Risk Factors For Carotid Disease Research Articles

Treatment of Symptomatic Carotid Webs: A Single-Center Review

IntroductionCarotid webs are abnormal thin shelf-like or flap-like tissue in the carotid bulb (proximal internal carotid artery). Rarely are carotid webs detected prior to symptoms since routine carotid artery surveillance is not performed in younger individuals without traditional risk factors for carotid disease. The cause and natural history remain unknown. In general, they are not common, but should be considered in the differential diagnosis of a patient who presents with ischemic neurologic symptoms. The web can create a flow disturbance, potentiating local thrombus formation, which can embolize producing resulting in cerebral ischemia. Current treatment is to reduce thrombus formation (antithrombotics and/or anticoagulation) or to alter the flow disturbance caused by the web (surgical removal or stent). MethodsWe retrospectively identified all patients presenting with acute ischemic stroke to our Comprehensive Stroke Center that were diagnosed with carotid web from January 2020 to December 2023. Patient demographics, presentation, hospital course including treatment and complications were collected and reported. ResultsFifteen patients presented with carotid web and stroke from 2020-2023 and 13 underwent carotid artery stenting or endarterectomy with no periprocedural complications. Most (40%) carotid webs were not primarily identified by the initial radiology interpretation. DiscussionWe discuss our experience of carotid web and its management as well as review of the current literature.

Carotid artery stenosis in asymptomatic patients who have received unilateral head-and-neck irradiation

To determine the prevalence of carotid artery stenosis in patients who have received ipsilateral head-and-neck radiotherapy and have no symptoms of cerebrovascular disease. Forty patients underwent ultrasound and computed tomography angiography of their carotid arteries. The vessels on the irradiated side were compared with those on the unirradiated side in a matched-pair analysis with regard to any stenosis, stenosis > or =60% in the internal carotid artery/carotid bulb, intima medial thickness (IMT), and grade of wall abnormalities. History, physical, and fasting blood levels were taken to detect risk factors for carotid disease. Fourteen irradiated carotid trees bore one or more stenosis vs. five in the unirradiated ones (p = 0.03). There were six bulb/internal carotid artery stenoses > or =60% in the irradiated carotids vs. one in the unirradiated (OR 6:1, p = 0.13). IMT and grade of vessel wall abnormality were higher in the irradiated carotids, but only at doses > or =50 Gy, and only at measurement points that lay within the radiation portals. Radiation appears to cause carotid artery stenosis. There may be a dose threshold for carotid wall changes, which has relevance for radiotherapy in several tumor sites.

Remnant lipoprotein and lipoprotein (a) as risk factors for stroke and carotid disease

Remnant lipoprotein (RLP) and lipoprotein (Lp) (a) are known to promote atherosclerosis and thrombosis. We studied whether these lipoproteins can be risk factors for stroke and carotid disease in 170 consecutive subjects (87 males and 83 females, mean age of 70 years). RLP was significantly higher in patients with ( N=45) than without ( N=125) ischemic stroke (Mann–Whitney's U-test, p=0.01), while there was no difference in Lp (a) between patients with and without it ( p=0.83). In contrast, there was a significant difference in Lp (a) ( p=0.003) but not in RLP ( p=0.26) between patients with ( N=76) and without ( N=94) maximum intima-media thickness (IMT) of 2.0 mm or more at carotid bifurcations. Logistic regression analysis showed that RLP is an independent risk factor for ischemic stroke [7.5 mg/dl or more, relative risk (RR) 2.84, 95% confidence interval (CI) 1.26–6.40]. Multivariate regression analysis showed that Lp (a) ( p=0.032) but not RLP ( p=0.518) is significantly correlated with IMT. The results indicate that RLP but not Lp (a) is an independent risk factor for ischemic stroke, while Lp (a) but not RLP is an independent risk factor for carotid disease in our Japanese subjects.

Consensus against both endarterectomy and routine screening for asymptomatic carotid artery stenosis. Canadian Stroke Consortium.

Despite several randomized controlled trials, the role of carotid endarterectomy for asymptomatic patients is controversial. Validated evidence-based guidelines are needed. Thirty-five members of the Canadian Stroke Consortium, an independent body of cerebrovascular disease experts, reviewed evidence-based guidelines developed by the Canadian Task Force on the Periodic Health Examination. We held 3 rounds of Delphi consensus to solicit opinion and agreement. We found a high level of interrater agreement for all guidelines using multiple statistical measures. Members agreed that evidence is insufficient to endorse carotid endarterectomy for asymptomatic patients with angiographically proven stenosis of more than 60% (kappa = 0.70, P < .01). Reasons cited included concern over the reproducibility of low surgical morbidity rates in the community at large, the questionable clinical benefit conferred by surgery, and the lack of proven reduction in the risk of major disabling stroke. Screening the general population for asymptomatic stenosis was unanimously rejected. Also, screening even patients with risk factors or proven atherosclerosis at other sites was not endorsed (kappa = 0.91 and kappa = 0.79, respectively, both P < .01). There is insufficient evidence to recommend carotid endarterectomy for asymptomatic patients. Evidence is also insufficient to endorse a screening strategy even for patients with risk factors for carotid disease. While stroke prevention remains a critical goal, we do not recommend that it be accomplished by screening or by performing carotid surgery in asymptomatic patients.