Severe Extracranial Carotid Artery Stenosis Research Articles

Comparative Analysis of Balloon Angioplasty Alone versus Carotid Artery Stenting for Severe Extracranial Carotid Artery Stenosis: A Four-Year Retrospective Study

This retrospective study aimed to compare the efficacy of balloon angioplasty alone (BAA) with carotid artery stenting (CAS) for severe extracranial carotid artery stenosis (ECAS). The primary outcomes assessed were restenosis requiring retreatment and symptomatic stroke occurrence within a four-year follow-up period. A total of 77 patients with 89 carotid artery stenoses undergoing endovascular carotid revascularization (ECR) between January 2015 and December 2019 were included. Neuroradiological evaluations, including computed tomography angiography (CTA) or magnetic resonance angiography (MRA), were performed at defined intervals. Statistical analyses were conducted to compare patient characteristics, angiographic outcomes, and clinical outcomes between the BAA and CAS groups. The study demonstrated successful outcomes in both groups with low adverse event rates. The overall restenosis rate was 40.2%, but severe restenosis requiring retreatment occurred in only 10 cases (7 in BAA, 3 in CAS). No significant difference was found in retreatment rates between the two groups (p=0.53). Stroke occurrence within the four-year follow-up period was observed in three patients, with no statistically significant difference between BAA and CAS groups CONCLUSIONS: This study provides valuable insights into the comparative effectiveness of BAA and CAS for severe ECAS. Despite slightly shorter intervals to restenosis in the BAA group, there was no significant difference in retreatment or stroke occurrence rates between the two procedures. BAA offers advantages in terms of retreatment options.

Association of Whole Blood Viscosity and Severe Extracranial Carotid Artery Stenosis

Association of Whole Blood Viscosity and Severe Extracranial Carotid Artery Stenosis

Metabolomics study in severe extracranial carotid artery stenosis

BackgroundSignificant genetic association has been found in patients with severe carotid artery stenosis (CAS). The present study wished to investigate if metabolites may also act as biomarkers for CAS.MethodsConsecutive patients with at least one carotid artery stenosis > = 60% on cerebral angiography were prospectively recruited from May 2007 to January 2016. Normal controls were recruited from outpatient clinic who had no stroke and coronary artery disease (CAD) history, and the brain magnetic resonance or computed tomographic angiography showed bilateral CAS < 30%. Risk factor profile, clinical characteristics, age, and clinical features were recorded. All subjects were male, and none had diabetes. 1H-NMR spectroscopy-based metabolomics analysis was carried out for plasma samples.ResultsTotally, 130 male subjects were recruited. Age had no significant difference between the controls and CAS group (60.2 ± 5.9 vs. 63.3 ± 6.0, p = 0.050). The CAS group had significantly higher frequency of CAD, hypertension, smoking and alcohol but lower body mass index than the controls (p < 0.05). The laboratory tests showed CAS group had significantly higher level of homocysteine but lower levels of cholesterol, high-density lipoprotein and hemoglobin than the controls (p < 0.05). The 1H-NMR based plasma metabolomics analysis indicated that choline was significantly lower in CAS patients. The VIP values of lipids were greater than 1.0, which were considered significantly different.ConclusionsOur results suggest homocysteine, choline and lipids in association with traditional risk factors may be involved in the pathogenesis of CAS. Diet adjustment to control homocysteine, choline and lipids may be helpful for the prevention of CAS.

ECAS score: a web-based risk model to predict moderate and severe extracranial carotid artery stenosis

Background and purposeTo develop and validate a risk model (Extracranial Carotid Artery Stenosis score, ECAS score) to predict moderate and severe ECAS. Furthermore, we compared discrimination of the ECAS score and three existing models with regard to both moderate and severe ECAS.MethodsThe ECAS score was developed based on the Renqiu Stroke Screening Study (RSSS), in which eligible patients were randomly divided into derivation (60%) and validation (40%) cohorts. ECAS was diagnosed by carotid duplex ultrasound according to the published criteria. Independent predictors of moderate (≥50%) and severe (≥70%) ECAS were obtained using multivariable logistic regression. The area under the receiver operating characteristic curve (AUROC) and the Hosmer–Lemeshow test were used to assess model discrimination and calibration.ResultsA total of 5010 participants were included and the mean age was 64.3. The proportion of ECAS of < 50%, 50–69%, 70–99% and occlusion was 4.4, 0.5, 0.4, and 0.4%, respectively. The ECAS score was developed from sets of predictors of moderate and severe ECAS. The ECAS score demonstrated good discrimination in the derivation and validation cohorts (AUROC range: 0.785–0.846). The Hosmer–Lemeshow tests of ECAS score for moderate and severe ECAS were not significant in the derivation and validation cohorts (all P > 0.05). When compared to the three existing models, the ECAS score showed significantly better discrimination for both moderate and severe ECAS (all P < 0.001).ConclusionThe ECAS score is a valid model for predicting moderate and severe ECAS. Further validation of the ECAS score in different populations and larger samples is warranted.

Abstract WP133: Intra Cerebral Atherosclerosis is the Major Risk Factor for Stroke in Post Coronary Artery Bypass Graft Surgery Patients

Introduction: Stroke is one of the most severe complications after Coronary artery bypass grafting (CABG) and is associated with high rates of morbidity and mortality. Hypothesis: We aimed to define the relationship between extracranial and intracranial carotid artery stenosis and the risk of stroke after CABG. Methods: A retrospective analysis of 1245 consecutive patients who underwent coronary artery bypass grafting (CABG) in our institution from March 2015 till March 2017 was performed. All of them had carotid duplex ultrasound as a routine preoperative assessment. Those patients who had severe extracranial carotid stenosis (&gt;70%), underwent computed tomography angiogram of head and neck cerebral vessels. Our analysis was mainly focused on assessing the relation between incidence of post-CABG stroke and severity of intra and extra cranial cerebral atherosclerosis. Results: Of the 1245 patients who underwent coronary artery bypass grafting(CABG) the routine preoperative carotid Doppler revealed severe extracranial carotid artery stenosis of &gt;70% in 160 patients, who eventually underwent computed tomography angiogram which has shown both extra and intracranial cerebral vascular stenosis in 124 patients. Total number of patients who had post CABG strokes are 42 (3.37%), out of which 39 (3.13%) had extensive extra and intracranial vascular stenosis whereas only 3 (0.24%) had isolated extracranial vascular stenosis. Patients with extensive extra and intracranial cerebral atherosclerosis has high rate of in-hospital strokes (within 14 days) compared with patients with isolated extracranial atherosclerotic disease. Conclusion: Extensive atherosclerosis including intra and extracranial cerebral arteries are major risk factors for stroke in patients undergoing CABG. Pre-operative assessment of both intra and extracranial cerebral arteries increases the probability of risk assessment in high risk CABG patients.

Relationship between neurological complications, cerebrovascular and cerebral perfusion following off-pump coronary artery bypass grafting

Objective:To investigate risk factors for neurological complications after off-pump coronary artery bypass grafting (OPCABG).Methods:We reviewed the cases of 813 patients who underwent OPCABG between August 2010 and September 2013.Data from preoperative 320 dynamic volume computed tomography (CT), CT angiography (CTA), CTA perfusion, and cerebrovascular function examinations were assessed. Neural function was assessed before and 7 days after operation, and patients were assigned to either the neurological complications or non-neurological complications group.Results:Neurological complications were observed in 23.4% (190/813) of patients; cerebral infarction in 1.1% (9/813); hypoxic ischemic encephalopathy in 2.3% (19/813); delirium in 1.5% (12/813); postoperative cognitive dysfunction in 12.9% (105/813); and anxiety/depression in 8.2% (67/813). Patients in the neurological complications group were older, were more likely to have a previous history of cerebrovascular disease and diabetes, had more severe extra-cranial carotid artery stenosis, had more severe stenosis on CTA, and had more perfusion abnormalities compared to patients in the non-neurological- complications group (P < 0.05). Logistic regression analysis identified the following independent risk factors for neurological complications: male gender (odds ratio [OR], 1.816; 95% confidence interval [CI], 1.017–3.244; P = 0.044); cerebrovascular disease history (OR, 1.837; 95% CI, 1.075–3.141; P = 0.026); and perfusion abnormalities (OR, 3.224; 95% CI, 2.073–5.013; P = 0.000). Occipital lobe cerebral blood flow (CBF); differences in temporal lobe, occipital lobe, and basal ganglial time to peak (TTP); and the difference in occipital lobe and basal ganglial mean transit time (MTT) were significantly higher in the neurological complications group (P < 0.05). For the TTP difference, the area under the receiver operating characteristic (ROC) curve was 0.606.Discussion:Neurological complications were observed in 23.4% of patients following OPCABG. Male gender, cerebrovascular disease history, and perfusion abnormalities were independent risk factors for neurological complications. Temporal lobe TTP on CTA perfusion was the best predictor of neurological complications.

Carotid Intervention in Acute Stroke

With advances in acute stroke management, patients with symptomatic severe carotid stenosis are frequently evaluated in the acute stage (ie, within the first few hours) after onset of symptoms. Patients with severe extracranial carotid artery stenosis presenting with acute stroke often have associated intracranial occlusive lesions. When invasive intra-arterial therapy is indicated, both revascularization of the extracranial and of the intracranial occlusive lesion is warranted to achieve a good functional outcome. In patients presenting with acute stroke, revascularization of severe extracranial carotid stenosis and even frank occlusion is possible; it improves distal flow and allows easier access to the often coexistent intracranial occlusion. In this article, the authors review the indications, techniques, and results of acute carotid interventions for acute stroke.

Transcranial Doppler Waveform Blunting in Severe Extracranial Carotid Artery Stenosis

Objective: To investigate the frequency of transcranial Doppler (TCD) waveform blunting in patients with severe (80–99%) symptomatic or asymptomatic extracranial carotid artery stenosis. Background: Severe carotid artery stenosis has been identified as a risk factor for ischemic stroke. Blunted Doppler flow waveforms (reduced systolic flow velocity and pulsatility) of the middle cerebral artery (MCA) are inferred to reflect hemodynamic impairment, possibly indicating an increased risk of stroke. Methods: The 114 consecutive patients (mean age 72.4 years, SD 9.0 years; 37% women; 46 clinically symptomatic, 68 asymptomatic) with 80–99% stenosis of the extracranial internal carotid artery (ICA), as determined by duplex sonography, were examined with TCD. Flow velocities, pulsatility index, and spectral waveforms of the MCA distal to the ICA stenosis were assessed blinded to the clinical status of the ICA: Doppler waveform blunting was defined as loss of the characteristic systolic peak. Odds ratios with 95% confidence intervals and χ² statistics were used to describe the association between waveform blunting and the symptomatic status of the ICA stenosis. Results: Among symptomatic patients, 23 (50%) had completed strokes, and a further 23 (50%) had transient neurologic deficits in the territory of the stenotic ICA. Blunted spectral waveform was found in 37 (80%, 95% CI 68–92%) of the symptomatic and 25 (37%; 95% CI 25–49%) of the asymptomatic patients. Symptomatic patients had significantly increased odds of having blunted TCD waveforms (OR 7.5, 95% CI 3.1–18.1, p < 0.001). Conclusions: Our findings suggest that TCD waveform blunting in the MCA as here described may be an additional risk factor in the setting of severe extracranial carotid artery stenosis. A prospectively designed study to confirm our results seems warranted.

Can Clinical Features Identify Severe Carotid Stenosis

Because access to cerebrovascular ultrasound imaging may be limited for patients with symptoms of cerebral ischemia, this prospective study investigated whether clinical features can identify patients with severe extracranial carotid artery stenosis. A total of 1,041 patients with symptoms of retinal or cerebral transient ischemic attacks or stroke were evaluated …

Subtypes and case-fatality rates of stroke:: A hospital-based stroke registry in Taiwan (SCAN-IV)

Stroke data bank can afford important information regarding risk factors, pathogenesis, prognosis, etc. By means of hospital-based stroke registry, we investigated the risk factors and case-fatality rates in different types of stroke and transient ischemic attack (TIA) patients at the National Taiwan University Hospital in 1995. After excluding ineligible patients, 995 patients aged 1–98 years (575 men and 420 women) were recruited. Men predominated in all age groups for stroke and TIA in general except for cerebral hemorrhage (CH) in patients aged <35 years and subarachnoid hemorrhage (SAH) in patients aged ≥45 years. Of these, 676 (67.9%), 41 (4.1%), 228 (22.9%) and 50 (5%) patients were classified in the categories of cerebral infarction (CI), TIA, CH and SAH, respectively. The CI/CH ratio was 2.96. Hypertension remained one of the most important risk factors for CI, CH and TIA patients. Severe extracranial carotid artery stenosis (≥50%) was found in 12% of the CI patients and 27% of the TIA patients, but not found in the CH and SAH patients. Of these patients, the 30-day case-fatality rate was 10.9%, highest in SAH (30%), followed by CH (24.1%) and CI (5.6%). There were 41 in-hospital stroke patients who had significantly higher case-fatality rates than the other stroke patients ( P<0.001 for all stroke, CI and CH patients by χ 2 test). As compared to the previous stroke registries in Taiwan, there is a secular trend of increasing CI/CH ratios. These findings in Taiwan were compared with those in other populations, including other Asian, Caucasian and black populations. The CI/CH ratios in Asian populations, including Chinese, Japanese and Korean, were much lower than those in Caucasian and black populations. Dietary, environmental and genetic factors probably play important roles in these differences.