Severe Carotid Artery Stenosis Research Articles

The Effects of Carotid Revascularization on 1-Year Cognitive Performance in Patients With Carotid Artery Stenosis.

The impact of carotid revascularization on cognitive function for patients with severe carotid artery stenosis remains uncertain. This study is aimed to investigate the 1-year neurocognitive outcomes of patients who accept carotid revascularization and identify the risk factors associated with postoperative cognitive decline. From April 2019 to April 2021, patients with ≥70% carotid artery stenosis who were treated with carotid endarterectomy (CEA) or carotid artery stenting (CAS) were recruited for this study. The Montreal Cognitive Assessment (MoCA) instrument was used to evaluate cognitive function preoperatively and at 3, 6, and 12 months postoperatively. Logistic regression analysis was built to identify potential risk factors for postoperative long-term cognitive decline. A total of 89 patients who met the criteria were enrolled and completed 1-year follow-up. At 3, 6, and 12 months after carotid revascularization, the total MoCA score, attention, language fluency, and delayed recall score were significantly improved compared with the baseline scores (p<0.05). At 12 months, there was also a significant improvement in cube copying compared with baseline (p=0.034). Logistic regression analysis showed that the advancing age, left side, and symptomatic carotid artery stenosis were independent risk factors for cognitive deterioration at 12 months after surgery. Overall, carotid revascularization has a beneficial effect on cognition function in patients with severe carotid artery stenosis, while advancing age, left side, and symptomatic carotid artery stenosis were significantly related to a decreased cognitive score after carotid revascularization. This study focused on the changes in cognitive function within 1 year after carotid revascularization in patients with severe carotid stenosis. Of course, carotid revascularization can improve the cognition function in these patients. On the other hand, we found the advancing age, left side and symptomatic carotid artery stenosis were significantly associated with decreased cognitive scores at 1 year after carotid revascularization, which suggests that clinicians may need to be aware of patients with these characteristics.

A fluid–structure interaction study to analyze the severity of carotid artery stenosis at different locations and its effect on various hemodynamic biomarkers

The study on arterial stenosis has gained rapid interest among researchers in the last decade because of its chronic consequences. Several researchers have tried to investigate stenosis and plaque progression in the carotid artery with different simulation models. In this study, a realistic 3-D geometry of the carotid artery has been used to analyze the effect of varying degrees of stenosis present at different locations of the carotid artery on various hemodynamic parameters. An extensive range of stenosis degrees, starting from a healthy artery(0 %stenosis) to 10%, 30%, 50%, 75%, and 90% stenosis, have been studied. These degrees of stenosis were planted at different locations of the artery grown simultaneously. The whole study was done under the realm of Fluid–Structure Interaction multiphysics. The change in velocity profiles at the areas of stenosis has been found along with the wall shear stress and arterial displacement. The magnitude of velocity and wall shear stress in the case of multiple stenosis locations has been found to be dependent on each other. The presence or absence of one stenosis affects the other, and given the regular and irregular patterns of the velocity profile, wall shear stress, and displacement, their inclusion in blood flow simulation studies having multiple stenoses should be considered.

Case report: Three characteristics of tyrosine kinase inhibitor-associated cerebrovascular stenosis. High threshold for infarction, atypical infarct area, and vascular recoverability under the use of ponatinib

While tyrosine kinase inhibitors (TKI)-associated cerebral vascular stenosis (CVS) exhibit distinct mechanisms compared to conventional stroke in basic research, the clinical strategy remains nearly the same other than TKI-switching. We present the case of a 22-year-old female with chronic myeloid leukemia without stroke risk factors, who developed ponatinib-associated CVS. Three potential characteristics of TKI-associated CVS were identified: a heightened threshold for infarction, an atypical infarct area, and vascular recoverability. Specifically, brain computed tomography remained normal despite 20 h of severe hemiplegia. The ischemic distribution was confined in gray matter and the anterior cerebral artery territory on magnetic resonance imaging, despite severe stenosis of the internal carotid artery. Ischemic changes resolved within 10 days and arterial stenosis improved after ponatinib withdrawal. These unique features, distinct from typical stroke, could lead to misdiagnosis as non-organic neurological disorders or other conditions in ponatinib-treated patients.

Relationship between Atherosclerosis Risk Factors and Carotid Artery Stenosis in Patients Undergoing Coronary Artery Bypass Graft

Background: Evaluation of the risk factors of atherosclerosis and carotid artery stenosis have been subjected to several investigations. The present study was conducted to determine the degree of carotid artery stenosis and investigate the relationship between atherosclerosis risk factors and coronary artery involvement in coronary artery bypass graft (CABG) patients. Methods: This cross-sectional study was conducted on 450 CABG candidate patients who visited Shahid Beheshti Hospital in Qom. The patients were divided into 4 groups according to the degree of carotid artery stenosis and were examined in terms of risk factors for atherosclerosis and coronary artery involvement. Finally, the data were analyzed using SPSS statistical software. Results: In total, about 18% of the patients had carotid artery stenosis, of them 13.6% had stenosis of less than 50%, 3.2% had stenosis of 50%–70%, and 1.2% had stenosis of more than 70%. Age, history of hypertension (HTN), hyperlipidemia, and previous history of cerebrovascular accident (CVA) showed a significant relationship with carotid artery stenosis. However, gender, BMI, diabetes, history of smoking, history of angiography and lipid profile of the patients did not show a significant relationship. Also, the incidence of CVA after CABG was 1.2%. Conclusion: The present study showed that old age, HTN, hyperlipidemia, and history of CVA are directly related to the severity of carotid artery stenosis.

Focal finger palsy and wrist pain due to cortical infarction: a case report

Abstract Background Hand knob infarction induced focal weakness of contralateral hand or distal arm, only accounts for less than 1% of all ischemic strokes. To date, there is no case with pain during sleep as the onset symptoms being reported. The atypical symptoms of hand knob infarction might increase the risk of delaying treatment especially in the hyperacute phase of stroke. Case presentation A 70-year-old man awoke from sleep due to sudden pain of his right medial wrist and presented to the emergency department with difficulty extending his right index and middle fingers within the time window of intravenous thrombolysis. But the intravenous thrombolysis was not given based on the NIHSS score (0) and atypical symptoms. MRI showed multiple DWI hyperintense lesions, including partial left hand knob area and left posterior central gyrus. CTA showed a severe focal stenosis of proximal left internal carotid artery. Conclusions The hand knob infarction might onset with unusual pain and should be carefully inspected in patients combined with acute onset of focal hand paresis.

Heavily Calcified Symptomatic Carotid Stenosis Treated With Off-Label Use of Lithotripsy Balloon Plus Stenting: 2-Dimensional Operative Video.

Severe symptomatic carotid artery stenosis poses a significant risk for recurrent strokes. Best treatment options depend on multiple factors, including patient medical conditions and lesion characteristics.1 Despite treatment options such as carotid endarterectomy, conventional carotid angioplasty/stent, and transcervical carotid revascularization, certain patients are not ideal candidates for any of these modalities. Novel technical advances such as intravascular lithotripsy (Shockwave Medical Inc.) have emerged as a potential treatment modality to treat patients with severely calcified plaques, a well-described limitation for carotid stent expansion and apposition.2-4 The safety and efficacy of intravascular lithotripsy have been demonstrated through select case series and coronary artery disease I-II-III studies, culminating in its Food and Drug Administration approval for the management of novo, calcified, stenotic coronary arteries before stent placement.2,5 This technical video presents an illustrative case of a patient with symptomatic severely calcified carotid plaque with previous neck radiation precluding endarterectomy, treated with off-label use of balloon lithotripsy plus stent.6 The patient consented to the procedure.

Analysis of contents of different kinds of fatty acids in carotid atherosclerotic plaques

Objective: To analyze the contents of different kinds of fatty acids in carotid atherosclerotic plaques. Methods: A total of 24 patients who underwent carotid endarterectomy at the Second Affiliated Hospital of Naval Medical University from October 2021 to September 2022 due to moderate and severe carotid artery stenosis were retrospectively enrolled, including 20 males and 4 females, with a median age[M(Q1, Q3)] of 68.5 (63.5, 72.3) years. According to the symptoms of cerebral ischemia, the patients were divided into a symptomatic group (12 cases) and an asymptomatic group (12 cases). Regarding the pathological characteristics, the patients were divided into a stable group (14 cases) and a vulnerable group (10 cases) according to carotid plaque pathology scores. The expression differences of different types of fatty acids in carotid plaques were analyzed by targeted fatty acid metabolomics technology based on ultra-performance liquid chromatography-mass spectrometry (UPLC-ESI-MS/MS) analysis. Results: In the 24 samples, the median amount of fatty acids [M (Q1, Q3)] was 1 113 (330, 5 897) ng/g. A total of 13 medium and long-chain fatty acids were detected, including saturated fatty acids, monounsaturated fatty acids and polyunsaturated fatty acids. The content of saturated fatty acids was 584 (290, 9 888) ng/g, accounting for the highest proportion of 51.8%. The content of polyunsaturated fatty acids was 1 444 (393, 4 264) ng/g, accounting for 44.4%. The content of monounsaturated fatty acids was 2 793 (1 558, 3 247) ng/g, accounting for 3.8%. The contents of linoleic acid, α-linolenic acid and oleic acid in carotid plaques in the symptomatic group were 1 760 (581, 3 006), 682 (527, 886) and 2 081 (1 358, 2 907) ng/g, respectively, which were lower than those in the asymptomatic group 3 149 (2 226, 4 683), 1 423 (964, 2 270) and 3 178 (2 352, 3 993) ng/g (all P<0.05). The contents of linoleic acid, α-linolenic acid and oleic acid in carotid plaques in the vulnerable group were 1 537 (588, 2 921), 649 (477, 850) and 2 081 (1 129, 2 831) ng/g, respectively, which were lower than those in the stable group 3 149 (2 047, 4 416), 1 423 (940, 2 184) and 3 091 (2 201, 3 973) ng/g (all P<0.05). There were no significant differences in the contents of 11, 14-eicosadienoic acid, γ-linolenic acid, eicosapentaenoic acid, arachidonic acid, erucic acid, margaric acid, pentadecanoic acid, stearic acid, dodecanoic acid and palmitic acid (all P>0.05). Conclusions: Saturated fatty acids are the main type in carotid plaques. The contents of oleic acid, α-linolenic acid and linoleic acid decrease in vulnerable plaques.

Carotid endarterectomy compared with carotid artery stenting for extracranial carotid artery stenosis: a retrospective single-centre study

Aim: One of the main risk factors for an ischemic stroke is significant carotid artery stenosis, and extracranial severe carotid artery stenosis accounts for 20% of ischemic strokes. Prior to the development of carotid artery stenting (CAS), the only effective and reliable treatment for carotid artery stenosis was carotid endarterectomy (CEA). This study compares the results of CAS and CEA in patients with significant carotid artery stenosis. Methods: Between 2018 and 2022, hospital records of all patients who underwent carotid artery revascularization at the institution were retrospectively analyzed. Patients were divided into two groups depending on whether CEA or CAS was performed for carotid revascularization. Propensity score matching was performed to reduce bias by equating the baseline clinical characteristics of the groups. To compare 30-day, 1-year, and long-term outcomes, rates of transient ischemic attack (TIA), myocardial infarction, stroke, all-cause mortality, and composite endpoints were analyzed. Results: After PSM, 76 patients each in the CEA and CAS groups were compared. The mean age was 69.80 years ± 11.35 years and 121 (80%) were male. The patients were followed up for a mean of 33 months ± 6 months. The incidence of TIA in the perioperative period [9 (12%) vs. 4 (5%); P &lt; 0.05], TIA and composite endpoint at 1-year period [11 (15%) vs. 2 (3%); P &lt; 0.05 and 27 (36%) vs. 16 (21%); P &lt; 0.05, respectively] were significantly higher in the CAS group than in the CEA group. No difference was observed between the groups in the long-term. Conclusions: There was no noticeable difference between the CEA and CAS groups in the examination of cases with severe carotid artery stenosis in terms of 1-month, and 1-year results (apart from TIA and composite endpoints), or long-term outcomes. Extracranial carotid artery stenosis can be treated safely and effectively also by CAS.

Reply to Letter: Serum Systemic Immune-Inflammation Index and Severity of Carotid Artery Stenosis

Reply to Letter: Serum Systemic Immune-Inflammation Index and Severity of Carotid Artery Stenosis

The role of carotid artery stenosis in predicting stroke after coronary artery bypass grafting in a Chinese cohort study

Current guidelines give priority to surgical treatment of carotid artery stenosis (CAS) before coronary artery bypass grafting (CABG), especially in symptomatic patients. Carotid artery stenting is an alternative treatment for narrowing of the carotid arteries. This study sought to demonstrate the role of severe CAS in predicting stroke after CABG and assess the efficacy of carotid artery stenting in preventing postoperative stroke in a Chinese cohort. From 2015 to 2021, 1799 consecutive patients undergoing isolated CABG surgery were retrospectively recruited in a Chinese cohort. The predictive value of severe CAS in postoperative stroke and carotid stenting in preventing postoperative stroke was statistically analyzed. The incidence of postoperative stroke was 1.67%. The incidence of CAS with stenosis ≥ 50% and ≥ 70% was 19.2% and 6.9%. After propensity matching, the incidence of stroke was 8.0% in the severe CAS group and 0% in the non-severe CAS group. We successfully established an optimal predictive nomogram for predicting severe CAS in patients undergoing CABG. Carotid artery stenting was found ineffective in preventing postoperative stroke. The present study provides the incidence of CAS and postoperative stroke in a Chinese cohort, identifies severe CAS as an independent risk factor for postoperative stroke after CABG, constructs a nomogram predicting the incidence of severe CAS, and evaluates the effectiveness of carotid artery stenting in preventing postoperative stroke after CABG.

Dynamic Cerebral Autoregulation After Carotid Endarterectomy.

Studies have shown that dynamic cerebral autoregulation (dCA) is impaired in patients with severe internal carotid artery (ICA) stenosis and that carotid endarterectomy (CEA) may improve dCA in these patients. However, the time course of dCA changes in patients after CEA remains unclear. Therefore, this study aimed to investigate the effects of CEA on the dCA in patients with carotid artery stenosis at different time points. This prospective study enrolled 44 patients (19 symptomatic stenosis patients and 25 asymptomatic stenosis patients) who underwent CEA and 44 age- and sex-matched controls. In the CEA group, the patients underwent dCA measurements at baseline, within 3 days, and 1 month after CEA. Transfer function parameters, phase difference (PD), and gain were used to quantify dCA. Changes in dCA before and after CEA were analyzed in detail. The bilateral PD of the patients before CEA was significantly lower than that of the control group. This damage did not improve within 3 days after surgery. One month after surgery, the PD on the affected side of the patients significantly improved compared with before surgery and reached the level of the control group. The PD of affected side across time points in symptomatic and asymptomatic stenosis patients is consistent with that in all patients. The dCA level did not improve immediately after CEA but significantly improved 1 month after surgery. This suggests that the occurrence of stroke should be considered in the acute period after CEA surgery, and its preventive effect on stroke may be effective after 1 month. We found the dCA level did not improve immediately after CEA but significantly improved 1 month after surgury. This suggests that the occuttencce of stroke and surgical complications (such as cerebral hyperperfusion syndrome) associated with impaired dCA in the acute phase after CEA surgery should be of particular concern.

Quantitative Assessment of Retinal and Choroidal Microvasculature in Asymptomatic Patients with Carotid Artery Stenosis.

Carotid disease contributes to 15-20% of all ischemic strokes, one of the leading causes of permanent disabilities and mortality globally. With its growing prevalence and the inflicted disability rates, screening for anomalies that precede the onset of its serious complications is of crucial global significance. To assess the relationship between retinal and choroidal perfusion changes with the degree of stenosis using quantitative Swept-source optical coherence tomography angiography (SS-OCTA) in patients with internal carotid artery stenosis. A retrospective cohort study was conducted in 72 eyes with carotid stenosis. According to the degree of stenosis, the participants were divided into a healthy group (Group 1: 34 eyes), a mild-moderate stenosis group (Group 2: 22 eyes), a severe stenosis group (Group3: 16 eyes). SS-OCTA was performed to scan macular fovea. Capillary density values in the different retinal and choroidal layers were the major measurements for our study. Mean vessel density in the mid-choroid layer was significantly higher in group 2 and 3 compared with group 1. Deep choroid disclosed significantly superior vascular density values in group 3 compared to groups 2 and 1. Superficial and deep capillary plexus showed decreased vascular density values when comparing group 3 with groups 1 and 2, although they were not significant. Our report provides the first evidence that choroidal microvascular changes were correlated with severity of carotid artery stenosis. OCTA can sensitively detect subtle, early changes in the ocular blood in carotid disease representing a useful, non-invasive and objective approach to the retinal microvasculature.

Abstract 096: Hypoperfusion Intensity Ratio Suggests Collateral Status, Stroke Mechanism, and Clinical Stability in Large Vessel Occlusion

Introduction Hypoperfusion Intensity Ratio (HIR), defined by the ratio of Tmax &gt;10s/Tmax &gt;6s on perfusion imaging, has been directly correlated with collateral status, stroke mechanism, and clinical outcomes in patients with acute large vessel occlusions [1,2]. We report a case of a patient with mild neurological symptoms despite an acute MCA M1 occlusion in which a very favorable HIR may have predicted clinical stability, extensive atherosclerotic burden, and compensatory leptomeningeal collaterals. Our aim was to provide support of the utility of HIR in quantifying collateral status and possibly predicting the underlying stroke mechanism and stroke progression of patients with acute large vessel occlusions. Methods Case report. Results A 61‐year‐old woman with a history of hypertension and hyperlipidemia, who is an active smoker with a known right extracranial carotid stenosis presented with acute left facial droop (NIHSS 1) upon awakening. CT head did not demonstrate early ischemic changes. CT angiogram demonstrated a right MCA M1 occlusion, marked narrowing of the right common carotid artery, and severe narrowing of the proximal innominate artery (Figure 1, Image A). CT perfusion demonstrated a Tmax &gt;6s delay of 41mL and HIR of 0, suggestive of robust collaterals (Figure 1, Image B). The patient was out of the window for tenecteplase administration. Thrombectomy was deferred due to a low NIHSS. MRI showed a right putamen and corona radiata infarct. DSA demonstrated crossed collateralization across the anterior communicating artery and robust right ACA‐MCA and PCA‐MCA leptomeningeal collaterals and retrograde filling of the brachiocephalic and right common carotid artery via the right vertebral artery. These findings were supported by quantitative MRA, which showed decreased blood flow in the right ICA, increased blood flow in right A2, increased blood flow in left A1, and retrograde right vertebral flow indicative of a brachiocephalic steal phenomenon. Her neurological exam remained stable upon discharge. She will be evaluated for brachiocephalic revascularization as an outpatient. Conclusion We present a patient with very mild symptoms due to an acute large vessel occlusion who remained clinically stable despite an acute MCA M1 occlusion, which was likely caused by ischemic conditioning related to chronic hypoperfusion secondary to severe brachiocephalic and right common carotid artery stenosis. Favorable HIR on perfusion imaging was predictive of robust collaterals, the underlying stroke mechanism, and the stable clinical course. Since clinical equipoise exists regarding the treatment of patients with low NIHSS in the setting of an acute large vessel occlusion, individualized selection remains paramount. HIR may serve as a quantitative radiographic marker to rapidly quantify collateral status and assist in decision‐making. Future studies exploring the role of HIR in predicting stroke progression are warranted.

Asymptomatic subarachnoid hemorrhage following carotid endarterectomy: illustrative case.

Carotid endarterectomy (CEA) and carotid artery stenting are common surgical interventions for internal carotid artery stenosis. Cerebral hyperperfusion syndrome (CHS) is a well-known complication of both procedures that can lead to intracranial hemorrhage and worsen clinical outcomes. Here, the authors report a rare case of non-aneurysmal subarachnoid hemorrhage (SAH) following CEA and review the relevant literature. A 70-year-old woman with hypertension and diabetes presented with progressive visual loss in the right eye and was diagnosed with ocular ischemic syndrome. Imaging revealed severe right cervical carotid artery stenosis. CEA was performed with no complications. Postoperatively, the patient's blood pressure was tightly controlled, with no evidence of CHS. However, an asymptomatic SAH was detected on postoperative day 7. Careful observation and blood pressure control were maintained. Since follow-up magnetic resonance imaging (MRI) showed no enlarging of the SAH and the patient was asymptomatic, she was discharged on postoperative day 15 with a modified Rankin scale score of 0. This case highlights the potential occurrence of non-aneurysmal SAH as a rare complication of CEA, even in asymptomatic patients. Repeated postoperative MRI is necessary to detect such complications. It is crucial to carefully control blood pressure after CEA regardless of symptoms.

Stenting for Severe C7 Stenosis of Internal Carotid Artery (ICA) and Related Literature Review

Intracranial Atherosclerosis (ICAS) is a common cerebrovascular lesion worldwide and an important cause of stroke [1]. Non-modifiable risk factors include age, gender, and genetics, with age being a key factor and atherosclerosis usually progressive, with no clinical manifestations until middle age. Ischemic Heart Disease (IHD) has increased fivefold among people aged 40 to 60. Before menopause, women are less prone to atherosclerosis than men, and the incidence of atherosclerosis is increased in postmenopausal women [2,3]. The inheritance of various genetic polymorphisms and the accumulation of family risk factors (such as diabetes and hypertension) create multiple conditions for the formation of atherosclerosis [4]. On the other hand, modifiable risk factors, such as smoking, hyperlipidemia, diabetes, and high blood pressure, can be improved by adjusting daily life. Studies have analyzed that white people are prone to extracranial arterial occlusive disease, while Asian, black and Hispanic people have a higher risk of intracranial atherosclerotic disease [1]. Therefore, the prevention of atherosclerotic disease, has been very urgent, to increase publicity, from the source to solve the problem.

Transradial intra-aortic catheter looping in the angioplasty of severe intracranial symptomatic arteriosclerotic diseases.

This study aims to investigate the effect and feasibility of intra-aortic catheter looping via transradial access in angioplasty for symptomatic intracranial severe (>70%) atherosclerotic stenosis or occlusion of large arteries (SISOLAs). Patients with SISOLAs who underwent transradial endovascular angioplasty using the catheter looping technique in the ascending aorta were retrospectively enrolled. The clinical data and treatment outcomes were analyzed. Fifteen patients aged 48-71 years were enrolled in this study. Left vertebrobasilar artery occlusion was present in 1 (6.7%) patient, severe left middle cerebral artery stenosis in 7 (46.7%) patients, severe left internal carotid artery (ICA) stenosis of the ophthalmic segment in 4 (26.7%) patients, severe left ICA stenosis of the cavernous segment in 2 (13.3%) patients, and severe right middle cerebral artery stenosis in 2 (13.3%) patients. The arterial stenosis ranged from 70 to 92% (mean 86%) before stenting. The looping of a guiding catheter in the ascending aorta via transradial access for angioplasty was successful in all patients (100%). The vertebral artery intracranial segment occlusion was successfully recanalized, while severe stenosis in the remaining 14 patients was successfully eliminated. After endovascular recanalization, the residual stenosis was reduced by 12-26% (median 18%). No puncture-related complications or surgical-related neurological complications occurred in these patients. In the follow-up angiography conducted on 10 (66.7%) patients after 6-25 months, no in-stent restenosis was detected. Intra-aortic guiding catheter looping via transradial access for endovascular angioplasty of SISOLAs is technically safe, feasible, and effective, especially when the transfemoral artery approach is difficult or impossible to undertake.

Association of carotid artery stenosis and ischemic stroke in patients undergoing coronary artery bypass grafting

Background. The incidence of stroke after Coronary artery bypass grafting (CABG) and the effect of carotid artery stenosis for risk assessment of stroke was strongly needed. This study compared the relation of ischemic stroke in the patients posted for CABG with varying degree of carotid artery stenosis (CAS) as measured by carotid artery Doppler. Patients and methods. This prospective cross-sectional study enrolled 422 patients with coronary artery disease (CAD) who underwent CABG. Out of them 170 patient with concomitant CAD were selected and divided into three groups such as mild, moderate and severe CAS. The occurrence of stroke was measured. Results. Unilateral CAS was common than bilateral CAS (71.2% vs 28.8%). Mild CAS was more than moderate and severe CAS (72.4% vs 21.2% vs 6.5%). Stroke observed in 1.2%, in which one patient had moderate CAS and other had severe CAS on the side of clinical stroke post CABG. Right carotid disease was frequent among 3 groups (51.8% vs 47.6%; 11.8% vs 10.6%; 4.1% vs 3.5%). Patient with old stroke showed significant correlation with the severity of CAD (p=0.02). Post-surgery stroke had significant correlation with previous history of stroke (p=0.001), severity of CAD (p=0.01) and bilateral CAS (p=0.02). Post-operative low volume state requiring prolonged ionotropic support showed significant correlation to stroke (p=0.02). Conclusion. Screening of patients for CAS in patients age &gt;65 years with previous stroke, and comorbidities aids the surgeon to take required measures to prevent stroke as a complication intraoperative or postoperative and decrease morbidity to the patient.

Stenting for severe C7 stenosis of internal carotid artery(ICA) and related literature review

Stenting for severe C7 stenosis of internal carotid artery(ICA) and related literature review

Retinal Microvascular Changes in Internal Carotid Artery Stenosis.

Purpose: We aimed to analyze retinal microvascular parameters, measured by optical coherence tomography angiography in patients with internal carotid artery stenosis compared to healthy individuals. Materials and Methods: A total of 41 eyes from 30 patients who had varying degrees of carotid stenosis, and 42 eyes from 42 healthy controls, were enrolled in this study. Depending on the degree of stenosis evaluated by Doppler ultrasonographic imaging, the patient group was further subclassified into mild, moderate, and severe carotid artery stenosis. Superficial and deep capillary plexus vessel densities, radial peripapillary capillary vessel density, foveal avascular zone, and flow densities in the choriocapillaris and outer retina were evaluated by optical coherence tomography angiography. Results: The superficial and deep capillary plexus vessel densities were significantly reduced among the groups, only sparing the foveal region. The mean superficial plexus vessel density was 45.67 ± 4.65 and 50.09 ± 4.05 for the patient and control group, respectively (p = 0.000). The mean deep capillary plexus density was 46.33% ± 7.31% and 53.27% ± 6.31% for the patient and control group, respectively (p = 0.000). The mean superficial and deep capillary vessel densities in the foveal region did not show any statistical difference between the patient and control groups (p = 0.333 for the superficial and p = 0.195 for the deep plexus vessel density). Radial peripapillary capillary vessel density was decreased in the patient group (p = 0.004). The foveal avascular zone area was wider in the patient group but this difference did not show a significant difference (p = 0.385). Conclusions: Retinal microvascular changes are a prominent outcome of internal carotid disease, and even mild stenosis can lead to alterations in the retinal microvascular bed which could be detected by OCTA. By early detection of microvascular changes in the retina in this patient group, we might speculate the overall vascular condition.

Carotid artery interventions - endarterectomy versus stenting.

Current management of patients with carotid artery stenosis is based on well-established guidelines, including surgical procedures - carotid endarterectomy (CEA) and endovascular carotid artery stenting (CAS) - and optimal medical treatment alone. Outcomes in the postprocedural period after CAS and CEA are similar, suggesting strong clinical durability for both treatments. Recent advances, which include the emergence of novel endovascular treatment tools and techniques, combined with more recent randomised trial data shed new light on optimal patient selection and treatment in contemporary practice. Improved, modern technologies including enhanced embolic protection devices and dual-layered micromesh stents yield better outcomes and should result in further improvements in CAS. In centres of excellence, nowadays, the majority of patients with severe carotid artery stenosis can be successfully treated with either CEA or CAS.