Society for Vascular Surgery clinical practice guidelines for management of extracranial cerebrovascular disease

AbuRahma, Ali F.; Avgerinos, Efthymios Makis; Chang, Robert W.; Darling, R. Clement; Duncan, Audra A.; Forbes, Thomas L.; Malas, Mahmoud B.; Murad, Mohammad Hassan; Perler, Bruce A.; Powell, Richard J.; Rockman, Caron B.; Wei, Zhou

doi:10.1016/j.jvs.2021.04.073

Cited by 318 publications

(252 citation statements)

References 158 publications

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“…Vascular ultrasound-based imaging techniques allow relatively inexpensive and nonevasive widely available means to detect VC and to differentiate between Mönckeberg's medial calcific sclerosis and the atherosclerosis-related lesions and assess arterial wall abnormalities, such as intima-medial wall thickening and endothelial dysfunction [ 21 ]. This has been well described within peripheral arterial disease, predominantly chronic limb threatening ischemia [ 22 ] and carotid atherosclerosis [ 23 ] where US is a valuable tool for disease and risk assessment, indicated by the guidelines. Our findings are in line with the consistent evidence that VCs affects the entire arterial tree, adding another vessel to the puzzle and draws attention upon careful radial artery evaluation, especially when US is performed before and during cannulation anyhow.…”

Section: Discussionmentioning

confidence: 99%

Radial Artery Calcification in Predicting Coronary Calcification and Atherosclerosis Burden

Achim

Kákonyi

Nagy

et al. 2022

Cardiology Research and Practice

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Background. Atherosclerosis is a systemic arterial disease with heterogeneous involvement in all vascular beds; however, studies examining the relationship between coronary and radial artery calcification are lacking. The purpose of this study was to assess the relationship between the two sites and the prognostic value of radial artery calcification (RC) for coronary artery disease. Methods. This is a single-center, retrospective cross-sectional study based on Doppler ultrasound of radial artery (RUS) and coronary artery angiography (CAG). We included a total of 202 patients undergoing RUS during distal radial access and CAG at the same procedure, between December 2020 and May 2021, from which 103 were found having RC during RUS (RC group) and 99 without (NRC group). Coronary calcifications were evaluated either by angiography examination (moderate and severe), positive CT (>100 Agatson units), or intracoronary imaging (IVUS, OCT). Results. A significant correlation was observed between radial calcification and coronary calcification variables (67.3% vs. 32.7%, p = 0.001 ). The correlation between risk factors such as age, smoking, chronic kidney disease, and diabetes mellitus was higher while sex did not play a role. The need of PCI and/or CABG was higher in the RC group (60% vs. 44%, p = 0.02 ). RC, therefore, predicts the extent and severity of coronary artery disease. Conclusion. RC may be frequently associated with calcific coronary plaques. These findings highlight the potential beneficial examination of radial arteries whenever CAD is suspected.

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Section: Discussionmentioning

confidence: 99%

Radial Artery Calcification in Predicting Coronary Calcification and Atherosclerosis Burden

Achim

Kákonyi

Nagy

et al. 2022

Cardiology Research and Practice

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“…We are performing an updated critical comparative audit of guidelines regarding carotid "revascularization" procedures. Unfortunately, the procedural biases mentioned above are still common, including in the most recently published guidelines (145)(146)(147). At least with respect to asymptomatic carotid stenosis patients, guidelines from Australia and Denmark discourage CEA and CAS or screening (148)(149)(150).…”

Section: What the Guidelines Saymentioning

confidence: 99%

Extra-Cranial Carotid Artery Stenosis: An Objective Analysis of the Available Evidence

Abbott

2022

Front. Neurol.

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Background and PurposeCarotid stenosis is arterial disease narrowing of the origin of the internal carotid artery (main brain artery). Knowing how to best manage this is imperative because it is common in older people and an important cause of stroke. Inappropriately high expectations have grown regarding the value of carotid artery procedures, such as surgery (endarterectomy) and stenting, for lowering the stroke risk associated with carotid stenosis. Meanwhile, the improving and predominant value of medical intervention (lifestyle coaching and medication) continues to be underappreciated.Methods and ResultsThis article aims to be an objective presentation and discussion of the scientific literature critical for decision making when the primary goal is to optimize patient outcome. This compilation follows from many years of author scrutiny to separate fact from fiction. Common sense conclusions are drawn from factual statements backed by original citations. Detailed research methodology is given in cited papers. This article has been written in plain language given the importance of the general public understanding this topic. Issues covered include key terminology and the economic impact of carotid stenosis. There is a summary of the evidence-base regarding the efficacy and safety of procedural and medical (non-invasive) interventions for both asymptomatic and symptomatic patients. Conclusions are drawn with respect to current best management and research priorities. Several “furphies” (misconceptions) are exposed that are commonly used to make carotid stenting and endarterectomy outcomes appear similar. Ongoing randomized trials are mentioned and why they are unlikely to identify a routine practice indication for carotid artery procedures. There is a discussion of relevant worldwide guidelines regarding carotid artery procedures, including how they should be improved. There is an outline of systematic changes that are resulting in better application of the evidence-base.ConclusionThe cornerstone of stroke prevention is medical intervention given it is non-invasive and protects against all arterial disease complications in all at risk. The “big” question is, does a carotid artery procedure add patient benefit in the modern era and, if so, for whom?

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“…There are several reasons that require carotid imaging, the predominant being evaluation after a cerebrovascular event but also for CVD screening, risk stratification, and prevention as well as for surveillance after a carotid procedure [1,3].…”

Section: The Role Of Carotid Arteries Imagingmentioning

confidence: 99%

“…Imaging of the carotid bifurcation is essential in all patients with symptoms of cerebral ischemia, whether they present as a TIA or complete stroke [1,3]. If significant carotid artery disease is identified as the source of symptoms, these patients are candidates for a carotid intervention to prevent a secondary stroke [3].…”

Section: The Role Of Carotid Arteries Imagingmentioning

confidence: 99%

International Union of Angiology (IUA) consensus paper on imaging strategies in atherosclerotic carotid artery imaging: From basic strategies to advanced approaches

Saba

Antignani²,

Gupta

et al. 2022

Atherosclerosis

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Society for Vascular Surgery clinical practice guidelines for management of extracranial cerebrovascular disease

Cited by 318 publications

References 158 publications

Radial Artery Calcification in Predicting Coronary Calcification and Atherosclerosis Burden

Radial Artery Calcification in Predicting Coronary Calcification and Atherosclerosis Burden

Extra-Cranial Carotid Artery Stenosis: An Objective Analysis of the Available Evidence

International Union of Angiology (IUA) consensus paper on imaging strategies in atherosclerotic carotid artery imaging: From basic strategies to advanced approaches

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