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Commentary on: “Predicting Carotid Artery Disease and Plaque Instability from Cell-derived Microparticles”
Better understanding of mechanisms behind carotid stenosis has challenged the traditional approach to carotid endarterectomy (CEA) as the gold standard for stroke prevention in symptomatic and asymptomatic carotid disease. For symptomatic patients, the high risk of new early embolic recurrence suggested not delaying surgical removal of the carotid embolic plaque for more than 2 weeks after the acute neurological event. For symptom-free patients management of the carotid stenosis by surgery has been even more debated because of the high likelihood of decreased stroke risks with systematic and intensive use of modern medical...
Source: European Journal of Vascular and Endovascular Surgery - August 30, 2014 Category: Surgery Authors: P. De Rango Tags: Invited Commentary Source Type: research

How urgent is the treatment of transient vision loss?
Amaurosis fugax, or transient monocular blindness (TMB) from an embolic phenomenon, represents an ophthalmic form of a cerebrovascular transient ischaemic attack (TIA), and it has been associated with an increased risk of hemispheric stroke. In this issue of the BJO, Naylor R et al1 describe the changes in physician behaviour after instituting a streamlined referral system for TMB patients to a TIA clinic, where optimal medical and rapid surgical treatment (where appropriate) were provided. They did not attempt to measure improved outcomes, taking them as a given based on their assessment of the recent literature, and they...
Source: British Journal of Ophthalmology - May 17, 2014 Category: Opthalmology Authors: Subramanian, P. S. Tags: Retina, Vision, Neurology Editorials Source Type: research

An audit of management practices in patients with suspected temporary monocular blindness
Conclusion There is a need to improve professional awareness of the importance of starting best medical therapy and performing CEA as soon as possible after onset of TMB.
Source: British Journal of Ophthalmology - May 17, 2014 Category: Opthalmology Authors: Naylor, A. R., Robinson, T. G., Eveson, D., Burns, J. Tags: Public health, Vision, Neurology Original articles - Clinical science Source Type: research

A Risk Prediction Model for Determining Appropriateness of CEA in Patients With Asymptomatic Carotid Artery Stenosis
A scoring system based on the probability of long-term survival can be used to determine patients most likely to benefit from carotid endarterectomy (CEA). There is considerable controversy about which patients with asymptomatic carotid stenosis, even high-grade asymptomatic carotid stenosis, are most likely to benefit from a prophylactic CEA. Indeed, there are those who believe that asymptomatic carotid stenosis may be best treated with carotid artery stenting and those who also contend that with modern medical therapy, asymptomatic carotid stenosis may be best treated with medical therapy alone. Although it seems intuit...
Source: Journal of Vascular Surgery - March 24, 2014 Category: Surgery Authors: M.F. Conrad, J. Kang, S. Mukhopadhyay Tags: Abstracts Source Type: research

Predictors of Restenosis After Carotid Endarterectomy: 17-Year Experience in a Tertiary Referral Vascular Center
Conclusion: Use of patch and lack of smoking history are associated with less restenosis and longer restenosis-free survival. Use of patch and use of postoperative statin improves overall survival. Although restenosis after CEA is relatively common, reintervention was rarely necessary.
Source: Vascular and Endovascular Surgery - March 5, 2014 Category: Surgery Authors: Chan, R. C., Chan, Y. C., Cheung, G. C., Cheng, S. W. Tags: Articles 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

Durability of eversion carotid endarterectomy
Conclusions: The results of this study show that eversion CEA can be performed in symptomatic and asymptomatic patients with an extremely low perioperative stroke/death risk and a negligible incidence of late restenosis/occlusion, thus assuring a persistently good protection against the risk of cerebral ischemia.
Source: Journal of Vascular Surgery - January 13, 2014 Category: Surgery Authors: Enzo Ballotta, Antonio Toniato, Giuseppe Da Giau, Renata Lorenzetti, Anna Da Roit, Claudio Baracchini Tags: Clinical research studies Source Type: research

An audit of management practices in patients with suspected temporary monocular blindness.
CONCLUSION: There is a need to improve professional awareness of the importance of starting best medical therapy and performing CEA as soon as possible after onset of TMB. PMID: 24187055 [PubMed - as supplied by publisher]
Source: The British Journal of Ophthalmology - November 1, 2013 Category: Opthalmology Authors: Naylor AR, Robinson TG, Eveson D, Burns J Tags: Br J Ophthalmol Source Type: research

Best evidence for medical therapy for carotid artery stenosis
This article presents and summarizes the evidence supporting best medical treatment for carotid artery stenosis.
Source: Journal of Vascular Surgery - October 1, 2013 Category: Surgery Authors: Jason Constantinou, Parveen Jayia, George Hamilton Tags: Evidence summary Source Type: research

Carotid endarterectomy for symptomatic low-grade carotid stenosis
Conclusions: This study shows that CEA is a safe, effective, and durable treatment for patients with symptomatic low-grade carotid stenosis associated with unstable plaque. Patients had excellent protection against further ischemic events and survived long enough to justify the initial surgical risk. Plaque instability seems to play a major part in the onset of ischemic events, regardless the entity of lumen narrowing.
Source: Journal of Vascular Surgery - August 19, 2013 Category: Surgery Authors: Enzo Ballotta, Annalisa Angelini, Franco Mazzalai, Giacomo Piatto, Antonio Toniato, Claudio Baracchini Tags: Clinical research studies 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

Invited commentary
There has been recent renewed scrutiny into the appropriateness of performing prophylactic interventions on patients with severe asymptomatic carotid artery atherosclerotic plaque to prevent future strokes. Prophylactic carotid endarterectomy (CEA) has been demonstrated in several randomized, prospective trials to provide superior stroke prevention compared with contemporaneous medical therapies in patients with severe carotid artery stenosis. However, ongoing current discussions have focused on the premise that the incidence of ischemic stroke may be decreasing and the hypothesis that improved pharmacologic therapies, suc...
Source: Journal of Vascular Surgery - June 30, 2013 Category: Surgery Authors: Caron B. Rockman Tags: Clinical research studies Source Type: research

Progression of asymptomatic carotid stenosis despite optimal medical therapy
Background: Despite level 1 evidence in support of carotid endarterectomy vs medical therapy in selected asymptomatic patients, an alternative posture is that optimal medical therapy (OMT) has not been adequately studied and that such OMT has reduced stroke risk in asymptomatic patients to levels wherein carotid endarterectomy is no longer justified. The goal of this study was to determine the natural history of patients with asymptomatic moderate (50%-69%) carotid artery stenosis (AMCAS) in a contemporary cohort as a function of their associated medical therapy.Methods: Patients with AMCAS determined by duplex ultrasound ...
Source: Journal of Vascular Surgery - June 30, 2013 Category: Surgery Authors: Mark F. Conrad, Valy Baloum, Shankha Mukhopadhyay, Ashu Garg, Virendra I. Patel, Richard P. Cambria Tags: Clinical research studies Source Type: research

Statins Reduce Neurologic Injury in Asymptomatic Carotid Endarterectomy Patients
This study defined neurologic injury after CEA as both clinical stroke and significant cognitive dysfunction. Agreeing to participate in the study were 328 asymptomatic patients with carotid stenosis scheduled for elective CEA. Patients were evaluated for perioperative stroke and cognitive dysfunction. Cognitive dysfunction was determined by a battery of neuropsychometric tests performed preoperatively and 1 day postoperatively (Heyer EJ et al, Arch Neurol 2002;59:217-22). Patients taking a statin medication at the time of their CEA had a lower incidence of clinical stroke (0.0% vs 3.1%; P = .02) and a lower incidence of c...
Source: Journal of Vascular Surgery - June 30, 2013 Category: Surgery Authors: E.J. Heyer, J.L. Mergeche, S.S. Bruce Tags: Abstracts Source Type: research

Statins influence long term restenosis and cardiovascular events following carotid endarterectomy.
Conclusions: Statins not only reduce cardiovascular events and mortality but may also have an important effect on the anatomic durability of CEA. These data support the use of statins in patients with carotid stenosis undergoing CEA. PMID: 23790064 [PubMed - as supplied by publisher]
Source: Current Vascular Pharmacology - June 17, 2013 Category: Drugs & Pharmacology Authors: Avgerinos ED, Kakisis JD, Moulakakis KG, Giannakopoulos TG, Sfyroeras G, Antonopoulos CN, Kadoglou NP, Liapis CD Tags: Curr Vasc Pharmacol Source Type: research

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