The Fate of a Patent Carotid Artery Contralateral to an Occlusion

Brengman, Matthew L.; O’Donnell, Sean D.; Mullenix, Phillip; Goff, James M.; Gillespie, David L.; Rich, Norman M.

doi:10.1007/s100169910014

Cited by 13 publications

(6 citation statements)

References 10 publications

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“…21,22 A significant number of patients with carotid artery occlusion will require endarterectomy of the patent contralateral carotid because the disease is likely to progress rapidly on that side. 21 Patients with 60% to 69% asymptomatic carotid artery stenosis and contralateral carotid occlusion, even with maximum medical therapy, have a high incidence of late (mean follow-up, 59.5 months) strokes and TIAs (33% and 27%, respectively). 22 It is therefore crucial to identify these patients and implement therapeutic measures.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with ipsilateral ICAO should undergo routine investigation of the contralateral carotid artery more frequently than individuals without a history of ICAO. 21,22 Additionally, prophylactic carotid endarterectomy for 60% to 69% contralateral carotid artery stenosis has been advocated. 22 The results of other studies 24,25 also support the concept that in internal carotid arteries with a moderate degree of stenosis (defined as 50% or more 24 or 50% to 79% 25 ) the risk of progression of carotid stenosis increases steadily with time to severe stenosis or even complete occlusion In any 2 arterial beds 42 (35) In all 3 arterial beds 9 (7.5) CAD, coronary artery disease; PAD, peripheral arterial disease.…”

Section: Discussionmentioning

confidence: 99%

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Internal Carotid Artery Occlusion: Association With Atherosclerotic Disease in Other Arterial Beds and Vascular Risk Factors

Paraskevas

Mikhailidis

Liapis³

2007

Angiology

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The aim of this article is to investigate the association between internal carotid artery occlusion (ICAO) and the presence of atherosclerotic disease and vascular risk factors. The clinical characteristics and risk factors of 120 patients presenting with ICAO were retrospectively reviewed. All patients (n = 120) had at least 1 of the 4 vascular risk factor (diabetes, smoking, hypercholesterolemia, and hypertension); 2, 3, or all 4 risk factors were present in 14 to 82 of the patients (11.7% to 68.3%), 10 to 39 of the patients (8.3% to 32.5%), and 9 of the patients (7.5%), respectively. A total of 84 patients (70%) with ICAO had disease in at least 1 additional vascular bed (aorta, coronary or lower limb arteries). In addition to ICAO, vascular disease was present in 2 and all 3 of these arterial beds in 42 (35%) and 9 (7.5%) patients, respectively. Furthermore, stenosis or occlusion of the ipsilateral or contralateral vertebral arteries was recorded in 19 of 120 patients (15.8%). Regarding the contralateral carotid artery, 1 patient had bilateral ICAO. One patient had contralateral common carotid artery occlusion, and 1 patient was excluded from the analysis because of surgery to the contralateral carotid artery. Of the remaining 117 patients, 34 (29.0%) had less than 50% contralateral carotid artery stenosis. Thirty-two patients (27.4%) had 50% to 69%, and 51 (43.6%) had 70% to 99% stenosis. Ultrasonographic imaging of the carotid plaque of the contralateral carotid artery revealed that 52 of the 120 arteries (43.3%) were uniformly or predominantly echolucent (types I and II, respectively). Fifty-nine (49.2%) were predominantly or uniformly echogenic (types III and IV), and 9 (7.5%) could not be classified. A similar distribution of echomorphology was observed on the occluded side. ICAO is associated with widespread atherosclerotic disease and a high prevalence of vascular risk factors. Detection of ICAO should prompt the investigation of other arterial beds and treatment of risk factors.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Internal Carotid Artery Occlusion: Association With Atherosclerotic Disease in Other Arterial Beds and Vascular Risk Factors

Paraskevas

Mikhailidis

Liapis³

2007

Angiology

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“…Reported graft retention using this procedure vary from 40 to 75%, and therefore there is room for improvement in the efficacy of this procedure 9 . It has been found that the key to fat graft retention is maximizing the surface area to volume ratio, and the vascularity of the recipient area 10, 11. Studies have suggested that adipose derived stem cells can survive the period of hypoxia post surgery that is thought to result in the necrosis of conventional fat 11 .…”

Section: Introductionmentioning

confidence: 99%

Cell assisted lipotransfer in breast augmentation and reconstruction: A systematic review of safety, efficacy, use of patient reported outcomes and study quality

et al. 2016

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BackgroundCell assisted lipotransfer serves as a novel technique for both breast reconstruction and breast augmentation. This systematic review assesses the efficacy, safety and use of patient reported outcome measures in studies involving cell assisted lipotransfer. We also carry out an objective assessment of study quality focussing on recruitment, follow-up and provide an up-to-date clinical trial landscaping analysis.MethodsKey electronic databases were searched according to PRISMA guidelines and pre-defined inclusion and exclusion criteria. Two independent reviewers examined the retrieved publications and performed data extraction.Results3980 publications were identified. Following screening, 11 studies were included for full review, representing a total of 336 patients with a follow-up time ranging from six to 42 months. A degree of variation was noted in graft retention and reported satisfaction levels, although there were only three comparative studies with conflicting results. Complications occurred at a rate of 37%. Additionally, there was a paucity of objective outcomes assessments (e.g. 3D assessment modalities or validated patient reported outcome measures) in the selected studies.ConclusionsCell assisted lipotransfer is a surgical technique that is currently employed sparingly within the plastic & reconstructive surgery community. Presently, further technical and outcome standardization is required, in addition to rigorous randomized controlled trials and supporting long-term follow-up data to better determine procedural safety and efficacy. Routine use of more objective outcome measures, particularly 3D assessments and validated patient reported outcome measures, will also help facilitate wider clinical adoption and establish procedural utility.

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“…Although no consistent predictors of mortality have been identified, some investigators have suggested an increased risk with diabetes, hypertension, and age. 9,20,42,43 In this study, patients discovered to have carotid occlusion demonstrated an atherosclerotic profile with an older, male demographic and with associated risk factors, including smoking, hypertension, diabetes, and concurrent coronary and peripheral arterial occlusive disease. A significant number of these patients presented with a neurological deficit, but they did not distinguish themselves from their asymptomatic cohort other than showing trends for age, Caucasian race, and concurrent peripheral vascular disease.…”

Section: Discussionmentioning

confidence: 87%

“…Other investigators have also noted a high incidence of contralateral disease and of disease progression. 23,43 The role and associated risks of endarterectomy in this setting have been debated. Subgroup analysis of the Asymptomatic Carotid Atherosclerosis Study group suggested increased longer-term incidence of ipsilateral stroke in asymptomatic patients with unilateral carotid occlusion undergoing contralateral endarterectomy and indicated lack of long-term surgical benefit for this group.…”

Section: Discussionmentioning

confidence: 99%

Outcome Analysis of Carotid Artery Occlusion

Alexander

Moawad

Super

2007

Vasc Endovascular Surg

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The outcome of carotid artery occlusion was studied through the retrospective identification of 115 affected patients. The majority were white (77%) males (61%) with multiple atherogenic risk factors and suffering ipsilateral stroke (57%). Those patients presenting with stroke were not distinguished by demographic features, risk factors, lipid profile, medical regimen, or subsequent mortality when compared with those without. Overall, 36 patients (31%) required contralateral carotid endarterectomy (CEA), with one (2.8%) perioperative stroke, whereas 4 (3%) underwent ipsilateral external CEA without incident. With 81% follow-up (mean 3.9 years), the overall mortality of the group was 46%; the annualized risk of ipsilateral stroke was 1.6%. This study documents a significant risk of stroke and contralateral occlusive disease with ipsilateral carotid artery occlusion, which cannot be reliably predicted by clinical criteria. Duplex surveillance is valuable, but flow velocity measurements alone may be misleading. Surgical endarterectomy can be performed with an acceptable rate of perioperative stroke.

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The Fate of a Patent Carotid Artery Contralateral to an Occlusion

Cited by 13 publications

References 10 publications

Internal Carotid Artery Occlusion: Association With Atherosclerotic Disease in Other Arterial Beds and Vascular Risk Factors

Internal Carotid Artery Occlusion: Association With Atherosclerotic Disease in Other Arterial Beds and Vascular Risk Factors

Cell assisted lipotransfer in breast augmentation and reconstruction: A systematic review of safety, efficacy, use of patient reported outcomes and study quality

Outcome Analysis of Carotid Artery Occlusion

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