Comparative Review of the Treatment Methodologies of Carotid Stenosis

Bae, Coney; Szuchmacher, Mauricio; Chang, John B.

doi:10.1055/s-0035-1545073

Cited by 9 publications

(6 citation statements)

References 70 publications

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“…CAS is initially caused by abnormal proliferation of vascular smooth muscle cells (VSMCs), accompanied by intimal hyperplasia caused by matrix deposition of extracellular connective tissue to form plaques and eventually develops into symptomatic stenosis ( 4 , 5 ). There are various measures to prevent or treat CAS, including endarterectomy, endovascular stent placement ( 6 ) and medication ( 7 ). However, prophylactic surgery for CAS is controversial for patients with asymptomatic CAS ( 8 ).…”

Section: Introductionmentioning

confidence: 99%

MicroRNA‑503‑5p improves carotid artery stenosis by inhibiting the proliferation of vascular smooth muscle cells

et al. 2020

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Carotid artery stenosis (CAS) is a common arteriosclerotic vascular disease affected by vascular smooth muscle cells (VSMCs). The aim of the present study was to investigate the expression and diagnostic value of microRNA (miR)-503-5p in asymptomatic patients with CAS and to further explore the effect of miR-503-5p on VSMC proliferation. The levels of miR-503-5p in the serum of 62 asymptomatic patients with CAS and 60 healthy controls were detected by reverse transcription-quantitative PCR. The association between miR-503-5p and the clinical characteristics of the patients was analyzed using the χ 2 test. A receiver operating characteristic curve was drawn to evaluate the diagnostic value of miR-503-5p to distinguish asymptomatic patients with CAS from healthy controls. Finally, miR-503-5p inhibitors and mimics were transfected into VSMCs in vitro to detect the effect of miR-503-5p on the proliferation ability through Cell Counting Kit-8 assays. The serum levels of miR-503-5p in asymptomatic patients with CAS were significantly reduced as compared with those in healthy individuals. The expression levels of miR-503-5p were significantly associated with diabetes and arterial stenosis. Furthermore, the area under the ROC curve was 0.817, the specificity was 79.03% and the sensitivity was 83.30%, which proved that miR-503-5p had a high diagnostic accuracy in patients with CAS. Finally, the in vitro proliferation assay indicated that overexpression of miR-503-5p significantly inhibited the proliferation of VSMCs. In conclusion, miR-503-5p is a potential diagnostic biomarker for asymptomatic CAS and overexpression of miR-503-5p may inhibit the proliferation of VSMCs and improve CAS.

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Section: Introductionmentioning

confidence: 99%

MicroRNA‑503‑5p improves carotid artery stenosis by inhibiting the proliferation of vascular smooth muscle cells

et al. 2020

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“…6 -9 While low dose aspirin (81-325 mg/day) is recommended after carotid surgery, the role of dual antiplatelet therapy (DAPT) remains less clear. 5,10 -14…”

Section: Introductionmentioning

confidence: 99%

“…[6][7][8][9] While low dose aspirin (81-325 mg/day) is recommended after carotid surgery, the role of dual antiplatelet therapy (DAPT) remains less clear. 5,[10][11][12][13][14] Carotid restenosis following endarterectomy has been reported in up to 20% of cases, with more recent studies reporting rates of less than 10%. 1,[15][16][17][18] While some studies have found reduced stoke rates when clopidogrel and aspirin are administered in combination, these results have not been reproduced in larger studies and have yet to be tested in a randomized trial.…”

Section: Introductionmentioning

confidence: 99%

Carotid Restenosis Following Endarterectomy in Patients Managed With Single Antiplatelet Therapy Versus Dual Antiplatelet Therapy

Glotzer

Rojas

Bouchard

et al. 2020

Vasc Endovascular Surg

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Background: Antiplatelet therapy is a cornerstone in the management of carotid artery disease following carotid endarterectomy (CEA). There is a paucity of data regarding the effect of dual antiplatelet therapy (DAPT) on restenosis rates. Methods: A retrospective review of patients who underwent CEA from January 1, 2007 to December 31, 2013 was performed at a single center. Study groups consisted of subjects who received DAPT and those who received single antiplatelet therapy (SAPT) following CEA. Restenosis was evaluated by carotid duplex. Severity and timing of restenosis, postoperative complications, and reinterventions were compared between study groups. Results: Between January 1, 2007 and December 31, 2013, 1453 patients underwent CEA. The SAPT group consisted of 245 patients and the DAPT group consisted of 1208 patients. No difference in restenosis was identified between groups at less than 6 weeks (6.5% vs. 11.7% 50-79% stenosis, 0% vs. 2.2% 80-99% stenosis, 2.2% vs. 0.6% occlusion, p = 0.368), and 6 weeks to 2 years (20.6% vs. 17.9% 50-79% stenosis, 1.1% vs. 1.0% 80-99% stenosis, 1.6% vs. 0.4% occlusion, p = 0.242). A higher rate of restenosis in SAPT was found greater than 2 years from surgery (68.4% vs. 82.4% <50% stenosis, 29.9% vs. 16.1% 50-79% stenosis, 0% vs. 0.6% 80-99% stenosis, 1.7% vs. 0.9% occlusion p = 0.004). This finding persisted on multivariable analysis with 31.6% of the SAPT group showing >50% stenosis vs. 17.6% of the DAPT group (adjusted OR 0.48, 95% CI 0.30-0.76, p = 0.002). In a propensity matched-population, 32.7% of the SAPT group demonstrated restenosis vs. 13.7% of the DAPT group (adjusted OR 0.35, 95% CI 0.16-0.77, p = 0.009). There was no difference in the need for reintervention between study groups (DAPT 3.8% vs SAPT 3.3%, p = 0.684). Conclusion: Following CEA, patients on DAPT exhibited lower rates of late restenosis. Despite this finding, a clinical difference in reintervention was not found during this study period.

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“…Several preventive measures have been developed to treat carotid artery stenosis, such as surgical plaque removal by carotid endarterectomy (CEA), endovascular stent placement, 26,28 and/or pharmacological treatment. 2 Nevertheless, the surgical management of asymptomatic patients with ≥ 70% carotid artery stenosis and < 10 years of life expectancy is highly controversial due to the improvement of the medical treatment. 13,25 The degree of carotid artery stenosis and plaque neovascularization, evaluated through imaging techniques such as contrast-enhanced ultrasound, positron emission tomography/computed tomography (PET/CT), and MRI, is being considered a most important predictor of carotid plaque vulnerability and, consequently, of increased risk of stroke in patients with carotid artery disease.…”

mentioning

confidence: 99%

Association between low levels of serum miR-638 and atherosclerotic plaque vulnerability in patients with high-grade carotid stenosis

Luque

Farwati

Krupiński

et al. 2019

Journal of Neurosurgery

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OBJECTIVE Carotid artery atherosclerosis is a major cause of ischemic stroke. However, reliable criteria to identify patients with high-risk carotid plaques beyond the severity of stenosis are still lacking. Circulating microRNAs (miRNAs) are being postulated as biomarkers for a variety of vascular immune-inflammatory diseases. The authors investigated whether cell-free circulating miR-638, highly expressed in vascular smooth muscle cells and implicated in proliferative vascular diseases, is associated with vulnerable atherosclerotic plaques in high-risk patients with advanced carotid artery stenosis undergoing carotid endarterectomy (CEA). METHODS The authors conducted a prospective study in 22 consecutive symptomatic patients with high-grade carotid stenosis undergoing CEA and 36 age- and sex-matched patients without ischemic stroke history or carotid atherosclerosis (control group). In addition, they reviewed data from a historical group of 9 CEA patients who underwent long-term follow-up after revascularization. Total RNA was isolated from all serum samples, and relative miR-638 expression levels were detected by reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and compared among groups. A correlation analysis of serum miR-638 levels with vascular risk factors and treatments, and with plaque features, was performed. The ability of serum miR-638 to discriminate between the non-CEA control group and the different CEA groups was assessed by receiver operating characteristic evaluation. A logistic regression model was employed to examine the association between stratified CEA patients and serum miR-638 levels. RESULTS Serum levels of miR-638 were significantly lower in symptomatic CEA patients (p = 0.009) and particularly in the subgroup of CEA patients who had experienced stroke (p = 0.0006) than in non-CEA controls. Discrimination of high-risk plaques was accurate (area under the curve [AUC] 0.66 for symptomatic CEA patients in general and 0.76 for those who had experienced stroke). When only patients with high cardiovascular risk were considered, the diagnostic value of serum miR-638 from symptomatic CEA patients and CEA patients who had experienced stroke improved (AUC 0.79 and 0.85). Moreover, serum miR-638 was negatively correlated with the occurrence of stroke, smoker status, presence of bilateral pathology, coronary artery disease, and cholesterol treatment; and with the high-risk fibroatheroma plaques extracted from CEA patients. Multivariate logistic regression analysis demonstrated that serum miR-638 was an independent predictor of plaque instability. Furthermore, serum miR-638 appeared to attain good discrimination for atherosclerotic stenosis in CEA patients based on analysis of blood samples obtained in the historical group before and 5 years after intervention (p = 0.04) (AUC = 0.79). CONCLUSIONS According to this preliminary proof-of-concept study, serum miR-638 might constitute a promising noninvasive biomarker associated with plaque vulnerability and ischemic stroke, partic...

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Comparative Review of the Treatment Methodologies of Carotid Stenosis

Cited by 9 publications

References 70 publications

MicroRNA‑503‑5p improves carotid artery stenosis by inhibiting the proliferation of vascular smooth muscle cells

MicroRNA‑503‑5p improves carotid artery stenosis by inhibiting the proliferation of vascular smooth muscle cells

Carotid Restenosis Following Endarterectomy in Patients Managed With Single Antiplatelet Therapy Versus Dual Antiplatelet Therapy

Association between low levels of serum miR-638 and atherosclerotic plaque vulnerability in patients with high-grade carotid stenosis

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