Benefit of Carotid Endarterectomy in Patients with Symptomatic Moderate or Severe Stenosis

Barnett, H. J. M.; Taylor, D. Wayne; Eliasziw, Michael; Aj, Fox; Ferguson, Gary G.; Haynes, R. Brian; Rankin, Richard N.; Clagett, G. Patrick; Hachinski, Vladimir; Sackett, David L.; Thorpe, Kevin E.; Meldrum, Heather; Spence, J. David

doi:10.1056/nejm199811123392002

Cited by 3,230 publications

(2,003 citation statements)

References 29 publications

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“…These results focus on the vessel lumen for purposes of comparison to x-ray angiography. The degrees of stenosis were divided into four categories, as commonly used (21). Three of the four patients in the Ͼ70% category subsequently received a carotid endarterectomy.…”

Section: Resultsmentioning

confidence: 99%

Performance of steady‐state free precession for imaging carotid artery disease

Zavodni

Emery

Wilman

2004

Magnetic Resonance Imaging

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Purpose: To evaluate steady-state free precession (SSFP) for diagnosing carotid artery disease. Materials and Methods:Following bilateral x-ray angiography, seven patients with suspected carotid artery disease were imaged with SSFP, black blood fast spin echo (BB FSE), and time-of-flight MR angiography (TOF MRA). The techniques were compared for characterizing the vessel lumen. Flow phantom experiments were also performed, using speeds of 0 to 40 cm/second, to further evaluate the merits of each MR technique.

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Section: Resultsmentioning

confidence: 99%

Performance of steady‐state free precession for imaging carotid artery disease

Zavodni

Emery

Wilman

2004

Magnetic Resonance Imaging

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“…[19][20][21][22] Outcome of these studies was a clinical cerebrovascular event, whether visible on computer tomography (CT) or not. As CMIs are too small to visualize on CT, they were not taken into account in this setting.…”

Section: Discussionmentioning

confidence: 99%

7.0 T MRI Detection of Cerebral Microinfarcts in Patients with a Symptomatic High-Grade Carotid artery Stenosis

Rotte

Köning

Hartog

et al. 2014

J Cereb Blood Flow Metab

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In the current study, the presence of cerebral cortical microinfarcts (CMIs) was evaluated in a series of 21 patients with a symptomatic high-grade 450% stenosis of the carotid artery. A T 2 -weighted fluid-attenuated inversion recovery sequence and a T 1 -weighted turbo field echo sequence of the brain were obtained at 7.0 Tesla magnetic resonance imaging. Primary study endpoint was the number of CMIs and macroinfarcts. In total, 53 cerebral infarcts (35 macroinfarcts; 18 CMIs) were found ipsilateral to the symptomatic carotid artery, in 14 patients (67%). In four of these patients, both CMIs and macroinfarcts were visible. In the contralateral hemisphere, seven infarcts (five macroinfarcts and two CMIs) were found in five patients (24%). In the ipsilateral hemispheres, the number of CMIs and macroinfarcts were significantly correlated (P = 0.02). Unpaired comparison of medians showed that the number of CMIs in the ipsilateral hemisphere was significantly higher than the number of CMIs in the contralateral hemisphere (P = 0.04). No significant correlation was found between stenosis grade and the number of any infarct. The current study shows that in symptomatic patients with significant extracranial carotid artery stenosis, CMIs are part of the total cerebrovascular burden and these CMIs prevail with a similar pattern as observed macroinfarcts.

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“…[99][100][101][102][103][104][105][106] In patients with ischemia in the territory of a stenotic carotid artery, CEA within the first 2 weeks reduces the risk of stroke, 35,93 but the benefit of surgery diminishes with time after the initial event. 107 Transient monocular blindness (amaurosis fugax) is caused by temporary reduction of blood flow to an eye.…”

Section: Clinical Assessment Of Patients With Focal Cerebral Ischemicmentioning

confidence: 99%

“…37 Over 5 years, the rate of ipsilateral stroke, including perioperative events, was 15.7% with CEA compared with 22% for medically managed patients. 35,37,86,167 The ECST (European Carotid Surgery Trial), which was nearly concurrent with NASCET, randomized 2518 patients with stenosis using a different method of measurement whereby the minimal residual lumen through the zone of stenosis was compared with the ECVD Guideline: Executive Summary E93 estimated diameter of the carotid bulb rather than the distal internal carotid artery ( Figure 3). The study found a benefit of CEA for patients with 70% to 99% stenosis but no benefit in those with milder stenosis.…”

Section: Symptomatic Patientsmentioning

confidence: 99%