Pharmacological interventions for asymptomatic carotid stenosis

Clezar, Caroline Nb; Flumignan, Carolina Dutra Queiroz; Cassola, Nicolle; Nakano, Luis Cu; Trevisani, Virgínia Fernandes Moça; Flumignan, Ronald Luiz Gomes

doi:10.1002/14651858.cd013573.pub2

Cited by 4 publications

(2 citation statements)

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“…A patient presenting with ICA stenosis of 50%-94% commonly undergoes a confirmatory test with a reference test (CTA or MRA) before revascularization 5 , 9 , 20 . In another analysis, we considered ICA stenosis to be positive at a 70%-94% range because it is considered more severe, associated with a greater risk of stroke and death, and this is still today the cutoff for indicating revascularization in asymptomatic patients who present additional risks 8 , 9 , 14 . The benefits of carotid revascularization in asymptomatic and symptomatic patients with 70%-94% lead us to consider this analysis crucial for clinical decision-making.…”

Section: Resultsmentioning

confidence: 99%

Accuracy of duplex ultrasonography versus angiotomography for the diagnosis of extracranial internal carotid stenosis

DAOLIO,

ZANIN,

FLUMIGNAN

et al. 2024

Rev. Col. Bras. Cir.

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Introduction: Internal carotid artery (ICA) stenosis causes about 15% of ischemic strokes. Duplex ultrasonography (DUS) is the first line of investigation of ICA stenosis, but its accuracy varies in the literature and it is usual to complement the study with another more accurate exam when faced with significant stenosis. There is a lack of studies that compare DUS with angiotomography (CTA) in the present literature. Methods: we performed an accuracy study, which compared DUS to CTA of patients in a tertiary hospital with a maximum interval of three months between tests. Patients were selected retrospectively, and two independent and certified vascular surgeons evaluated each image in a masked manner. When there was discordance, a third evaluator was summoned. We evaluated the diagnostic accuracy of ICA stenosis of 50-94% and 70-94%. Results: we included 45 patients and 84 arteries after inclusion and exclusion criteria applied. For the 50-94% stenosis range, DUS accuracy was 69%, sensitivity 89%, and specificity 63%. For the 70-94% stenosis range, DUS accuracy was 84%, sensitivity 61%, and specificity 93%. There was discordance between CTA evaluators with a change from clinical to surgical management in at least 37.5% of the conflicting reports. Conclusion: DUS had an accuracy of 69% for stenoses of 50-94% and 84% for stenoses of 70-94% of the ICA. The CTA analysis depended directly on the evaluator with a change in clinical conduct in more than 37% of cases.

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Section: Resultsmentioning

confidence: 99%

Accuracy of duplex ultrasonography versus angiotomography for the diagnosis of extracranial internal carotid stenosis

DAOLIO,

ZANIN,

FLUMIGNAN

et al. 2024

Rev. Col. Bras. Cir.

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“…An essential line of research in the future would be precisely the assessment of the role of PU for secondary prevention of cerebral infarction with a high risk of a cerebral hemorrhage in lacunar versus nonlacunar ischemic stroke,[ 37 38 39 40 41 ] because the pathophysiology, prognosis, and clinical features of lacunar strokes are different from other acute cerebrovascular diseases.…”

Section: Problems and Perspectivesmentioning

confidence: 99%

Probucol will become a new model for treating cerebral infarction with a high risk of hemorrhage: A narrative review

Lang,

Zhang,

Zheng

et al. 2023

Brain Circulation

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Lipid-lowering agents are relevant in stroke prevention. Probucol (PU) is an antioxidative and lipid-lowering drug that has been used to treat atherosclerotic cardiovascular diseases and xanthomas. The drug penetrates the core of low-density lipoprotein cholesterol (LDL-C) particles, enhancing the activity of plasma cholesterol l ester transfer protein (CETP) and strengthening the liver scavenger receptor type I, resulting in reducing LDL-C; by increasing the activity of paraoxonase 1, upregulating the antioxidant function of high-density lipoprotein (HDL), and it decreases the serum HDL-cholesterol (HDL-C) level. This drug has been retired from the Western markets for lowering HDL-C levels and Q-interval prolongation. The latter side effect has been rarely reported and may be transient. Recent clinical evidence supports the effectiveness of PU in preventing cardiovascular events and in reducing mortality, irrespective of the reduction of HDL-C. Based on basic research and clinical studies, it appears that PU might be a valuable alternative when statins are ineffective or contraindicated, in patients at high risk of recurrence of cerebral ischemia and hemorrhage.

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