Severity of Asymptomatic Carotid Stenosis and Risk of Ipsilateral Hemispheric Ischaemic Events: Results from the ACSRS Study

Nicolaides, Andrew; Kakkos, Stavros K.; Griffin, Maura; Sabetai, Michael M.; Dhanjil, Surinder; Tegos, Thomas; Thomas, Dafydd J.; Giannoukas, A.; Geroulakos, George; Georgiou, Niki; Francis, Susan; Ioannidou, Eleni; Doré, Caroline J

doi:10.1016/j.ejvs.2005.04.031

Cited by 215 publications

(129 citation statements)

References 31 publications

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“…However, currently there is a discrepancy between these scientific studies and clinical practice; despite of many publications and discussions, plaque imaging techniques are not really the basics of clinical decision making or current guidelines and in the majority of cases decision towards revascularization are not based on plaque morphology but on the degree of stenosis [108][109][110]. Evaluation of the role of predictive effects of the previously described imaging parameters are needed and further studies are necessary to incorporate the potential of the advanced imaging techniques in the identification of the vulnerable plaque to selection of the therapeutical approach.…”

Section: Clinical Practice and Results From The Scientific Studiesmentioning

confidence: 99%

Imaging of the Carotid Artery Vulnerable Plaque

Saba¹,

Anzidei

Marincola

et al. 2013

Cardiovasc Intervent Radiol

111

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Atherosclerosis involving the carotid arteries has a high prevalence in the population worldwide. This condition is significant because accidents of the carotid artery plaque are associated with the development of cerebrovascular events. For this reason, carotid atherosclerotic disease needs to be diagnosed and those determinants that are associated to an increased risk of stroke need to be identified. The degree of stenosis typically has been considered the parameter of choice to determine the therapeutical approach, but several recently published investigations have demonstrated that the degree of luminal stenosis is only an indirect indicator of the atherosclerotic process and that direct assessment of the plaque structure and composition may be key to predict the development of future cerebrovascular ischemic events. The concept of ''vulnerable plaque'' was born, referring to those plaque's parameters that concur to the instability of the plaque making it more prone to the rupture and distal embolization. The purpose of this review is to describe the imaging characteristics of ''vulnerable carotid plaques.''

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Section: Clinical Practice and Results From The Scientific Studiesmentioning

confidence: 99%

Imaging of the Carotid Artery Vulnerable Plaque

Saba¹,

Anzidei

Marincola

et al. 2013

Cardiovasc Intervent Radiol

111

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“…41,42 Concerning stent placement in these patients, one should consider other risk criteria and not only the stenosis degree. 43 …”

Section: Limitationsmentioning

confidence: 99%

Unprotected Carotid Artery Stenting in Symptomatic Patients with High-Grade Stenosis: Results and Long-Term Follow-Up in a Single-Center Experience

Oteros¹,

Jimenez-Gomez²,

Bravo-Rodríguez³

et al. 2012

AJNR Am J Neuroradiol

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“…22,23 The present study also shows that diabetes and previous contralateral symptoms were independent risk factors for neurological events ipsilateral to an asymptomatic carotid stenosis, which confirms the results of previous studies. 4,24 Although advanced age and hypertension are well-recognized risk factors for stroke, in this study they were not independent risk factors for ischemic neurological events ipsilateral to a carotid stenosis. This lack of association has also been reported previously.…”

Section: Discussionmentioning

confidence: 76%

Progression Rate and Ipsilateral Neurological Events in Asymptomatic Carotid Stenosis

Hirt¹

2014

Stroke

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Background and Purpose— Progression of asymptomatic carotid stenoses with >50% luminal narrowing is associated with an increased risk of stroke. The significance of the progression rate in these patients is unknown. The main aim of this study was to evaluate the rate of change of carotid luminal narrowing over 1 year, as a risk factor for ipsilateral ischemic events, in patients with a >50% asymptomatic carotid stenosis. Secondary aims were to establish the incidence of changes in carotid luminal narrowing and establish additional risk factors for ipsilateral neurological events. Methods— A retrospective analysis was conducted of data derived from the deferred endarterectomy arm of the Asymptomatic Carotid Surgery Trial. Patients were followed up for ≥5 years with serial carotid duplex examinations. Data were derived from information obtained at randomization and annual follow-up visits with carotid duplex examination. Potential risk factors for ipsilateral neurological events were analyzed in Poisson regression models. Results— Data from 1469 patients were included. Two hundred forty-four had ipsilateral events; 240 had ipsilateral carotid surgery; 370 died from nonstroke causes; and 82 had an asymptomatic carotid occlusion. The annual incidence of progression in the cohort as a whole was 5.2%. Ipsilateral events occurred in 17% of patients. Diabetes and previous contralateral symptoms showed a significant independent association with ipsilateral neurological events. Ipsilateral events were associated with high rates of progression over 1 year but not with low progression rates or regression. Conclusions— Fast rates of progression of carotid luminal narrowing should be interpreted as a sign of significantly increased risk of future ipsilateral neurological events.

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Severity of Asymptomatic Carotid Stenosis and Risk of Ipsilateral Hemispheric Ischaemic Events: Results from the ACSRS Study

Cited by 215 publications

References 31 publications

Imaging of the Carotid Artery Vulnerable Plaque

Imaging of the Carotid Artery Vulnerable Plaque

Unprotected Carotid Artery Stenting in Symptomatic Patients with High-Grade Stenosis: Results and Long-Term Follow-Up in a Single-Center Experience

Progression Rate and Ipsilateral Neurological Events in Asymptomatic Carotid Stenosis

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