Critical Carotid Artery Stenosis Research Articles

Feasibility and Intermediate Results of Transcarotid Revascularization with a Prosthetic Conduit

IntroductionTranscarotid artery revascularization (TCAR) is a hybrid technique with excellent initial outcomes. The technical success and safety of TCAR is heavily dependent on an anatomically suitable common carotid artery (CCA). Many patients do not meet anatomic criteria and therefore are not eligible for this therapy. We sought to extend the eligibility of TCAR to patients with unfavorable CCA anatomy via the adoption of a prosthetic arterial conduit. MethodsA single center retrospective study of patients with critical carotid artery stenosis who underwent TCAR via a prosthetic conduit between June 2019 and October 2021 was performed. All patients in the study were considered high-risk for carotid endarterectomy (CEA) based on anatomic features, such as restenosis post-CEA and neck radiation. Unfavorable CCA anatomy was defined as a clavicle to carotid bifurcation distance < 5 cm, a CCA diameter < 6 mm, and/or significant atherosclerotic disease at the intended arterial access site. The primary outcome of interest was technical success. Secondary outcomes included perioperative complications, intermediate and long-term patency, intermediate and long-term stroke and/or mortality and in-hospital length of stay. Follow-up ranged from 1-29 months. ResultsEight patients underwent ten TCAR procedures via a prosthetic conduit. A total of two procedures (20%) were performed on female patients and eight procedures (75%) were performed on male patients. The mean age was 65 years old (standard deviation (SD) 11 years). Technical success was 100%. The 30-day ipsilateral stroke rate was 0%. The 30-day patency was 90%. There was no re-exploration for hemorrhage and 30 day mortality was 0%. ConclusionsTCAR is an excellent option for carotid artery revascularization. Unfavorable CCA anatomy has limited its applicability. TCAR via a prosthetic conduit has the potential to expand eligibility for this promising therapy.

Preoperative Risk Factors Impacting Length of Stay After Transcarotid Artery Revascularization

Transcarotid artery revascularization (TCAR), using interoperative flow reversal is a unique, hybrid operation utilized in treating critical carotid artery stenosis. Over the past decade, TCAR has been increasingly used to treat asymptomatic carotid artery disease and has a similar risk profile to traditional carotid endarterectomy. Postoperative length of stay (LOS) has a significant impact on cost-effectiveness and quality outcomes in this expanded setting. The objective of this study is to develop a multivariate regression model to identify key preoperative variables and their impact factor on LOS after TCAR for asymptomatic carotid artery stenosis. We hypothesized that high-risk preoperative patient factors historically identified in carotid endarterectomy would similarly impact LOS after TCAR. A multi-institution, retrospective study of all adult patients undergoing TCAR with flow-reversal for intraoperative neuroprotection was performed using the Society for Vascular Surgery Vascular Quality Initiative (VQI) from January 2016 to August 2021. Patients with prolonged preoperative hospitalization (preoperative LOS ≥1day) were excluded to enhance the capture of carotid artery stenosis as the index admission. Univariate analysis was done on preoperative factors against LOS using nonparametric statistical tests. A multivariate model was then constructed using a negative binomial regression. The study population was split into 80% "training" data for model formulation and 20% "test" data for model validation. Thirteen thousand four hundred eighty-three patients undergoing TCAR for asymptomatic carotid stenosis met the study's inclusion criteria with a median postoperative LOS of 1.82days. Factors in VQI found to have a significant effect on LOS and retained in the multivariate model were lesion type (restenosis versus atherosclerotic), age, gender, chronic obstructive pulmonary disease, preoperative beta blocker, calcific lesion burden, hypertension status, and race (P<0.05). The model accurately predicted LOS after TCAR within 1day for 86.04% and within 2days for 94.51% of patients in the test population. This large-scale analysis from 2016 to 2021 spans a considerable expansion in the practice of TCAR for asymptomatic carotid disease. All preoperative variables shown to significantly increase the postoperative LOS were derived from the VQI data set. As LOS is a measure of health-care efficiency and cost-effectiveness, this model can be used to identify patients at risk for increased postoperative LOS. It has the potential to be incorporated into a patient/physician decision support tool to optimize resource planning and patient selection for elective TCAR.

Abstract 14484: Shockwave Lithotripsy as a Non Surgical Modality for Calcified Carotid Stenosis

An 80-year-old gentleman with significant bilateral carotid artery stenosis and previous right carotid endarterectomy underwent a CT Angiogram of the Head and Neck due to multiple episodes of syncope. The study revealed heavily calcified atherosclerotic disease at the left carotid bulb and bifurcation, causing high-grade luminal stenosis of 80 to 82% at the origin of the internal carotid artery. Hence, a decision was made to obtain a cerebral angiogram. Aortic arch angiogram revealed a type III arch, following which a cerebral catheter wire was engaged in the left carotid artery. A selective angiogram showed 80% calcified stenosis at the level of bifurcation, with the left external carotid artery being 100% occluded. Given the heavily calcified lesion, supra core guidewire was crossed across the lesion, followed by advancement of protection device into the distal segment of the left internal carotid artery. Balloon angioplasty was performed twice from the ostial to the proximal segment of the left internal carotid artery. An attempt was made to place a stent without any success. Subsequently, a decision was made to proceed with shockwave lithoplasty. We inserted a transvenous pacemaker with a backup rate of 40 bpm. A Shockwave catheter was inserted and shockwaves were delivered with multiple inflation techniques at 4 atmospheric pressure for 15 seconds each. Periodic neuro assessments were normal. This was followed by the placement of stents in the distal left common carotid and ostial to proximal left internal carotid artery reducing the calcified 80% stenosed lesion to 10% with excellent angiographic results. Subsequently, the filter and the catheter were removed and the femoral artery access site was secured. The patient tolerated the procedure very well without any immediate or delayed complications. The intracerebral vasculature remained intact as confirmed by a cerebral angiogram. TVP was removed and the patient was discharged in a stable condition after 2 days. Hence, Shockwave lithotripsy can be successfully used for critical carotid artery stenosis in patients that pose a high surgical risk. It helps soften the lesion for better dilatation of the vessel and achieve improved luminal gain for appropriate stent expansion.

Association of serum elabela levels with carotid artery stenosis in patients with non-cardioembolic ischemic stroke.

Aim: Elabela (ELA) is a peptide of the apelinergic system and is known to play a role in endothelial homeostasis and vascular pathobiology. In this study, the relationship between carotid artery stenosis, which is the main culprit, and ELA level in patients with non-cardioembolic ischemic stroke was investigated. Materials & methods: Cross-sectional observation included two groups of 40 patients with critical carotid artery stenosis and 40 patients with age-sex matched noncritical carotid artery stenosis. Results: ELA levels were significantly higher in the noncritical stenosis group. ELA had a significantly moderate negative correlation with the carotid score (r=-0.334, p=0.003), maximal carotid plaque length (r=-0.413, p<0.001) and degree of stenosis (r=-0.397, p<0.001). Conclusions: There is a significant inverse correlation between critical carotid artery disease and ELA level in patients with non-cardioembolic ischemic stroke.

Carotid Endarterectomy Prior to Ventricular Assist Device Placement in a Patient with Cardiogenic Shock

<h3>Introduction</h3> Atherosclerotic disease in the cervical vessels may be a contraindication for implantation of left ventricular assist devices (LVADs). The occurrence of ischemic stroke represents an obstacle to rehabilitation, and its incidence seems to be higher in this population. Carotid endarterectomy (CEA) is a preferable surgical treatment in patients with high bleeding risk. This case report suggests that CEA followed by implantation of LVADs can be feasible. <h3>Case Report</h3> A 55 y/o woman with advanced heart failure (AHF) due to ischemic cardiomyopathy was admitted in the hospital with cardiogenic shock and started treatment. She evolved with three failures in weaning the inotropic agent, and was evaluated for heart transplantation (HT). She had a panel-reactive antibody with 79% class II and a critical right carotid artery stenosis was evidenced. She had preserved right ventricular function; consequently, implantation of LVAD was an option. However, she presented an episode of hypotension, dysarthria and left hemiparesis in the preoperative period that reversed after intra-aortic balloon (IAB) placement and hemodynamic stabilization. Computed tomography angiography showed right internal carotid artery sub-occlusion and transcranial Doppler ultrasound with the cerebral flow within normal range despite hemodynamic support. CEA of both the right internal and common carotid artery was performed. The patient tolerated the procedure despite using inotropic and IAB, recovering with no neurological deficit. Heart Mate III was implanted after 15 days. The patient evolved well and is currently in an outpatient follow-up for 1 year. <h3>Summary</h3> The appropriate interval between CEA and LVAD implantation is not well established; however, we assume that early intervention might reduce a cerebral ischemic event's risk. If a stroke occurred during LVAD implantation, rehabilitation would be expensive and complex, and future HT might be contraindicated. The team agreed that the most appropriate technique, in this case, was CEA instead of percutaneous stent implantation as the second technique would require dual antiplatelet therapy. With the increasing number of patients with AHF undergoing LVAD, comorbidities such as severe cerebrovascular disease may occur. This case report suggests that CEA followed by LVAD insertion can be safe and feasible even in cardiogenic shock.

Managing Vascular Surgery Emergencies and Referrals During the COVID-19 Pandemic at a Tertiary Centre in Oman.

ObjectivesThis study aimed to discuss the different challenges faced while managing emergency vascular surgery cases during the COVID-19 pandemic and how these challenges were overcome.MethodsThis study details 14 emergency cases that were managed during a period of one month from mid-March to mid-April at Sultan Qaboos University Hospital, Muscat, Oman. The cases included acute limb ischaemia, critical limb ischaemia, type B dissection of the thoracic aorta, thoraco-abdominal aneurysm, critical internal carotid artery stenosis, trauma, infected arteriovenous forearm loop graft and thrombosed arteriovenous fistulas.ResultsOnly one patient was confirmed to have COVID-19. Five were negative for COVID-19 while the remaining eight were not tested. Various strategies on how the vascular surgical team accommodated changes in hospital protocols and nationwide lockdown are discussed in detail.ConclusionsWith the judicious use of personal protective equipment and consumable surgical and endovascular devices, communication with support services and other hospitals and implementation of triage protocols, it was possible to manage vascular surgery emergencies effectively.

Expression Of MiRNA-33 And MiRNA-155 In Symptomatic And Asymptomatic Carotid Artery Stenosis

Background: The aim of this study was to evaluate miRNA-33 and miRNA-155 expression in Peripheral Blood Mononuclear Cells (PBMC) and carotid specimens of patients affected by Critical Carotid Artery Stenosis (CAS). Material and Methods: We selected 17 asymptomatic (CAS-A group) and 10 symptomatic (CAS-S group) patients with CAS. Ten patients with traditional cardiovascular risk factors (RF group), matched for age and sex, were used as control group. Results: A significant increase in miRNA-33 expression was observed both in peripheral blood and in carotid specimens of CAS-A patients (p 0.04) in comparison with CAS-S and RF, whereas no significant difference were found among the groups regarding miRNA-155 expression both in peripheral blood and in carotid specimens. Conclusions: This is to our knowledge the first report on miRNAs expression in human PBMCs from CAS patients. Results of this study suggest that miRNA-33 in involved in the process underling plaque formation and growth, but not in plaque instability and ischemic brain damage, whereas miRNA-155 is expressed during all the phases of atherosclerotic disease.

Role of Magnetic Resonance Spectroscopy in Evaluation of Cerebral Metabolic Status Before and After Carotid Endarterectomy/Thromboendarterectomy and Carotid Artery Stenting in Patients with Asymptomatic Critical Internal Carotid Artery Stenosis.

BackgroundThe relative efficacy of carotid endarterectomy (CEA)/thromboendarterectomy (TEA) and carotid artery stenting (CAS) already has been compared in randomized controlled trials and a meta-analysis, but only limited data exist describing the status of cerebral metabolism before and after these interventions.The aim of the present study was to compare metabolic changes before and after treatment of carotid stenosis and assess their potential clinical implications.Material/MethodsPatients with asymptomatic unilateral critical internal CAS were imaged with proton 3T magnetic resonance spectroscopy (H-MRS) because the technique is more sensitive than regular magnetic resonance imaging for detection of the early signs of ischemic events. Abnormal metabolite ratios detected with H-MRS may precede actual morphological changes associated with hypoperfusion as well as reperfusion changes. Ipsilateral and contralateral middle cerebral artery vascular territories were both evaluated before and after vascular intervention. H-MRS was performed within 24 h before and after surgery. Correlations in the metabolic data from H-MRS for N-acetylaspartic acid (NAA)+N-acetylaspartylglutamate, creatinine (Cr)+phosphocreatinine, and phosphocholine+glycerophosphocholine (Cho) were sought.ResultsH-MRS voxels from 11 subjects were analyzed. Values for dCho/CrI, dCho/CrC and Cho/Naal (P<0.001) were significantly higher ipsilaterally than contralaterally. Ratios for dNaa/ChoC and Cho/NaaC were significantly higher on the non-operated side (P<0.001).ConclusionsH-MRS may be helpful for assessment of patients with CAS, particularly because unlike other modalities, it reveals postoperative changes in metabolic brain status. Initial results indicate the important role of perioperative neuroprotective treatment.

Safety and Feasibility of Simultaneous Transcarotid Revascularization With Flow Reversal and Coronary Artery Bypass Grafting for Concomitant Carotid Artery Stenosis and Coronary Artery Disease.

The management of patients with combined severe carotid artery and coronary artery disease (CAD) is controversial. Transcarotid stenting with flow reversal (TCAR) is a novel hybrid technique for carotid revascularization. We sought to investigate the safety and feasibility of simultaneous TCAR and coronary artery bypass grafting (CABG) for concomitant carotid and CAD. A single-institution, retrospective study of patients with critical carotid artery stenosis and symptomatic CAD who underwent simultaneous TCAR-CABG was completed. The primary outcomes were technical success, perioperative stroke, death, and hemorrhage. Four patients underwent TCAR-CABG. All patients were male with a mean age of 64. Technical success was achieved in all cases. There were no perioperative strokes or deaths. There were no reexplorations for hemorrhage. Transcarotid stenting with flow reversal-CABG is a technically feasible hybrid approach for simultaneous carotid and coronary revascularization. It should be part of the vascular surgeon's armamentarium for coexisting carotid and coronary disease. Further research focused on patient selection and perioperative antiplatelet management is warranted prior to the widespread adoption of this technique.

Critical carotid artery stenosis involving a persistent primitive hypoglossal artery

Persistent primitive hypoglossal artery (PPHA) is a rare internal carotid-vertebrobasilar anatomic variant. Awareness of this anomaly and its propensity for atherosclerotic disease is important to avoid misinterpretation of diagnostic studies and to allow appropriate interventional planning. As the predominant vascular supply to the anterior and posterior cerebral circulation, its luminal compromise can lead to devastating ischemic complications. Carotid endarterectomy and carotid stenting have both been performed to treat lesions involving a PPHA. Herein, we report a case of carotid endarterectomy involving a PPHA and discuss the clinical and surgical implications of a carotid lesion in the presence of a PPHA.

Are systolic velocity duplex metrics negatively affected by flow aliasing in areas of critical internal carotid artery stenosis

ABSTRACTPurpose: Duplex scanning is a useful noninvasive screening tool for the detection of carotid bifurcation disease. Internal carotid artery (ICA) peak systolic velocity (PSV) and ICA/common carotid artery (CCA) PSV ratios are proven metrics determining 70%-99% ICA stenosis. A potential disadvantage of using dramatically increasing systolic velocity measurements in areas of critical arterial stenosis is flow aliasing. Diastolic velocity should be less influenced by this flow artifact. We evaluate ICA and CCA end diastolic velocity (EDV) metrics in predicting severe ICA stenosis and document the prevalence of an aliasing artifact in a population of patients with critical ICA stenosis.Methods: Consecutive patients undergoing carotid duplex assessments and contrast angiography were compared (n = 140). ICA and CCA PSV and EDV were recorded as was evidence of the flow aliasing of ICA waveforms. ICA/CCA PSV and EDV ratios were calculated. Duplex parameters were compared with angiographic ICA measurements. Receiver-operator characteristic curve (ROC) analysis was used to determine optimal criteria to identify ICA stenosis of 70% to 99%.Results: Of 256 carotid bifurcation duplex studies, critical angiographic stenosis was present in 105 arteries. Only four completed arterial duplex scans demonstrated flow aliasing. In three of these patients, systolic metrics were non-diagnostic versus ICA/CCA EDV ratios. An ICA/CCA EDV ratio of 2.3 provided the best combination of sensitivity 73.8% and specificity 75.18%.Conclusion: ICA/CCA diastolic ratios reliably determine 70% or greater ICA stenosis. Flow aliasing infrequently complicates ICA PSV.

Comorbidities and Health-Related Quality of Life Following Revascularization for Asymptomatic Critical Internal Carotid Artery Stenosis Treated with Carotid Endarterectomy or Angioplasty with Stenting.

BackgroundThis study aimed to evaluate the relationship between existing comorbidities and the effectiveness of revascularization of asymptomatic critical internal carotid artery (ICA) stenosis treated with carotid endarterectomy (CEA) or carotid artery stenting (CAS) and short-term and long-term outcome in terms of health-related quality of life (HRQoL).Material/MethodsPatients with asymptomatic critical ICA stenosis (n=62) included a group treated with CEA (n=31) and a group treated with CAS (n=31). A Health Assessment Questionnaire designed for this study was used to assess ten comorbidities, and the Short Form 36 Health Survey Questionnaire (SF-36) was used to evaluate HRQoL following CEA and CAS.ResultsThree comorbidities significantly influenced the effectiveness of revascularization in all patients studied who underwent CEA and CAS, which included symptomatic atherosclerosis in other vascular areas (p=0.048), coronary artery disease (CAD) (p=0.004), and previous myocardial infarction (MI) (p=0.004). In the CEA group, CAD and previous MI were significant comorbidities (p=0.002), when compared with the CAS group (p=0.635). In the CAS group, chronic obstructive pulmonary disease (COPD) was a significant comorbidity in terms of outcome (p=0.025).ConclusionsThe comorbidities of atherosclerotic vascular disease, CAD, and previous MI had a significant influence of the effectiveness of the revascularization and postoperative HRQoL in all patients studied with asymptomatic critical ICA stenosis who were treated with CEA and CAS. When the two groups were compared, CAD and previous MI were significant comorbidities in the CEA group, and COPD was a significant comorbidity in the CAS group.

Acute retinal arterial ischemia.

Acute retinal arterial ischemia, which includes transient monocular vision loss (TMVL), branch retinal artery occlusion (BRAO), central retinal artery occlusion (CRAO) and ophthalmic artery occlusion (OAO), is most commonly the consequence of an embolic phenomenon from the ipsilateral carotid artery, heart or aortic arch, leading to partial or complete occlusion of the central retinal artery (CRA) or its branches. Acute retinal arterial ischemia is the ocular equivalent of acute cerebral ischemia and is an ophthalmic and medical emergency. Patients with acute retinal arterial ischemia are at a high risk of having further vascular events, such as subsequent strokes and myocardial infarctions (MIs). Therefore, prompt diagnosis and urgent referral to appropriate specialists and centers is necessary for further work-up (such as brain magnetic resonance imaging with diffusion weighted imaging, vascular imaging, and cardiac monitoring and imaging) and potential treatment of an urgent etiology (e.g., carotid dissection or critical carotid artery stenosis). Since there are no proven, effective treatments to improve visual outcome following permanent retinal arterial ischemia (central or branch retinal artery occlusion), treatment must focus on secondary prevention measures to decrease the likelihood of subsequent ischemic events.

Transradial carotid artery stenting with the use of a novel integrated embolic protection technology (RCD code: I-1B.O)

We present the case of a 79‑year‑old woman with critical right internal carotid artery stenosis in whom carotid artery stenting was performed via a right radial artery approach with the use of a novel integrated embolic protection technology- Paladin System® (Contego Medical). JRCD 2018; 3 (7): 239–242

ABCD2 risk score does not predict the presence of cerebral microemboli in patients with hyper-acute symptomatic critical carotid artery stenosis

IntroductionABCD2 risk score and cerebral microemboli detected by transcranial Doppler (TCD) have been separately shown to the predict risk of recurrent acute stroke. We studied whether ABCD2 risk score predicts...

Critical Carotid Artery Stenosis in Coronary and Non-Coronary Patients - Frequency of Risk Factors.

Introduction:Stroke is one of the largest socio medical problems of modern times. In addition to the third leading cause of death, it is the first cause of non-trauma disability. Numerous studies show a correlation of risk factors and arteriosclerotic lesions in the coronary arteries and carotid arteries.Patients and methods:Study was conducted at the Clinical Center University of Sarajevo, Clinic for Cardiology surgery, methodologically cross-sectional study and partly manipulative and clinical prevention study, conducted on a representative sample of 100 patients. The subject was divided into 2 groups, coronary and non-coronary patients. Both groups of patients underwent color Doppler of carotid arteries, medical history and laboratory analysis.Results:The results confirm the hypothesis that the critical carotid artery stenosis is more present in patients with coronary disease, while the association of risk factors has been demonstrated for diabetes, hypertension and dyslipidemia.Conclusion:Screening of carotid arteries in patients scheduled for coronary revascularization is essential. With the presence of critical stenosis of the carotid artery, surgery of carotid artery should be done before coronary revascularization. The implementation of aggressive education and prevention of risk factors for cardiovascular disease is needed.

MMP-12 and TIMP Behavior in Symptomatic and Asymptomatic Critical Carotid Artery Stenosis

The aim of this study was to evaluate the levels of matrix metalloproteinase-12 (MMP-12) and tissue inhibitors of metalloproteinases (TIMP)-1, TIMP-2, TIMP-3, and TIMP-4 in patients with symptomatic and asymptomatic critical carotid artery stenosis (CAS). We enrolled 10 patients affected by symptomatic CAS within 12 hours from onset of stroke (S group) and 30 patients with asymptomatic CAS (CAS group); 31 patients matched for age, sex, and traditional cardiovascular risk factors were used as controls (RF group). Serum levels of MMP-12, TIMP-1, TIMP-2, TIMP-3, and TIMP-4 were assessed by Luminex. MMP-12 levels were significantly higher both in the S and CAS groups than in the RF group (P < .001). We found a significant decrease of all TIMPs in the CAS group compared with the RF group, whereas a significant increase was observed in the S group compared with the CAS group. A significant increase of TIMP-3 and TIMP-4 levels was observed in the S group compared with all other groups. MMP-12 is related to critical CAS both symptomatic and asymptomatic, being mainly released in the late stage of plaque development. Moreover, we suggest that a specific pattern of matrix degrading enzyme inhibitors arises during the early phases of stroke.

Role of T helper 17 lymphocyte subpopolations in critical carotid artery stenosis

Role of T helper 17 lymphocyte subpopolations in critical carotid artery stenosis

FGF-23 levels in patients with critical carotid artery stenosis

The aim of this study was to evaluate fibroblast growth factor (FGF)-23 serum levels and its tissue expression in patients with critical carotid artery stenosis (CAS). We selected 35 patients with critical CAS undergoing carotid thromboendoarterectomy. In each patient, FGF-23 serum levels were evaluated just prior to the surgery (t0) and 30 min (t1) thereafter. Moreover, macrophage cytokines were measured at baselines. Carotid artery specimens were used for immune histochemistry. On the basis of the histology, the patients were divided into 2 groups: A with complicated plaque and B with uncomplicated plaque. Twenty complicated plaques (57.14%, group A,) and 15 uncomplicated (42.86%, group B) were evaluated: calcifications were present in 16/20 (80%) complicated plaques and in 6/15 (40%) uncomplicated plaques. An inflammatory infiltrate was observed in 26/35 carotid samples: 18/26 (69.23%) complicated and 8/26 (30.76%) uncomplicated. FGF-23(+) cells were present in 17/20 complicated (85%) and in 8 uncomplicated (53%) plaques. The double-staining immunofluorescence confirmed that macrophage cells (CD68(+)) were also positive for FGF-23 staining. Serum levels of FGF-23 were significantly higher in group A versus group B at t0 (p < 0.05) and t1 (p 0.0047). Moreover, in group A patients a significant increase of FGF-23 serum levels was observed at t1 in comparison with t0 (p 0.0011). Our results suggest that FGF-23 acts in the late phases of atherosclerotic disease and may potentially represent a marker of complications in critical CAS.

Community-Based Screening and the Detection of Critical Carotid Artery Stenosis and Abdominal Aortic Aneurysm

Background: Community-based cardiovascular screening has the opportunity to detect critical cardiovascular disease and positively affect public health outcomes. Disease deemed to be critical or severe at detection requires appropriate medical follow-up. This article examined the self-reported outcomes of individuals who had undergone community-based cardiovascular screening and had critical findings for abdominal aortic aneurysm (AAA) or carotid artery stenosis (CAS). Methods: Over 390,000 screening records for AAA and over 490,000 screening records for CAS were reviewed to identify individuals with critical screening findings. A critical AAA is defined as an aneurysm ≥ 5cm and critical CAS is defined as a hemodynamically significant stenosis with recorded peak systolic velocities of ≥300 cm/s, in this population. Identified individuals were then contacted via phone and surveyed about the medical care they received after their screening. Results: Review of the screening records found a prevalence of critical AAA findings of 0.037% (146 participants) and critical CAS findings of 0.12% (579 participants). 61% of participants with critical findings were reached for follow-up from both groups. Over 96% of participants with critical AAA and over 92% of participants with critical CAS had some forms of medical follow-up. Conclusions: Community-based cardiovascular screening has the ability to detect critical levels of disease. Findings of critical disease in the reviewed population are similar to the findings from previously published studies. Importantly, medical treatment received by those who seek follow-up appears to be consistent with recommended treatment guidelines. Identification and management of critical disease represent meaningful public and individual health benefits and the possibility of cost-savings.