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Safety of urgent carotid endarterectomy following thrombolysis.
CONCLUSIONS: Given the trend toward expedited treatment of acute ischemic stroke with subsequent transfer to regional referral centers, vascular specialists will be confronted with an increasing number of patients who may require urgent CEA after antecedent IVT. Further study is warranted to clearly delineate the appropriate interval from IVT to CEA and, specifically, to establish the safety of CEA with 72 hours of tPA administration. PMID: 32225134 [PubMed - in process]
Source: The Journal of Cardiovascular Surgery - March 31, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Brinster CJ, Sternbergh WC Tags: J Cardiovasc Surg (Torino) Source Type: research

Timing of procedural stroke and death in asymptomatic patients undergoing carotid endarterectomy: individual patient analysis from four RCTs.
CONCLUSION: At least half of the procedural strokes in this study were ischaemic and ipsilateral to the treated artery. Half of all procedural complications occurred on the day of surgery, but one-third after day 3 when many patients had been discharged. PMID: 32162310 [PubMed - as supplied by publisher]
Source: The British Journal of Surgery - March 11, 2020 Category: Surgery Authors: Poorthuis MHF, Bulbulia R, Morris DR, Pan H, Rothwell PM, Algra A, Becquemin JP, Bonati LH, Brott TG, Brown MM, Calvet D, Eckstein HH, Fraedrich G, Gregson J, Greving JP, Hendrikse J, Howard G, Jansen O, Mas JL, Lewis SC, de Borst GJ, Halliday A, Carotid Tags: Br J Surg Source Type: research

Innovative Multiparametric Characterization of Carotid Plaque Vulnerability by Ultrasound
ConclusionUltrafast ultrasound imaging is an innovative, easily accessible technique that provides imaging modalities on top of the conventional B-mode. Ultrafast ultrasound biomarkers such as plaque stiffness heterogeneity, WSS and intraplaque micro-flows could help to define the vulnerability of the carotid plaque in order to stratify patients that could benefit most from endarterectomy or intensive medical therapy.
Source: Frontiers in Physiology - March 2, 2020 Category: Physiology Source Type: research

Magnetic Resonance Imaging Identified Brain Ischaemia in Symptomatic Patients Undergoing Carotid Endarterectomy Is Related to Histologically Apparent Intraplaque Haemorrhage
Intraplaque haemorrhage (IPH) has been independently associated with a higher risk of future ipsilateral stroke in patients with carotid artery stenosis. Evaluation of plaque characteristics may contribute to risk assessment of recurrent (silent) cerebrovascular events in order to prioritise patients for timing of treatment. It is unknown if patients showing histologically apparent IPH also have increased risk of silent ischaemic brain lesions in the waiting period between index event and revascularisation.
Source: Journal of Vascular Surgery - December 18, 2019 Category: Surgery Authors: M.L. Rots, N. Timmerman, D.P.V. de Kleijn, G. Pasterkamp, M.M. Brown, L.H. Bonati, G.J. de Borst Source Type: research

Start of Antiplatelet Therapy Increases the Prevalence of Intraplaque Hemorrhage in Patients With Advanced Carotid Artery Lesions: A Longitudinal MR Imaging Study
Introduction: Intraplaque hemorrhage (IPH) is an important feature of plaque vulnerability. Patients with a history of transient ischemic attack or stroke are treated with platelet aggregation inhibitors to prevent secondary myocardial infarction or ischemic stroke. Although antiplatelet medication is effective in reduction of clot formation, it also has adverse effects. It has therefore been hypothesized that platelet aggregation inhibitors could also initiate the onset or progression of IPH. A histopathological study on 154 carotid endarterectomy plaques found that preoperative antiplatelet therapy was associated with an...
Source: European Journal of Vascular and Endovascular Surgery - November 30, 2019 Category: Surgery Authors: Genevi ève Crombag, Madieke Liem, Eline Koornstra, Floris Schreuder, Dianne Nolen-van Dam, Carlo Lucci, Rob van der Geest, Mat Daemen, Anton van der Steen, Jeroen Hendrikse, Werner Mess, Aad van der Lugt, Joachim Wildberger, Robert van Oostenbrugge, Paul Source Type: research

Magnetic Resonance Imaging Identified Brain Ischaemia in Symptomatic Patients Undergoing Carotid Endarterectomy Is Related to Histologically Apparent Intraplaque Haemorrhage
Intraplaque haemorrhage (IPH) has been independently associated with a higher risk of future ipsilateral stroke in patients with carotid artery stenosis. Evaluation of plaque characteristics may contribute to risk assessment of recurrent (silent) cerebrovascular events in order to prioritise patients for timing of treatment. It is unknown if patients showing histologically apparent IPH also have increased risk of silent ischaemic brain lesions in the waiting period between index event and revascularisation.
Source: European Journal of Vascular and Endovascular Surgery - October 17, 2019 Category: Surgery Authors: Marjolijn L. Rots, Nathalie Timmerman, Dominique P.V. de Kleijn, Gerard Pasterkamp, Martin M. Brown, Leo H. Bonati, Gert J. de Borst Source Type: research

Magnetic Resonance Imaging Identified Brain Ischaemia in Symptomatic Patients Undergoing Carotid Endarterectomy Is Related to Histologically Apparent Intraplaque Haemorrhage.
CONCLUSION: Symptomatic patients with ipsilateral carotid stenosis and silent brain ischaemia on pre-operative MR-DWI, more often showed pathological evidence of IPH compared with those without ischaemic lesions. This identifies carotid IPH as a marker for patients at risk of silent brain ischaemia and possibly for future stroke and other arterial disease complications. Such patients may be more likely to benefit from CEA than those without evidence of ipsilateral carotid IPH. PMID: 31631008 [PubMed - as supplied by publisher]
Source: PubMed: Eur J Vasc Endovasc ... - October 16, 2019 Category: Surgery Authors: Rots ML, Timmerman N, de Kleijn DPV, Pasterkamp G, Brown MM, Bonati LH, de Borst GJ Tags: Eur J Vasc Endovasc Surg Source Type: research

Carotid endarterectomy after systemic thrombolysis in a stroke population
Vascular specialists are increasingly being requested to perform carotid endarterectomy (CEA) after intravenous thrombolysis (IVT) for stroke patients, raising concerns about hemorrhagic complications. Few case series and registry reports have assessed the question, and even fewer studies have included a control group. The aim of this study was to evaluate the overall outcome of patients undergoing CEA after IVT and to compare them with contemporary patients with CEA after simple stroke (non-IVT group).
Source: Journal of Vascular Surgery - September 12, 2019 Category: Surgery Authors: William Fortin, Miguel Chaput, Stephane Elkouri, Nathalie Beaudoin, Jean-Fran çois Blair 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

Stenosis Length and Degree Interact With the Risk of Cerebrovascular Events Related to Internal Carotid Artery Stenosis
Conclusion: We found a statistically insignificant tendency for the ultrasound-measured length of sICAS<70% to be longer than that of sICAS≥70%. Moreover, the ultrasound-measured length of sICAS<90% was significantly longer than that of sICAS 90%. Among patients with sICAS≥70%, the degree and length of stenosis were inversely correlated. Larger studies are needed before a clinical implication can be drawn from these results. Introduction Internal carotid artery stenosis (ICAS) causes around one-fifth of ischemic cerebrovascular stroke and has the highest risk of early stroke recurrence...
Source: Frontiers in Neurology - April 8, 2019 Category: Neurology Source Type: research

Hemoglobin A1c-related histologic characteristics of symptomatic carotid plaques
Conclusions: Increased HbA1c values seem to contribute to plaque instability through the formation of a thin fibrous cup. Thus, of the carotid artery plaque parameters including fibrous cup thickness, plaque rupture, lipid core, inflammation, intraplaque hemorrhage, thrombus, calcification, necrotic core, and neovascularization, fibrous cup thickness is the only histomorphological feature that affected by HbA1c.
Source: Nigerian Journal of Clinical Practice - March 5, 2019 Category: Rural Health Authors: M Tecellioglu S Alan S Kamisli FS Tecellioglu O Kamisli C Ozcan Source Type: research

Association between physical activity and sedentary behaviour on carotid atherosclerotic plaques: an epidemiological and histological study in 90 asymptomatic patients.
CONCLUSION: In this cross-sectional study of asymptomatic patients who underwent endarterectomy (i) higher reported PA, (ii) intensity of PA and (iii) lower reported SB were associated with lower prevalence of intraplaque haemorrhage. This could be a mechanism whereby PA protects against cerebrovascular disease (stroke) and death. PMID: 30842104 [PubMed - as supplied by publisher]
Source: British Journal of Sports Medicine - March 5, 2019 Category: Sports Medicine Authors: Mury P, Mura M, Della-Schiava N, Chanon S, Vieille-Marchiset A, Nicaise V, Chirico EN, Collet-Benzaquen D, Lermusiaux P, Connes P, Millon A, Pialoux V Tags: Br J Sports Med Source Type: research

Identifying asymptomatic patients at high-risk for stroke.
CONCLUSIONS: Results from ongoing large, multi-centre randomised clinical trials comparing carotid endarterectomy and carotid artery stenting with good medical therapy may be consistent with earlier trials, showing a halving of the long-term risk of stroke following successful carotid revascularisation. However, they may well lack sufficient statistical power to identify higher-risk subgroups in whom the absolute gains of treatment are significantly higher. Large contemporary cohort studies are needed to provide further clarity regarding high-risk features associated with increased long-term stroke risk in asymptomatic pat...
Source: The Journal of Cardiovascular Surgery - February 20, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Gaba K, Bulbulia R Tags: J Cardiovasc Surg (Torino) Source Type: research

Invited commentary
Since current guidelines based on randomized clinical trials1-6 have established degree of carotid stenosis as the primary surrogate for stroke risk and indication for carotid endarterectomy or stenting, accurate assessment of the degree of carotid stenosis has been the traditional focus of carotid imaging.7 However, the degree of carotid stenosis is an inadequate assessment of stroke risk, and other key factors for determining carotid plaque vulnerability include intraplaque hemorrhage, plaque rupture, and luminal thrombus.
Source: Journal of Vascular Surgery - November 20, 2018 Category: Surgery Authors: Karen J. Ho Tags: From bench to bedside Source Type: research

Carotid Endarterectomy After Systemic Thrombolysis in Stroke Patients: A Retrospective Comparative Analysis
Vascular specialists are increasingly being requested to perform carotid endarterectomy (CEA) after intravenous thrombolysis (IVT) for stroke patients, raising concerns about hemorrhagic complications. Few case series and registry reports have assessed the question, focusing on comparison with symptomatic patients. The goal was to evaluate the hemorrhagic and overall outcomes of patients undergoing CEA after IVT and to compare them with a similar population.
Source: Journal of Vascular Surgery - August 22, 2018 Category: Surgery Authors: William Fortin, St éphane Elkouri, Nathalie Beaudoin, Miguel Chaput, Jean-François Blair Source Type: research

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