Asymptomatic Carotid Artery Stenosis
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Asymptomatic Carotid Artery Stenosis
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Author : Issam D. Moussa
language : en
Publisher: CRC Press
Release Date : 2007-03-06
Asymptomatic Carotid Artery Stenosis written by Issam D. Moussa and has been published by CRC Press this book supported file pdf, txt, epub, kindle and other format this book has been release on 2007-03-06 with Medical categories.
This well-illustrated text reviews the current state of knowledge with regard to the various anatomic and physiologic methods available to identify asymptomatic patients who are at high risk to develop a future stroke. Asymptomatic Carotid Artery Stenosis is particularly targeted towards physicians involved in clinical decision making regarding rev
Management Of Asymptomatic Carotid Stenosis
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Author : Gowri Raman
language : en
Publisher:
Release Date : 2012
Management Of Asymptomatic Carotid Stenosis written by Gowri Raman and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2012 with categories.
Stroke is a leading cause of death in the United States. Although the number of deaths from stroke has declined in recent years, it continues to be a major public health problem in the United States, with an estimated $34.3 billion in direct cost and indirect cost of stroke in the year 2008. Carotid artery stenosis represents an important risk factor for ischemic stroke, which accounts for nearly 90 percent of all strokes among U.S. men and women. Carotid artery stenosis is increasingly prevalent from the fifth decade of life onward. Patients with vascular disease and multiple risk factors (e.g., diabetes, hypertension, hyperlipidemia, and smoking) have a higher probability of having asymptomatic carotid stenosis. Since carotid artery atherosclerosis can largely proceed silently and unpredictably, the first manifestation can be a debilitating or fatal stroke. Asymptomatic carotid artery stenosis affects approximately 7 percent of women and over 12 percent of men, older than 70 years of age. Clinically important stenosis, at which the risk of stroke is increased, is defined as stenosis of over 50 or 60 percent. Natural history studies have reported that patients with asymptomatic carotid stenosis are at an increased risk of ipsilateral carotid territory ischemic stroke ranging from 5 to 17 percent. The goal of management of asymptomatic carotid stenosis is to decrease the risk of stroke and stroke-related deaths. However, screening asymptomatic patients for carotid stenosis is not part of common clinical practice as noted in a review by the U.S. Preventive Services Task Force from 1996, which concluded that evidence was insufficient to recommend either for or against screening. As the general U.S. population ages, and with the availability of noninvasive imaging studies, asymptomatic carotid artery stenosis may be more frequently detected in the course of patient management. Auscultation of the carotid arteries to listen for bruits is by convention an initial means of clinical assessment of high-risk patients, but the presence of bruits is not necessarily indicative of significant stenosis. Since carotid auscultation has limited sensitivity in detecting significant carotid stenosis, additional imaging modalities including digital subtraction angiography (DSA), Doppler ultrasound (DUS), computed tomography angiography (CTA), and magnetic resonance angiography (MRA) are being increasingly utilized. The most commonly used measurement method of carotid stenosis used in clinical trials or most common angiographic method was introduced in the North American Symptomatic Carotid Endarterectomy Trial (NASCET). In the NASCET method, the stenosis is measured as the ratio of the linear luminal diameter of the narrowest portion of the artery's diseased segment divided by the diameter of the healthy distal carotid artery (above the post-stenotic dilation). An alternative method was used in the European Carotid Surgery Trial (ECST), which utilized the estimated carotid bulb at the site of maximal stenosis as the denominator. The ECST method tends to yield higher degrees of stenosis, but measurements made by each method can be converted to those of the other using a simple arithmetic equation. According to the 2003 Society of Radiologists in Ultrasound consensus criteria, a carotid stenosis is not quantified as an exact percentage of luminal stenosis but can be classified by range of stenoses that represent clinically relevant categories (normal,
Screening For Asymptomatic Carotid Artery Stenosis
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Author : Agency for Healthcare Research and Quality
language : en
Publisher: CreateSpace
Release Date : 2015-02-11
Screening For Asymptomatic Carotid Artery Stenosis written by Agency for Healthcare Research and Quality and has been published by CreateSpace this book supported file pdf, txt, epub, kindle and other format this book has been release on 2015-02-11 with Medical categories.
Carotid artery stenosis refers to atherosclerotic narrowing of the extracranial carotid arteries. It typically refers to the internal carotid arteries or the common and internal carotid arteries. A “clinically important” degree of stenosis is defined as the percentage of stenosis that corresponds to a substantially increased risk for stroke. However, because stroke risk depends on more than just the degree of stenosis, it is difficult to set a lower limit on the range that defines potential clinical importance. Asymptomatic patients have no significant neurologic symptoms referable to the carotid artery and have not experienced a cerebrovascular event (i.e., a stroke or transient ischemic attack). The main purpose of this report is to systematically evaluate the current evidence on whether screening asymptomatic adults for CAS reduces the risk for fatal or nonfatal ipsilateral stroke and the evidence on harms associated with screening and interventions for CAS. The scope and methods of this report differ from earlier USPSTF reviews on this topic by 1) using systematic methods for all key question, 2) addressing new key questions about the availability of valid, reliable risk stratification tools to distinguish a person's likelihood for asymptomatic CAS and to distinguish risk for ipsilateral stroke caused by CAS or for harms from surgery or intervention in persons with asymptomatic CAS (recommendations of some groups state that screening might be considered for persons with multiple risk factors), 3) adding carotid angioplasty and stenting (CAAS) to the included interventions, 4) adding a question about the incremental benefit of medical therapy for asymptomatic CAS, and 5) conducting quantitative synthesis for many outcomes.
Screening For Asymptomatic Carotid Artery Stenosis
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Author : Tracy A. Wolff
language : en
Publisher:
Release Date : 2007
Screening For Asymptomatic Carotid Artery Stenosis written by Tracy A. Wolff and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2007 with categories.
BACKGROUND: Cerebrovascular disease is the third leading cause of death in the U.S. The proportion of all strokes attributable to previously asymptomatic carotid stenosis is low. In 1996, the United States Preventive Services Task Force concluded that there was insufficient evidence to recommend for or against screening of asymptomatic persons for CAS using physical exam or carotid ultrasound. PURPOSE: To examine the evidence of benefits and harms of screening asymptomatic patients with duplex ultrasound and treatment with carotid endarterectomy (CEA) for carotid artery stenosis (CAS). DATA SOURCES: MEDLINE and Cochrane Library searches (January 1994-April 2007), recent systematic reviews, reference lists of retrieved articles, and expert suggestions. STUDY SELECTION: English language studies were selected to answer the following: Is there direct evidence that screening with ultrasound for asymptomatic CAS reduces strokes? What is the accuracy of ultrasound to detect CAS? Does intervention with CEA reduce morbidity or mortality? Does screening or CEA result in harm? The following study types were selected: randomized controlled trials (RCT) of screening for CAS; RCTs of CEA versus medical treatment; systematic reviews of screening tests; observational studies of harms from CEA. DATA EXTRACTION: Studies were reviewed, abstracted, and rated for quality using predefined USPSTF criteria. DATA SYNTHESIS: There have been no RCTs of screening for CAS. According to systematic reviews, the sensitivity of ultrasound is approximately 94% and the specificity is approximately 92%. Treatment of CAS in selected patients with selected surgeons could lead to an approximately 5% absolute reduction in strokes over 5 years. Thirty-day stroke and death rates from CEA vary from 2.7% to 4.7% in RCTs; higher rates have been reported in observational studies (up to 6.7%). LIMITATIONS: There is inadequate evidence to stratify people into categories of risk for clinically important CAS. The RCTs of CEA versus medical treatment were conducted in selected populations with selected surgeons. CONCLUSIONS: The actual stroke reduction from screening asymptomatic patients and treatment with CEA is unknown; the benefit is limited by a low overall prevalence of treatable disease in the general asymptomatic population and harms from treatment.
Carotid Stenosis New Insights For The Healthcare Professional 2011 Edition
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Author :
language : en
Publisher: ScholarlyEditions
Release Date : 2012-01-09
Carotid Stenosis New Insights For The Healthcare Professional 2011 Edition written by and has been published by ScholarlyEditions this book supported file pdf, txt, epub, kindle and other format this book has been release on 2012-01-09 with Medical categories.
Carotid Stenosis: New Insights for the Healthcare Professional: 2011 Edition is a ScholarlyPaper™ that delivers timely, authoritative, and intensively focused information about Carotid Stenosis in a compact format. The editors have built Carotid Stenosis: New Insights for the Healthcare Professional: 2011 Edition on the vast information databases of ScholarlyNews.™ You can expect the information about Carotid Stenosis in this eBook to be deeper than what you can access anywhere else, as well as consistently reliable, authoritative, informed, and relevant. The content of Carotid Stenosis: New Insights for the Healthcare Professional: 2011 Edition has been produced by the world’s leading scientists, engineers, analysts, research institutions, and companies. All of the content is from peer-reviewed sources, and all of it is written, assembled, and edited by the editors at ScholarlyEditions™ and available exclusively from us. You now have a source you can cite with authority, confidence, and credibility. More information is available at http://www.ScholarlyEditions.com/.
Screening For Asymptomatic Carotid Artery Stenosis
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Author :
language : en
Publisher:
Release Date : 2007
Screening For Asymptomatic Carotid Artery Stenosis written by and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2007 with categories.
The Carotid And Supra Aortic Trunks
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Author : Michel Henry
language : en
Publisher: John Wiley & Sons
Release Date : 2011-02-25
The Carotid And Supra Aortic Trunks written by Michel Henry and has been published by John Wiley & Sons this book supported file pdf, txt, epub, kindle and other format this book has been release on 2011-02-25 with Medical categories.
Carotid Angioplasty and Stenting (CAS) is a new approach to treat a carotid stenosis. This new book provides interventional cardiologists, both as beginners or fully experienced, with a reference on all aspects of angioplasty and stenting of the carotid and supra-aortic trunks. Focusing on both the entire range of angioplasty and stenting treatment options for the surgeon treating patients on the operating table, and the range of radiological techniques used for the cardiologist to diagnose carotid artery stenosis (CAS) and associated conditions, this important book describes the best indications, the different techniques, the results, and also the limitations of CAS based on randomized studies and particularly the last published data (CREST study). Suitable for both novice and experienced interventionalists, it also addresses diagnosis of a carotid stenosis and complications from CAS and how to manage them.
Predictors Of Cerebral Ischemic Events In Patients With Asymptomatic Carotid Artery Stenosis
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Author : Eric Ehrensperger
language : en
Publisher:
Release Date : 2008
Predictors Of Cerebral Ischemic Events In Patients With Asymptomatic Carotid Artery Stenosis written by Eric Ehrensperger and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2008 with categories.
Carotid Artery Disease
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Author : Rita Rezzani
language : en
Publisher: BoD – Books on Demand
Release Date : 2014-01-22
Carotid Artery Disease written by Rita Rezzani and has been published by BoD – Books on Demand this book supported file pdf, txt, epub, kindle and other format this book has been release on 2014-01-22 with Medical categories.
This book will bring out the state of art of carotid stenosis in the basic and clinical approaches for better understanding of the mechanisms and useful therapies for these disease. We hope that would be a new current trend understanding new aspects regarding this scientific problematic involving not only anatomical, functional but also clinical questions.
Carotid Artery Stenting
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Author : Nadim Al-Mubarak
language : en
Publisher: Lippincott Williams & Wilkins
Release Date : 2004
Carotid Artery Stenting written by Nadim Al-Mubarak and has been published by Lippincott Williams & Wilkins this book supported file pdf, txt, epub, kindle and other format this book has been release on 2004 with Medical categories.
Written by internationally recognized experts in interventional cardiology, this comprehensive clinical reference on carotid artery stenting provides illustrated, step-by-step descriptions of techniques and details on indications, contraindications, patient selection, complications, technology, and clinical trials. The first section reviews clinical results and experience, including the CAVATAS trial findings on stroke prevention. The second section describes stenting techniques and includes information from major trials on design and application of devices. The third section presents guidelines and current regulations on establishing a carotid stenting program. The book concludes with a preview of future directions.