Severe Asymptomatic Carotid Stenosis Research Articles

Posterior Cerebral Artery Perfusion Is Associated With Cognitive Prognosis After Endarterectomy in Patients With Asymptomatic Severe Carotid Stenosis

Posterior Cerebral Artery Perfusion Is Associated With Cognitive Prognosis After Endarterectomy in Patients With Asymptomatic Severe Carotid Stenosis

Development of a Risk Prediction Nomogram for Carotid Restenosis in the One Year RECAST Registry

Long term benefit of carotid angioplasty and stenting (CAS) can be reduced by recurrent stroke related to in stent restenosis (ISR). An individualised predictive tool is needed to identify ISR events. A nomogram for individual risk assessment of ISR ≥ 70% after CAS is proposed. A national observational, prospective, multicentre registry was conducted between January 2015 and December 2020. Cohorts of patients with symptomatic or asymptomatic severe carotid stenosis who underwent CAS were included with a follow up of at least 1 year after CAS. Duplex ultrasound was used to assess in stent restenosis. Pre-operative factors were compared between the non-ISR and ISR groups. Kaplan-Meier and Cox regression were used for variable selection. The nomogram was formulated and validated by concordance indices and calibration curves. An in stent restenosis risk table was generated for risk stratification. A total of 354 patients were included in the analysis. The ISR rate of ≥ 70% was 7.6% (n = 27). Peripheral arterial disease (hazard ratio [HR] 3.18, 95% confidence interval [CI] 1.23 - 8.24, p = .017), anterior communicating artery absence (HR 3.38, 95% CI 1.27 - 8.94, p = .016), diabetes mellitus (HR 3.34, 95% CI 1.21 - 9.26, p = .020), female sex (HR 2.99, 95% CI 1.04 - 8.60, p = .041), and pre-procedure pathologic ultrasound vasoreactivity (HR 3.87, 95% CI 1.43 -10.50, p = .008), as independent risk factors for ISR of ≥ 70%, were included in the nomogram. Concordance index at 12 and 24 months was 0.83. In low risk groups, ISR of ≥ 70% occurred in 4.8% of patients during follow up compared with 56.2% of patients in the high risk groups (p < .001). The nomogram and risk evaluation score have good predictive ability for ISR. They can be used as practical clinical tools for individualised risk assessment.

Carotid Artery Stenting Versus Carotid Artery Endarterectomy in Asymptomatic Severe Carotid Stenosis: An Updated Meta-Analysis.

Carotid artery stenting (CAS) and carotid artery endarterectomy (CEA) are revascularization options for the management of severe carotid disease in asymptomatic patients. We aimed to compare the peri-procedural outcomes of the two modalities. A systematic review of the databases PUBMED, EBSCO, and Cochrane Library was performed. All the studies that reported periprocedural outcomes (within 30 days) in asymptomatic carotid stenosis patients were included in the meta-analysis. Random effects models with inverse-variance weighting were used to estimate pooled risk ratios (RRs) to compare the outcomes. Fifteen studies (including seven randomized controlled trials) met the inclusion criteria. A total of 15251 patients were included, out of which 6419 (42%) underwent CAS and 8832 (57.9%) underwent CEA. There was no statistical difference in the primary composite outcome of death/stroke/myocardial infarction (MI) (RR 1.02, 95% CI [0.69-1.51], p 0.93). No difference was found in the secondary outcome of all-cause mortality. CAS was associated with a slightly lower risk of MI and cranial nerve palsy. CAS was associated with a slightly higher risk of stroke with no difference in the occurrence of disabling stroke or ipsilateral stroke. In general terms, the study confirms equipoise in the two treatment strategies with a higher risk of MI and cranial nerve palsy with CEA and a higher risk of non-disabling stroke with CAS.

Hemispheric coupling between structural and functional asymmetries in clinically asymptomatic carotid stenosis with cognitive impairment.

Advanced carotid stenosis is a known risk factor for ischemic stroke and vascular dementia, and it is associated with multidomain cognitive impairment as well as asymmetric alterations in hemispheric structure and function. Here we introduced a novel measure-the asymmetry index of amplitude of low-frequency fluctuations (ALFF_AI)-derived from resting-state functional magnetic resonance imaging. This measure captures the hemispheric asymmetry of intrinsic brain activity using high-dimensional registration. We aimed to investigate functional brain asymmetric alterations in patients with severe asymptomatic carotid stenosis (SACS). Furthermore, we extended the analyses of ALFF_AI to different frequencies to detect frequency-specific alterations. Finally, we examined the coupling between hemispheric asymmetric structure and function and the relationship between these results and cognitive tests, as well as the white matter hyperintensity burden. SACS patients presented significantly decreased ALFF_AI in several clusters, including the visual, auditory, parahippocampal, Rolandic, and superior parietal regions. At low frequencies (0.01-0.25Hz), the ALFF_AI exhibited prominent group differences as frequency increased. Further structure-function coupling analysis indicated that SACS patients had lower coupling in the lateral prefrontal, superior medial frontal, middle temporal, superior parietal, and striatum regions but higher coupling in the lateral occipital regions. These findings suggest that, under potential hemodynamic burden, SACS patients demonstrate asymmetric hemispheric configurations of intrinsic activity patterns and a decoupling between structural and functional asymmetries.

Abstract 14274: Management of Severe Asymptomatic Carotid Stenosis, Best Medical versus Stenting versus Endarterectomy, a Network Meta Analysis of Randomized Controlled Trials

Background: We conducted a network meta-analysis to investigate the efficacy and safety of best medical therapy (BMT) versus carotid artery stenting (CAS) versus carotid endarterectomy (CEA) in patients with severe asymptomatic carotid stenosis. Methods: We systematically searched Web of Science, SCOPUS, EMBASE, PubMed, and Cochrane Central till March 1 st , 2023, to include any randomized control trial (RCT) that assesses the efficacy of BMT, CAS, or CEA in the management of severe asymptomatic carotid stenosis. A network meta-analysis was conducted using R software pooling dichotomous outcomes using risk ratio (RR) and 95% confidence interval (CI). Results: Eight RCTs with 10,094 patients were included. Compared to BMT, both CAS and CEA showed a statistically significant higher risk of the 30 days composite (stroke, myocardial infarction (MI), and mortality) (RR: 4.37 [95% CI 2.35 - 8.11]) (RR: 4.04 [95% CI 2.08 - 7.85]), respectively; mortality (RR: 6.93 [95% CI 1.60 - 29.98]) (RR: 8.12 [95% CI 1.88 - 35.16]), respectively; MI with (RR: 16.03 [95% CI 1.96 - 26.14]) (RR: 27.51 [95% CI 1.65 - 45.46]), respectively; and stroke (RR: 3.42 [95% CI 1.70 - 6.88]) (RR: 2.48 [95% CI 1.23 - 4.99]), respectively. However, both CAS and CEA did not show statistically significant differences between BMT five-year mortality and MI. Finally, CEA showed a statistically significant lower risk of 5-year restenosis with (RR: 0.38 [95% CI 0.12 - 0.88]) and stroke (RR: 0.27 [95% CI 0.22 - 0.98]) compared to BMT. Conclusion: BMT for severe asymptomatic carotid stenosis holds an equal efficacy compared to CSA and CEA, yet an even lower risk regarding short-term outcomes. However, CEA shows a lower risk compared to BMT and CSA in terms of long-term (five-year) stroke and restenosis. Further research is still warranted to clarify which patients can benefit most from invasive strategies and to furtherly investigate BMT due to the currently limited evidence.

Application of mask images of contrast-enhanced MR angiography to detect carotid intraplaque hemorrhage in patients with moderate to severe symptomatic and asymptomatic carotid stenosis

PurposeCarotid intraplaque hemorrhage (IPH) on MRI predicts stroke. Magnetization-prepared rapid acquisition gradient (MP-RAGE) is widely used to detect IPH. CE-MRA is used routinely to assess stenosis. Initial studies indicated that IPH can be identified on mask images of CE-MRA, while Time-of-Flight (TOF) images were reported to have high specificity but lower sensitivity. We investigated the diagnostic accuracy of detecting IPH on mask images of CE-MRA and TOF. MethodsThirty-six patients with ≥ 50% stenosis enrolled in the ongoing 2nd European Carotid Surgery Trial underwent carotid MRI. A 5-point quality score was used. Inter-observer agreement between two independent readers was determined. The sensitivity and specificity of IPH detection on mask MRA and TOF were calculated with MP-RAGE as a reference standard. ResultsOf the 36 patients included in the current analysis, 66/72 carotid arteries could be scored. The inter-observer agreements for identifying IPH on MP-RAGE, mask, and TOF were outstanding (κ: 0.93, 0.96, and 0.85). The image quality of mask (1.42 ± 0.66) and TOF (2.42 ± 0.66) was significantly lower than MP-RAGE (3.47 ± 0.61). When T1w images were used to delineate the outer carotid wall, very high specificities (>95%) of IPH detection on mask and TOF images were found, while the sensitivity was high for mask images (>81%) and poor for TOF (50–60%). Without these images, the specificity was still high (>97%), while the sensitivity reduced to 62–71%. ConclusionDespite the lower image quality, routinely acquired mask images from CE-MRA, but not TOF, can be used as an alternative to MP-RAGE images to visualize IPH.

Assessment of Preoperative and Postoperative Cognitive Performance in Asymptomatic Patients Undergoing Carotid Endarterectomy: A Pilot Study

The association between vascular cognitive impairment and carotid stenosis and the possible improvements in vascular cognitive impairment favored by the intervention of carotid endarterectomy (CEA) have not yet been clearly defined. The aim of this pilot study was to prospectively evaluate whether cognitive functions can be influenced by carotid endarterectomy performed in patients with asymptomatic severe carotid stenosis. From January to August 2022, 105 consecutive CEAs were performed in patients with severe asymptomatic carotid stenosis at our institution. Of these, 28 provided informed consent for inclusion in the study and were therefore enrolled, representing our study group. The evaluation of the cognitive functions was made by using the Montreal Cognitive Assessment (MoCA), which was administered to the participants at the moment of the preoperative anesthesiologic assessment, usually between 1 and 7 days prior to surgery. Following the intervention and within the third postoperative month, a clinical and instrumental control visit was performed and during that visit the MoCA questionnaire was again administered to the patients. A comparison between the mean corrected pre- and postoperative values of the MoCA questionnaire was performed using Student t test. Multivariate analysis for the factors affecting the lack of postoperative improvement was performed. Patients were more frequently male (18 patients, 64%) with a mean age of 74.4 ± 7.9 years. The mean MoCA test value in the preoperative was 22.68 ± 3.34, thus slightly below the threshold value for identifying the presence of cognitive impairment. The distribution of the values followed a normal pattern. There were nor perioperative deaths neither neurological events. All the patients had their 3-month reevaluation; no neurological events were detected in this period. At the three-month follow-up, the mean MoCA test score was 23.4 ± 3.4, with a statistical trend toward significant improvement (P = .08; 95% confidence interval, −1.8 to 0.34). The most noticeable improvements were found in the visuospatial, language and abstraction domains, while they were less marked in the domains of attention and memory. Multivariate analysis for the factors affecting the lack of postoperative improvement showed a trend toward worse results in diabetic patients, in those with silent ipsilateral brain lesions and in those on neuropsychiatric drug therapy. Our pilot study, consistently with the literature, confirmed a mild cognitive improvement after CEA performed in asymptomatic patients; however, larger studies with a higher number of patients and a longer follow-up are necessary before considering the possibility of suggesting CEA in order to prevent or reverse cognitive decline.

Timing and Outcomes of Precoronary Artery Bypass Grafting Carotid Endarterectomy

The Society for Vascular Surgery Clinical Practice Guidelines suggests the timing of carotid endarterectomy (CEA) in patients with symptomatic or bilateral severe asymptomatic carotid stenosis needing coronary artery bypass grafting (CABG) be performed either with preoperative CEA or concomitantly with CABG. The optimal timing of CEA in patients with high grade unilateral stenosis, however, has been controversial due to equivocal and/or scarce data. This study examines our experience with pre-CABG CEA and timing in this patient population. This is a single-center retrospective review of all patients who underwent CEA before or during CABG between January 2010 and January 2021. All patients receiving CEA were anesthetized by a dedicated cardiac anesthesiologist. Patients were compared based on timing of CEA in relation to CABG: concomitant (CABG day 0 from CEA) and nonconcomitant (CABG day 1-30 after CEA). The nonconcomitant cohort was substratified into hyperacute (CABG within 48 hours), acute (CABG within 2 weeks), and subacute (CABG within 30 days). Demographics and status of carotid disease were collated. Primary outcomes included stroke, defined as new neurologic deficit, myocardial infarction (MI), 30-day readmission, and 30-day mortality. A total of 39 patients were identified in the study population. Of these, 9 (23%) patients underwent CEA and CABG concomitantly, with 30 receiving nonconcomitant CEA (hyperacute [9, 23%]; acute [16, 41%]; subacute [5, 13%]). Baseline demographics and comorbidities were similar between groups. The degree of internal carotid artery stenosis, presence of high-grade contralateral stenosis, and symptomatic carotid presentation did not impact perioperative outcomes. One stroke occurred after a concomitant CEA/CABG that was a bi-hemispheric event believed to be due to cannulating a highly diseased ascending aorta. One patient in the concomitant cohort developed postoperative MI, cardiogenic shock, and subsequent death (Table I). There was no observed stroke, MI, or death in the nonconcomitant cohort. Thirty-day readmission and mortality were similar between all groups (Tables I and II). However, when comparing aggregate stoke/MI (Table I), a statistically significant difference was observed in favor of the nonconcomitant cohort (P = .007). Careful consideration is needed when determining appropriate timing for coronary revascularization in patients with carotid disease. These data suggest that nonconcomitant, preoperative CEA can be performed safely by a dedicated cardiac anesthesiologist before CABG. Concomitant CEA/CABG, as reflected in these data, carries an added procedural risk of stroke and a potentially poor cardiac outcome. Further study is warranted to elucidate the role of timing in perioperative outcomes for patients requiring CEA and CABG.Table IPerioperative outcomes for patients undergoing coronary artery bypass grafting (CABG) within 30 days of carotid endarterectomy (CEA)Concomitant CABG (n = 9)Nonconcomitant CABG (n = 30)P valuePostoperative events (MI, NS), No. (%)2 (22.2)0 (0).007a30-day readmission, No. (%)1 (11.1)3 (10).9330-day mortality, No. (%)1 (11.1)0 (0).07MI, Myocardial infarction; NS, neurologic symptoms. Open table in a new tab Table IIPerioperative outcomes for patients undergoing coronary artery bypass grafting (CABG) within 30 days of carotid endarterectomy (CEA), with the nonconcomitant CEA/CABG cohort substratified by timingConcomitant CABG (n = 9)Hyperacute CABG (n = 9)Acute CABG (n = 16)Subacute CABG (n = 5)P valuePostoperative events (MI, NS), No. (%)2 (11.1)0 (0)0 (0)0 (0).3530-day readmission, No. (%)1 (11.1)0 (0)1 (6.3)2 (40).1130-day mortality, No. (%)1 (11.1)0 (0)0 (0)0 (0).35MI, Myocardial infarction; NS, neurologic symptoms. Open table in a new tab

Carotid Artery Stenosis: A Look Into the Diagnostic and Management Strategies, and Related Complications.

Carotid stenosis (CS) is a buildup of atherosclerotic plaque within the artery leading to a wide range of symptoms, from mild symptoms, including blurred vision and confusion, to much more life-threatening presentations, including paralysis due to stroke. The presentation is insidious, with symptoms exhibiting predominantly at severe stenosis; hence the emphasis is placed on the importance of early diagnosis, treatment, and lifestyle modifications. CS is seen undergoing almost the same pathogenesis of any atherosclerotic plaque formation, from endothelial damage of the artery lumen to the formation of a fibrous cap with a foam cell, lipid-filled core. The findings of our review article were consistent with the recent literature, depicting that comorbid hypertension, diabetes, and chronic kidney disease (CKD), and lifestyle aspects, including smoking and diet, played the most salient role in plaque development. Among several imaging modalities, duplex ultrasound (DUS) imaging is the widely preferred method in clinical practice. Carotid endarterectomy (CEA) and carotid stenting are the primarily advocated procedures for symptomatic severe stenosis, with similar long-term outcomes. Although, earlier clinical trials showed promising results in mitigating the risk of stroke among asymptomatic severe CS with surgical intervention. However, recent advancements have shifted the focus to medical management alone due to comparable results among the asymptomatic population. Both surgical and medical regimens are beneficial in treating patients, but it is still an ongoing debate as to which is predominantly superior. The currently advancing trials and research will help elucidate definitive guidelines. However, the massive impact of lifestyle modifications advocates some degree of individualized multidisciplinary management strategies.

Efficacy and Safety of Carotid Endarterectomy Versus Carotid Artery Stenting in Asymptomatic Severe Carotid Stenosis:

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Asymptomatic carotid stenosis is associated with both edge and network reconfigurations identified by single-subject cortical thickness networks.

Patients with asymptomatic carotid stenosis, even without stroke, are at high risk for cognitive impairment, and the neuroanatomical basis remains unclear. Using a novel edge-centric structural connectivity (eSC) analysis from individualized single-subject cortical thickness networks, we aimed to examine eSC and network measures in severe (> 70%) asymptomatic carotid stenosis (SACS). Twenty-four SACS patients and 24 demographically- and comorbidities-matched controls were included, and structural MRI and multidomain cognitive data were acquired. Individual eSC was estimated via the Manhattan distances of pairwise cortical thickness histograms. In the eSC analysis, SACS patients showed longer interhemispheric but shorter intrahemispheric Manhattan distances seeding from left lateral temporal regions; in network analysis the SACS patients had a decreased system segregation paralleling with white matter hyperintensity burden and recall memory. Further network-based statistic analysis identified several eSC and subgraph features centred around the Perisylvian regions that predicted silent lesion load and cognitive tests. We conclude that SACS exhibits abnormal eSC and a less-optimized trade-off between physical cost and network segregation, providing a reference and perspective for identifying high-risk individuals.

Prediction of long-term mortality for patients with severe asymptomatic de novo carotid stenosis undergoing carotid endarterectomy (PREMY2SE-CEA): Derivation and validation of a novel risk score

ObjectiveThe aim of the present study was to develop and validate a risk prediction model for the prediction of long-term mortality for patients with severe asymptomatic de novo carotid stenosis undergoing carotid endarterectomy (PREMY2SE-CEA). MethodsData were collected retrospectively from a dedicated database of consecutive patients who had undergone elective CEA for severe (>70% using the NASCET [North American Symptomatic Carotid Endarterectomy Trial] criteria) asymptomatic carotid stenosis at two Italian University Hospitals from 2008 through 2016. Internal validation of the score was performed after random sampling in a 3:1 fashion. The primary end point of the PREMY2SE-CEA risk score was the 5-year mortality. ResultsOf the 1214 patients, 901 were included in the derivation cohort and 313 in the validation cohort. Using multivariable logistic regression with backward elimination, a parsimonious model was derived. A risk score incorporating eight risk factors was generated and found to be highly predictive of long-term mortality in the derivation (odds ratio [OR], 1.38; 95% confidence interval [CI], 1.28-1.41; P < .001) and validation (OR, 1.29; 95% CI, 1.21-1.37; P <.001) cohorts. The discrimination power in the receiver operating characteristic curve analysis was C = 0.775 (95% CI, 0.74-.80), and the optimism-corrected area under the curve in the bootstrapped samples was 0.761 (P < .001). A strong correlation was found between the predicted and actual mortality rates in the validation cohort (r = 0.71; P < .001). ConclusionsIn the present study, we have described the development, evaluation, and validation of a risk prediction model (PREMY2SE-CEA) for long-term mortality after CEA in asymptomatic patients. Physicians could use the PREMY2SE-CEA risk scoring tool to complement their estimates of life expectancy and prompt selective consideration of prophylactic CEA to improve the long-term benefits of interventions.

Carotid Endarterectomy Surgeries: A Multimodality Intraoperative Neurophysiological Monitoring Approach.

Patients with untreated carotid artery stenosis remain at high risk for stroke. Carotid endarterectomy (CEA) is a surgical procedure for the treatment of symptomatic and severe asymptomatic carotid stenosis. A small percentage of patients who do not have good collateral circulation are at high risk of cerebral ischemia during the cross-clamping of the carotid artery. Aspects of CEA, such as cross-clamping and routine shunting, can also carry the risk of perioperative stroke through dislodgement of emboli causing thrombosis, therefore, selective shunting is highly recommended during the CEA procedure. A multimodality approach of intraoperative neurophysiological monitoring (IONM) techniques such as somatosensory evoked potential (SSEP) and electroencephalography (EEG) can be used to monitor cerebral perfusion throughout the duration of the surgery and to predict the need for a selective shunt after cross-clamping. Additional use of transcranial Doppler (TCD) in the multimodality approach can aid in visualizing the cerebral blood flow and detecting any microemboli that may also cause a stroke. A multimodality IONM approach has been reported as more sensitive and specific for predicting and minimizing any postoperative neurological deficits.

Incidence of Ischemic Stroke in Patients With Asymptomatic Severe Carotid Stenosis Without Surgical Intervention

Optimal management of patients with asymptomatic severe carotid stenosis is uncertain, due to advances in medical care and a lack of contemporary data comparing medical and surgical treatment. To estimate stroke outcomes among patients with medically treated asymptomatic severe carotid stenosis who did not undergo surgical intervention. Retrospective cohort study that included 3737 adult participants with asymptomatic severe (70%-99%) carotid stenosis diagnosed between 2008 and 2012 and no prior intervention or ipsilateral neurologic event in the prior 6 months. Participants received follow-up through 2019, and all were members of an integrated US regional health system serving 4.5 million members. Imaging diagnosis of asymptomatic carotid stenosis of 70% to 99%. Occurrence of ipsilateral carotid-related acute ischemic stroke. Censoring occurred with death, disenrollment, or ipsilateral intervention. Among 94 822 patients with qualifying imaging studies, 4230 arteries in 3737 (mean age, 73.8 [SD 9.5 years]; 57.4% male) patients met selection criteria including 2539 arteries in 2314 patients who never received intervention. The mean follow-up in this cohort was 4.1 years (SD 3.6 years). Prior to any intervention, there were 133 ipsilateral strokes with a mean annual stroke rate of 0.9% (95% confidence interval [CI], 0.7%-1.2%). The Kaplan-Meier estimate of ipsilateral stroke by 5 years was 4.7% (95% CI, 3.9%-5.7%). In a community-based cohort of patients with asymptomatic severe carotid stenosis who did not undergo surgical intervention, the estimated rate of ipsilateral carotid-related acute ischemic stroke was 4.7% over 5 years. These findings may inform decision-making regarding surgical and medical treatment for patients with asymptomatic severe carotid artery stenosis.

Carotid artery screening in high risk asymptomatic individuals: outcomes of 3000 carotid screening.

The primary aims of the study to evaluate the efficacy of carotid screening tests to identify asymptomatic carotid artery stenosis among high-risk patients and early prevention of stroke. The estimated prevalence of asymptomatic severe carotid stenosis (≥70%) in the general adult population ranges up to 3.1%. However, the prevalence is higher in comorbid individuals. This makes it important to perform screening testing for early diagnosis and treatment in predetermined high-risk patients. In this prospective study, 3000 selected patients screened during March 2017 and September 2018 at the most populated family health center. Participants selected among registered individuals who have at least one of the risk factors such as hypertension, hyperlipidemia, diabetes mellitus, obesity, and smoking. All the participants were asymptomatic and above the age of 55. Bilateral carotid artery screening performed by Duplex Ultrasonography (DUSG) at the first call and one year later. Patients with severe carotid and/or coronary artery stenosis treated by surgical revascularization or stent implantation in the light of the latest guidelines. Carotid screening among high-risk asymptomatic individuals is of great importance to identify severe carotid artery as well as coronary artery stenosis. Patient education during screening may play a crucial role in preventing the disease.

December 2021 Stroke Highlights

December 2021 <i>Stroke</i> Highlights

Science, Medicine, and the Anesthesiologist

Science, Medicine, and the Anesthesiologist

High Stroke Rate in Patients with Asymptomatic Severe Carotid Stenosis Who Are Medically Managed

High Stroke Rate in Patients with Asymptomatic Severe Carotid Stenosis Who Are Medically Managed

Management of asymptomatic severe carotid artery stenosis in patients undergoing coronary artery bypass surgery: Clinical analysis

Amaç: Koroner arter hastalığı nedeni ile ameliyat yapılacak olan hastalarda semptomatik karotis arter darlığının tedavisi hakkında kılavuzlarda görüş birliği sağlanmış, asemptomatik hastalarda ise kesin görüş birliği sağlanamamıştır. Bu hastalara yaklaşım şeklimizi ve sonuçlarımızı paylaşmak istedik.&#x0D; Gereç ve Yöntemler: Ocak 2016-Ocak 2021 tarihleri arasında koroner arter baypas cerrahisi uyguladığımız tek taraflı %70’ten yüksek karotis arter darlığı bulunan asemptomatik 40 hasta (Grup 1) ile koroner arter baypas cerrahisi uygulanan fakat karotis arter darlığı olmayan 40 hasta (Grup 2) serebrovasküler komplikasyonlar ve cerrahinin sonuçları yönünden karşılaştırıldı. Tüm hastalara koroner arter baypas cerrahisi uygulandı ve karotis arter darlığına müdahale edilmedi.&#x0D; Bulgular: Preoperatif hipertansiyon görülme oranı Grup 1’de daha fazlaydı (%65 ve %32,5, p=0,007). Grup 1 hastalarda koroner arter baypas ameliyatı baypas greft sayısı Grup 2 hastalara göre daha fazla idi (3,250,58 ve 2,870,68, p=0,010). Hiçbir hastada majör serebrovasküler olaya rastlanmadı ve mortalite gelişmedi. &#x0D; Sonuç: Asemptomatik tek taraflı karotis darlığının eşlik ettiği koroner arter hastalarında koroner arter cerrahisinin güvenli olduğu sonucuna vardık. Bu konu ile ilgili kesin görüş birliğine ulaşabilmek için çok merkezli prospektif araştırmaların yapılmasının faydalı olacaktır.

Gray matter asymmetry in asymptomatic carotid stenosis.

Even clinically “asymptomatic” carotid stenosis is associated with multidomain cognitive impairment, gray matter (GM) atrophy, and silent lesion. However, the links between them remain unclear. Using structural MRI data, we examined GM asymmetry index (AI) and white matter hyperintensity (WMH) in 24 patients with severe asymptomatic carotid stenosis (SACS), 24 comorbidity‐matched controls, and independent samples of 84 elderly controls and 22 young adults. As compared to controls, SACS patients showed worse verbal memories, higher WMH burden, and right‐lateralized GM in posterior middle temporal and mouth‐somatomotor regions. These clusters extended to pars triangularis, lateral temporal, and cerebellar regions, when compared with young adults. Further, a full‐path of WMH burden (X), GM volume (atrophy, M1), AI (asymmetry, M2), and neuropsychological variables (Y) through a serial mediation model was analyzed. This analysis identified that left‐dominated GM atrophy and right‐lateralized asymmetry in the posterior middle temporal cortex mediated the relationship between WMH burden and recall memory in SACS patients. These results suggest that the unbalanced hemispheric atrophy in the posterior middle temporal cortex is crucial to mediating relationship between WMH burden and verbal recall memories, which may underlie accelerated aging and cognitive deterioration in patients with SACS and other vascular cognitive impairment.