Management of Extracranial Carotid Artery Disease

Ooi, Yinn Cher; Gonzalez, Nestor R.

doi:10.1016/j.ccl.2014.09.001

Cited by 69 publications

(48 citation statements)

References 326 publications

(310 reference statements)

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“…1 Stroke is the second most common cause of death worldwide, 2 and approximately 18%-25% of all strokes are due to carotid atherosclerotic disease. 3 Conventionally, identification of atherosclerosis affecting the carotid artery is based on measurements of the degree of luminal stenosis and surface irregularities 4,5 by sonography, catheterbased angiography, and, nowadays, CTA or MRA. 6,7 However, histopathologic studies initially performed on coronary arteries and subsequently on carotid arteries demonstrate considerable differences between plaques with identical degrees of stenosis.…”

mentioning

confidence: 99%

Carotid Artery Wall Imaging: Perspective and Guidelines from the ASNR Vessel Wall Imaging Study Group and Expert Consensus Recommendations of the American Society of Neuroradiology

Saba

Yuan²,

Hatsukami

et al. 2018

AJNR Am J Neuroradiol

215

232

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Identification of carotid artery atherosclerosis is conventionally based on measurements of luminal stenosis and surface irregularities using in vivo imaging techniques including sonography, CT and MR angiography, and digital subtraction angiography. However, histopathologic studies demonstrate considerable differences between plaques with identical degrees of stenosis and indicate that certain plaque features are associated with increased risk for ischemic events. The ability to look beyond the lumen using highly developed vessel wall imaging methods to identify plaque vulnerable to disruption has prompted an active debate as to whether a paradigm shift is needed to move away from relying on measurements of luminal stenosis for gauging the risk of ischemic injury. Further evaluation in randomized clinical trials will help to better define the exact role of plaque imaging in clinical decision-making. However, current carotid vessel wall imaging techniques can be informative. The goal of this article is to present the perspective of the ASNR Vessel Wall Imaging Study Group as it relates to the current status of arterial wall imaging in carotid artery disease.

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mentioning

confidence: 99%

Carotid Artery Wall Imaging: Perspective and Guidelines from the ASNR Vessel Wall Imaging Study Group and Expert Consensus Recommendations of the American Society of Neuroradiology

Saba

Yuan²,

Hatsukami

et al. 2018

AJNR Am J Neuroradiol

215

232

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“…Given the low prevalence of carotid stenosis, many organizations do not recommend screening in the general population [3][4][5]. Meanwhile, other researchers [24,25] suggested screening, especially for those with multiple risk factors for atherosclerosis, such as hypertension, hyperlipidemia, family history of atherosclerosis or ischemic stroke before 60 years of age and smoking. Jones [26] reported that the prevalence of carotid plaque was 21.0% in a total of 173 middle-aged subjects, which was similar to our findings.…”

Section: Discussionmentioning

confidence: 99%

A model to predict unstable carotid plaques in population with high risk of stroke

Yin

Liu

et al. 2020

BMC Cardiovasc Disord

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Background: Several models have been developed to predict asymptomatic carotid stenosis (ACS), however these models did not pay much attention to people with lower level of stenosis (<50% or carotid plaques, especially instable carotid plaques) who might benefit from early interventions. Here, we developed a new model to predict unstable carotid plaques through systematic screening in population with high risk of stroke. Methods: Community residents who participated the China National Stroke Screening and Prevention Project (CNSSPP) were screened for their stroke risks. A total of 2841 individuals with high risk of stroke were enrolled in this study, 266 (9.4%) of them were found unstable carotid plaques. A total of 19 risk factors were included in this study. Subjects were randomly distributed into Derivation Set group or Validation Set group. According to their carotid ultrasonography records, subjects in derivation set group were further categorized into unstable plaque group or stable plaque group. Results: 174 cases and 1720 cases from Derivation Set group were categorized into unstable plaque group and stable plaque group respectively. The independent risk factors for carotid unstable plaque were: male (

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“…DSA is currently recognized as the gold standard for the diagnosis of ICA dissection and grading carotid atherosclerotic disease [5]. However, it is an invasive and high-risk procedure.…”

Section: Digital Subtraction Angiographymentioning

confidence: 99%

Rapid Diagnosis of Carotid Intramural Hematoma with HR-MRI

Peng¹,

Wang²,

Fu³

et al. 2018

Intern Med

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Carotid intramural hematoma, a type of carotid artery dissection, is hard to detect with traditional imaging examinations including color ultrasonography, computed tomography angiography (CTA), and digital subtraction angiography (DSA) because of the unaffected tunica intima. In this article, we report and discuss two cases of carotid intramural hematoma. In the first case, the patient experienced sudden-onset dysarthria with difficulty chewing and sucking. The diagnosis of ischemic stroke was further supported with the clinical presentation, physical examination, and a head CT scan. Later, the head and neck CTA examination detected the left carotid vessel had an irregular vascular wall and luminal stenosis, which was ultimately confirmed as intramural hematoma after performing neck high-resolution MRI (HR-MRI). Another patient was rapidly diagnosed with acute ischemic stroke using a head MRI scan, but the qualitative nature of the responsible vessel could not be distinguished by CTA and DSA. They could only demonstrate full occlusion of the carotid artery. HR-MRI was needed to identify the intramural hematoma-type ICA dissection. In conclusion, compared with CTA and DSA, HR-MRI is a cost-effective imaging examination with high resolution and easy repeatability. It can more accurately determine the nature of the vascular wall, the relationship of vessels and surrounding tissues, and effectively assists in the clinical judgement for intramural hematoma and other atypical carotid artery dissections.

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Management of Extracranial Carotid Artery Disease

Cited by 69 publications

References 326 publications

Carotid Artery Wall Imaging: Perspective and Guidelines from the ASNR Vessel Wall Imaging Study Group and Expert Consensus Recommendations of the American Society of Neuroradiology

Carotid Artery Wall Imaging: Perspective and Guidelines from the ASNR Vessel Wall Imaging Study Group and Expert Consensus Recommendations of the American Society of Neuroradiology

A model to predict unstable carotid plaques in population with high risk of stroke

Rapid Diagnosis of Carotid Intramural Hematoma with HR-MRI

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