Carotid Stenosis: From Diagnosis to Management, Where Do We Stand?

Gokaldas, Reshma; Singh, Maheep; Lal, Sonia; Benenstein, Ricardo; Sahni, Ramandeep

doi:10.1007/s11883-014-0480-7

Cited by 37 publications

(23 citation statements)

References 39 publications

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“…Plaque was defined as a focal thickening ≥1.5 mm measured from the media–adventitia interface to the intima–lumen interface 22. Internal carotid artery stenosis was defined as follows: stenosis 16–50 per cent spectral broadening during all the cardiac cycle and systolic blood velocity <140 cm/s; stenosis >50 per cent as systolic blood velocity ≥140 cm/s and spectral broadening during all the cardiac cycle; occlusion as absence of Doppler signal 23. Carotid atherosclerosis was defined as the presence of plaque and/or stenosis and/or occlusion at the carotid vascular tree.…”

Section: Methodsmentioning

confidence: 99%

Delayed Flow-Mediated Vasodilation and Critical Coronary Stenosis

Irace

Rosa

Tripolino

et al. 2018

Journal of Investigative Medicine

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Endothelial dysfunction, wall thickening and plaque are progressive manifestations of atherosclerosis. Delayed or absent brachial artery dilation after ischemic stimulus has been associated with severity of extracoronary and coronary atherosclerosis. In the current study, we aimed to verify if delayed or absent dilation associates with critical coronary stenosis. We also evaluated the association between coronary stenosis, carotid artery wall thickness and peripheral artery disease. Endothelial function was investigated by flow-mediated dilation of the brachial artery up to 3 min after ischemia, and patients classified as early, late or no dilators. Coronary angiography was performed through transradial or femoral artery approach. Computerized quantitative angiography was used to obtain percent stenosis of all lesions, while the Gensini score was used to evaluate the severity of coronary atherosclerosis. Seventy-four patients were enrolled. Carotid wall thickness and plaque, and peripheral artery disease were detected by ultrasound. Subjects with critical coronary stenosis showed a higher prevalence of delayed or absent dilation (coronary stenosis ≥70 per cent: late dilators 50 per cent, no dilators 35 per cent; coronary stenosis ≤70 per cent : late dilators 27 per cent, no dilators 6 per cent). The Gensini score was progressively higher in late dilators and no dilators compared with early dilators (early: 4.5±13.5; late 17.5±27.1; no 39.7±55.0; P<0.02). Carotid atherosclerosis and peripheral artery disease were more prevalent in subjects with critical coronary stenosis. Delayed or absent dilation associates with coronary stenosis and different degree of coronary atherosclerosis. The kinetic of arterial dilation seems to be relevant as the magnitude of dilation.

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Section: Methodsmentioning

confidence: 99%

Delayed Flow-Mediated Vasodilation and Critical Coronary Stenosis

Irace

Rosa

Tripolino

et al. 2018

Journal of Investigative Medicine

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“…First, the data comparing CAS and CEA are heterogeneous and subject to highly variable interpretations. The current literature has been used by professional societies and practitioners to both support as well as raise concern about the use of CAS for treatment of carotid stenosis 36, 37, 38, 39. Second, there are huge financial incentives at stake in the treatment of severe carotid disease.…”

Section: Lessons Learned From Carotid Artery Stentingmentioning

confidence: 99%

“…The current literature has been used by professional societies and practitioners to both support as well as raise concern about the use of CAS for treatment of carotid stenosis. [36][37][38][39] Second, there are huge financial incentives at stake in the treatment of severe carotid disease. Third, CEA and CAS have traditionally been performed by professionally distinct specialties, and this offers an opportunity to examine how physicians could collaborate to harness a new technology to optimize patient care.…”

Section: Lessons Learned From Carotid Artery Stentingmentioning

confidence: 99%

Choice and Selection of Treatment Modalities for Cardiac Patients: An Interventional Cardiology Perspective

Agarwal

Tuzcu

Kapadia

2015

JAHA

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“…It is usually induced by atherosclerotic lesions, and is considered to be one of the major causes of stroke and cerebral ischemic events (CIE) [ 1 ]. Research has shown that symptomatic CAS will increase the risk of stroke, furthermore, even if the CAS is asymptomatic, it still can place an individual at more than 3% increased risk of suffering from stroke in the next year [ 2 , 3 ]. For the treatment of patients with CAS, the most important aspect is how to prevent an ischemic stroke and minimize related deaths.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic value of miR-186-5p for carotid artery stenosis and its predictive significance for future cerebral ischemic event

Zhang

Zhao

et al. 2020

Diagn Pathol

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Background MicroRNAs (miRNAs) serve as novel promising biomarkers for the diagnosis and prognosis of many human diseases. This study investigated the diagnostic value of miR-186-5p for asymptomatic carotid artery stenosis (CAS), and its predictive value for future cerebral ischemic events (CIEs). Methods Sixty-seven cases with asymptomatic CAS and 60 healthy individuals were recruited. Serum levels of miR-186-5p were tested by using qRT-PCR. Receiving–operator characteristic (ROC) curve was drawn based on sensitivity and specificity analyses. All asymptomatic CAS cases were followed up for 5 years. Kaplan-Meier method was applied for the evaluation of the predictive value of miR-186-5p for the occurrence of CIE. Results The serum level of miR-186-5p was increased significantly in asymptomatic CAS patients. MiR-186-5p was the most significant factor associated with the high degree of carotid stenosis in asymptomatic CAS patients. In the ROC curve analysis, the AUC was 0.919, with the sensitivity of 89.6% and specificity of 81.7% at the cutoff value of 1.221. Kaplan-Meier method results revealed that high miR-186-5p level was associated with the occurrence of CIEs. High miR-186-5p level and high degree of carotid stenosis were independent factors for the occurrence of CIEs. Conclusion MiR-186-5p serves as a potential diagnostic biomarker for patients with asymptomatic CAS, and predicts the occurrence of future CIEs.

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Carotid Stenosis: From Diagnosis to Management, Where Do We Stand?

Cited by 37 publications

References 39 publications

Delayed Flow-Mediated Vasodilation and Critical Coronary Stenosis

Delayed Flow-Mediated Vasodilation and Critical Coronary Stenosis

Choice and Selection of Treatment Modalities for Cardiac Patients: An Interventional Cardiology Perspective

Diagnostic value of miR-186-5p for carotid artery stenosis and its predictive significance for future cerebral ischemic event

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