Risk Of Carotid Artery Stenosis Research Articles

Radiation Dose-Induced Carotid Artery Stenosis and Brain Necrosis in Head and Neck Cancer-A Real World Cohort Study.

Objective: This study aims to examine whether radiation therapy doses are related to incidences of carotid artery stenosis and brain necrosis in a large-scale real-world database. Methods: We identified a cohort of HNC patients from the catastrophic illness patient dataset using ICD-9 or ICD-10 to compare the incidence and risks of carotid artery stenosis (CAS) and brain necrosis (RIBN) in patients who received a radiation therapy dose of ≥5400 cGy/30 fractions (group A) with those who received a radiation therapy dose of <5400 cGy/30 fractions (group B). The incidence and hazard ratios were quantified using Cox proportional hazards models. Results: A total of 19,964 patients were identified in group A and group B. Among them, 965 and 863 cases of CAS and 435 and 359 cases of RIBN were identified in group A and group B, respectively. There was no statistically significant association between the two groups for CAS risk, whereas there was a statistically significant association between the two groups for RIBN risk. The most common primary site of head and neck cancers was the nasopharynx (1144 of 19,964, 5.73%). Conclusions: Our study suggests that RT may increase the risk of carotid stenosis and brain necrosis in patients with NPC. To ensure patient safety during treatment, the optimal balance between tumor control and toxicity prevention in individual patients through minimization of the radiation dose to all relevant OARs must be properly understood.

Quantifying ocular microcirculation in hypertension patients with carotid artery stenosis.

Carotid artery stenosis (CAS) is one of the most common macrovascular complications of hypertension. The ophthalmic artery springs from the internal carotid artery; however, the effect of CAS on ocular microcirculation has not been quantified in hypertension patients. This study aimed to quantify ocular microcirculation metrics in hypertension with CAS (HCAS) patients and to explore the relationship between micro- and macroangiopathy in hypertension. All participants (community-based) underwent detailed assessments, including carotid ultrasonography, optical coherence tomography angiography (OCTA), and enhanced depth imaging (EDI)-OCT. CAS was diagnosed using carotid ultrasonography. Retinal microcirculation metrics, including vessel density (VD), skeleton density (SD), fractal dimension (FD), and foveal avascular zone (FAZ), were quantified using OCTA and ImageJ software. Choroidal microcirculation metrics, including subfoveal choroidal thickness (SFCT), luminal area (LA), and choroidal vascularity index (CVI), were quantified using EDI-OCT and ImageJ. Retinal vessel caliber metrics, including central retinal artery equivalent (CRAE), central retinal vein equivalent (CRVE), and artery/vein ratio (AVR), were calculated using revised formulas. The above metrics were compared among the HCAS group, hypertension with no CAS (HNCAS) group, and healthy control group. The mutual effects between ocular metrics and CAS were evaluated using regression analyses. In a comparison of the HCAS vs. HNCAS groups, retinal metrics including VD, SD, FD, and choroidal metrics including CVI and LA were significantly decreased in the HCAS group (all p < 0.05); however, FAZ, SFCT, and retinal vessel caliber metrics including CRAE, CRVE, and AVR were comparable between groups (all p > 0.05). In a comparison of HNCAS and the healthy control group, VD, SD, and CRAE showed that AVR was significantly decreased in the HNCAS group (all p < 0.05); meanwhile, choroidal metrics were comparable between groups (all p > 0.05). Linear regression analyses showed that intima-media thickness (IMT) (p = 0.01) and peak systolic velocity (PSV) (p = 0.002) were negatively related to retinal VD in hypertension patients. Logistic regression analyses disclosed that older age (p < 0.001), smoking history (p = 0.002), lower VD (p = 0.04), SD (p = 0.02), and CVI (p < 0.001) were related to the presence of CAS in hypertension patients. CAS in hypertension-induced hypoperfusion in retinal and choroidal microcirculation and the decreased retinal VD and choroidal CVI were significantly associated with the presence of CAS in patients with hypertension, suggesting that hypertension macro- and microangiopathy were mutually affected and share the common pathophysiology. Furthermore, OCT could be a useful tool to assess hypertension patient's CAS risk profiles in a non-invasive way.

Long-term risk of carotid stenosis and cerebrovascular disease after radiation therapy for head and neck cancer.

Recipients of radiation therapy (RT) for head and neck cancer (HNC) are at significantly increased risk for carotid artery stenosis (CAS) and cerebrovascular disease (CVD). We sought to determine (1) cumulative incidences of CAS and CVD among HNC survivors after RT and (2) whether CAS is associated with a RT dose response effect. This single-institution retrospective cohort study examined patients with nonmetastatic HNC who completed (chemo)RT from January 2000 through October 2020 and subsequently received carotid imaging surveillance ≤2years following RT completion and, in the absence of CAS, every 3 years thereafter. Exclusion criteria included history of known CAS/CVD. Asymptomatic CAS was defined as ≥50% reduction of luminal diameter, symptomatic CAS as stroke ortransient ischemic attack, and composite CAS as asymptomatic or symptomaticCAS. Of 628 patients undergoing curative intent RT for HNC, median follow-up was 4.8years (interquartile range, 2.6-8.3), with 97 patients followed ≥10years. Median age was 61years and 69% of patients received concurrent chemotherapy and 28% were treated postoperatively. Actuarial 10-year incidences of asymptomatic, symptomatic, and composite CAS were 29.6% (95% CI, 23.9-35.5), 10.1% (95% CI, 7.0-13.9), and 27.2% (95% CI, 22.5-32.1), respectively. Multivariable Cox models significant association between asymptomatic CAS and absolute carotid artery volume receiving ≥10 Gy (per mL: hazard ratio, 1.09; 95% CI, 1.02-1.16). HNC survivors are at high risk for post-RT CAS. A dose response effect was observed for asymptomatic CAS at doses as low as 10Gy. Recipients of radiation therapy for head and neck cancer are at significantly increased risk for carotid artery stenosis and cerebrovascular disease. However, carotid artery screening is not routinely performed among head and neck survivors following radiation therapy. In this single-institution retrospective cohort study, patients with head and neck cancer were initially screened for carotid artery stenosis ≤2years following radiation therapy completion, then every 3 years thereafter. The 10-year actuarial incidence of carotid artery stenosis was >25% and stroke/transient ischemic attack >10%. Multivariable analysis demonstrated significant associations between asymptomatic carotid artery stenosis and artery volumes receiving ≥10Gy.

MP05-17 RISKS OF CAROTID ARTERY STENOSIS AND ATHEROSCLEROTIC CARDIOVASCULAR DISEASE IN PATIENTS WITH CALCIUM KIDNEY STONE: ASSESSMENT OF SYSTEMIC INFLAMMATORY BIOMARKERS

You have accessJournal of UrologyCME1 Apr 2023MP05-17 RISKS OF CAROTID ARTERY STENOSIS AND ATHEROSCLEROTIC CARDIOVASCULAR DISEASE IN PATIENTS WITH CALCIUM KIDNEY STONE: ASSESSMENT OF SYSTEMIC INFLAMMATORY BIOMARKERS Chang Te Wang, Chan Jung Liu, Hau Chern Jan, and Ho Shiang Huang Chang Te WangChang Te Wang More articles by this author , Chan Jung LiuChan Jung Liu More articles by this author , Hau Chern JanHau Chern Jan More articles by this author , and Ho Shiang HuangHo Shiang Huang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003216.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To assess the clinical significance of preoperative inflammatory biomarkers combined with atherosclerotic cardiovascular disease (ASCVD) risk score to evaluate carotid artery stenosis in patients with calcium kidney stones. METHODS: We conducted a prospective observational case-control study, enrolling seventy four patients with calcium kidney stones and sixty six age- and sex-matched healthy controls. We calculated the inflammatory biomarkers including the neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), and systemic inflammation response index (SIRI). Ultrasound of the carotid arteries was performed on all participants to identify the severity of the stenosis. RESULTS: All inflammatory biomarkers and the severity of carotid artery stenosis were higher in the calcium kidney stone group than in controls. After stratification of ASCVD, inflammatory biomarkers and carotid artery stenosis severity were still significantly higher in the calcium kidney stone group. Multivariate analyses showed that calcium kidney stones significantly increased the risk of ASCVD and carotid artery stenosis. In multivariate linear logistic regression analyses, calcium kidney stone and ASCVD score had a significant association with carotid artery occlusion, but SIRI did not. CONCLUSIONS: Calcium kidney stone is associated with higher levels of inflammatory biomarkers and carotid artery stenosis. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e50 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Chang Te Wang More articles by this author Chan Jung Liu More articles by this author Hau Chern Jan More articles by this author Ho Shiang Huang More articles by this author Expand All Advertisement PDF downloadLoading ...

Long-Term Risk of Carotid Stenosis and Cerebrovascular Disease after Radiation Therapy for Head and Neck Cancer

<h3>Purpose/Objective(s)</h3> The incidence of asymptomatic carotid artery stenosis (CAS) in the general population is ∼5%. CAS is a known toxicity of radiation therapy (RT) for head and neck cancer (HNC). CAS screening is not routinely performed after RT despite the increased risk of cerebrovascular disease (CVD) in this population. Here we report long-term incidence and associated risk factors for CAS and CVD after RT for HNC. <h3>Materials/Methods</h3> Records were retrospectively identified for all patients undergoing carotid ultrasound (U/S) screening following RT for HNC at a single institution between November 2000 and October 2020. Exclusion criteria included CAS or CVD prior to RT. Carotid U/S screening was obtained within 24 months of RT completion, then every three years in the absence of CAS or annually following CAS diagnosis. Asymptomatic CAS was defined as radiographic luminal narrowing ≥50%; CVD was defined as stroke or transient ischemic attack, and composite CAS was defined as asymptomatic CAS and/or CVD. Cumulative incidence estimates (CIE) of asymptomatic CAS, CVD, and composite CAS were estimated. Univariate and multivariable (MVA) Cox proportional hazards regression was used to study potential associations between clinical parameters and the CVD and composite CAS outcomes. <h3>Results</h3> Among 628 patients, median follow-up was 4.8 years (IQR 2.6 - 8.3 yr) with 97 patients followed beyond 10 yr. Median age was 61 yo. 56% of patients had a history of smoking. 61% had an oropharyngeal primary tumor (64% p16+). Squamous cell carcinoma was the most common histology (94%). 57% patients completed 70 Gy over 35 fractions, 69% received concurrent chemotherapy, and 28% were treated post-operatively. Asymptomatic CAS was identified in 111 (18%) with 50 (45%) prescribed CAS-related medication and 24 (22%) undergoing carotid endarterectomy or stenting. 5, 10, and 12-year CIE for asymptomatic CAS were 19.8%, 37.1%, and 50.2%, respectively. MVA showed that a history of peripheral arterial disease ([PAD]; HR 4.5, 95% CI 1.7 - 11.8) and myocardial infarction ([MI]; HR 3.3; 95% CI 1.1 - 9.8) were predictive of time to asymptomatic CAS. CVD events were observed in 45 (7.2%) patients, of whom 27 (60%) were found to have asymptomatic CAS. 5, 10, and 12-year CIE for CVD were 5.4%, 12.4%, and 21.7%, respectively. On MVA, male sex (HR 3.3, 95% CI 1.1 - 10) and type 2 diabetes mellitus ([DM2]; HR 2.3, 95% CI 1.2 - 4.6) were significantly associated with CVD. 5, 10, and 12-year CIE for composite CAS were 17.5%, 32.3%, and 43.6%, respectively. On MVA, male sex (HR 2.0, 95% CI 1.1 – 3.3), PAD (HR 3.1, 95% CI 1.2 - 7.8), and MI (HR 2.5, 95% CI 1.1 - 5.9) were significantly associated with composite CAS. <h3>Conclusion</h3> Long-term follow up shows a steady increase in the risk of asymptomatic CAS and CVD following RT for HNC. It is independently associated with sex, PAD, MI, and DM2. Ongoing analyses include dosimetric analysis of CAS and CVD per carotid artery and cost-effectiveness of carotid ultrasound screening.

Risks of Carotid Artery Stenosis and Atherosclerotic Cardiovascular Disease in Patients with Calcium Kidney Stone: Assessment of Systemic Inflammatory Biomarkers.

(1) Background: To assess the clinical significance of preoperative inflammatory biomarkers combined with atherosclerotic cardiovascular disease (ASCVD) risk score to evaluate carotid artery stenosis in patients with calcium kidney stones; (2) Methods: We conducted a prospective observational case-control study, enrolling 74 patients with calcium kidney stones and 66 age- and sex-matched healthy controls. We calculated the inflammatory biomarkers including the neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), and systemic inflammation response index (SIRI). An ultrasound of the carotid arteries was performed on all participants to identify the severity of the stenosis; (3) Results: All inflammatory biomarkers and the severity of carotid artery stenosis were higher in the calcium kidney stone group than in controls. After stratification of ASCVD, inflammatory biomarkers and carotid artery stenosis severity were still significantly higher in the calcium kidney stone group. Multivariate analyses showed that calcium kidney stones significantly increased the risk of ASCVD and carotid artery stenosis. In multivariate linear logistic regression analyses, calcium kidney stone and ASCVD score had a significant association with carotid artery occlusion, but SIRI did not; (4) Conclusions: Calcium kidney stone is associated with higher levels of inflammatory biomarkers and carotid artery stenosis. Calcium kidney stone is associated with higher levels of inflammatory biomarkers and carotid artery stenosis.

In-Stent Restenosis after Carotid Stenting

Carotid artery stenosis is a major risk factor for ischemic stroke. Currently, carotid endarterectomy (CEA) is the surgical treatment of choice for carotid artery stenosis. Carotid artery stenting (CAS) increases the risk of carotid artery stenosis. CAS is one of the treatment options available, particularly for high-risk CEA patients. Although CAS has the advantages of being less invasive, causing less patient discomfort, and requiring a shorter hospital stay, some patients may develop in-stent restenosis (ISR). ISR is closely related to clinical events such as transient ischemic attacks and ischemic stroke recurrence. The author examines the mechanism, influencing factors, and research progress of ISR following CAS, as well as its prevention and treatment, in order to provide clinical insights for clinicians.

Long non-coding RNA RMST serves as a diagnostic biomarker in patients with carotid artery stenosis and predicts the occurrence of cerebral ischemic event: A retrospective study.

The purpose of this retrospective study is to explore the diagnostic and prognostic roles of serum RMST in carotid artery stenosis (CAS). Serum levels of RMST were detected in CAS patients, and the relationship between degree of carotid stenosis and RMST levels was analyzed. The ROC curve was drawn to evaluate RMST value in predicting the risk of CAS. Then, all CAS patients received a 5-year follow-up. K-M curve was used to analyze the significance of RMST on prognosis of CAS patients. Multi-factor cox logistic regression analysis was conducted to evaluate independent factors for outcome of CAS patients. An increased RMST expression was certified in CAS patients when compared with healthy controls. The increase of serum RMST expression was related to high degree of carotid stenosis. In addition, serum RMST was a possible diagnosis and an independent influencing factor of prognosis in patients with CAS. Raised serum RMST level was found in patients with CAS. Detecting RMST expression levels was of high value for predicting the occurrence and outcomes in CAS.

Abstract 123: Carotid Artery Stenosis In Underrepresented Populations Defined By Factors Other Than Race/ethnicity: Results From All Of Us

Background: While existing evidence points to differences in the prevalence of Carotid Artery Stenosis (CAS) across race/ethnic groups, these differences have not been fully studied in underrepresented populations defined by other factors. We leveraged the recently introduced NIH All of Us Research Program to test the hypothesis that CAS disproportionally affects underrepresented groups defined by factors other than race/ethnicity. Methods: We evaluated data from the All of Us Research Program. We conducted a cross-sectional analysis including study participants with available data from both baseline questionnaires and electronic health records. We ascertained CAS using validated ICD-9/10 codes and corresponding Observational Medical Outcomes Partnership codes. Following the conceptual framework provided by All of Us, we considered underrepresented groups defined not only by race/ethnicity but also by gender identity/sexual orientation, education and income. We fitted multivariable logistic regression models adjusting for vascular risk factors. Results: We included 203,813 study participants in the analysis (mean age 51.5 (SD 16.7), 124,735 (61%) were female). The prevalence of CAS in the overall cohort was 2.7% (n=5,420). For underrepresented groups defined by factors other than race/ethnicity, income &lt;$35K USD (OR 1.16; 1.08-1.25; p&lt;0.001) was associated with higher odds of CAS whereas having less than high school degree (OR 0.87; 0.75-1.00; p=0.05) was associated with lower odds of CAS in multivariable analyses. No significant differences were seen for sexual/gender minorities (p=0.95). For underrepresented groups defined by race/ethnicity, Black (OR 0.87; 95%CI 0.78-0.96; p=0.005) and Hispanic participants (OR 0.83; 95%CI 0.73-0.94; p=0.003) had lower odds of CAS. Conclusions: Among participants enrolled in the All of Us Research Program, lower income was associated with higher risk of CAS whereas Hispanic and Black race/ethnicity were associated with lower risk of CAS. These results underscore the importance of evaluating underrepresented groups beyond those defined by race/ethnicity and highlight the potential of the NIH All of Us Research Program to accelerate health disparities research on this topic.

Связь ультразвуковых маркеров жировой ткани со стенозом сонных артерий

The aim of the research. To evaluate the features of ultrasound markers of adipose tissue in individuals with coronary artery disease, to identify a relationship with the presence of carotid artery stenosis. Material and methods. Th e study included 125 coronary artery disease patients hospitalised in the emergency cardiology department (41.6% females, 58.4 % males). The mean age of the surveyed was 68 (61.0; 74.0) years. Results. According to the results of the study, it has been found that the risk of carotid artery stenosis is associated with increasing age and IAFT thickness (OR=1.02, 95 % CI: 1.0-1.04, p=0.035). Th e traditional obesity index (BMI) showed no statistically significant associations (OR=0.73, 95 % CI: 0.25-2.09, p=0.548). Apart from that, in individuals with normal body weight and carotid stenosis, IAFT values were higher compared to the group with normal body weight without stenosis (p=0.029). It has also been determined that the value of ultrasonic parameters of adipose tissue has age and gender diff erences. Thus, women have 1.5 times higher SATmin than men, while men have 1.4 times higher WFA as compared to women. With increasing age, a decrease in the thickness of the IAFT and PFT was observed. Conclusion. The data obtained dictate the need for further study of ultrasonic markers of adipose tissue in different gender, age and nosological groups in order to identify the most sensitive parameters.

Vascular events from carotid artery atherosclerosis after radiation therapy for laryngeal and hypopharyngeal cancer: the incidence and risk factors.

ABSTRACTIn this retrospective cohort study, we evaluated the incidence of vascular events from carotid artery atherosclerosis after radiotherapy indication for laryngeal and hypopharyngeal cancer. From January 2007 to December 2016, we investigated 111 laryngeal/hypopharyngeal cancer patients who underwent curative radiotherapy and were followed up for ≥1 year (median follow-up duration, 60 months). We evaluated the incidence of vascular events from carotid artery atherosclerosis, defined as a transient ischemic attack or an atherothrombotic cerebral infarction, or from undergoing treatment such as carotid artery stenting for carotid artery stenosis. The median radiation dose was 66 Gy (range, 60–74); 48 patients (43.2%) received concurrent chemotherapy. The 5-year overall survival was 86.2%. Six patients required treatment for carotid artery disease. Carotid stenting was performed in three patients with carotid artery stenosis; three patients developed atherosclerotic cerebral infarction and received medical treatment, with a median of 51.7 months (range, 0.3–78.3) after radiotherapy initiation. The vascular event occurrence rate was 5.4% within 5 years and 10.7% within 8 years. In the univariate analysis, dyslipidemia, diabetes mellitus, and carotid calcification were significant factors for event occurrence. Because three out of six cases occurred out of the irradiated field, no carotid artery or carotid bulb dosimetric parameters showed significant correlation. As laryngeal/hypopharyngeal cancer patients, particularly with complications including dyslipidemia and diabetes mellitus, are at a high risk of carotid artery stenosis after radiotherapy, long-term carotid artery evaluation is necessary. Early intervention by stroke specialists can reduce the risk of fatal cerebral infarction.

Contemporary Prevalence and risk factors of carotid artery stenosis in asymptomatic low-income Chinese individuals: a population-based study

ABSTRACT Objectives Carotid artery stenosis (CAS) is an established risk factor for cerebrovascular disease. However, the contemporary prevalence and risk factors of CAS in asymptomatic rural Chinese individuals, especially low-income populations, remains unclear. Therefore, we aimed to explore the present prevalence and risk factors of CAS in a low-income Chinese population. Methods A total of 3126 people aged ≥ 45 years without history of stroke or cardiovascular disease were recruited for this study. B-mode ultrasonography was performed to evaluate the presence of CAS. We used multivariate analysis to determine potential risk factors for CAS. Results The overall prevalence of CAS in this population was 6.7%, with a prevalence of 8.8% for men and 5.0% for women. The risk of CAS increased with older age and a higher level of low-density lipoprotein cholesterol (LDL-C), systolic blood pressure (SBP), and fasting blood glucose (FBG) (all P < 0.05). Each 1-mmHg increase in SBP increased the risk of CAS by 0.011 times, each 1-mmol/L increase in LDL-C increased the risk of CAS by 0.192 times, and each 1-mmol/L increase in FBG increased the risk of CAS by 0.067 times. In addition, the risk of CAS increased 52.9% in men compared to that in women, increased 100.2% in current drinkers compared to that in never drinkers, and increased 38.9% in patients with diabetes compared to those without diabetes (all P < 0.05). Conclusions These findings suggest that the prevalence of CAS remains high in low-income individuals. Male sex, older age, current drinking, diabetes, and high levels of LDL-C, SBP, and FBG increase the risk of CAS. Thus, to prevent cerebrovascular disease and reduce the severe disease-associated burden for low-income individuals, there is a definitive need to control the risk factors of CAS.

Identifying Patients Undergoing Coronary Artery Bypass Grafting at Low Risk for Carotid Artery Stenosis

Boitano, Laura T. MD; Axtell, Andrea L. MD; Tanious, Adam MD, MMSc; Latz, Christopher MD; Clouse, William D. MD, FACS; Conrad, Mark F. MD, FACS Author Information

The association between metabolic syndrome and asymptomatic carotid artery stenosis in menopausal women: a cross-sectional study in a Chinese population.

BackgroundTo examine the association of metabolic syndrome (MetS) with carotid artery stenosis (CAS), especially in menopausal women in China.Materials and methodsA cross-sectional study of menopause women aged ≥40 years were enrolled from the Jidong community of Tangshan City between 2013 and 2014 to examine the association between MetS and CAS. Logistic regression analyses were performed to analyze the association between MetS and the presence of CAS.ResultsA total of 762 menopause women with mean age 59.3±5.6 years were enrolled in our analysis. Of all the people, 111 participants in CAS group (n=159) and 297 participants in no CAS group (n=603) were diagnosed with MetS meantime. Menopausal women with MetS had increased risk of CAS (OR, 2.383; 95% CI, 1.639–3.464), and the association was further verified by adjusting for confounding factors (OR, 1.949; 95% CI, 1.269–2.994). In addition, age, physical activity (never or moderate), body mass index (>24 kg/m2), and family income (<3,000 RMB) were independent important factors to CAS development in those with MetS.ConclusionMetS is associated with CAS especially in women after menopause.

The risk of carotid stenosis in head and neck cancer patients after radiation therapy

ObjectivesHead and neck radiotherapy (RT) is a risk factor for cerebrovascular disease. We performed a retrospective cohort study to evaluate carotid artery stenosis (CAS) incidence in head and neck cancer (HNC) patients undergoing RT, characterizing associated risk factors. Materials and methodsRecords were retrospectively reviewed for HNC patients undergoing carotid ultrasound screening after definitive or adjuvant RT between January 2000 and May 2016. CAS was defined as ≥50% stenosis on imaging, stroke, or transient ischemic attack. Actuarial CAS rates were calculated by Kaplan-Meier method. Univariate and multivariate analyses predicted CAS risk based on carotid dosimetric and clinical parameters. Results366 patients met inclusion criteria. Median time from RT completion to last follow-up was 4.1 yr. Actuarial risk for CAS was 29% (95% CI 22–36%) at 8 years. Univariate analysis showed that smoking (HR 1.7; 95% CI 1.1–2.7), hyperlipidemia (HR 1.6; 95% CI 1.03–2.6), diabetes (HR 2.8; 95% CI 1.6–4.8), coronary artery disease (HR 2.4; 95% CI 1.4–4.2), and peripheral artery disease (HR 3.6; 95% CI 1.1–11.6) were significantly associated with increased CAS. In multivariate analysis, diabetes was predictive of time to CAS (HR 1.9; 95% CI 1.1–3.4). Carotid dose parameters were not significantly associated with CAS. ConclusionsCAS incidence is high after head and neck radiotherapy, gradually rising over time. No clear dose-response effect between carotid dose and CAS was identified for HNC patients. Carotid artery screening and preventative strategies should be employed in this high-risk patient population.

Carotid Artery Stenting.

Carotid artery stenosis is relatively common and is a significant cause of ischemic stroke, but carotid revascularization can reduce the risk of ischemic stroke in patients with significant symptomatic stenosis. Carotid endarterectomy has been and remains the gold standard treatment to reduce the risk of carotid artery stenosis. Carotid artery stenting (CAS) (or carotid artery stent implantation) is another method of carotid revascularization, which has developed rapidly over the last 30 years. To date, the frequency of use of CAS is increasing, and clinical outcomes are improving with technical advancements. However, the value of CAS remains unclear in patients with significant carotid artery stenosis. This review article discusses the basic concepts and procedural techniques involved in CAS.

Physical Activity and Characteristics of the Carotid Artery Wall in High-Risk Patients-The SMART (Second Manifestations of Arterial Disease) Study.

BackgroundPhysical activity reduces the risk of vascular disease. This benefit is not entirely explained through an effect on vascular risk factors. We examined the relationship of physical activity and characteristics of the carotid artery wall in patients with vascular disease or risk factors.Methods and ResultsCross‐sectional analyses were performed in 9578 patients from the SMART (Second Manifestations of Arterial Disease) study, a prospective cohort study among patients with vascular disease or risk factors. Physical activity was assessed using questionnaires. Carotid intima‐media thickness and carotid artery stenosis of both common carotid arteries was measured. In a subset of 3165 participants carotid diastolic diameter and distension were assessed. Carotid stiffness was expressed as the distensibility coefficient and Young's elastic modulus. Regression analyses adjusted for vascular risk factors showed that physical activity was inversely associated with diastolic diameter (fifth versus first quintile B=−0.13 mm; 95% CI, −0.21 to −0.05) and decreased risk of carotid artery stenosis (relative risk, 0.58; 95% CI, 0.48–0.69). A light level of physical activity was associated with less carotid stiffness (second versus first quintile; Young's elastic modulus B=−0.11 kPa−1×10−3; 95% CI, −0.16 to −0.06; distensibility coefficient B=0.93 kPa×103; 95% CI, 0.34–1.51), but there was no additional benefit with increasing levels of physical activity. In patients with vascular disease, physical activity was inversely associated with common carotid intima‐media thickness, but not in patients with vascular risk factors.ConclusionsIn patients with vascular disease or risk factors, increased physical activity was associated with smaller carotid diastolic diameter, decreased risk of carotid artery stenosis, and less carotid stiffness, but it only showed benefits on carotid intima‐media thickness in patients with vascular disease.

Evaluation of Carotid Ultrasonography Screening Among Kidney Transplant Candidates: A Single-Center, Retrospective Study.

BackgroundKidney transplant candidates undergo rigorous testing prior to clearance for transplantation. Because kidney transplant candidates may be at increased risk for carotid artery stenosis because of arteriosclerosis and atherosclerosis secondary to hypertension, vascular calcification, and diabetes, carotid ultrasound is often performed with the intent of preventing a cerebrovascular accident in the perioperative or posttransplant period. To our knowledge, there has not been a study investigating the utility of screening carotid ultrasonography in pretransplant candidates. The purpose of the present study was to investigate the yield of carotid ultrasonography in end-stage renal disease patients, at high risk for having clinically significant vascular disease evaluated at our center for kidney transplantation during the years 2009 to 2014.MethodsData for carotid ultrasound findings and risk factors for carotid artery disease were extracted from the medical records.ResultsA total of 882 patients were included in our study of which only 13 patients (1.47% of the cohort) had significant carotid artery stenosis (>70%) on ultrasound testing. Using multiple logistic regression on the outcome of carotid stenosis, congestive heart failure (adjusted odds ratio, 5.2), and peripheral vascular disease (adjusted odds ratio, 4.4) were positively associated with carotid stenosis.ConclusionsThe prevalence of significant carotid artery stenosis was only 1.47% in our cohort of kidney transplant candidates, and the routine use of carotid ultrasound testing in this population may not be an efficient use of clinical resources. Use of risk factors, such as congestive heart failure or peripheral vascular disease, may identify patients who are more likely to benefit from carotid ultrasonography screening.

Family history as a risk factor for carotid artery stenosis.

We investigated whether family history of stroke or coronary heart disease (CHD) is associated with presence of carotid artery stenosis (CAS). The study cohort included 864 patients (72±8 years; 68% men) with CAS and 1698 controls (61±11 years; 55% men) referred for noninvasive vascular testing. CAS was defined as ≥70% stenosis in the internal carotid artery on ultrasound or history of carotid revascularization. Controls did not have CAS or history of cerebrovascular disease or CHD. Family history of stroke and CHD was defined as having ≥1 first-degree relative who had stroke or CHD before age 65 years. Logistic regression analysis was used to evaluate whether family history of stroke or CHD was associated with presence of CAS, independent of conventional risk factors. Family history of stroke and CHD was present more often in patients with CAS than in controls, with a resulting odds ratios (95% confidence interval) of 2.02 (1.61-2.53) and 2.01 (1.70-2.37), respectively. The associations remained significant after adjustment for age, sex, body mass index, smoking, diabetes mellitus, hypertension, and dyslipidemia; odds ratios: 1.41 (1.06-1.90) and 1.69 (1.35-2.10), respectively. A greater number of affected relatives with stroke or CHD was associated with higher odds of CAS; adjusted odds ratios: 1.25 (0.91-1.72) and 1.46 (1.14-1.89) versus 2.65 (1.35-5.40) and 2.13 (1.57-2.90) for patients with 1 and ≥2 affected relatives with stroke and CHD, respectively. Family history of stroke, and of CHD were each associated with CAS, suggesting that shared genetic and environmental factors contribute to the risk of CAS. We show that (1) family history of stroke or CHD is independently associated with presence of CAS; (2) sibling history of stroke or CHD confers greater risk than parental history; and (3) the magnitude of the association is greater in those with greater number of affected relatives, independent of the size of the family [corrected].

Incidence and risk factors of significant carotid artery stenosis in asymptomatic survivors of head and neck cancer after radiotherapy

The incidence and risk factors of carotid artery stenosis in asymptomatic patients after head and neck radiation therapy (RT) are unknown. This retrospective study reviewed asymptomatic patients treated with RT for head and neck cancer from 2000 to 2009 who underwent screening carotid ultrasound. Two hundred twenty-four patients were included, the majority of whom had stage III to IV disease and received cisplatin-based chemotherapy. Median time from RT completion to last carotid ultrasound was 3 years. Actuarial rate of carotid artery stenosis at 4 years was 14% (95% confidence interval [CI], 4% to 22%). Multivariate analysis revealed that carotid artery stenosis was associated with Framingham risk factors (hazard ratio [HR], 1.6 per factor; 95% CI, 1.2-2.2; p = .003). Among 135 patients treated with intensity-modulated radiation therapy (IMRT), the HR for carotid artery stenosis was 1.4 for every 10 Gy increase in mean RT dose to the carotid bulb plus 2 cm (95% CI, 0.8-2.4; p = .35). Prevention and screening programs should be considered for head and neck cancer survivors given the high risk of carotid artery stenosis.