V. Asymptomatic Cerebrovascular Diseases

Shinohara, Yukito; Yanagihara, Takehiko; Abe, Kōji; Yoshimine, Toshiki; Fujinaka, Toshiyuki; Chuma, Takayo; Ochi, Fumio; Nagayama, Masao; Suzuki, Noriyuki; Katayama, Yasuo; Kimura, Akio; Kayama, Takamasa

doi:10.1016/j.jstrokecerebrovasdis.2011.05.012

Cited by 9 publications

(39 citation statements)

References 128 publications

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“…On the basis of reports thereafter about the natural history, especially of small UIAs, risk factors for aneurysmal rupture and SAH resulting from small aneurysms, the Japan Stroke Society released statements for the management of UIAs within guidelines for the management of stroke, 15 and relatively clear recommendations for UIA management have also been reported. 16 Morita et al 6 (Unruptured Cerebral Aneurysm Study [UCAS] Japan Investigators) documented 111 patients with a 0.95% annual rate of rupture during a follow-up comprising 11 660 aneurysm-years.…”

Section: Discussionmentioning

confidence: 99%

“…However, the patients were a mean of 10 years, and most aneurysms (87.3%) were <10 mm. Although the Japanese guidelines recommend treating UIAs ≥5 mm in maximal diameter, 15 UIAs <5 mm account for 35.4% of the total; Oishi et al 10 reported that 223 (44.6%) of 500 small (<10 mm in diameter) treated UIAs were <5 mm. As part of the annual health checks characteristic of the unique Japanese healthcare system, complete physical examinations and whole brain screenings are widespread, and more small UIAs have been discovered through these routine procedures than elsewhere.…”

Section: Discussionmentioning

confidence: 99%

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Endovascular Therapy for Asymptomatic Unruptured Intracranial Aneurysms

Shigematsu

Fujinaka

Yoshimine

et al. 2013

Stroke

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Background and Purpose— National registration studies (the Japanese Registry of Neuroendovascular Therapy [JR-NET] and JR-NET2) have determined the current status and outcomes of neuroendovascular therapy (neuro-EVT). We analyzed short-term outcomes of EVT for asymptomatic unruptured intracranial aneurysms (UIAs). Methods— We extracted periprocedural information about EVT for 4767 asymptomatic UIAs from 31 968 registered procedural records of all EVT in the JR-NET and JR-NET2 databases. We assessed the features of the aneurysms and procedures, immediate radiographic findings, procedure-related complications, and clinical outcomes at 30 days after the procedures. Results— We located 80.0% of UIAs in the anterior circulation, and the most frequent were paraclinoid. The diameter of 2.5%, 32.9%, 51.9%, 12.0%, and 0.7% of the UIAs was <3, 3 to 4, 5 to 9, 10 to 19, and >20 mm, respectively. EVT failed in only 2.1%. Adjunctive techniques were applied in 54.8% of procedures. Pre- and postprocedural antiplatelet agents were prescribed in 85.6% and 84.0%, respectively, of the procedures. The immediate radiographic outcomes of 57.7%, 31.9%, and 10.0% of the UIAs comprised complete occlusion, residual necks, and residual aneurysms, respectively. Complications that were associated with 9.1% of procedures comprised 2.0% hemorrhagic and 4.6% ischemic, and the 30-day morbidity and mortality rates were 2.12% and 0.31%, respectively. Conclusions— The radiographic results of EVT for asymptomatic UIAs in Japan were acceptable, with low mortality and morbidity rates.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Endovascular Therapy for Asymptomatic Unruptured Intracranial Aneurysms

Shigematsu

Fujinaka

Yoshimine

et al. 2013

Stroke

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“…[27][28][29][30][31][32][33][34][35][36][37][38][39]41,42,[46][47][48]50,51,[53][54][55][56][57][58][59]61,62 All 33 guidelines with procedural recommendations for SCS covered the moderate and severe ranges, except one which just covered the severe range (>70%) 40 and another that covered the moderate (50%-69%) range only if defined by conventional angiography. 41 Where the method of measuring SCS was indicated (17 guidelines), it was by the NASCET method 27,28,33,34,[36][37][38]40,41,[46][47][48][49]52,55,56,58,59 or by the NASCET or ECST method. [23][24...…”

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confidence: 99%

“…According to the European Society for Vascular Surgery guidelines, 32 average-CEA-risk refers to patients who would fulfill the inclusion criteria for the randomized trials of medical treatment alone versus additional CEA 72-78 and, therefore, high-CEA-risk refers to those who would not meet these criteria. Two guidelines 41,46,47 cited the Stenting and Angioplasty With Protection in Patients at High Risk for Endarterectomy Trial (SAPPHIRE) 79 for defining high-CEA-risk clinical scenarios. Twenty-nine guidelines included specific recommendations for the use of CAS for patients with high-CEA-risk ACS 28,31,32,[35][36][37][38]41,[43][44][45][46][47][55][56][57][58]62,63 or SCS,27,28,[31][32][33][34][35][36][38][39][40][41][42][44][45][46][47][48][49][50][51][52][53][54]…”

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confidence: 99%

“…28,[31][32][33]36,38,40,41,[44][45][46][47][50][51][52][53]55,56,58,61 Examples of high-CEA-risk because of medical comorbidities were age >80 years, New York Heart Association class III or IV heart failure, cardiac ejection fraction <30%, class III or IV angina, left main or multivessel coronary artery disease, severe uncorrectable coronary artery disease, myocardial infarction (MI) within 4 weeks, need for cardiac surgery within 30 days, severe lung disease and obesity. were used to substantiate a nonprocedural approach to ACS. …”

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confidence: 99%

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Systematic Review of Guidelines for the Management of Asymptomatic and Symptomatic Carotid Stenosis

Abbott

Paraskevas

Kakkos

et al. 2015

Stroke

250

212

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Background and Purpose-We systematically compared and appraised contemporary guidelines on management of asymptomatic and symptomatic carotid artery stenosis. Methods-We systematically searched for guideline recommendations on carotid endarterectomy (CEA) or carotid angioplasty/stenting (CAS) published in any language between January 1, 2008, and January 28, 2015. Only the latest guideline per writing group was selected. Each guideline was analyzed independently by 2 to 6 authors to determine clinical scenarios covered, recommendations given, and scientific evidence used. Results-Thirty-four eligible guidelines were identified from 23 different regions/countries in 6 languages. Of 28 guidelines with asymptomatic carotid artery stenosis procedural recommendations, 24 (86%) endorsed CEA (recommended it should or may be provided) for ≈50% to 99% average-surgical-risk asymptomatic carotid artery stenosis, 17 (61%) endorsed CAS, 8 (29%) opposed CAS, and 1 (4%) endorsed medical treatment alone. For asymptomatic carotid artery stenosis patients considered high-CEA-risk because of comorbidities, vascular anatomy, or undefined reasons, CAS was endorsed in 13 guidelines (46%). Thirty-one of 33 guidelines (94%) with symptomatic carotid artery stenosis procedural recommendations endorsed CEA for patients with ≈50% to 99% average-CEA-risk symptomatic carotid artery stenosis, 19 (58%) endorsed CAS and 9 (27%) opposed CAS. For high-CEA-risk symptomatic carotid artery stenosis because of comorbidities, vascular anatomy, or undefined reasons, CAS was endorsed in 27 guidelines (82%). Guideline procedural recommendations were based only on results of trials in which patients were randomized 12 to 34 years ago, rarely reflected medical treatment improvements and often understated potential CAS hazards. Qualifying terminology summarizing recommendations or evidence lacked standardization, impeding guideline interpretation, and comparison. This systematic review of contemporary international guidelines was performed to compare and appraise recommendations for the management of patients with ACS and SCS (including accessibility, organization, clarity, and consistency) and the evidence used in making these recommendations. Conclusions-This Methods Guideline SearchesGuidelines with recommendations on the use of CEA or CAS or both patients with ACS or SCS or both were sought systematically using popular search engines, bibliographies, and author professional networks. PubMed and ISI Web of Knowledge were searched independently and synchronously by 2 authors on September 9, 2013 (A.L.A., K.I.P.). PubMed was searched using carotid guideline and then stroke guideline in the title, yielding 91 references after duplicate removal. ISI Web of Knowledge was searched using carotid and guideline and then stroke and guideline in the title, yielding 422 references after removal of duplicates, abstracts, reference materials, letters, corrections, meetings, news, and case reports. Wider searches using the words carotid or stroke and guideline in any ...

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