Natural History of Nonoperated, Significant Carotid Stenosis

Satiani, Bhagwan; Porter, Robert M.; Biggers, K. Mcdaniel; Das, Biplab

doi:10.1016/s0890-5096(07)60014-4

Cited by 20 publications

(8 citation statements)

References 18 publications

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“…with 50e99% asymptomatic carotid stenoses published since 1985. 1,2,18,21,22,25,26,28,32,34,37,39,40,44,53 Once again, there is evidence of a sustained decline in the annual rate of stroke (ipsilateral and any) over the last two decades and which has continued since the publication of ACST in 2004. The most recent study (SMART) reported annual rates of 'any stroke' and ipsilateral stroke of <1%.…”

Section: Figurementioning

confidence: 99%

Who Benefits Most from Intervention for Asymptomatic Carotid Stenosis: Patients or Professionals?

Naylor

Gaines

Rothwell

2009

European Journal of Vascular and Endovascular Surgery

142

108

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Although there is level I evidence supporting the role of carotid endarterectomy (CEA) in patients with asymptomatic disease, opinion remains polarised regarding what constitutes optimal management, especially as carotid artery stenting (CAS) has emerged as a less invasive alternative. Reasons for this lack of consensus amongst surgeons, interventionists, neurologists and stroke physicians include our continued inability to identify 'high risk for stroke' patients in whom to target costly therapies. For example, recent data from the USA suggest that up to $21 billion is being spent each year on ultimately 'unnecessary' interventions. Second, is growing evidence that improvements in what now constitutes modern 'best medical therapy' has significantly reduced the risk of stroke compared to that observed in ACAS and ACST. If true, this will compromise risk:benefit analyses used in national and international guidelines. At a time when evidence suggests that up to 94% of interventions may not benefit the patient, the authors urge that at least one of the randomised trials comparing CEA with CAS in asymptomatic patients includes an adequately powered third limb for BMT. Timely investment now could optimise patient care and resource utilisation for all of us in the future.

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Section: Figurementioning

confidence: 99%

Who Benefits Most from Intervention for Asymptomatic Carotid Stenosis: Patients or Professionals?

Naylor

Gaines

Rothwell

2009

European Journal of Vascular and Endovascular Surgery

142

108

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“…amaurosis fugax, transient paresthesia, limb weakness, tingling and aphasia known as transient ischemic attacks (TIA). Ischemic strokes can develop in two ways: either when diminished cerebral blood flow occurring in severe stenosis of the extracranial artery causes hypoperfusion of brain structures [ 2 – 4 ]; or when a cerebral artery is occluded by emboli released from the usually ulcerated, thrombogenic plaque, irrespectively of the actual grade of stenosis [ 5 , 6 ]. Both pathological mechanisms might also occur concurrently.…”

Section: Introductionmentioning

confidence: 99%

Low prevalence of collateral cerebral circulation in the circle of Willis in patients with severe carotid artery stenosis and recent ischemic stroke

Badacz¹,

Przewłocki²,

Karch³

et al. 2015

pwki

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IntroductionThe circle of Willis is thought to play a key role in development of collateral flow in patients with internal carotid artery stenosis (ICAS).AimTo assess flow in the circle of Willis in patients with recent ischemic stroke (IS).Material and methodsThe study included 371 patients, 102 symptomatic with severe ICAS and recent IS (within the last 3 months) (group I) and 269 asymptomatic with severe ICAS (group II). Flow in the middle (MCA), anterior (ACA) and posterior (PCA) cerebral arteries and pattern of the cross-flow through anterior (ACoA) and posterior (PCoA) communicating arteries were assessed with transcranial color-coded Doppler ultrasonography (TCCD).ResultsThe ACoA or PCoA was less prevalent in group I than in group II (54% vs. 78%, p < 0.001 and 20% vs. 42%, p < 0.001, respectively), resulting in lower peak-systolic velocity (PSV) in the MCA in group I vs. group II (p = 0.015). Any collateral pathway was present in 67% of patients in group I, compared to 86% in group II (p < 0.001). Both PSV and end-diastolic (EDV) flow velocity in the ACA were lower in patients with recent IS, compared to asymptomatic subjects (71 ±24 cm/s vs. 86 ±34 cm/s, p < 0.001 and 32 ±12 cm/s vs. 37 ±17 cm/s, p = 0.038, respectively). Presence of ACoA or PCoA and higher PSV in the MCA and ACA were associated with significant risk reduction of IS (RR = 0.28 (95% CI = 0.16–0.49, p < 0.001), RR = 0.28 (95% CI = 0.15–0.52, p < 0.001), RR = 0.97 (95% CI = 0.96–0.99, p < 0.001), RR = 0.99 (95% CI = 0.98–0.99, p < 0.032), respectively). However, ROC curves failed to show reliable MCA or ACA PSV cut-offs for IS risk assessment.ConclusionsThe ACoA and PCoA seem to play a key role in the evaluation of IS risk in subjects with severe ICAS.

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“…Extracranial carotid artery atherothrombosis accounts for about 10% of all ischemic stroke (IS) (1). It carries an average annual risk of stroke of 2-8% among asymptomatic patients with severe carotid artery disease (CAS) and about 7-20% among symptomatic patients with CAS (2)(3)(4)(5)(6). Carotid endarterectomy (CEA) has been the 'gold standard' for treatment of patients with CAS (7)(8)(9)(10).…”

Section: Tatjana Rundekmentioning

confidence: 99%

Beyond Percent Stenosis: Carotid Plaque Surface Irregularity and Risk of Stroke

Rundek¹

2007

International Journal of Stroke

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Natural History of Nonoperated, Significant Carotid Stenosis

Cited by 20 publications

References 18 publications

Who Benefits Most from Intervention for Asymptomatic Carotid Stenosis: Patients or Professionals?

Who Benefits Most from Intervention for Asymptomatic Carotid Stenosis: Patients or Professionals?

Low prevalence of collateral cerebral circulation in the circle of Willis in patients with severe carotid artery stenosis and recent ischemic stroke

Beyond Percent Stenosis: Carotid Plaque Surface Irregularity and Risk of Stroke

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