Secondary Stroke Prevention in the Era of Carotid Stenting

Hassoun, Heitham T.; Malas, Mahmoud B.; Freischlag, Julie A.

doi:10.1001/archsurg.2010.204

Cited by 6 publications

(3 citation statements)

References 39 publications

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“…CAS is believed to prevent stroke as a less invasive alternative to carotid endarterectomy (CEA) in selected patients with symptomatic carotid stenosis [14] [15], but its influence on cognitive performance in patients remains controversial [16] [17]. The results in our study agreed with the results from previous reports which have shown improvements in cognitive function in patients treated with carotid stent placement [18]- [22].…”

Section: Discussionsupporting

confidence: 88%

Effect of Carotid Artery Stenting and Extracranial-Intracranial By-Pass on Cognitive Function: Preliminary Results

Liu¹,

Zhou²

2015

IJCM

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Background: To compare the neuropsychological consequences after carotid artery stenting (CAS) and extracranial-intracranial bypass (EC-IC bypass). Methods: A total of 43 patients referred to CAS, 32 patients referred to EC-IC bypass and 43 control subjects were enrolled in the study. Neuropsychologic testing was performed before and three months after procedure. A paired Student t test was used to compare neuropsychologic test scores at baseline and three months after procedure in each group. Cognitive changes in a three-month follow-up were not normally distributed and compared among/between groups with Kruskal-Wallis test. Results: Three months after the treatment both the CAS and EC-IC bypass groups showed improved cognitive performance compared to baseline, whereas the same improvement wasn't seen in the control group. The scores from Activities of Daily Living also improved in all three groups in a three-month follow-up, and EC-IC group presented a more distinct increase in daily life abilities comparing to the other two groups. Conclusions: CAS and EC-IC bypass in patients with a carotid or intracranial stenosis may result in cognitive improvement three months after surgery.

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Section: Discussionsupporting

confidence: 88%

Effect of Carotid Artery Stenting and Extracranial-Intracranial By-Pass on Cognitive Function: Preliminary Results

Liu¹,

Zhou²

2015

IJCM

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“…Several randomized trials have compared treatment modalities for carotid stenosis in the prevention of disease progression, stroke and death [16][17][18][19][20][21]. The investigators in these trials have consistently identified proper patient selection as the key to maximize benefits from each treatment modality.…”

Section: Discussionmentioning

confidence: 99%

Predicting Stroke Risk in Patients with Carotid Artery Stenosis Using Contrast Enhanced Carotid Duplex Ultrasound to Quantify Plaque Vasa-Vasorum Volume: Results of a Pilot Study

Malas¹,

Arhuidese²,

Nejim³

et al. 2017

J Vasc Endovasc Surg

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Introduction:In selecting patients for carotid revascularization, relying solely on symptoms and/or degree of stenosis is not sufficient. Patients with severe stenosis often remain asymptomatic, while other patients with moderate stenosis experience stroke. In contemporary practice, surgery or intervention is carried out much more often in asymptomatic patients. With the advent of improved medical management, the indications for surgery or intervention in the asymptomatic have become unclear. We utilized a technique for measuring Plaque Vasavasorum Volume (PVV) using Contrast Enhanced Carotid Duplex Ultrasound (CE-CDU) as a novel method for identifying asymptomatic patients with carotid artery stenosis who are at highest risk for stroke and thus more likely to benefit from early revascularization.Objective: To establish the diagnostic accuracy and reliability of PVV measured by CE-CDU in identifying high risk carotid plaques and to identify a diagnostic cut-off point beyond which the risk of stroke exceeds the risk of surgery/intervention in asymptomatic patients with carotid stenosis. Methods:The Stroke Prevention with Plaque Vasa-vasorum in Carotid Stenosis Study (SPIVICS) is a two phase multi-center double blinded prospective study. The first phase is a cross-sectional study of patients who qualify for carotid endarterectomy per current guidelines (asymptomatic patients with >70% stenosis and symptomatic patients with >50% stenosis). End points are analyzed using standard univariate and multivariate regression, correlation and diagnostic analyses.Outcomes: Primary outcome relating to plaque morphology is the PVV volume. Clinical outcomes are neurologic symptoms (Amaurosis fugax, transient ischemic attack, and stroke) and asymptomatic events detected on imaging.Results: A total of 16 patients were examined in this pilot study. Three were leadin subjects and four of them had severe calcified plaque and VV was not visualized. For those who had a successful screen, Mean age was 69 (± 7) years, Five males and the mean plaque VVV was 0.29 (± 0.62) mm. Conclusion:Plaque Vasa-vasorum Volume is a promising predictor of stroke risk. By identifying patients who are truly at high risk for stroke, PVV measured by CE-CDU will establish more reliable criteria for patient selection for intervention. This in turn will help with stroke prevention, limit disability, save lives, and expend health care resources in a more selective manner.

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“…3 Buoyed by advancements in endovascular therapy, carotid artery angioplasty and stenting has increased in popularity and utility, primarily for atherosclerotic occlusive disease. 4,5 However, neither an open nor endovascular approach to treat the cervical carotid artery has been reported for this rare problem because fibrosing mediastinitis, as its name indicates, is generally confined to the mediastinum. Interestingly in this case, the cervical carotid artery at the carotid bifurcation was involved by direct extension of the fibrosing mass from the mediastinum extending up the right neck.…”

Section: Discussionmentioning

confidence: 99%

Endovascular management of carotid artery stenosis secondary to sclerosing mediastinitis

Smolock

Blackmon

Garami

et al. 2012

Journal of Vascular Surgery

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Sclerosing mediastinitis is a rare, progressive condition characterized by extensive fibrotic reaction. We report the first known case of symptomatic, extrinsic compression of the carotid artery by fibrotic extension of sclerosing mediastinitis. A 54-year-old woman began experiencing neurologic symptoms from extension of a known mediastinal mass resulting in 70% to 79% stenosis of the right internal carotid artery. The stenosis was treated with endovascular stenting. Completion angiogram revealed a good result with <10% residual stenosis. At 18-month follow-up, the patient was symptom free without evidence of re-stenosis. Endovascular therapy provides a novel and durable solution in the midterm to this very rare problem.

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Secondary Stroke Prevention in the Era of Carotid Stenting

Cited by 6 publications

References 39 publications

Effect of Carotid Artery Stenting and Extracranial-Intracranial By-Pass on Cognitive Function: Preliminary Results

Effect of Carotid Artery Stenting and Extracranial-Intracranial By-Pass on Cognitive Function: Preliminary Results

Predicting Stroke Risk in Patients with Carotid Artery Stenosis Using Contrast Enhanced Carotid Duplex Ultrasound to Quantify Plaque Vasa-Vasorum Volume: Results of a Pilot Study

Endovascular management of carotid artery stenosis secondary to sclerosing mediastinitis

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