk of perioperative cardiac and neurological events.
Source: Journal of Stroke and Cerebrovascular Diseases - August 9, 2023 Category: Neurology Authors: Hongchen Zhao, Zigao Wang, Yifeng Ling, Yiting Mao, Qiang Dong, Wenjie Cao Source Type: research

Factors associated with delay to carotid endarterectomy for acute ischaemic stroke in South Australia: A multicentre retrospective cohort study
The greatest benefits of carotid endarterectomy (CEA) accrue when performed within two weeks of acute ischaemic stroke (AIS) due to symptomatic carotid stenosis. Previous studies have identified multiple factors contributing to CEA delay.
Source: Journal of Stroke and Cerebrovascular Diseases - December 22, 2022 Category: Neurology Authors: Rudy Goh, Stephen Bacchi, Joshua G. Kovoor, Aashray K. Gupta, Minh-Son To, Christopher D. Ovenden, Joseph Dawson, Wilson Vallat, David Schultz, Jim Jannes, Timothy Kleinig Source Type: research

Cost-effectiveness of carotid artery stenting vs endarterectomy: A simulation
Clinical trials conducted before the introduction of modern medical management to prevent stroke demonstrated that carotid endarterectomy (CEA) and carotid artery stenting (CAS) prevent stroke following transient ischemic attack (TIA). We compared the cost-effectiveness of CEA, CAS, and modern medical management in two secular settings of medical management in individuals with incident TIA and type 2 diabetes.
Source: Journal of Stroke and Cerebrovascular Diseases - November 30, 2022 Category: Neurology Authors: Deanna J. Marriott, Shihchen Kuo, Wen Ye, Deborah A. Levine, William H. Herman Source Type: research

Prediction of cerebral hyperperfusion following carotid endarterectomy using intravoxel incoherent motion magnetic resonance imaging
One of the risk factors for cerebral hyperperfusion following carotid endarterectomy (CEA) is a chronic reduction in cerebral perfusion pressure due to internal carotid artery (ICA) stenosis, which is clinically detected as increased cerebral blood volume (CBV). The perfusion fraction (f) is one of the intra-voxel incoherent motion (IVIM) parameters obtained using magnetic resonance (MR) imaging that theoretically reflects CBV. The present study aimed to determine whether preoperative IVIM-f on MR imaging predicts development of cerebral hyperperfusion following CEA.
Source: Journal of Stroke and Cerebrovascular Diseases - November 25, 2022 Category: Neurology Authors: Tatsuhiko Takahashi, Ikuko Uwano, Yosuke Akamatsu, Kohei Chida, Masakazu Kobayashi, Kenji Yoshida, Shunrou Fujiwara, Yoshitaka Kubo, Makoto Sasaki, Kuniaki Ogasawara Source Type: research

Immunohistochemical analysis of MMP-9 and COX-2 expression in carotid atherosclerotic plaques among patients undergoing carotid endarterectomy: A prospective study
Atherosclerotic disease of the internal carotid artery is the most common cause of ischemic stroke making it the second commonest cause of death; therefore, the benefit of carotid endarterectomy (CEA) in both symptomatic and asymptomatic patients has been demonstrated by several randomized trials.1-3 Several studies highlighted that carotid atherosclerotic plaque remodelling can be partially mediated by matrix metalloproteinases (MMPs).4-7 Increased activity of MMPs can contribute to the degradation of collagen within the fibrous cap, making the cap thinner, more vulnerable and prone to rupture.
Source: Journal of Stroke and Cerebrovascular Diseases - September 5, 2022 Category: Neurology Authors: Davorin Sef, Miljenko Kovacevic, Bojan Jernej, Karlo Novacic, Marko Slavica, Jelka Petrak, Igor Medved, Milan Milosevic Source Type: research

Interventional compared with medical management of symptomatic carotid web: A systematic review
Carotid web (CaW) is non-atheromatous, shelf-like intraluminal projection, generally affecting the posterolateral wall of the proximal internal carotid artery, and associated with embolic stroke, particularly in younger patients without traditional stroke risk factors. Treatment options for symptomatic CaWs include interventional therapy with carotid endarterectomy or carotid stenting versus medical therapy with antiplatelet or anticoagulants. As safety and efficacy of these approaches have been incompletely delineated in small-to-moderate case series, we performed a systematic review of outcomes with interventional and medical management.
Source: Journal of Stroke and Cerebrovascular Diseases - August 20, 2022 Category: Neurology Authors: Smit D. Patel, Fadar Oliver Otite, Karan Topiwala, Hamidreza Saber, Naoki Kaneko, Eric Sussman, Tapan V. Mehta, Ramachandra Tummala, Jason Hinman, Raul Nogueira, Diogo C. Haussen, David S. Liebeskind, Jeffrey L. Saver Source Type: research

Preoperative antithrombotic treatment in acutely symptomatic carotid artery stenosis
Early recurrence of cerebral ischemia in acutely symptomatic carotid artery stenosis can precede revascularization. The optimal antithrombotic regimen for this high-risk population is not well established. Although antiplatelet agents are commonly used, there is limited evidence for the use of anticoagulants. We sought to understand the safety and efficacy of short-term preoperative anticoagulants in secondary prevention of recurrent cerebral ischemic events from acutely symptomatic carotid stenosis in patients awaiting carotid endarterectomy (CEA).
Source: Journal of Stroke and Cerebrovascular Diseases - February 24, 2022 Category: Neurology Authors: Juan Carlos Martinez-Gutierrez, Alexis T. Roy, Salvatore D'Amato, Jillian M. Berkman, Daniel Montes, Cheryl A. Kimball, Guy A. Rordorf, Lori B. Chibnik, Javier M. Romero, Scott B. Silverman Source Type: research

Renal Dysfunction is the Strongest Prognostic Factor After Carotid Artery Stenting According to Real-World Data
This study focused on the prognostic factors of CAS using real-world data.
Source: Journal of Stroke and Cerebrovascular Diseases - December 25, 2021 Category: Neurology Authors: Shigeta Miyake, Ryosuke Suzuki, Taisuke Akimoto, Yu Iida, Wataru Shimohigoshi, Yasunobu Nakai, Hiroshi Manaka, Nobuyuki Shimizu, Tetsuya Yamamoto Source Type: research

Elevated Neutrophil to Lymphocyte Ratio is Associated with Worse Outcomes after Carotid Endarterectomy in Asymptomatic Patients
Management of carotid artery stenosis (CAS) remains controversial and proper patient selection critical. Elevated neutrophil to lymphocyte ratio (NLR) has been associated with poor outcomes after vascular procedures. The effect of NLR on outcomes after carotid endarterectomy (CEA) in asymptomatic and symptomatic patients is assessed.
Source: Journal of Stroke and Cerebrovascular Diseases - September 29, 2021 Category: Neurology Authors: Alexander H. King, Ann H. Kim, Stephen Kwan, Jasmine Lee, Alvin H. Schmaier, Norman H. Kumins, Karem C. Harth, Virginia L. Wong, Benjamin D. Colvard, Vikram S. Kashyap, Jae S. Cho Source Type: research

Efficacy of Carotid Artery Stenting Performed under General Anesthesia with Somatosensory Evoked Potential Monitoring
Carotid artery stenting (CAS) is an alternative to carotid endarterectomy (CEA) for carotid stenosis. Although it can be performed under local anesthesia, due to ischemic intolerance, patients sometimes become uncomfortable during the procedure and cannot maintain rest, rendering it difficult to perform CAS. Moreover, the carotid sinus reflex may cause hemodynamic instability, which has been reported to increase postoperative complications.1 –4
Source: Journal of Stroke and Cerebrovascular Diseases - August 15, 2021 Category: Neurology Authors: Masayuki Gekka, Toshiya Osanai, Takeshi Aoki, Naoki Nakayama, Ken Kazumata, Kiyohiro Houkin, Miki Fujimura Source Type: research

Contralateral Stenosis and Echolucent Plaque Morphology are Associated with Elevated Stroke Risk in Patients Treated with Asymptomatic Carotid Artery Stenosis within a Controlled Clinical Trial (SPACE-2)
Asymptomatic carotid artery stenosis (ACS) has a low risk of stroke. To achieve an advantage over noninterventional best medical treatment (BMT), carotid endarterectomy (CEA) or carotid artery stenting (CAS) must be performed with the lowest possible risk of stroke. Therefore, an analysis of risk-elevating factors is essential. Grade of ipsilateral and contralateral stenosis as well as plaque morphology are known risk factors in ACS.
Source: Journal of Stroke and Cerebrovascular Diseases - July 24, 2021 Category: Neurology Authors: Tilman Reiff, Hans-Henning Eckstein, Ulrich Mansmann, Olav Jansen, Gustav Fraedrich, Harald Mudra, Dittmar B öckler, Michael Böhm, Hartmut Brückmann, E. Sebastian Debus, Jens Fiehler, Klaus Mathias, E. Bernd Ringelstein, Jürg Schmidli, Robert Stingele Source Type: research

Carotid Endarterectomy Using Lone Star Retractor System
As you know, atherosclerosis is a serious public problem and is the leading cause of morbidity and mortality not only in western countries but also in Asia. Cervical carotid disease is typical atherosclerosis, which is responsible for ischemic stroke. The effectiveness of carotid endarterectomy (CEA) for advanced carotid stenosis has been established in many large studies,1 –3 and CEA is the gold standard in surgical treatment. On the other hand, endovascular carotid artery stenting (CAS) has become increasingly popular recently.
Source: Journal of Stroke and Cerebrovascular Diseases - February 27, 2021 Category: Neurology Authors: Ichiro Kawahara, Eri Shiozaki, Yuka Ogawa, Yoichi Morofuji, Wataru Haraguchi, Tomonori Ono, Keisuke Tsutsumi, Kazuya Honda, Takehiro Ito Source Type: research

Carotid Endarterectomy is often not Possible after an Unheralded Stroke: Unheralded Stroke in Carotid Artery Stenosis
The ongoing literature recommends carotid endarterectomy (CEA) primarily for patients with neurological symptoms, however CEA can be precluded by the onset of a severe stroke or a total carotid occlusion. The present study aims to evaluate the effect of unheralded strokes in patients with a previously asymptomatic carotid stenosis (ACS) possibly considered for CEA.
Source: Journal of Stroke and Cerebrovascular Diseases - January 8, 2021 Category: Neurology Authors: Rodolfo Pini, Gianluca Faggioli, Antonio Muscari, Cristina Rocchi, Sergio Palermo, Andrea Vacirca, Enrico Gallitto, Mauro Gargiulo Source Type: research

Red and White Thrombus Characteristics in Patients Undergoing Carotid Endarterectomy
Ischemic heart disease and stroke, which are associated with atherosclerosis in the coronary and carotid arteries, accounted for one-third of deaths worldwide.1 The stroke type can be ischemic or hemorrhagic. Hemorrhagic stroke is divided into intracerebral and subarachnoid hemorrhage types. Ischemic stroke occurs because of small vessel occlusion, large artery atherosclerosis, cardiogenic embolism, and other causes.2 Ischemic stroke and transient ischemic attack (TIA) usually arise from unstable carotid lesions, which cause thrombus formation or carotid artery occlusion.
Source: Journal of Stroke and Cerebrovascular Diseases - December 2, 2020 Category: Neurology Authors: Hatice Tosun, Suat Kam ışlı, Mehmet Tecellioğlu, Saadet Alan, Fahriye Seçil Tecellioğlu, Mustafa Namık Öztanır, Yüksel Kablan Source Type: research

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