Carotid wall thickness and stroke risk in patients with asymptomatic internal carotid stenosis

Silvestrini, Mauro; Cagnetti, Claudia; Pasqualetti, Patrizio; Albanesi, Carlo; Altamura, Claudia; Lanciotti, C.; Bartolini, Marco; Mattei, Francesca; Provinciali, Leandro; Vernieri, Fabrizio

doi:10.1016/j.atherosclerosis.2009.12.033

Cited by 33 publications

(27 citation statements)

References 26 publications

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“…To measure IMT, a semiautomatic software (QLAB version 8, Philips Medical Systems, Andover, MA, USA) was used to improve measurement reliability and reproducibility. 13,22 Examinations were performed by the same two experienced operators. Interreader reproducibility was assessed by having the two sonographers blindly selected and redigitized a B-mode CCA image from the 20-second videotape recording of a randomly selected set of 200 studies originally read by a third sonographer.…”

Section: Ultrasonographic Examinationmentioning

confidence: 99%

Ultrasonographic Markers of Vascular Risk in Patients with Asymptomatic Carotid Stenosis

Silvestrini

Altamura

Cerqua

et al. 2013

J Cereb Blood Flow Metab

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Six-hundred twenty-one subjects with unilateral asymptomatic severe internal carotid artery (ICA) stenosis were prospectively evaluated with a median follow-up of 27 months (min ¼ 6, max ¼ 68). Vascular risk profile, plaque characteristic, stenosis progression, and common carotid artery intima-media thickness (IMT) were investigated in all patients. Outcome measures were occurrence of ischemic stroke ipsilateral to ICA stenosis and vascular death, while myocardial infarction, contralateral strokes, and transient ischemic attack were considered as competing events. A total of 99 subjects (15.9%) suffered from a vascular event. Among them, 39 were strokes ipsilateral to the stenosis (6.3%). Degree of stenosis, stenosis progression, and common carotid artery IMT resulted as independent predictive factors of ipsilateral stroke. Considering a stenosis of 60% to 70% as reference, a degree between 71% and 90% increased the risk by 2.45, while a degree between 91% and 99% increased the risk by 3.26. The progression of stenosis was a strong risk factor (hazard ratio ¼ 4.32). Finally, the role of carotid IMT was confirmed as crucial additional measure, with an increased risk by 25% for each 0.1 mm IMT increase. Our data suggest that IMT, stenosis progression and severity should be considered as risk factors for cerebrovascular events in asymptomatic subjects with severe ICA stenosis.

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Section: Ultrasonographic Examinationmentioning

confidence: 99%

Ultrasonographic Markers of Vascular Risk in Patients with Asymptomatic Carotid Stenosis

Silvestrini

Altamura

Cerqua

et al. 2013

J Cereb Blood Flow Metab

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“…Ischemic vascular disease can have many causes, but if inducer-treated epilepsy patients were truly subject to higher rates of myocardial infarction and stroke from the aforementioned serologic alterations, one would expect that vascular disease in these patients would have an atherosclerotic etiology. Carotid intima-media thickness (CA-IMT) as assessed by ultrasound is considered to be a surrogate measure of atherogenesis and has been strongly correlated with risk of both stroke and myocardial infarction in several prospective studies [48–50]. One study of patients treated mainly with enzyme-inducing drugs showed higher CA-IMT relative to controls [51].…”

Section: Effects Of Aeds On Carotid Intima-media Thicknessmentioning

confidence: 99%

Antiepileptic Drugs and Markers of Vascular Risk

LoPinto-Khoury

Mintzer

2010

Curr Treat Options Neurol

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The most-used treatments for epilepsy worldwide are older-generation drugs such as phenytoin, carbamazepine, phenobarbital, and valproic acid, which have prominent enzymatic effects. Our sense of comfort with these treatments is starting to fade, however, as more and more potential long-term consequences of these drugs come to light. Epidemiologic studies demonstrate that ischemic disease of the heart and brain is more common among patients with epilepsy. Enzyme-inducing drugs are associated with elevations in a host of surrogate markers of vascular risk, suggesting that they could be responsible for increased rates of cardiovascular and cerebrovascular disease. The enzymeinhibiting drug valproate may have adverse consequences of its own pertaining to glucose and lipid metabolism. These effects stand in addition to those well established in the literature regarding bone metabolism, hormonal abnormalities, and drug-drug interactions. Because patients with epilepsy require medication for years, and often for life, it is difficult to justify the long-term use of these agents when there are capable alternatives. Many of the adverse effects of the older drugs appear to be rapidly reversible, prompting consideration of whether patients who are currently treated with these agents should be switched to alternative therapies, even in the absence of obvious side effects. Newer medications without effects on hepatic enzymes likely do not have these chronic metabolic consequences, and we recommend their use over older-generation drugs whenever possible.

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“…Increased carotid artery intima-media thickness (cIMT) is related to development of future cardiovascular events (Davis et al 2001;O'Leary et al 1999;Silvestrini et al 2010). It is regarded as an established marker of subclinical atherosclerosis, and has been suggested as a general measure of atherosclerosis burden (Zureik et al 2000).…”

Section: Introductionmentioning

confidence: 99%

Improved Correlation between Carotid and Coronary Atherosclerosis SYNTAX Score Using Automated Ultrasound Carotid Bulb Plaque IMT Measurement

Ikeda

Gupta

Dey³

et al. 2015

Ultrasound in Medicine & Biology

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Carotid wall thickness and stroke risk in patients with asymptomatic internal carotid stenosis

Cited by 33 publications

References 26 publications

Ultrasonographic Markers of Vascular Risk in Patients with Asymptomatic Carotid Stenosis

Ultrasonographic Markers of Vascular Risk in Patients with Asymptomatic Carotid Stenosis

Antiepileptic Drugs and Markers of Vascular Risk

Improved Correlation between Carotid and Coronary Atherosclerosis SYNTAX Score Using Automated Ultrasound Carotid Bulb Plaque IMT Measurement

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