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Prescription of Guideline-Based Medical Therapies at Discharge After Carotid Artery Stenting and Endarterectomy: An NCDR Analysis Clinical Sciences
Conclusions— US antiplatelet agent and statin discharge prescription rates were suboptimal after both CAS and CEA and varied by revascularization modality, operating physician specialty, and hospital characteristics. Improved and more uniform utilization after these procedures will be critical to the success of comprehensive stroke risk reduction efforts.
Source: Stroke - August 21, 2016 Category: Neurology Authors: Aronow, H. D., Kennedy, K. F., Wayangankar, S. A., Katzen, B. T., Schneider, P. A., Abou-Chebl, A., Rosenfield, K. A. Tags: Secondary Prevention, Cardiovascular Surgery, Stent, Cerebrovascular Disease/Stroke, Peripheral Vascular Disease Clinical Sciences Source Type: research

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

Rates of Stroke in Patients With Different Presentations of Carotid Artery Stenosis
CONCLUSION: This cohort study showed no large differences in stroke rates among people with different presentations of carotid artery stenosis.PMID:37295600 | DOI:10.1016/j.ejvs.2023.05.041
Source: PubMed: Eur J Vasc Endovasc ... - June 9, 2023 Category: Surgery Authors: Dylan R Morris Tejas P Singh Tahmid Zaman Ramesh Velu Francis Quigley Jason Jenkins Jonathan Golledge 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

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

Optimal medical treatment versus carotid endarterectomy: the rationale and design of the Aggressive Medical Treatment Evaluation for Asymptomatic Carotid Artery Stenosis (AMTEC) study
The objective is to compare the efficacy of carotid endarterectomy + optimal medical therapy versus optimal medical therapy alone in patients with asymptomatic (70–79%) extracranial carotid stenosis. DesignThe Aggressive Medical Treatment Evaluation for Asymptomatic Carotid Artery Stenosis study is a prospective, randomized, parallel, two‐arm, multicenter trial. Primary end‐points will be analyzed using standard time‐to‐event statistical modeling with adjustment for major baseline covariates. The primary analysis is on an intent‐to‐treat basis. Study OutcomesThe primary outcome is nonfatal stroke, nonfata...
Source: International Journal of Stroke - March 15, 2013 Category: Neurology Authors: Igor Kolos, Mikhail Loukianov, Nikolay Dupik, Sergey Boytsov, Alexandr Deev Tags: Protocols Source Type: research

Urgent Best Medical Therapy May Obviate the Need for Urgent Surgery in Patients With Symptomatic Carotid Stenosis Clinical Sciences
Conclusions— CEA can be performed in the subacute period without significantly increasing the operative risk. The urgent best medical treatment was associated with significant reduction in the risk of early NR in CEA patients. It seems that urgent aggressive best medical treatment may obviate the need for urgent CEA.
Source: Stroke - July 22, 2013 Category: Neurology Authors: Shahidi, S., Owen-Falkenberg, A., Hjerpsted, U., Rai, A., Ellemann, K. Tags: Secondary prevention, Antiplatelets, Carotid endarterectomy, Transient Ischemic Attacks Clinical Sciences 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

Contemporary Stroke Risks of Patients with Asymptomatic Carotid Stenosis: Design and Characteristics of a Large Prospective Cohort Study
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 - November 30, 2019 Category: Surgery Authors: Michiel Poorthuis, Dylan Morris, Kamran Gaba, Dominic Howard, Gert de Borst, Richard Bulbulia, Alison Halliday, UKCCS Collaborative Group: John Radcliffe Hospital Oxford and Gloucestershire Hospitals NHS Foundation Trust Source Type: research

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