Carotid ultrasound findings as a predictor of long-term survival after abdominal aortic aneurysm repair: a 14-year prospective study

Liapis, Christos D.; Kakisis, John D.; Dimitroulis, Dimitrios; Daskalopoulos, Marios E.; Nikolaou, Alexios; Kostakis, A.

doi:10.1016/s0741-5214(03)00716-x

Cited by 26 publications

(18 citation statements)

References 36 publications

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“…In another study, it was shown that in 208 patients electively operated for an AAA, the presence of an asymptomatic CAS of 50% or greater was independently associated with vascular mortality (HRϭ3.6, 95% CIϭ1.3 to 10.1) and morbidity (HRϭ4.0, 95% CIϭ1.8 to 9.0). 13 These studies and our present study indicate that, overall, in patients with clinical manifestations of arterial disease, the presence of asymptomatic CAS (Ն50%) is a risk indicator of new vascular events. One of the differences between the previous studies and this study is that our study was conducted in a large prospective cohort of patients with well-defined diagnostic inclusion criteria of manifest arterial disease.…”

Section: Discussionsupporting

confidence: 76%

“…Two small studies, restricted to patients with coronary heart disease (CHD) or abdominal aortic aneurysm (AAA), also reported an increased risk of vascular death or MI in patients with asymptomatic CAS. 12,13 The aim of the present large prospective cohort study was to examine the relation between asymptomatic carotid artery stenosis and the risk of vascular events in patients with various clinical manifestations of arterial disease or presence of type 2 diabetes mellitus but without a history of cerebrovascular disease.…”

mentioning

confidence: 99%

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Asymptomatic Carotid Artery Stenosis and the Risk of New Vascular Events in Patients With Manifest Arterial Disease

Goessens

Visseren

Kappelle

et al. 2007

Stroke

207

125

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for the SMART Study GroupBackground and Purpose-The frequency of asymptomatic carotid artery stenosis (CAS) increases with age from 0.5% in individuals below 50 years of age to 5% to 10% in individuals over 65 years of age in the general population. Its prognostic value has been examined in the general population but less often in patients with clinical manifestations of arterial disease other than retinal or cerebral ischemia. We examined the relationship between asymptomatic CAS and the risk of subsequent events in this specific group of patients. Methods-This study involved 2684 consecutive patients with clinical manifestations of arterial disease or type 2 diabetes mellitus, but without a history of cerebral ischemia, enrolled in the SMART study (Second Manifestations of ARTerial disease). The degree of asymptomatic CAS was assessed with Duplex scanning and defined on the basis of the blood flow velocity patterns at baseline in both carotid arteries. None of the patients underwent carotid endarterectomy or endovascular intervention. During the follow-up period, vascular events (vascular death, ischemic stroke, and myocardial infarction) were documented in detail. Data were analyzed with Cox proportional hazards regression and adjusted for age, gender, and classic vascular risk factors. Results-Asymptomatic CAS of 50% or greater was present in 221 (8%) patients. During a mean follow up of 3.6 years (SDϭ2.3), a first vascular event occurred in 253 patients (9%). The cumulative incidence rate for the composite of subsequent vascular events after 5 years was 12.3% (95% CIϭ10.7 to 13.9), for cerebral infarction 2.2% (95% CIϭ1.4 to 2.8), and for myocardial infarction 8.0% (95% CIϭ6.6 to 9.4). Adjusted for age and gender, asymptomatic CAS of 50% or greater was related to a higher risk of subsequent vascular events (hazard ratioϭ1.5, 95% CIϭ1.1 to 2.1), in particular of vascular death (hazard ratioϭ1.8, 95% CIϭ1.2 to 2.6). After additional adjustment for vascular risk factors, the hazard ratios remained essentially the same. Conclusion-Asymptomatic carotid artery stenosis is an independent predictor of vascular events, especially vascular death, in patients with clinical manifestations of arterial disease or type 2 diabetes but without a history of cerebral ischemia.

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Section: Discussionsupporting

confidence: 76%

mentioning

confidence: 99%

Asymptomatic Carotid Artery Stenosis and the Risk of New Vascular Events in Patients With Manifest Arterial Disease

Goessens

Visseren

Kappelle

et al. 2007

Stroke

207

125

View full text Add to dashboard Cite

show abstract

“…Smaller studies have suggested that the incidence of severe coronary artery disease in people with an AAA remains at about 50 per cent 10 . The incidence of significant carotid artery stenosis among people with an AAA is much less, with one study reporting that only 25 per cent had stenosis of more than 50 per cent in at least one carotid artery 11 .…”

Section: Introductionmentioning

confidence: 99%

Incidence of cardiovascular events and death after open or endovascular repair of abdominal aortic aneurysm in the randomized EVAR trial 1

Brown

Thompson

Greenhalgh

et al. 2011

British Journal of Surgery

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“…Patients who suffer from carotid artery stenosis are more prone to develop clinically relevant atherosclerotic disease at other predilection sites compared with a healthy population [20][21][22][23]. For this purpose, duplex derived intima media thickness is often used as a surrogate endpoint in pharmaceutical studies [24].…”

Section: Rationalementioning

confidence: 99%

Athero-express: Differential atherosclerotic plaque expression of mRNA and protein in relation to cardiovascular events and patient characteristics. Rationale and design

et al. 2004

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In clinical practice, biological markers are not available to routinely assess the progression of atherosclerotic disease or the development of restenosis following endarterectomy or catheter based interventions. Endarterectomy procedures provide an opportunity to study mechanisms of restenosis and progression of atherosclerotic disease since atherosclerotic tissue is obtained. Athero-Express is an ongoing prospective study, initiated in 2002, with the objective to investigate the etiological value of plaque characteristics for long term outcome. Patients are included who undergo an endarterectomy of the carotid artery. At baseline blood is withdrawn, patients fill in an extensive questionnaire and diagnostic examinations are performed. Atherosclerotic plaques are freshly harvested, immunohistochemically stained and examined for the presence of macrophages, smooth muscle cells, collagen and fat. Parts of the atherosclerotic plaques are freshly frozen to study protease activity and protein and RNA expressions. Patients undergo a duplex follow up to assess procedural restenosis (primary endpoint) at 3 months, 1 year and 2 years. Secondary endpoints encompass major adverse cardiovascular events. In the future, the creation of this biobank with atherosclerotic specimen will allow the design of cross-sectional and follow up studies with the objective to investigate the expression of newly discovered genes and proteins and their interaction with patients and plaque characteristics in the progression of atherosclerotic disease. Objective is to include 1000-1200 patients in 5 years. In January 2004, 289 patients had been included. It is expected that 250 patients will be included yearly.

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Carotid ultrasound findings as a predictor of long-term survival after abdominal aortic aneurysm repair: a 14-year prospective study

Cited by 26 publications

References 36 publications

Asymptomatic Carotid Artery Stenosis and the Risk of New Vascular Events in Patients With Manifest Arterial Disease

Asymptomatic Carotid Artery Stenosis and the Risk of New Vascular Events in Patients With Manifest Arterial Disease

Incidence of cardiovascular events and death after open or endovascular repair of abdominal aortic aneurysm in the randomized EVAR trial 1

Athero-express: Differential atherosclerotic plaque expression of mRNA and protein in relation to cardiovascular events and patient characteristics. Rationale and design

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