Disease progression in contralateral carotid artery is common after endarterectomy

Raman, Kathleen G.; Layne, Susan M.; Makaroun, Michel S.; Kelley, Mary E.; Rhee, Robert Y.; Tzeng, Edith; Muluk, Visala S.; Muluk, Satish C.

doi:10.1016/j.jvs.2003.08.016

Cited by 49 publications

(47 citation statements)

References 26 publications

(22 reference statements)

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“…11,12,[32][33][34][35][36][37] In the present study, 22.1% of patients experienced progression of ICS during 36.2 months after contralateral CAS, which is consistent with observations from previous reports. Several studies have described risk factors for ICS progression, including female sex, black race, baseline ICS 50% or greater, systolic blood pressure Ͼ160 mm Hg, CAD, smoking, low ankle-brachial pressure index, and echolucent plaques.…”

Section: Discussionsupporting

confidence: 90%

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Cilostazol Prevents Progression of Asymptomatic Carotid Artery Stenosis in Patients with Contralateral Carotid Artery Stenting

Kato

Sakai

Takagi

et al. 2012

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:The progression of atherosclerosis is related to various factors. Although antiplatelet therapy is used for the management of acute ischemic stroke and for the prevention of recurrent stroke, the antiplatelet agent cilostazol may also reduce restenosis after stent implantation in any vessel. This study was performed to assess the impact of cilostazol on plaque progression in the carotid artery contralateral to a stented artery.

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Section: Discussionsupporting

confidence: 90%

“…[10][11][12][13] Patients who undergo CAS are given antiplatelet agents in addition to other antiatherosclerotic medications. Antiplatelet agents are effective for the reduction of stent thrombosis after CAS and for the reduction of the risk of vascular events in other arterial beds, which provides a rationale for their long-term use in these patients.…”

mentioning

confidence: 99%

Cilostazol Prevents Progression of Asymptomatic Carotid Artery Stenosis in Patients with Contralateral Carotid Artery Stenting

Kato

Sakai

Takagi

et al. 2012

AJNR Am J Neuroradiol

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“…[16][17][18] Some natural history studies of populations with asymptomatic carotid stenosis have investigated progression of stenosis in the artery contralateral to CEA, but the natural history of severe stenosis is not usually available because so many patients with suitable (≥60% to 70%) stenosis undergo prophylactic endarterectomy leaving only some, who may be less fit for surgery, for long-term follow-up. 7,[19][20][21][22] In 1 natural history study of progression of stenosis in carotid artery disease, Lewis found there was a significantly higher risk of stroke or death (risk ratio, 3.0; 95% confidence interval, 1.3-6.7) once stenosis reached 80% stenosis or more. 23 Ballotta 7 followed up carotid stenosis contralateral to CEA and found that progression from moderate (50% to 69%) to severe (70% to 99%) stenosis was strongly associated with transient ischemic attack or stroke, >80% of the neurological events in this study occurring in this group of patients.…”

Section: Strokementioning

confidence: 99%

Risk of Stroke From New Carotid Artery Occlusion in the Asymptomatic Carotid Surgery Trial-1

Hartog

Halliday²,

Hayter³

et al. 2013

Stroke

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Background and Purpose— In the Asymptomatic Carotid Surgery Trial-1 (ACST-1), 3120 patients with tight asymptomatic carotid stenosis were randomly assigned to medical treatment alone or to carotid endarterectomy and appropriate medication. Successful carotid endarterectomy significantly reduced 10-year stroke risk in younger patients. This study was undertaken to determine the risk of new occlusion and stroke during trial follow-up. Methods— Patients with contralateral occlusion at trial entry (n=276) or incomplete duplex follow-up (n=137) were excluded. Risk of occlusion and stroke in patients with occlusion was estimated by Kaplan–Meier analysis. Cox proportional hazard regression models were used to determine risk factors for developing new occlusion and stroke. Results— Median follow-up in 2707 patients was 80.0 months (interquartile range, 52.0–115.0). New occlusions occurred in 197 patients (1.1% per annum) but were more likely to occur in arteries with tight stenosis and in unoperated patients. Overall risk of stroke was 7.6% (95% confidence interval [CI], 6.6–8.7) and 15.5% (95% CI, 13.6–17.4) at 5 and 10 years, respectively; for patients with new occlusion, this significantly increased to 17.0% (95% CI, 11.6–22.4) and 20.8% (95% CI, 14.1–26.2), respectively ( P <0.001). Stroke was significantly more likely to occur in patients developing occlusion (hazard ratio, 1.78; 95% CI, 1.26–2.51) irrespective of allocated treatment. Conclusions— New occlusions were uncommon after carotid endarterectomy in ACST-1. During long-term follow-up, occlusion and stroke were commoner among patients with ≥70% stenosis, most of whom had not undergone carotid endarterectomy. Occlusion was an independent prognostic risk factor for occurrence of stroke.

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“…48,60 Numerous studies have analyzed the rate and severity of carotid artery occlusive progression, but the results show considerable differences. 11,25,49 Table 2 summarizes the results of some of these studies.…”

Section: Progression Of Carotid Artery Occlusive Diseasementioning

confidence: 99%

“…7,23,37,48 Carotid artery disease progression appears to be associated with diabetes, smoking, hypertension, and, in patients with more severe stenosis, heterogeneous plaque and contralateral disease. 6,11,37,48,60 Moreover, the severity of the stenosis is a risk factor for progression, with moderate stenosis being 5-fold more likely to progress than mild or no stenosis.…”

Section: Progression Of Carotid Artery Occlusive Diseasementioning

confidence: 99%

Clinical considerations in the management of asymptomatic carotid artery stenosis

Taussky

Hanel

Meyer

2011

FOC

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Incidental findings pose considerable management dilemmas for the treating physician and psychological burden for the respective patient. With an aging population, more patients will be diagnosed with asymptomatic internal carotid artery stenosis. Patients will have to be counseled with regard to treatment options according to their individual risk profile and according to professionals' knowledge of evidence-based data derived from large randomized control trials. Treatment consensus has long been lacking for patients with asymptomatic carotid artery stenosis prior to any randomized controlled trials. Additionally, an individual's risk profile may be hard to assess according to knowledge gained from randomized controlled trials. Moreover, while earlier studies compared carotid endarterectomy and medical therapy, in the past years, a new therapeutic modality, carotid artery angioplasty and stenting, has emerged as a possible alternative. This has been evaluated in a recent randomized controlled trial, the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST), which compared carotid endarterectomy with angioplasty and stenting in both symptomatic and asymptomatic patients. The following review summarizes current knowledge of the natural history, diagnosis, and treatment strategies to counsel patients with asymptomatic carotid artery stenosis.

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Disease progression in contralateral carotid artery is common after endarterectomy

Cited by 49 publications

References 26 publications

Cilostazol Prevents Progression of Asymptomatic Carotid Artery Stenosis in Patients with Contralateral Carotid Artery Stenting

Cilostazol Prevents Progression of Asymptomatic Carotid Artery Stenosis in Patients with Contralateral Carotid Artery Stenting

Risk of Stroke From New Carotid Artery Occlusion in the Asymptomatic Carotid Surgery Trial-1

Clinical considerations in the management of asymptomatic carotid artery stenosis

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