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A comparative effectiveness study of carotid intervention for long-term stroke prevention in patients with severe asymptomatic stenosis from a large integrated health system
CONCLUSIONS: In this contemporary cohort study of patients with ACS utilizing rigorous analytic methodology, CEA appears to have a small but statistically significant effect on stroke prevention out to 8 years. Further study is needed to appropriately select the subset of patients most likely to benefit from intervention.PMID:37406943 | DOI:10.1016/j.jvs.2023.06.024
Source: Atherosclerosis - July 5, 2023 Category: Cardiology Authors: Robert W Chang Noel Pimentel Lue-Yen Tucker Kara A Rothenberg Andrew L Avins Alexander C Flint Rishad M Faruqi Mai N Nguyen-Huynh Romain Neugebauer Source Type: research

Neurologic outcomes of carotid and other emergent interventions for ischemic stroke over six years with dataset enhanced by machine learning
Current mainstays of ischemic stroke treatment include the use of thrombolysis (tissue plasminogen activator, tPA), urgent carotid endarterectomy (uCEA) or carotid artery stenting (uCAS), and mechanical endovascular reperfusion/thrombectomy (MER). Scarce data describe the presenting stroke severity and neurologic outcomes for these acute ischemic stroke interventions, alone or in combination. The authors hypothesize that patients undergoing carotid interventions experience better functional neurologic outcomes than other stroke interventions.
Source: Journal of Vascular Surgery - June 24, 2022 Category: Surgery Authors: P. Andrew Rivera, Jeffrey Burton, Aaron Hayson, Bethany Jennings, Gabriel Vidal, W.C. Sternbergh, Daniel Fort, Hernan A. Bazan Source Type: research

Neurologic outcomes of carotid and other emergent interventions for ischemic stroke over 6  years with dataset enhanced by machine learning
The current mainstays of ischemic stroke treatment include the use of thrombolysis (tissue plasminogen activator [tPA]), urgent carotid endarterectomy (uCEA) or urgent carotid artery stenting (uCAS), and mechanical endovascular reperfusion/thrombectomy (MER). Scarce data describe the presenting stroke severity and neurologic outcomes for these acute ischemic stroke interventions, alone or in combination. The authors hypothesize that patients undergoing carotid interventions experience better functional neurologic outcomes than other stroke interventions.
Source: Journal of Vascular Surgery - June 24, 2022 Category: Surgery Authors: P. Andrew Rivera, Jeffrey Burton, Aaron Hayson, Bethany Jennings, Gabriel Vidal, Waldemar C. Sternbergh, Daniel Fort, Hernan A. Bazan Source Type: research

Neurologic Outcomes of Carotid and Other Emergent Interventions for Ischemic Stroke Over 6  Years With Analysis Enhanced by Machine Learning
Despite continued evolution in treatment, stroke continues to represent one of the most common and debilitating diseases patients suffer. We created a novel machine-learning natural language processing algorithm to assist in performing outcomes research for patients undergoing treatment for stroke. This method enhanced our ability to accurately determine neurologic outcomes for all urgent stroke interventions. Results demonstrate stroke severity and functional neurologic outcomes for all ischemic stroke patients undergoing (1) urgent carotid endarterectomy (uCEA)/urgent carotid artery stenting (uCAS), (2) tissue plasminoge...
Source: Journal of Vascular Surgery - December 20, 2021 Category: Surgery Authors: P. Andrew Rivera, Bethany Jennings, Jeff Burton, Aaron Hayson, Faith Mason, Jaron Pettis, Adam Berenson, W.C. Sternbergh, Samuel Money, Daniel Fort, Hernan Bazan Source Type: research

Potential of machine learning to predict early ischemic events after carotid endarterectomy or stenting: a comparison with surgeon predictions
AbstractCarotid endarterectomy (CEA) and carotid artery stenting (CAS) are recommended for high stroke-risk patients with carotid artery stenosis to reduce ischemic events. However, we often face difficulty in determining the best treatment strategy. We aimed to develop an accurate post-CEA/CAS outcome prediction model using machine learning that will serve as a basis for a new decision support tool for patient-specific treatment planning. Retrospectively collected data from 165 consecutive patients with carotid stenosis underwent CEA or CAS and were divided into training and test samples. The following five machine learni...
Source: Neurosurgical Review - June 2, 2021 Category: Neurosurgery Source Type: research

Evaluation of Neurocognitive Abilities in Patients Undergoing Carotid Endarterectomy Surgery
CONCLUSION: The purpose of CEA in the past was the prevention of ischemic stroke and cerebrovascular disease (CVD) rather than neurocognitive recovery. Factors affecting neurocognition in CEA are multifactorial. Preservation and improvement of neurocognition are more important than any other period of history. By prioritizing cognitive abilities in the treatment of carotid stenosis, individualization of the treatment will help maximize the increase in cognitive abilities by providing optimum benefit to the patient of each factor.PMID:33635257 | DOI:10.1532/hsf.3371
Source: The Heart Surgery Forum - February 26, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Zafer Cengiz Er Kivanc Atilgan Source Type: research

Surgical Approaches to Stroke Risk Reduction
This article examines the evidence for using the available options. RECENT FINDINGS Carotid endarterectomy is an effective treatment option for reducing the risk of stroke in appropriately selected patients. Patients should be stratified for future stroke risk based on both the degree of stenosis and the presence of symptoms referable to the culprit lesion. Carotid stenting is also useful in reducing stroke risk, again in carefully selected patients. Because of the publication of significant data regarding both carotid endarterectomy and carotid artery stenting in the last several years, selection can be far more person...
Source: CONTINUUM: Lifelong Learning in Neurology - April 1, 2020 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

Large Artery Atherosclerotic Occlusive Disease
ABSTRACT: Purpose of Review: Extracranial or intracranial large artery atherosclerosis is often identified as a potential etiologic cause for ischemic stroke and transient ischemic attack. Given the high prevalence of large artery atherosclerosis in the general population, determining whether an identified atherosclerotic lesion is truly the cause of a patient’s symptomatology can be difficult. In all cases, optimally treating each patient to minimize future stroke risk is paramount. Extracranial or intracranial large artery atherosclerosis can be broadly compartmentalized into four distinct clinical scenarios based upon...
Source: CONTINUUM: Lifelong Learning in Neurology - February 1, 2017 Category: Neurology Tags: Review Articles Source Type: research

Carotid artery stenting
Learning objectives After reading this article the reader should:Know the appropriate diagnostic workup for patients with carotid artery disease. Be able to put in perspective, based on strengths and limitations, the results of randomised trials comparing carotid artery stenting and carotid endarterectomy. Be able to identify patients that may benefit from carotid artery stenting. Introduction In western countries, stroke is the fourth leading cause of death, after heart disease, cancer and chronic respiratory diseases.1 Carotid artery disease may be responsible for 10–15% of all ischaemic strokes.2 Randomised contro...
Source: Heart - June 9, 2016 Category: Cardiology Authors: Roffi, M., Kulcsar, Z., Carrera, E., Cremonesi, A. Tags: Education in Heart, Drugs: cardiovascular system, Interventional cardiology, Epidemiology, Tobacco use Source Type: research