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:10.1016/j.jacc.2010.11.005

Cited by 366 publications

(105 citation statements)

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“…Patients with carotid artery disease or with peripheral artery disease of the lower extremities are at high risk for major adverse cardiovascular events, [1][2][3] and patients with peripheral artery disease of the lower extremities are also at high risk for major adverse limb events such as severe limb ischaemia and amputation. 4 In addition to smoking cessation and exercise, statins, angiotensin converting enzyme (ACE) inhibitors, and antiplatelet agents (aspirin or a P2Y12 inhibitor) are used to reduce vascular complications.…”

Section: Introductionmentioning

confidence: 99%

Rivaroxaban with or without aspirin in patients with stable peripheral or carotid artery disease: an international, randomised, double-blind, placebo-controlled trial

et al. 2018

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BACKGROUND Patients with peripheral artery disease have an increased risk of cardiovascular morbidity and mortality. Antiplatelet agents are widely used to reduce these complications. METHODS This was a multicentre, double-blind, randomised placebo-controlled trial for which patients were recruited at 602 hospitals, clinics, or community practices from 33 countries across six continents. Eligible patients had a history of peripheral artery disease of the lower extremities (previous peripheral bypass surgery or angioplasty, limb or foot amputation, intermittent claudication with objective evidence of peripheral artery disease), of the carotid arteries (previous carotid artery revascularisation or asymptomatic carotid artery stenosis of at least 50%), or coronary artery disease with an ankle-brachial index of less than 0·90. After a 30-day run-in period, patients were randomly assigned (1:1:1) to receive oral rivaroxaban (2·5 mg twice a day) plus aspirin (100 mg once a day), rivaroxaban twice a day (5 mg with aspirin placebo once a day), or to aspirin once a day (100 mg and rivaroxaban placebo twice a day). Randomisation was computer generated. Each treatment group was double dummy, and the patient, investigators, and central study staff were masked to treatment allocation. The primary outcome was cardiovascular death, myocardial infarction or stroke; the primary peripheral artery disease outcome was major adverse limb events including major amputation. This trial is registered with ClinicalTrials.gov, number NCT01776424, and is closed to new participants. FINDINGS Between March 12, 2013, and May 10, 2016, we ; HR 0·67, 95% CI 0·45-1·00, p=0·05). The median duration of treatment was 21 months. The use of the rivaroxaban plus aspirin combination increased major bleeding compared with the aspirin alone group (77 [3%] of 2492 vs 48 [2%] of 2504; HR 1·61, 95% CI 1·12-2·31, p=0·0089), which was mainly gastrointestinal. Similarly, major bleeding occurred in 79 (3%) of 2474 patients with rivaroxaban 5 mg, and in 48 (2%) of 2504 in the aspirin alone group (HR 1·68, 95% CI 1·17-2·40; p=0·0043). INTERPRETATION Low-dose rivaroxaban taken twice a day plus aspirin once a day reduced major adverse cardiovascular and limb events when compared with aspirin alone. Although major bleeding was increased, fatal or critical organ bleeding was not. This combination therapy represents an important advance in the management of patients with peripheral artery disease. Rivaroxaban alone did not significantly reduce major adverse cardiovascular events compared with asprin alone, but reduced major adverse limb events and increased major bleeding. FUNDING Bayer AG. Methods This was a multicentre, double-blind, randomised placebo-controlled trial for which patients were recruited at 602 hospitals, clinics, or community practices from 33 countries across six continents. Eligible patients had a history of peripheral artery disease of the lower extremities (previous peripheral bypass surgery or angioplasty, limb or foot amputation, i...

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Section: Introductionmentioning

confidence: 99%

Rivaroxaban with or without aspirin in patients with stable peripheral or carotid artery disease: an international, randomised, double-blind, placebo-controlled trial

et al. 2018

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“…Randomize çalışmalar yeterli olmamakla birlikte, geçici iskemik atak ya da iskemik inme eşlik etsin ya da etmesin servikal arter diseksiyonunun tedavisinde antikoagulan ilaçlar 3-6 ay kadar kullanılmaktadır (2,16).…”

Section: Discussionunclassified

Mi̇nör Travmaya İki̇nci̇l Geli̇şen Sol Karoti̇d Ve Bi̇lateral Vertebral Arter Di̇seksi̇yonu Olgusu

Yaylacı¹,

Serinken²,

Dikmen³

2014

J Contemp Med

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ÖZETServikal arter diseksiyonu, genç hastalarda nonateroskelerotik inmenin en sık nedenidir. Bu hastalar sıklıkla baş ve boyun ağrısı şikayeti ile başvururlar. En sık rastlanan neden minör travmadır. Servikal arter diseksiyonu hem anterior hem posterior sistemi etkileyebilir, sonrasında kalıcı veya geçici nörolojik bulgulara neden olabilir. Bu yazıda 34 yaşında, baş ve boyun ağrısı şikayeti ile başvuran ve yapılan radyolojik incelemeler sonucu bilateral vertebral arter ve sol internal karotid arter olmak üzere ekstrakranyal üç damarda diseksiyon saptanan olgu sunulmaktadır. Acil hekimleri açısından periyodik baş ağrısı öyküsü olan genç olgularda hastanın daha önce yaşadığı ağrının başvuru sırasındaki ağrı ile benzer özellikte olup olmadığının ve majör/minör travma öyküsünün sorgulanması; servikal arter diseksiyonu ön tanısının akla gelmesi ve gerekli radyolojik incelemelerin planlanması açısından kritik öneme sahiptir.Anahtar kelimeler: Arter diseksiyonu, minör travma, boyun ağrısı, acil servis ABSTRACTThe most common reason of non-aterosclerotic stroke is cervical artery dissection for young patients. They frequently admitted to emergency department with the complaints of headache and pain at neck as a result of minor trauma. Cervical artery dissection may effect both anterior and posterior system and then cause neurological symptoms permanently or temporarily. In this study, the case who was 34 years old, admitted to the hospital with the complaints of headache and pain at neck and diagnosed as dissection of extracranial three artery ; bilateral vertebral artery and left internal carotid artery with the result of radiological examination, has been represented. In terms of emergency physician, investigation of the story of minor or major trauma and the relationship between the pain during first adminstiration and previous pain for young patients who have headache periodically, have an important role to consider the pre-diagnosis of cervical artery dissection and to plan the proper radiological examination.

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“…Patients were included if they had a carotid artery stent placed between November 2013 and October 2016 for symptomatic carotid artery stenosis (i.e., transient ischemic attack [TIA] or prior stroke) or as indicated by current guidelines. 3,8 Patients were excluded from this study if they did not meet the aforementioned criteria or were younger than 18 years of age. Seventy-four consecutive patients met the inclusion criteria, of whom 10 were lost to follow-up, ultimately leaving 64 in the final analysis cohort.…”

Section: Methodsmentioning

confidence: 99%

The circle of Willis predicts the antihypertensive effects of carotid artery stenting

Santiago-Dieppa

Hirshman

Wali

et al. 2017

FOC

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OBJECTIVE Carotid artery stenting (CAS) has antihypertensive effects, but the durability and degree of this response remain variable. The authors propose that this clinical variability is a function of the presence or absence of a complete circle of Willis (COW). Incomplete COWs perfuse through a higher-resistance pial collateral pathway, and therefore patients may require a higher mean arterial pressure (MAP). Carotid artery revascularization in these patients would reduce the end-organ collateral demand that has been hypothesized to drive the MAP response. METHODS Using a retrospective, nonrandomized within-subject case-control design, the authors compared the postoperative effects of CAS in patients with and without a complete COW by using changes in MAP and antihypertensive medication as end points. They recorded MAP and antihypertensive medications 3 months prior to surgery, preoperatively, immediately postoperatively, and at the 3-month follow-up. RESULTS Data were collected from 64 consecutive patients undergoing CAS. Patients without a complete COW (25%) were more likely to demonstrate a decrease in BP response to stenting (i.e., a drop in MAP of 10 mm Hg and/or a reduction or cessation of BP medications at 3 months postoperatively). Of the patients in the incomplete COW cohort, 75% had this outcome, whereas of those in the complete COW cohort, only 41% had it (p < 0.041). These findings remained statistically significant in a logistic regression analysis for possible confounders (p < 0.024). A receiver operating curve analysis of preoperative data indicated that a MAP > 96.3 mm Hg was 55.5% sensitive and 57.4% specific for predicting a complete COW and that patients with a MAP > 96.3 mm Hg were more likely to demonstrate a good MAP decrease following CAS (p < 0.0092). CONCLUSIONS CAS is associated with a significant decrease in MAP and/or a reduction/cessation in BP medications in patients in whom a complete COW is absent.

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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 366 publications

References 339 publications

Rivaroxaban with or without aspirin in patients with stable peripheral or carotid artery disease: an international, randomised, double-blind, placebo-controlled trial

Rivaroxaban with or without aspirin in patients with stable peripheral or carotid artery disease: an international, randomised, double-blind, placebo-controlled trial

Mi̇nör Travmaya İki̇nci̇l Geli̇şen Sol Karoti̇d Ve Bi̇lateral Vertebral Arter Di̇seksi̇yonu Olgusu

The circle of Willis predicts the antihypertensive effects of carotid artery stenting

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