Degree of contralateral carotid stenosis improves preoperative risk stratification of patients with asymptomatic ipsilateral carotid stenosis

Basic, Jelena; Assadian, Afshin; Strassegger, Johann; Senekowitsch, C.; Wickenhauser, Georg; Koulas, Spyridon; Waldhör, Thomas; Duschek, Nikolaus

doi:10.1016/j.jvs.2015.08.067

Cited by 6 publications

(4 citation statements)

References 42 publications

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“…This mechanism is the main cause of a negative outcome. In this respect, several studies have shown that chronic hypoperfusion can be asymptomatic even over a long period of time with good contralateral compensation, increased over time, by collateral flow ( 5 ).…”

Section: Discussionmentioning

confidence: 99%

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Ipsilateral and contralateral carotid stenosis contribute to the outcome of reperfusion treatment for ischemic stroke

Viticchi,

Falsetti,

Riva

et al. 2023

Front. Neurol.

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IntroductionIpsilateral and contralateral carotid stenosis (ICS, CCS) influence acute ischemic stroke (AIS) severity and prognosis. Few data are available about their impact on reperfusion therapies efficacy. Aim of this study was to evaluate the impact of ICS and CCS on the effect of intravenous thrombolysis (IT), mechanical thrombectomy (MT) or both and of antiplatelet therapy (AT).MethodsWe enrolled all the consecutive patients admitted for AIS to our stroke unit and submitted to IT, MT, IT+MT, or AT. We established the presence of a significant ICS or CCS (≥70%) by ultrasound examination or brain angio-CT, or MRI. Clinical and instrumental information were collected; delta National Institutes of Health Stroke Scale (NIHSS) from pre-treatment to patients' discharge was employed as the main outcome measure.ResultsIn total, 460 subjects were enrolled, 86 with ICS and 38 with CCS. We observed a significant linear trend of delta (NIHSS) between carotid stenosis categories for patients undergoing IT (p = 0.011), MT (p = 0.046), and MT+IT (p = 0.040), but no significant trend among subjects receiving no reperfusion treatments was observed (p = 0.174).DiscussionAccording to our findings, ICS and CCS negatively influence AIS patients' outcome treated by interventional therapies. ICS might exert an unfavorable effect both by cerebral hypoperfusion and by continuous microembolization toward ischemic area, while CCS is probable involved in reducing the collateral circles effectiveness. The importance of early carotid stenosis detection and treatment should then be reevaluated not only to manage the prevention approaches but also to obtain insights about post-stroke treatment strategies efficacy.

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Section: Discussionmentioning

confidence: 99%

“…Higher mortality in AIS patients with a CCS > 50% and an ipsilateral patent carotid artery has been observed ( 3 , 4 ). The presence of significant CCS in patients with severe ICS was found to be an independent risk factor for acute cerebral vascular impairment with a 3-fold higher risk of TIA or stroke ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

Ipsilateral and contralateral carotid stenosis contribute to the outcome of reperfusion treatment for ischemic stroke

Viticchi,

Falsetti,

Riva

et al. 2023

Front. Neurol.

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“… 13 Thus, it is important to evaluate the degree of preoperative carotid artery stenosis to accurately assess the risk and predict the need for CEA. 1 , 6 , 14 Therefore, standardizing cut-off values for parameters is of great significance for patient screening and evaluating clinical treatment. However, in the early 1990s, some studies 7 – 9 reported that diagnostic criteria assessed using CDU overestimated the stenosis degree for bilateral carotid artery stenosis.…”

Section: Discussionmentioning

confidence: 99%

Effect of anterior communicating artery patency on the flow velocity in bilateral carotid artery stenosis after carotid endarterectomy

et al. 2023

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Background: The effect of anterior communicating artery (ACoA) patency on the flow velocity of the extracranial carotid arteries is unclear. Methods: A total of 285 patients with carotid artery stenosis were included between January 2019 and January 2021. All patients received unilateral carotid endarterectomy (CEA). The patients were classified into ACoA-patent (161) and ACoA-nonpatent (124) groups using digital subtraction angiography (DSA) and/or computed tomography angiography (CTA). The peak systolic velocity (PSV) and end-diastolic velocity (EDV) measured by carotid duplex ultrasonography (CDU) were compared between both groups, pre- and post-CEA. Results: There was no significant difference in the risk factors for cerebrovascular disease between the two groups. Within 1 week after CEA, the PSV and EDV on operative and nonoperative carotid (contralateral carotid in the same patient) arteries decreased significantly (both p < 0.01). Comparison of nonoperative carotid artery pre- and post-CEA between the two groups showed that post-CEA PSV and EDV in the ACoA-patent group were significantly lower than that of pre-CEA (PSV and EDV, t = 11.507 and 6.716, respectively, both p < 0.001) (according to the Society of Radiologists in Ultrasound Consensus Conference [SRUCC] PSV standard). There was no significant difference in the ACoA-nonpatent group (PSV: t = 1.924, p = 0.057; EDV: t = 1.237, p = 0.218). In the nonoperative carotid artery of the ACoA-patent group, the degree of stenosis assessed by CDU was inconsistent with that of DSA/CTA (κ = 0.294), whereas that in the ACoA-nonpatent group had a high consistency (κ = 0.982). Among 161 ACoA-patent cases, 68 showed overestimated stenosis. Conclusions: The patent ACoA increases PSV and EDV, causing an overestimation of carotid artery stenosis.

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“…Basic и соавт. подтвердили, что степень контралатерального стеноза имеет прямую корреляцию с риском периоперационного инсульта [18]. A. Gupta и соавт.…”

Section: Discussionunclassified

Carotid endarterectomy for atherosclerotic occlusion of the contralateral internal carotid artery

Muchamadeev¹,

Oborin²

2021

PKiK

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Aim. To analyse perioperative and long-term results of carotid endarterectomy for occlusion or stenosis of the contralateral internal carotid artery.Methods. This study included 184 patients who underwent carotid endarterectomy for either occlusion (group 1, n = 74) or stenosis (group 2, n = 110) of the contralateral internal carotid artery. Carotid endarterectomy with eversion was performed in 97% of the patients while the conventional procedure with a patch was used in the remaining 3%.Results. The incidence of perioperative stroke / transient ischemic attack (TIA) in groups 1 and 2 was 1.35% and 1.82%, respectively (p = 0.806). Stroke / TIA within 30 days after surgery occurred in 2 patients in group 1 and in 1 patient in group 2 (p = 0.346); however, none were associated with death. In contrast, 3 cases of myocardial infarction (MI) were seen in group 1, two of which resulted in death. No instances of MI were seen in group 2. Long-term freedom from stroke and myocardial infarction, estimated using the Kaplan-Meier method, was not significantly different between the groups (p = 0.240 and p = 0.657, respectively). Long-term survival was similar in both groups (p = 0.281). An analysis of the risk factors for major cardiovascular events, both immediate and in the long-term, showed that plaque instability was the most significant (p = 0.004), followed by lesions in the arteries of the lower extremities (p = 0.002).Conclusion. Short-term and long-term cerebral complications were not significantly different between patients with occlusion or stenosis of the contralateral internal carotid artery. However, patients with occlusion were significantly more likely to experience MI, necessitating a detailed diagnosis of coronary artery disease. Instability of the atherosclerotic substrate and multifocal atherosclerosis were identified as independent risk factors for major cardiovascular events.Received 18 May 2021. Revised 30 July 2021. Accepted 11 August 2021.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Contribution of the authors: The authors contributed equally to this article.

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Degree of contralateral carotid stenosis improves preoperative risk stratification of patients with asymptomatic ipsilateral carotid stenosis

Cited by 6 publications

References 42 publications

Ipsilateral and contralateral carotid stenosis contribute to the outcome of reperfusion treatment for ischemic stroke

Ipsilateral and contralateral carotid stenosis contribute to the outcome of reperfusion treatment for ischemic stroke

Effect of anterior communicating artery patency on the flow velocity in bilateral carotid artery stenosis after carotid endarterectomy

Carotid endarterectomy for atherosclerotic occlusion of the contralateral internal carotid artery

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