Carotid Stenosis

Thammongkolchai, Thananan; Riaz, Anum; Sundararajan, Sophia

doi:10.1161/strokeaha.117.017779

Cited by 9 publications

(4 citation statements)

References 11 publications

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“…[17][18][19] More recent data suggests that the nature of the plaque may play a larger role in predicting future strokes, and as plaque morphology imaging continues to improve, these studies are likely to provide important complementary information. 20,21 In conclusion, our study compared the percent stenosis as measured by the physician operator at facilities applying for IAC accreditation with that measured by a panel of independent expert reviewers. We found that real-world operators tended to use measurement techniques that led to a higher estimation of the percent of stenosis compared with that found using strict NASCET criteria.…”

Section: Discussionmentioning

confidence: 99%

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Variation in Carotid Artery Stenosis Measurements Among Facilities Seeking Carotid Stenting Facility Accreditation

Jareczek

Farrell²,

Lehman

et al. 2023

Stroke

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Background: Based on the inclusion criteria of clinical trials, the degree of cervical carotid artery stenosis is often used as an indication for stent placement in the setting of extracranial carotid atherosclerotic disease. However, the rigor and consistency with which stenosis is measured outside of clinical trials are unclear. In an agreement study using a cross-sectional sample, we compared the percent stenosis as measured by real-world physician operators to that measured by independent expert reviewers. Methods: As part of the carotid stenting facility accreditation review, images were obtained from 68 cases of patients who underwent carotid stent placement. Data collected included demographics, stroke severity measures, and the documented degree of stenosis, termed operator-reported stenosis (ORS), by 34 operators from 14 clinical sites. The ORS was compared with reviewer-measured stenosis (RMS) as assessed by 5 clinicians experienced in treating carotid artery disease. Results: The median ORS was 90.0% (interquartile range, 80.0%–90.0%) versus a median RMS of 61.1% (interquartile range, 49.8%–73.6%), with a median difference of 21.8% (interquartile range, 13.7%–34.4%), P <0.001. The median difference in ORS and RMS for asymptomatic versus symptomatic patients was not statistically different (24.6% versus 19.6%; P =0.406). The median difference between ORS and RMS for facilities granted initial accreditation was smaller compared with facilities whose accreditation was delayed (17.9% versus 25.5%, P =0.035). The intraclass correlation between ORS and RMS was 0.16, indicating poor agreement. If RMS measurements were used, 72% of symptomatic patients and 10% of asymptomatic patients in the population examined would meet the Centers for Medicare and Medicaid Services criteria for stent placement. Conclusions: Real-world operators tend to overestimate carotid artery stenosis compared with external expert reviewers. Measurements from facilities granted initial accreditation were closer to expert measurements than those from facilities whose accreditation was delayed. Since decisions regarding carotid revascularization are often based on percent stenosis, such measuring discrepancies likely lead to increased procedural utilization.

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Section: Discussionmentioning

confidence: 99%

“…17–19 More recent data suggests that the nature of the plaque may play a larger role in predicting future strokes, and as plaque morphology imaging continues to improve, these studies are likely to provide important complementary information. 20,21…”

Section: Discussionmentioning

confidence: 99%

Variation in Carotid Artery Stenosis Measurements Among Facilities Seeking Carotid Stenting Facility Accreditation

Jareczek

Farrell²,

Lehman

et al. 2023

Stroke

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“…2 In the Chinese Intracranial Atherosclerosis study, a population-based cohort, 15% of ICAD patients with multiple vascular risk factors had stroke recurrence over 1 year. 3 In contrast to coronary/carotid artery plaques where established imaging features might predict a myocardial or cerebral ischaemic event, [4][5][6][7][8][9] the morphology of ICAD lesions immediately after or portending a stroke was largely unknown. The sole parameter forecasting stroke relapse in symptomatic ICAD had been 'luminal stenosis' which, however, might imply distal perfusion deficit alone but would not account for stroke mechanisms like arteryto-artery thromboembolism, lacunar syndrome from junctional atheroma or branch hypoperfusion.…”

Section: Introductionmentioning

confidence: 99%

Plaque morphology in acute symptomatic intracranial atherosclerotic disease

Leung

Wang

Zou

et al. 2020

J Neurol Neurosurg Psychiatry

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BackgroundIntracranial atherosclerotic disease (ICAD) is globally a major ischaemic stroke subtype with high recurrence. Understanding the morphology of symptomatic ICAD plaques, largely unknown by far, may help identify vulnerable lesions prone to relapse.MethodsWe prospectively recruited patients with acute ischaemic stroke or transient ischaemic attack attributed to high-grade ICAD (60%–99% stenosis). Plaque morphological parameters were assessed in three-dimensional rotational angiography, including surface contour, luminal stenosis, plaque length/thickness, upstream shoulder angulation, axial/longitudinal plaque distribution and presence of adjoining branch atheromatous disease (BAD). We compared morphological features of smooth, irregular and ulcerative plaques and correlated them with cerebral ischaemic lesion load downstream in MRI.ResultsAmong 180 recruited patients (median age=60 years; 63.3% male; median stenosis=75%), plaque contour was smooth (51 (28.3%)), irregular (101 (56.1%)) or ulcerative (28 (15.6%)). Surface ulcers were mostly at proximal (46.4%) and middle one-third (35.7%) of the lesions. Most (84.4%) plaques were eccentric, and half had their maximum thickness over the distal end. Ulcerative lesions were thicker (medians 1.6 vs 1.3 mm; p=0.003), had steeper upstream shoulder angulation (56.2° vs 31.0°; p<0.001) and more adjoining BAD (83.3% vs 57.0%; p=0.033) than non-ulcerative plaques. Ulcerative plaques were significantly associated with coexisting acute and chronic infarcts downstream (35.7% vs 12.5%; adjusted OR 4.29, 95% CI 1.65 to 11.14, p=0.003). Sensitivity analyses in patients with anterior-circulation ICAD lesions showed similar results in the associations between the plaque types and infarct load.ConclusionsUlcerative intracranial atherosclerotic plaques were associated with vulnerable morphological features and had a higher cumulative infarct load downstream.

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“…В связи с тем что системный атеросклеротический процесс осложняется развитием атеротромбоза, актуальным является изучение тромбоцитарного гемостаза, включая агрегационную активность тромбоцитов на различные индукторы у пациентов, перенесших как ИИ, так и реконструктивные операции на магистральных артериях головы. Известно, что риск ИИ при КС >50% составляет свыше 5% и ежегодно увеличивается, при этом ежегодный риск развития повторного ИИ составляет 5-9%, достигая 25-45% за 5-летний период [13][14][15]. Для профилактики ИИ применяется каротидная эндартерэктомия (КЭАЭ), эффективность которой в отношении предупреждения ИИ убедительно доказана [16][17][18].…”

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Dynamic of cerebrovascular disorders in patients with carotid stenosis

Pyshkina¹,

Абиева²,

Yasamanova³

et al. 2018

Z. nevrol. psikhiatr. im. S.S. Korsakova

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Цель исследования. Изучение состояния церебральной гемодинамики и тромбоцитарного гемостаза у пациентов с каротидным стенозом (КС). Материал и методы. Обследовали 123 пациентов с атеросклеротическим поражением сосудов каротидной системы. В 1-ю группу были включены 53 пациента (средний возраст 52±12,5 года), перенесшие каротидную эндартерэктомию (КЭАЭ), во 2-ю-70 больных с КС, которые лечились консервативно (средний возраст 58,5±15,9 года). Оценивали состояние кровотока по магистральным артериям головы (УЗДГ), агрегацию тромбоцитов, индуцированную адреналином, частоту острых сердечно-сосудистых событий, возникших на протяжении 12 мес. Результаты и заключение. Выраженность неврологического дефицита и когнитивных нарушений увеличивалась по мере нарастания степени КС. КЭАЭ приводит к улучшению показателей церебральной гемодинамики и стабилизации когнитивных функций. Неблагоприятное течение заболевания имело место у 23,6% больных (инсульт/инфаркт в течение года у 5,7%, прогрессирование ишемии головного мозга у 20%, рестеноз в течение 5 лет после КЭАЭ у 15%). У 53% оперированных и 60% неоперированных больных выявлены гиперагрегация тромбоцитов, индуцированная АДФ и адреналином, и сниженная агрегация тромбоцитов, индуцированная коллагеном на фоне приема АСК. Таким образом, применение комбинированной антиагрегантной терапии обеспечивает нормализацию тромбоцитарного гемостаза и снижение частоты острых сердечнососудистых событий. Ключевые слова: атеросклеротический стеноз сонных артерий, агрегация тромбоцитов, гемодинамика, каротидная эндартерэктомия, хроническая ишемия мозга, профилактика.

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Carotid Stenosis

Cited by 9 publications

References 11 publications

Variation in Carotid Artery Stenosis Measurements Among Facilities Seeking Carotid Stenting Facility Accreditation

Variation in Carotid Artery Stenosis Measurements Among Facilities Seeking Carotid Stenting Facility Accreditation

Plaque morphology in acute symptomatic intracranial atherosclerotic disease

Dynamic of cerebrovascular disorders in patients with carotid stenosis

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