Risk Factors For Carotid Stenosis Research Articles

The differences between carotid web and carotid web with plaque: based on multimodal ultrasonic and clinical characteristics.

This study aimed to examine the clinical and multimodal ultrasonic characteristics differences between carotid web (CW) and CW with plaque as well as the potential risk factors for stroke caused by CW. We retrospectively enrolled patients diagnosed with CW by CTA or high-resolution MRI (HRMRI) and simultaneously underwent contrast enhanced ultrasound (CEUS) and superb microvascular imaging examinations from January 2015 to October 2022. The CW angle was measured using computer-aided software. The variations between CW and CW with plaque were evaluated, and univariable and multivariable logistic regressions were utilized to identify possible risk predictors for stroke caused by CW. Two hundred ninety-nine patients with an average age of 60.85 (± 8.77) years were included. Sex, age, history of smoking, alcohol, hypertension, diabetes mellitus, homocysteine level, and treatment, as well as web length and thickness, luminal stenosis, location wall, number, CW angle, and CEUS enhancement, were quite different among CW and CW with plaque patients (p < 0.05). The logistic regression analysis showed that web length was an independent predictor of luminal stenosis in CW patients. For patients with CW and plaque, plaque and web thickness, as well as plaque enhancement, were associated with stenosis. Furthermore, luminal stenosis and plaque length were risk factors for symptoms. The multimodal ultrasonic and clinical manifestations of CW and CW with plaque are quite different. Web length is an independent risk factor for carotid artery stenosis in CW patients, whereas luminal stenosis and plaque length were risk factors for symptoms in CW with plaque patients. Exploring the similarities and differences between the carotid web and the carotid web with plaque, based on the stereo-geometric spatial position relationship and hemodynamic changes, may provide further insights into the underlying mechanisms of stroke occurrence caused by the carotid web. 1. Multimodal ultrasonic and clinical manifestations of carotid web and carotid web with plaque are substantially different. 2. A thin triangular endoluminal defect is identified as a typical feature of the web on superb microvascular imaging, and two kinds of typical ultrasonic features of CW with plaque are also identified. 3. Web length is an independent risk factor for carotid stenosis in carotid web patients, whereas luminal stenosis and plaque length are risk factors for symptoms in patients with CW and plaque.

Inflammation and endothelial function relevant genetic polymorphisms in carotid stenosis in southwestern China.

To evaluate the relationship between carotid stenosis with variants in genes referred to inflammation and endothelial function. There was a multi-center, cross sectional survey in southwestern China. The eight communities were selected at random in southwestern China. The residents aged ≥40 years volunteered to participate in face-to-face survey. Subjects with at least three of the aforementioned eight stroke related risk factors or a history of stroke were classified as high-risk population for stroke. A total of 2,377 subjects were the high-risk population for stroke in the eight communities, and degree of carotid stenosis was assessed by carotid ultrasound. Genotypes of 6 variants in 3 genes related to inflammation and endothelial function were examined. Gene-gene interaction was analyzed by generalized multifactor dimensionality reduction (GMDR). Carotid stenosis were found in 295 (12.41%) subjects, of whom 51 (17.29%) had moderate or severe stenosis. According to multivariate logistic regression analysis, we found that HABP2rs7923349TT was independent risk factor for carotid stenosis (OR, 1.96, 95% CI: 1.22-3.13, P = 0.005) and ITGA2rs1991013AG and HABP2rs7923349TT were independent risk factors for moderate to severe carotid stenosis (OR, 2.28, 95% CI: 1.28-4.07, P = 0.005; OR, 2.90, 95% CI: 1.19-7.08, P = 0.019). GMDR analysis showed that there was a significant gene-gene interaction between ITGA2 rs4865756 and HABP2 rs7923349, and the high-risk interactive genotype in the two variants was independently associated with a higher risk for carotid stenosis after adjusting the covariates (OR,1. 42, 95% CI 1.10-1.84, P = 0.008). Prevalence of carotid stenosis was very high in the high-risk stroke population in southwestern China. Variants in genes referred in endothelial function were associated with the carotid stenosis. The high-risk interactive genotype in ITGA2 rs4865756 and HABP2 rs7923349 was independently associated with a higher risk for carotid stenosis.

Indications for carotid Doppler ultrasound in asymptomatic patients - are we ordering it correctly?

Carotid arteries are frequently the site of pathologies, the most common being atherosclerosis, which may result in the formation of plaques, causing stenosis. Doppler ultrasound is currently the exam of choice for assessment of the carotid arteries in asymptomatic patients to screen for and diagnose vascular lesions. Current guidelines recommend screening patients who have risk factors for carotid stenosis and who are able and willing to undergo medical treatment and/or carotid intervention. Screening asymptomatic patients in the general adult population who have no significant risk factors is not recommended. To assess whether medical experts rely on the literature to request Doppler ultrasound for screening. A retrospective selection of patients was performed based on requests for carotid ultrasound. The data collected were computed and analyzed using RStudio version 1.3.959. The request was evaluated as appropriate as long as the patients presented at least one risk factor for carotid plaques. Fifty-five out of 152 patients met criteria for carotid screening. The most frequent indication in the study population was vascular check-up. Arterial hypertension was the most prevalent risk factor. Vascular surgery specialists were more likely to order the exam correctly (odds ratio for correct indications: 3.52 [CI 1.14 - 10.87], with p=0.02). The rate of correct Doppler ultrasound requests was 36% (95%CI 29 to 42%). An excess of requests for carotid ultrasound screening was found in this study. Vascular surgeons more often requested the test correctly.

Indicações para ecodoppler de carótidas em pacientes assintomáticos - estamos solicitando corretamente?

Abstract Background Carotid arteries are frequently the site of pathologies, the most common being atherosclerosis, which may result in the formation of plaques, causing stenosis. Doppler ultrasound is currently the exam of choice for assessment of the carotid arteries in asymptomatic patients to screen for and diagnose vascular lesions. Current guidelines recommend screening patients who have risk factors for carotid stenosis and who are able and willing to undergo medical treatment and/or carotid intervention. Screening asymptomatic patients in the general adult population who have no significant risk factors is not recommended. Objectives To assess whether medical experts rely on the literature to request Doppler ultrasound for screening. Methods A retrospective selection of patients was performed based on requests for carotid ultrasound. The data collected were computed and analyzed using RStudio version 1.3.959. Results The request was evaluated as appropriate as long as the patients presented at least one risk factor for carotid plaques. Fifty-five out of 152 patients met criteria for carotid screening. The most frequent indication in the study population was vascular check-up. Arterial hypertension was the most prevalent risk factor. Vascular surgery specialists were more likely to order the exam correctly (odds ratio for correct indications: 3.52 [CI 1.14 - 10.87], with p=0.02). The rate of correct Doppler ultrasound requests was 36% (95%CI 29 to 42%). Conclusions An excess of requests for carotid ultrasound screening was found in this study. Vascular surgeons more often requested the test correctly.

Relationship between lifestyle and metabolic factors and carotid atherosclerosis: A survey of 47,063 fatty and non-fatty liver patients in China.

Background and aimsCarotid atherosclerosis and stenosis are common lesions of the artery wall that form the basis of cardiovascular events. Compared with coronary atherosclerosis, few studies have explored the influencing factors of carotid atherosclerosis. The aim of this study was to explore the influencing factors of carotid atherosclerosis and carotid stenosis without and with fatty liver disease (FLD).MethodsA total of 47,063 adults were recruited for this cross-sectional study. The color Doppler ultrasound, including metabolic factors and lifestyle surveys, was used to determine whether the participants had FLD and carotid artery disease. Multiple logistic regression was used to investigate the influencing factors of lifestyle and metabolism of carotid atherosclerosis and stenosis in the participants with and without FLD.ResultsIn participants without FLD, current alcohol consumption (OR: 0.749, 95% CI: 0.588) and hip circumference (OR: 0.970, 95% CI: 0.961, 0.979) were the main protective factors for carotid atherosclerosis. Systolic blood pressure (OR: 1.022, 95% CI: 1.019, 1.025) and diastolic blood pressure (OR: 1.005, 95% CI: 1.001, 1.010), elevated fasting blood glucose (OR: 1.012, 95% CI: 1.005, 1.019), and non-sedentary behavior (OR: 1.084, 95% CI: 1.014, 1.160) were the main risk factors for carotid atherosclerosis. Hip circumference (OR: 0.932, 95% CI: 0.910, 0.954) and low-density lipoprotein (OR: 0.979, 95% CI: 0.964, 0.994) were protective factors for carotid stenosis. Smoking (OR: 3.525, 95% CI: 1.113, 11.169) and unqualified exercise (OR: 1.402, 95% CI: 1.083, 1.815) were risk factors for carotid stenosis. In participants with FLD, smoking (OR: 0.827, 95% CI: 0.703, 0.973) and hip circumference (OR: 0.967, 95% CI: 0.958, 0.977) were the main protective factors for carotid atherosclerosis. BMI 18.5–23.9 (OR: 1.163, 95% CI: 1.002, 1.351), non-sedentary behavior (OR: 1.086, 95% CI: 1.009, 1.168), and waist circumference (OR: 1.030, 95% CI: 1.022, 1.038) were the main risk factors for carotid atherosclerosis.ConclusionBased on a large-sample check-up population in China, this study investigated the influencing factors of carotid atherosclerosis and carotid stenosis in fatty liver and non-fatty liver patients and explored the influencing factors of metabolism and lifestyle, which were mainly focused on exercise, sedentary behavior, smoking, alcohol consumption, hip circumference, and blood pressure.

Hemodynamic risk factors for carotid stenosis:

Hemodynamic risk factors for carotid stenosis:

PC068. Carotid Intervention Compared With Medical Management Decreases Stroke and Mortality in Patients with Amaurosis Fugax or Retinal Artery Occlusion

Amaurosis fugax (AF) is a risk factor for carotid stenosis and subsequent ischemic stroke. However, this risk differs from that of patients who experience transient ischemic attacks involving the cerebral hemisphere. Retinal artery occlusion (RAO) is another common ocular phenomenon that does not always cause AF. It remains unknown whether asymptomatic RAO without AF also increases the risk of stroke. Few studies have compared the outcomes of medical management vs carotid intervention in this specific population of patients with AF/RAO and carotid stenosis. We hypothesize that patients with AF/RAO and carotid stenosis who receive either carotid endarterectomy (CEA) or carotid artery stenting (CAS) will exhibit decreased subsequent stroke. The Healthcare Cost and Utilization Project State Inpatient Database from Florida between 2006 and 2015 was queried using International Classification of Diseases, Ninth Revision codes. Patients were stratified into two cohorts: conservative management and intervention. The intervention group was further subdivided into CEA and CAS. Outcome variables included mortality and stroke. Univariate analysis was conducted using t-testing for continuous variables and χ2 tests for categorical variables. Multivariate logistic regression was used to analyze 6-month mortality and stroke risk after initial RAO or AF diagnosis. A total of 9121 patients with AF or RAO were identified, and 2594 procedures were completed (2242 CEAs and 352 CAS procedures). Average age was 68.5 years. Male sex (65.2% vs 52.3%; P < .001) and white race (90.4% vs 77.1%; P < .001) were significantly more common in the surgical cohort than in the medical cohort. Multivariate regression analysis was then used to adjust for these disparate demographic data between cohorts. We found that patients with AF/RAO who underwent CEA or CAS demonstrated a 24% decreased risk of mortality (P < .001) and 31% decreased risk of stroke (P < .001) within 6 months of initial AF/RAO diagnosis compared with patients with medical management. Subgroup analysis further revealed that in patients with only RAO (without AF) who underwent CEA or CAS, there is a 63% decreased risk of mortality (P = .247) and 13% decreased risk of stroke (P = .001) compared with patients with medical management. Similarly, in patients with AF without RAO who underwent carotid intervention, there is a 46% decreased risk of mortality (P < .002) and 29% decreased risk of stroke (P < .001). Patients with either AF or RAO exhibit decreased mortality and stroke after carotid intervention (CEA or CAS) compared with those who are medically managed.

Examination of hemodynamic environments of carotid stenosis with computational fluid dynamics

IntroductionCarotid arterial geometry is an independent risk factor for carotid stenosis, in which hemodynamics, classically low oscillatory shear stress, is thought to be involved. However, there are few reports indicating quantitative analyses of hemodynamic environments in carotid stenosis. Thus, we are conducting a prospective clinical study with computational fluid dynamic techniques, and 454 cases of carotid stenosis have been registered to date. Here, we focused on unilateral stenotic cases among them and compared hemodynamic distributions between stenotic and non‐stenotic sides. We also examined hemodynamic distributions of carotid arteries after releasing stenosis by carotid endarterectomy.MethodsHemodynamic distributions were examined using ANSYS‐CFX software. Patient‐specific arterial geometries and inflow velocities were obtained from 3‐dimensional computed tomographic angiography and carotid ultrasound Doppler examinations, respectively.ResultsIn both the stenotic area and the area proximal to the stenotic area, hemodynamic metrics indicating the magnitude of time‐averaged wall shear stress (TAWSS) were significantly higher compared with the non‐stenotic side (p=0.0027 and 0.0007, rspectively), whereas WSS disturbance‐based metrics, i.e. oscillating shear index (OSI, p=0.0006 and 0.0008) and normalized transverse WSS (NtransWSS, p&lt;0.0001 and p=0.0029), were rather lower. However, in the region distal to the stenotic area, OSI (p=0.0009) and NtransWSS (p=0.0021), but not TAWSS (p=0.4564), were significantly higher as compared with the same area of non‐stenotic side (Figure). WSS gradient on carotid bulb after carotid endarterectomy was significantly higher compared with controls (p=0.037), suggesting that the carotid arteries may primarily have geometric risks for stronger hemodynamic stress.ConclusionsThe results suggested that hemodynamic environments in carotid stenosis are more complex than previously thought. High WSS in the stenotic area and enhanced WSS disturbance downstream of the stenotic area may be associated with progression of stenosis and plaque rupture.Support or Funding InformationThis study is supported by the Grant‐in‐Aid for the Japanese National Hospital Organization Multi‐Center Clinical Research, AMED under Grant Number JP15gm0810006h0301, and JSPS KAKENHI Grant Number 15K10323.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

The TXA2R rs1131882, P2Y1 rs1371097 and GPIIIa rs2317676 three-loci interactions may increase the risk of carotid stenosis in patients with ischemic stroke

BackgroundThe genetic risk factors for carotid stenosis are not fully understood. The aim of this study is to investigate the relationship between variants in platelet activation-relevant genes and carotid stenosis in patients with ischemic stroke (IS).MethodsEleven variants of platelet activation-relevant genes, aggregates of platelet-leukocyte, and platelet aggregation were examined in 236 IS patients with carotid stenosis and 378 patients without carotid stenosis. High-resolution B-mode ultrasound was used to assess carotid stenosis. Generalized multifactor dimensionality reduction (GMDR) methods were applied in analyzing gene-gene interactions to determine whether there was any interactive role of assessed variants in affecting risk of carotid stenosis.ResultsPlatelet aggregation and aggregates of platelet-leukocyte showed higher value in patients with carotid stenosis, compared with patients without carotid stenosis. Excluding potential disturbance variables, these 11 variants were not associated with carotid stenosis. However, according to the GMDR analysis, gene-gene interactions among TXA2R rs1131882, P2Y1 rs1371097 and GPIIIa rs2317676 had a synergistic influence on carotid stenosis. The high-risk interactions between the three variants showed a relationship with higher platelet activation, and have independent associations with risk of carotid stenosis (OR = 2.72, 95% CI: 1.28–7.82, P = 0.001).ConclusionThe interactions among rs1131882, rs1371097 and rs2317676 perhaps increase the risk of symptomatic carotid stenosis, and maybe a potential marker for carotid stenosis. In this study, the combinatorial analysis made good use in elucidating complex risk factors in the heredity of carotid stenosis.

Prevalence of Carotid Stenosis and Incidence of Ischemic Stroke in Patients Undergoing Non-Coronary Cardiac Surgery.

IntroductionMany publications on coronary surgery and carotid stenosis (CS) can be found, but we do not have enough information about the relationship between ischemic stroke, CS and non-coronary cardiac surgery.ObjectivesTo evaluate the incidence and risk factors associated with the stroke and CS ≥50% in patients undergoing non-coronary surgeries.ObjectivesWe assessed 241 patients, aged 40 years or older, between 2009 and 2016, operated in Santa Casa de Misericórdia de Ponta Grossa-PR, Brazil. We perform carotid Doppler in patients 40 years of age or older before any cardiac surgery as a routine. The incidence and possible risk factors for CS ≥50% and perioperative stroke were analyzed by univariate statistical analysis.Results11 patients (4.56%) presented perioperative stroke. The risk factor for stroke was CS ≥50%: OR=5.3750 (1.2909-22.3805), P=0.0208. Eighteen patients (7.46%) had CS ≥50% and their risk factors were extracardiac arteriopathy: OR=18.6607 (6.3644-54.7143), P<0.0001; COPD: OR=3.9040 (1.4491-10.5179), P=0.0071; diabetes mellitus: OR=2.9844 (1.0453-8.5204), P=0.0411; recent myocardial infarction: OR=13.8125 (1.8239-104.6052), P=0.0110; EuroSCORE II higher P=0.0056. ConclusionThe incidences of stroke and CS ≥50% were 4.56% and 7.46%, respectively. The risk factor for stroke was CS ≥50% and for CS ≥50% were extracardiac arteriopathy, COPD, diabetes mellitus, recent myocardial infarction and higher EuroSCORE II.

Snoring and carotid artery disease: A new risk factor emerges.

Previous studies have identified a relationship between snoring, carotid intima media thickening, and the presence of atherosclerosis. This study examines the correlation between snoring and carotid artery disease through use of duplex ultrasound identifying greater than 50% internal carotid artery stenosis. Prospective cohort study. Patients presenting to three academic vascular laboratories for carotid duplex examination completed the following surveys: demographic information, assessment of risk factors for carotid stenosis, assessment of history of obstructive sleep apnea, or continuous positive airway pressure use and Snoring Outcomes Survey. Patients were categorized into 2 groups based on the presence or absence of carotid disease. Data were analyzed by univariate contingency tables and logistic regression analysis. Five hundred one patients completed the survey, of whom 243/501 (49%) had evidence of carotid occlusive disease. On univariate analysis, smoking, hypertension, heart disease, hypercholesterolemia, diabetes, and stroke all correlated with greater than 50% carotid stenosis. Multivariate analysis indicated that snorers were significantly more likely to have carotid disease. Three hundred twenty-seven participants were thought to have primary snoring. On univariate analysis, snorers were found to be significantly more likely to have carotid disease. After adjustment for covariates, snoring was not significant for carotid disease. However, multivariate analysis showed snorers to be significantly more likely to have bilateral carotid disease. This study shows a potential relationship between snoring and bilateral carotid artery stenosis greater than 50%; snorers have risk of carotid stenosis twice that of nonsnorers. Further investigation is warranted to better elucidate this relationship. 2b Laryngoscope, 129:265-268, 2019.

0503: Asymptomatic carotid stenosis in patient with acute coronary syndrome: who should be screened?

While prevalence and risk factors of carotid stenosis in acute coronary sydrome (ACS) are under investigated, we evaluated patients admitted in our intensive care unit for an ACS in order to define if a screening of this population would be relevant. Systematic carotid Doppler ultrasound screening was done on 102 consecutive patients admitted to the intensive care unit after an ACS with or without ST elevation. Degree of stenosis was determined using NASCET and hemodynamic critera. Clinical data and risk factors of atherosclerosis were collected for all patients. The Chi square test was used for categorical variables and ordinal variables were analyzed using Wilcoxon or Student’s tests. Fifty-two percent of patient (n=53) had at least one carotid stenosis. Mild stenosis (<50%) concerned 45 patients (44%) while 6 patients (6%) had moderate (50-69%) stenosis and 2 patients (2%) had severe (>70%) stenosis. As shown is the table, on univariate analysis, the only predictive factors of moderate and severe stenosis were age >75years (OR=11.8; p=0,016), diabetes mellitus (OR=3.9; p=0,05), history of myocardial infarction (OR=11.4; p=0,002) and left ventricular ejection fraction <40% (OR=6.6; p=0,007). Abstract 0503 – Table: Predictive factors of carotid stenosis >50% in patient with ACS OR IC 95% p Risk Factors Sexe (male) NA NA 0,32 Age >75 years 11,8 1,95-71,5 0,016 Current smoking 0,15 0,03-0,9 0,047 Diabetes mellitus 3,9 0,75-15,9 0,053 Hypertension 3,1 0,7-14,2 0,15 Hyperlipidemia 1,7 0,43-7,05 0,71 Cardiovascular history Peripheral artery disease 6,57 0,76-56,8 0,09 History of stroke or TIA 1,89 0,24-14,9 0,95 History of myocardial infarction 11,4 2,6-49,35 0,002 ACS initial presentation and coronary angiography results STEMI 0,3 0,06-1,28 0,22 Multi-vessel lesions 3,23 0,79-13,1 0,07 Left main artery stenosis 3,15 0,63-15,7 0,17 Left ventricular ejection fraction <40% 6,6 1,58-27,48 0,007 Carotid stenosis is frequent in this population but lesions are often mild and a systematic screening should probably not be recommended. Patients >75 years, diabetics or those with severe coronaropathy seem however to represent a sub-population at risk to have a stenosis ≥50% in which a screening could be proposed during the hospitalisation.

O-011 cervical carotid stenting: the effect of distal filtration on outcomes

Purpose We conducted a retrospective review of all the carotid stent interventions performed at our institution in order to investigate the success rate and clinical outcomes of the intervention and whether these were affected by including or omitting use of a distal filter. Material and methods Institutional IRB approval was obtained. A total 41 patients (19 M/22 F) underwent carotid stent placement at our institution between 2010 and 2013; five of the patients had bilateral stents for a total of 46 interventions. Data was collected from medical records and included patient demographics, medical history, procedural details, imaging findings and short term clinical outcomes. The association between use of a distal filter and the length of the procedure, the success rate and the immediate clinical outcome were investigated. Results The majority of the patients (76%) had two or more risk factors for carotid stenosis and 52% had one or more co-morbidity, such as cardiac disease, severe lung or renal disease. Indications included recent stroke in 6 patients (13%) and TIA in 14 patients (32%), with minor or no symptoms in 24 patients (52%). In 28 consecutive interventions (61%) a distal protections filter was used and in the next 18, the distal filter was omitted. The success rate for all the carotid stent interventions was 100%. Three patients had minor infarcts in the immediate post-operative period documented by MRI and two patients had major infarcts. One patient died secondary to a large reperfusion intracranial hemorrhage. The two major infarcts and two of the minor infarct were in cases that used the distal filter. One minor infarct was the only complication in the group without the distal filter. The length of procedure was longer in the distal filter group (mean difference of 18 min), approaching statistical significance (p = 0.06). In four of the cases, there was significant difficulty in retrieving the distal filter, causing increased procedure length and total fluoroscopy time. Discussion/conclusion The use of distal filter posed potential intra-procedural risks such as difficulty to retrieve, contributing to increased procedure time and cost whereas it had no negative impact on the immediate clinical outcome. We hope that this study will provide important quality control information of whether eliminating the use of distal filter is a cost-effective and safe alternative in carotid stent interventions. Disclosures A. Achiriloaie: None. J. Jacobson: None. U. Oyoyo: None. R. Strilaeff: None.

OC-0415: Incidence and risk factors of carotid stenosis after head and neck radiotherapy

OC-0415: Incidence and risk factors of carotid stenosis after head and neck radiotherapy

Duplex Study of Carotid Artery in Patients with Ischemic Stroke

Objective: To determine the frequency and characteristics of carotid artery stenosis in acute ischemic stroke patients and to assess the significance of common risk factors for carotid stenosis in these patients. Method: It was cross-sectional observational study which was carried out in neurology department of Bangabandhu Sheikh Mujib Medical University (BSMMU) during the period of January 2010 to December 2011 and one hundred patients admitted with acute ischemic stroke were included in the study. Doppler ultrasound was performed during hospitalization to find out carotid artery stenosis. Statistics analysis was done with SPSS - 14. Results: Out of one hundred (100) patients, eighty (80%) were males and twenty were (20%) were females. The patients were dividing into two groups with and without carotid stenosis. Less than 50% carotid artery stenosis (insignificant stenosis) was seen in 40% ( n=40) cases and significant stenosis was seen in 60% (n=60) patients. Overall 86% (n= 46) out of 60 patients were found to have carotid artery stenosis on the ipsilateral side corresponding to the ischemic lesion and 19% (n=11) had stenosis on the contralateral side. Out of significant stenosis ,mild (50% stenosis) in 12% (n=7) patients, moderate ( 51-69% ) stenosis in 50%( n= 30 ) patients and severe (&gt;70%) stenosis in twenty (n=33%) patients . Near total occlusion was seen in three (5%) patients. The presence of stenosis was significantly correlated with older age and the presence of multiple risk factors. Conclusion: Carotid artery stenosis is strongly associated with ischemic stroke. Doppler studies are recommended for the high risk patients for the primary as well as secondary prevention of ischemic stroke.DOI: http://dx.doi.org/10.3329/bjn.v28i2.17172 Bangladesh Journal of Neuroscience 2012; Vol. 28 (2): 67-73

Duplex Study of Carotid Artery in Patients With Ischemic Stroke

Brief Description of the Purpose of the StudyTo determine the frequency and characteristics of carotid artery stenosis in acute ischemic stroke patients and to assess the significance of common risk factors for carotid stenosis in these patientsMethodsIt was cross-section observational study in one hundred hospital admitted patients with acute ischemic stroke . Doppler ultrasound was performed during the hospitalization to find out the degree of carotid artery stenosis.Main ResultsOut of one hundred (100) patients, eighty (80%) were males and twenty were (20%) were females. The patients were dividing into two groups with and without carotid stenosis. Less than 50% carotid artery stenosis (insignificant stenosis) was seen in 40% (n=40) cases and significant stenosis was seen in 60% (n=60) patients. Overall 86% (n= 46) out of 60 patients were found have carotid artery stenosis on the ipsilateral side corresponding to the ischemic lesion. And 19% (n=11) had stenosis on the contra lateral side as well. Degree of stenosis was mild (50% stenosis) in 12% (n=7) patients, moderate (51-69%) stenosis in 50% (n= 30) patients and severe (>70%) stenosis in twenty (n=33%) patients . Near total occlusion was seen in three (5%) patients. The presence of stenosis was significantly correlated with older age and the presence of multiple risk factorsImportance of the ConclusionsDoppler studies are recommended for the high risk patients for the primary as well as secondary prevention of ischemic stroke Brief Description of the Purpose of the StudyTo determine the frequency and characteristics of carotid artery stenosis in acute ischemic stroke patients and to assess the significance of common risk factors for carotid stenosis in these patients To determine the frequency and characteristics of carotid artery stenosis in acute ischemic stroke patients and to assess the significance of common risk factors for carotid stenosis in these patients MethodsIt was cross-section observational study in one hundred hospital admitted patients with acute ischemic stroke . Doppler ultrasound was performed during the hospitalization to find out the degree of carotid artery stenosis. It was cross-section observational study in one hundred hospital admitted patients with acute ischemic stroke . Doppler ultrasound was performed during the hospitalization to find out the degree of carotid artery stenosis. Main ResultsOut of one hundred (100) patients, eighty (80%) were males and twenty were (20%) were females. The patients were dividing into two groups with and without carotid stenosis. Less than 50% carotid artery stenosis (insignificant stenosis) was seen in 40% (n=40) cases and significant stenosis was seen in 60% (n=60) patients. Overall 86% (n= 46) out of 60 patients were found have carotid artery stenosis on the ipsilateral side corresponding to the ischemic lesion. And 19% (n=11) had stenosis on the contra lateral side as well. Degree of stenosis was mild (50% stenosis) in 12% (n=7) patients, moderate (51-69%) stenosis in 50% (n= 30) patients and severe (>70%) stenosis in twenty (n=33%) patients . Near total occlusion was seen in three (5%) patients. The presence of stenosis was significantly correlated with older age and the presence of multiple risk factors Out of one hundred (100) patients, eighty (80%) were males and twenty were (20%) were females. The patients were dividing into two groups with and without carotid stenosis. Less than 50% carotid artery stenosis (insignificant stenosis) was seen in 40% (n=40) cases and significant stenosis was seen in 60% (n=60) patients. Overall 86% (n= 46) out of 60 patients were found have carotid artery stenosis on the ipsilateral side corresponding to the ischemic lesion. And 19% (n=11) had stenosis on the contra lateral side as well. Degree of stenosis was mild (50% stenosis) in 12% (n=7) patients, moderate (51-69%) stenosis in 50% (n= 30) patients and severe (>70%) stenosis in twenty (n=33%) patients . Near total occlusion was seen in three (5%) patients. The presence of stenosis was significantly correlated with older age and the presence of multiple risk factors Importance of the ConclusionsDoppler studies are recommended for the high risk patients for the primary as well as secondary prevention of ischemic stroke Doppler studies are recommended for the high risk patients for the primary as well as secondary prevention of ischemic stroke

Snoring and Severity of Symptomatic and Asymptomatic Carotid Stenosis: A Population-Based Study

Obstructive sleep apnea has increasingly been linked to cardiovascular damage. More recently, the snoring component itself has been independently linked to the presence of carotid atheroma, via local arterial trauma. We aimed to identify whether a snoring history is a risk factor for carotid stenosis in individuals presenting with a TIA or ischemic stroke. Participants in the Oxford Vascular Study (OXVASC) were asked about their snoring history as part of an entry questionnaire. In 561 individuals with a recent TIA or stroke, who had both a complete snoring questionnaire and carotid imaging, the relationship between presence and severity of snoring and the degree of carotid artery stenosis in both the symptomatic (culprit) and asymptomatic (non-culprit) sides. Of 561 participants (287 male, mean/SD age = 73.3/11.0 years), 90 (16.0%) had ≥ 50% carotid stenosis, and 154 (27.5%) snored frequently (≥ 1-2 times/week). No significant associations were identified between frequency of self-reported snoring, and the degree of culprit and non-culprit carotid vessel stenosis, or plaque morphology. No significant association could be identified between a history of frequent snoring and the presence of carotid atheroma, degree of stenosis, or plaque type.

Current Treatments for Carotid Artery Disease

Carotid artery disease&nbsp;is one of the main causes of stroke, apart&nbsp;from&nbsp;other&nbsp;cardiac&nbsp;causes&nbsp;or&nbsp;disease&nbsp;of&nbsp;the&nbsp;brain&nbsp;itself. About 80% of all strokes are ischemic and&nbsp;approximately&nbsp;25-50% of these are caused by an unstable carotid artery plaque.1&nbsp;The risk factors for carotid stenosis are similar to those for athero- sclerosis and include hypertension, diabetes, cigarette smoking and dyslipidemia. Prevention of stroke caused by carotid bifurcation stenosis can be achieved by accurate identification and evaluation of patients at risk. Pathophysiology of carotid atherosclerosis is similar to that in other vascular beds. However, atherosclerosis in the carotid artery is usually unifocal, and 90% of lesions are located within 2 cm. of the internal carotid artery (ICA) origin. Extracranial internal carotid artery stenosis accounts for 15 to 20% of ischemic strokes, depending on the population studied. The degree of carotid stenosis is associated with the degree of stroke risk. Carotid ath- erosclerosis can produce retinal and cerebral symptoms by way of 1 of 2 major mechanisms. progressive carotid stenosis leading to insitu occlusion and hypoperfusion (less common), or intracranial arterial occlusion resulting from embolization (more common). Embolism from unstable plaque is the major mechanism of stroke in carotid atherosclerosis.2,3&nbsp;Stroke is more likely to be due to embolism rather than hypoperfusion even in patients with &gt;70% carotid stenosis, and the risk of stroke may be lower in patients with &gt;90% stenosis, due to post-stenotic narrowing in the distal ICA, which reduces flow and risk of embolism. Patients present- ing with carotid distribution cerebral ischemia should be thoroughly evaluated for treatable causes, including sources of emboli from the carotid arteries, heart, and aortic arch. Patients with or without carotid stenosis may also develop symptomatic cerebral hypoperfusion from systemic causes.

Risk Factors for Carotid Stenosis in Thai Patients With Ischemic Stroke/TIA

We looked for risk factors for significant carotid stenosis (CS) in patients with ischemic stroke. We included all patients treated for an ischemic stroke/transient ischemic attack (TIA) and had a carotid duplex done from August 2006 to November 2008. A total of 458 patients were included. Significant CS of the extracranial internal carotid artery and the common carotid artery were found in 10.9% (50 of 458 patients). Age (≥65 years old) was the independent risk factor for CS (OR 4.0, P < .0001). The patients with a CS had more history of coronary artery disease (12% vs 8%, P = .32), prior ischemic stroke (18% vs 11%, P = .17), atrial fibrillation (10% vs 5%, P = .19), and smoking (28% vs 24%, P = .18) compared with the patients without CS. The evaluation of the carotid arteries should be recommended in patients with ischemic stroke/TIA, especially in the older ones (≥65 years old).

A Novel Zip2 Gln/Arg/Leu Codon 2 Polymorphism Is Associated with Carotid Artery Disease in Aging

Zinc deficiency represents a risk factor for carotid stenosis (CS) development. In mammals, members of the ZIP family regulate zinc uptake, and hZip2 is a human zinc importer upregulated by zinc depletion. The purpose of this study was to investigate the association of a novel Zip2 Gln/Arg/Leu codon 2 polymorphism with CS, analyzing 250 CS patients and 259 elderly controls. CS patients showed an increased GG genotype frequency (60% vs. 47.5%), and a reduced TT frequency (6% vs. 10%) (p < 0.05 by chi(2) test). In conclusion, Zip2 Gln/Arg/Leu polymorphism plays a role in the susceptibility to carotid artery disease.