Carotid Artery Stenosis: A Look Into the Diagnostic and Management Strategies, and Related Complications

Abstract

Carotid stenosis (CS) is a buildup of atherosclerotic plaque within the artery leading to a wide range of symptoms, from mild symptoms, including blurred vision and confusion, to much more life-threatening presentations, including paralysis due to stroke. The presentation is insidious, with symptoms exhibiting predominantly at severe stenosis; hence the emphasis is placed on the importance of early diagnosis, treatment, and lifestyle modifications. CS is seen undergoing almost the same pathogenesis of any atherosclerotic plaque formation, from endothelial damage of the artery lumen to the formation of a fibrous cap with a foam cell, lipid-filled core. The findings of our review article were consistent with the recent literature, depicting that comorbid hypertension, diabetes, and chronic kidney disease (CKD), and lifestyle aspects, including smoking and diet, played the most salient role in plaque development. Among several imaging modalities, duplex ultrasound (DUS) imaging is the widely preferred method in clinical practice. Carotid endarterectomy (CEA) and carotid stenting are the primarily advocated procedures for symptomatic severe stenosis, with similar long-term outcomes. Although, earlier clinical trials showed promising results in mitigating the risk of stroke among asymptomatic severe CS with surgical intervention. However, recent advancements have shifted the focus to medical management alone due to comparable results among the asymptomatic population. Both surgical and medical regimens are beneficial in treating patients, but it is still an ongoing debate as to which is predominantly superior. The currently advancing trials and research will help elucidate definitive guidelines. However, the massive impact of lifestyle modifications advocates some degree of individualized multidisciplinary management strategies.

Evaluating the Performance of Automated Machine Learning (AutoML) Tools for Heart Disease Diagnosis and Prediction

“…A grid search was performed using various combinations of hyperparameters, including n-estimators (100, 200, 300, 400, 500), learning-rate (0.3, 0.1, 0.05), max-features (1, 0.7, 0.5, 0.4, 0.3), subsample (1, 0.5, 0.3), max-samples (1, 0.5, 0.3, 0.2), and bootstrap (True, False). (7). Ensemble Voting Classifier: Based on the fine-tuned estimators (AdaBoost, random forest, gradient boosting, XGBoost) and the other top-performing estimators (SVC, SGD, logistic regression), an ensemble voting classifier was constructed.…”

“…Risk factors for CVD include obesity, hypertension, hyperglycemia, and "high alcohol intake" [4]. Doctors usually diagnose CAD through a combination of physical examination, family history, and diagnostic tests including angiography, a type of contrast X-ray that measures the extent of narrowing of the blood vessels [5][6][7]. Other diagnostic tools include electrocardiography, sonography, and blood testing [4].…”

Inflammatory Biomarkers to Predict Major Adverse Cardiovascular Events in Patients with Carotid Artery Stenosis

“…However, the condition is heterogeneous in that some patients will remain asymptomatic throughout their disease course, while others will suffer debilitating strokes leading to permanent disability or death [ 1 , 3 ]. Currently, it is challenging to predict the clinical course of patients with CAS [ 4 ]. Although imaging to determine the severity of atherosclerosis may help predict adverse events, it comes with limitations [ 5 , 6 ].…”

Eversion Carotid Endarterectomy in a Patient With Complete Blockage of the Carotid Arteries (Clinical Case)

“…In the last decade, stroke has become the second leading cause of death, second only to coronary heart disease [5,6]. Carotid arteries affection by the atherosclerotic process causes a high risk of ischemic stroke, which is directly proportional to the degree of stenosis.…”