2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Executive Summary

Brott, Thomas G.; Halperin, Jonathan L.; Abbara, Suhny; Bacharach, J. Michael; Barr, John D.; Bush, Ruth L.; Cates, Christopher U.; Creager, Mark A.; Fowler, Susan B.; Friday, Gary; Hertzberg, Vicki; McIff, E. Bruce; Moore, Wesley S.; Panagos, Peter D.; Riles, Thomas S.; Rosenwasser, Robert H.; Taylor, Allen J.

doi:10.1161/str.0b013e3182112d08

Cited by 125 publications

(68 citation statements)

References 367 publications

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“…However, non-atherosclerotic carotid disease can have similar symptoms with rather uncommon causes such as giant cell arteritis (GCA) [2,4]. …”

Section: Discussionmentioning

confidence: 99%

Case report: giant cell arteritis in a patient with carotid atherosclerosis – a diagnostic dilemma

Fayyaz

2018

Journal of Community Hospital Internal Medicine Perspectives

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Carotid atherosclerosis and giant cell arteritis (GCA) are two distinct medical conditions with an overlapping clinical spectrum of vascular symptoms such as vision loss and ischemic stroke. This is because both diseases cause arterial ischemia with a predilection for carotid vasculature. In addition, high-vascular risk individuals who are diagnosed with GCA are usually elderly with age >55 years with high-vascular risk and thus can have underlying atherosclerosis. All these factors can pose a diagnostic dilemma for the physicians as GCA is a medical emergency which if left untreated can result in significant morbidity and mortality. Thus, it is important to avoid attributing occlusive arterial disease in elderly patients to atherosclerosis alone because some may have GCA. We present a case report in which presence of diffuse atherosclerosis was a major pitfall while making a timely diagnosis of GCA.

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“…However, non-atherosclerotic carotid disease can have similar symptoms with rather uncommon causes such as giant cell arteritis (GCA) [2,4]. …”

Section: Discussionmentioning

confidence: 99%

Case report: giant cell arteritis in a patient with carotid atherosclerosis – a diagnostic dilemma

Fayyaz

2018

Journal of Community Hospital Internal Medicine Perspectives

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“…This approach seems reasonable given the long-term risk of stroke, which is generally low regardless of AP or AC treatment [4,6,27,28]. Despite recent guidelines supporting either AC or AP use in CAD treatment [29,30], prior studies suggest that clinicians often empirically anticoagulate patients with acute CAD [31,32,33]. …”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Novel Oral Anticoagulants in Patients with Cervical Artery Dissections

Caprio¹,

Bernstein²,

Alberts³

et al. 2014

Cerebrovasc Dis

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Background: American and European guidelines support antiplatelet agents and anticoagulants as reasonable treatments of cervical artery dissection (CAD), though randomized clinical trials are lacking. The utility of novel oral anticoagulants (NOAC), effective in reducing embolic stroke risk in non-valvular atrial fibrillation (NVAF), has not been reported in patients with CAD. We report on the use, safety, and efficacy of NOACs in the treatment of CAD. Methods: We retrospectively identified patients diagnosed with CAD at a single academic center between January 2010 and August 2013. Patients were categorized by their antithrombotic treatment at hospital discharge with a NOAC (dabigatran, rivaroxaban, or apixaban), traditional anticoagulant (AC: warfarin or treatment dose low-molecular weight heparin), or antiplatelet agent (AP: aspirin, clopidogrel, or aspirin/extended-release dypyridamole). Using appropriate tests, we compared the baseline medical history, presenting clinical symptoms and initial radiographic characteristics among patients in the 3 treatment groups. We then evaluated for the following outcomes: recurrent stroke, vessel recanalization, and bleeding complications. p values <0.05 were considered significant. Results: Of the 149 included patients (mean age 43.4 years; 63.1% female; 70.5% vertebral artery CAD), 39 (26.2%), 70 (47.0%), and 40 (26.8%) were treated with a NOAC, AC, and AP, respectively. More patients with severe stenosis or occlusion were treated with NOAC than with AC or AP (61.8 vs. 60.0 vs. 22.5%, p = 0.002). Other baseline clinical and radiographic findings, including the presence of acute infarction and hematoma, did not differ between the 3 treatment groups. One hundred and thirty-five (90.6%) patients had clinical follow-up (median time 7.5 months) and 125 (83.9%) had radiographic follow-up (median time 5 months) information. There were 2 recurrent strokes in the NOAC group and 1 in each of the AC and AP groups (p = 0.822). There were more major hemorrhagic events in the AC group (11.4%) compared to the NOAC (0.0%) and AP (2.5%) groups (p = 0.034). Three patients treated with NOAC and none treated with AC or AP had a worsened degree of stenosis on follow-up imaging (8.6 vs. 0.0 vs. 0.0%, p = 0.019). Conclusion: Compared to traditional anticoagulants for CAD, treatment with NOACs is associated with similar rates of recurrent stroke, fewer hemorrhagic complications, but greater rates of radiographic worsening. These data suggest that NOACs may be a reasonable alternative in the management of CAD. Prospective validation of these findings is needed.

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“…These recommendations are widely represented in the current ASA/AHA guidelines 2011, proposing consideration of endovascular treatment for patients with stroke or TIA and extracranial carotid or vertebral arterial dissection in cases of definite recurrent cerebral ischemic events [21]. However, there is currently no recognized consensus among both neurologists and neuroradiologists of a preferred time point for stenting or even the type of stent device used.…”

Section: Discussionmentioning

confidence: 99%

“…The current ASA/AHA guidelines 2011 recommend antithrombotic treatment for patients with ischemic stroke or TIA and CeAD. Stenting should only be considered in patients with recurrent cerebral ischemic events despite optimal antithrombotic therapy [21]. …”

Section: Introductionmentioning

confidence: 99%

Endovascular Treatment of Cervical Artery Dissection: Ten Case Reports and Review of the Literature

et al. 2012

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Purpose: The role of endovascular treatment in cases of cervical artery dissection (CeAD) is debatable. With an increasing number of endovascular therapies such as endovascular recanalization and embolization the number of complications such as iatrogenic dissection is also rising. We report our experience with endovascular stenting in the treatment of patients presenting with CeAD. Methods: We included all consecutive patients with CeAD (n = 168) treated in our hospital between 2001 and 2010 for our retrospective study. Patients with CeAD were considered eligible for stenting: (1) in iatrogenic dissections and (2) in noniatrogenic dissections if they suffered from recurrent ischemic events despite antithrombotic treatment. Results: During our observation period 10 out of 168 patients presenting with CeAD were selected for stenting. Several types of stents were used. Stenting was technically successful in 8 but unsuccessful in 2 patients with complete arterial occlusion. Stent-related clinically apparent complications occurred in 3 of the 10 patients. All were transient. During a mean follow-up of 47 (±24.8) months none of the patients had new cerebrovascular ischemic events. Conclusion: In our patient sample stenting due to dissection is a rare procedure performed in less than 10% of CAD patients. It should be considered as a feasible rescue treatment in cases of impending stroke despite optimal antithrombotic therapy.

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2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Executive Summary

Cited by 125 publications

References 367 publications

Case report: giant cell arteritis in a patient with carotid atherosclerosis – a diagnostic dilemma

Case report: giant cell arteritis in a patient with carotid atherosclerosis – a diagnostic dilemma

Efficacy and Safety of Novel Oral Anticoagulants in Patients with Cervical Artery Dissections

Endovascular Treatment of Cervical Artery Dissection: Ten Case Reports and Review of the Literature

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