Endarterectomy, Best Medical Treatment or Both for Stroke Prevention in Patients with Asymptomatic Carotid Artery Stenosis

Cardona, Pedro; Rubio, Francisco; Martínez-Yélamos, Sergio; Krupiński, Jerzy

doi:10.1159/000107388

Cited by 8 publications

(4 citation statements)

References 60 publications

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“…Plaque characteristics found by imaging techniques may help risk stratify patients with asymptomatic carotid stenosis [19]. The expression of cytokines secreted by macrophages and bone-related factors in calcified and noncalcified carotid plaques have not heretofore been investigated.…”

Section: Introductionmentioning

confidence: 99%

Human Carotid Plaque Calcification and Vulnerability

et al. 2009

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Background: Inflammation is a key mechanism in human atherosclerotic plaque vulnerability and disruption. The objective was to determine the differential gene expression of pro- and anti-inflammatory factors in the fibrous cap and shoulder region of noncalcified and calcified carotid endarterectomy plaques. Methods: Thirty carotid endarterectomy plaques were classified as type Va (noncalcified, n = 15) and type Vb (calcified, n = 15) in accordance with the American Heart Association consensus. Using laser capture microdissection, fibrous cap and shoulder regions were excisedfrom frozen sections. Gene expression of pro- [interleukin 1 (IL-1), IL-8 and monocyte chemoattractant protein 1 (MCP-1)] and anti-inflammatory (IL-10) factors, and bone formation (bone morphogenetic protein 6 and osteocalcin) mediators were quantitated by real-time PCR. Protein levels were determined using Western blotting. Results: Mean percent carotid stenosis and calcification area were 79 and 5% in Va-plaques (40% symptomatic) and 77 and 42% in Vb-plaques (20% symptomatic). Macrophages infiltrating the region of the fibrous cap and the shoulder were more numerous in non-calcified plaques compared with calcified plaques (p < 0.01]. mRNA expression of MCP-1 and IL-8, and protein levels of IL-8 were also greater in Va plaques compared to Vb plaques (p < 0.05). Protein levels and mRNA expression of osteocalcin were greater in Vb compared to Va plaques (p < 0.05). Conclusions: Fibrous cap inflammation is more likely to occur in noncalcified than in calcified plaques. These findings suggest that carotid atherosclerotic plaque calcification is a structural marker of plaque stability.

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Section: Introductionmentioning

confidence: 99%

Human Carotid Plaque Calcification and Vulnerability

et al. 2009

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“…These trials have, however, excluded or included only small numbers of very elderly patients, providing limited evidence about the effectiveness of the operation for these patients [9]. This represents an important gap because stroke is the second leading cause of death in individuals aged 85 and over [10] who, by 2050, will number approximately 20.9 million in the USA [11].…”

Section: Introductionmentioning

confidence: 99%

Postendarterectomy Mortality in Octogenarians and Nonagenarians in the USA from 1993 to 1999

et al. 2009

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Background: Relatively little is known about trends in the utilization or outcomes of carotid endarterectomy (CEA) in the very elderly. We determined trends in the rates of CEA and perioperative (in-hospital and 30-day) and long-term (1-, 2-, 3-, 4- and 5-year) mortality in a US national sample of patients ≧80 years of age. Methods: All fee-for-service Medicare patients (80–89 and ≧90 years of age) who had a CEA [ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification): 38.12] from 1993 to 1999 were identified using the Centers for Medicare and Medicaid Services Inpatient Standard Analytic Files. Demographic characteristics and comorbid conditions were determined using ICD-9-CM diagnostic codes within the year prior to the index hospitalization for CEA. Results: A total of 140,376 CEA were performed in patients aged 80–89 years and 6,446 in those aged ≧90 years during this 7-year period. The annual number of operations increased from 13,115 in 1993 to 21,582 in 1999 for octogenarians, and from 481 in 1993 to 1,257 in 1999 for nonagenarians. Perioperative mortality was 2.2% in octogenarians and 3.3% in nonagenarians. Long-term mortality increased by approximately 10% per year after the operation, and was 43% in octogenarians and 56% in nonagenarians at 5 years. Perioperative mortality rates remained relatively stable over the 7-year period for both age groups although comorbidities increased. Conclusions: The number of CEA performed in the very elderly in the USA increased from 1993 to 1999. Perioperative mortality rates were high compared with trial results, while long-term survivorship was comparable to that of similarly-aged peers in the USA.

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“…Many studies have investigated the association between atherosclerosis and ischemic events in large populations [15,16,17,18]. However, only a few studies have focused on the mechanical characteristics of the carotid artery, including distension, and atherosclerosis [19,20].…”

Section: Introductionmentioning

confidence: 99%

Spatial Distension Variations Are Associated with Focal Atherosclerotic Plaques

Graf

Schreuder²,

Mess³

et al. 2009

Cerebrovasc Dis

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Background: Alterations in arterial absolute distension (AD) and relative distension (RD) in the common carotid artery (CCA), as observed by ultrasound, may relate to atherosclerotic processes in a nearby vascular segment. The main objective of the study was to establish to what extent these mechanical vascular alterations relate to carotid bulb stenosis. Methods: The AD, RD and their interrecording variation (ΔAD and ΔRD), representing the spatial inhomogeneity of AD and RD, were evaluated in 308 CCA and associated with the degree of bulb stenosis. Results: The mechanical CCA parameters were marginally correlated to the degree of ipsilateral (r = –0.14 for AD and r = –0.28 for RD) and contralateral stenosis (r = –0.21 for AD and r = –0.27 for RD). However, ΔAD (r = 0.54; p < 0.001) and ΔRD (r = 0.59; p < 0.001) were significantly correlated to ipsilateral stenosis, independent of age, gender and pulse pressure. Conclusions: The indices of CCA arterial stiffness are weakly associated with ipsilateral bulb stenosis, but their interrecording variation is a good indicator for atherosclerotic alterations in the carotid bulb. The results indicate that a focal atherosclerotic lesion is associated with modifications in the dynamic characteristics of a nearby vascular segment.

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Endarterectomy, Best Medical Treatment or Both for Stroke Prevention in Patients with Asymptomatic Carotid Artery Stenosis

Cited by 8 publications

References 60 publications

Human Carotid Plaque Calcification and Vulnerability

Human Carotid Plaque Calcification and Vulnerability

Postendarterectomy Mortality in Octogenarians and Nonagenarians in the USA from 1993 to 1999

Spatial Distension Variations Are Associated with Focal Atherosclerotic Plaques

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