Management Of Asymptomatic Carotid 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,

Management Of Asymptomatic Carotid Stenosis

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Author :
language : en
Publisher:
Release Date : 2012

Management Of Asymptomatic Carotid 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 2012 with categories.

Emerging Areas In Extracranial Carotid Stenosis Evaluation And Management

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Author : Seemant Chaturvedi
language : en
Publisher: Frontiers Media SA
Release Date : 2022-07-12

Emerging Areas In Extracranial Carotid Stenosis Evaluation And Management written by Seemant Chaturvedi and has been published by Frontiers Media SA this book supported file pdf, txt, epub, kindle and other format this book has been release on 2022-07-12 with Medical categories.

Angioplasty In Asymptomatic Carotid Artery Stenosis Vs Endarterectomy Compared To Best Medical Treatment One Year Interim Results Of Space 2

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Author : Tilman Reiff
language : en
Publisher:
Release Date : 2020

Angioplasty In Asymptomatic Carotid Artery Stenosis Vs Endarterectomy Compared To Best Medical Treatment One Year Interim Results Of Space 2 written by Tilman Reiff and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2020 with categories.

Abstract: Background Treatment of individuals with asymptomatic carotid artery stenosis is still handled controversially. Recommendations for treatment of asymptomatic carotid stenosis with carotid endarterectomy (CEA) are based on trials having recruited patients more than 15 years ago. Registry data indicate that advances in best medical treatment (BMT) may lead to a markedly decreasing risk of stroke in asymptomatic carotid stenosis. The aim of the SPACE-2 trial (ISRCTN78592017) was to compare the stroke preventive effects of BMT alone with that of BMT in combination with CEA or carotid artery stenting (CAS), respectively, in patients with asymptomatic carotid artery stenosis of ≥70% European Carotid Surgery Trial (ECST) criteria. Methods SPACE-2 is a randomized, controlled, multicenter, open study. A major secondary endpoint was the cumulative rate of any stroke (ischemic or hemorrhagic) or death from any cause within 30 days plus an ipsilateral ischemic stroke within one year of follow-up. Safety was assessed as the rate of any stroke and death from any cause within 30 days after CEA or CAS. Protocol changes had to be implemented. The results on the one-year period after treatment are reported. Findings It was planned to enroll 3550 patients. Due to low recruitment, the enrollment of patients was stopped prematurely after randomization of 513 patients in 36 centers to CEA (n = 203), CAS (n = 197), or BMT (n = 113). The one-year rate of the major secondary endpoint did not significantly differ between groups (CEA 2.5%, CAS 3.0%, BMT 0.9%; p = 0.530) as well as rates of any stroke (CEA 3.9%, CAS 4.1%, BMT 0.9%; p = 0.256) and all-cause mortality (CEA 2.5%, CAS 1.0%, BMT 3.5%; p = 0.304). About half of all strokes occurred in the peri-interventional period. Higher albeit statistically non-significant rates of restenosis occurred in the stenting group (CEA 2.0% vs. CAS 5.6%; p = 0.068) without evidence of increased stroke rates. Interpretation The low sample size of this prematurely stopped trial of 513 patients implies that its power is not sufficient to show that CEA or CAS is superior to a modern medical therapy (BMT) in the primary prevention of ischemic stroke in patients with an asymptomatic carotid stenosis up to one year after treatment. Also, no evidence for differences in safety between CAS and CEA during the first year after treatment could be derived. Follow-up will be performed up to five years. Data may be used for pooled analysis with ongoing trials

Asymptomatic Carotid Stenosis Treatment Strategies Determinants Of Early Surgical Outcome

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Author :
language : en
Publisher:
Release Date : 2017

Asymptomatic Carotid Stenosis Treatment Strategies Determinants Of Early Surgical Outcome written by and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2017 with categories.

Perioperative Monitoring In Carotid Surgery

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Author : S. Horsch
language : en
Publisher: Springer Science & Business Media
Release Date : 2013-03-14

Perioperative Monitoring In Carotid Surgery written by S. Horsch and has been published by Springer Science & Business Media this book supported file pdf, txt, epub, kindle and other format this book has been release on 2013-03-14 with Medical categories.

The efficiency of carotid surgery on an asymptomatic carotid artery stenosis and its superiority to conservative treatment was clearly demonstrated in the ACAS study. The stroke risk over a five year follow-up period could be reduced by 55 % and the combined stroke and mortality rate was shown to be a mere 2. 3 %. The efficacy of surgical treatment in also reducing stroke rates in the case of a symptomatic carotid stenosis was proven in the NASCET and ECTS prospective randomized studies. Of extreme importance in these procedures is, however, precise quality control and quality assessment. This is presently a topic of tremendous interest in reconstructive vascular surgery and is constantly being discussed in specialist circles and beyond. Documentation and the possibility of accurate reconstruction of the intraoperative situation are in high demand. Perioperative monitoring of neurological function, particularly the monitoring during carotid surgery, are the aspects underlying constant revision and reassessment to ensure quality control and assurance of a negligeable mortality and morbidity rate. The aim of this book is to discuss the presently available perioperative control methods, examinations, and quality assessments, and the critical consideration of these. We would like to express our thanks to all authors who helped achieve the sense and aim of this book. A special word of thanks to Dr. Kerstin Simons (assistant surgeon) for assisting in the editing of the numerous presentations in this book. Particularly we thank Dr.

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/.

Baseline Cognitive Function Among 1 000 Participants In The Carotid Revascularization And Medical Management For Asymptomatic Carotid Stenosis Trial Crest 2

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Author : Terina Myers
language : en
Publisher:
Release Date : 2017

Baseline Cognitive Function Among 1 000 Participants In The Carotid Revascularization And Medical Management For Asymptomatic Carotid Stenosis Trial Crest 2 written by Terina Myers and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2017 with categories.

Background and Aims: We wanted to determine baseline cognition via telephone assessment among individuals in CREST-2 (clinicaltrials.gov NCT02089217), which enrolls cognitively competent individuals with asymptomatic carotid artery occlusive disease or remotely symptomatic atherosclerotic stenosis. Participants undergo baseline cognitive assessment before revascularization or starting medical management alone, and at periodic follow-up. To minimize assessment variability of cognition across >120 CREST-2 centers, we employ centrally-administered telephone assessments, based on the population-based REGARDS cohort study. Methods: Data came from the first 1,000 patients . We used the REGARDS protocol of CERAD Word List Learning (WLL-Sum) and Delayed Recall (WLL-Delay), and Word Fluency for the letter u201cFu201d and Animal Names. Using the general population norms from REGARD (N>23,000), we calculated Z-scores for each CREST-2 test, based on the mean score for age-sex-education matched REGARDS participants.Results: The mean age was 69 yrs, 59%M, and 47% left-sided stenosis. Among our tests, the burden of impairment was found in WLL Learning (p

Screening For Asymptomatic Carotid Artery Stenosis In The General Population

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Author : Janelle Guirguis-Blake
language : en
Publisher:
Release Date : 2021

Screening For Asymptomatic Carotid Artery Stenosis In The General Population written by Janelle Guirguis-Blake and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2021 with categories.

OBJECTIVE: To perform a targeted systematic review of evidence regarding the benefits and harms of screening for asymptomatic carotid artery stenosis in the general population to support the update of the USPSTF's 2014 D recommendation for this topic. DATA SOURCES: We conducted a literature search of MEDLINE, PubMed Publisher-Supplied Records, and the Cochrane Central Register of Controlled Trials (CENTRAL) from January 1, 2014, to February 14, 2020. In addition, we conducted ongoing surveillance of relevant literature through November 20, 2020. STUDY SELECTION: We screened 2,374 abstracts and 144 full-text articles against a priori inclusion criteria. Retrospective analyses of vascular surgical registries were limited to data collected in the United States. DATA ANALYSIS: Working independently, two investigators critically appraised each article that met inclusion criteria using design-specific criteria. We abstracted and narratively synthesized data from included studies. The results discussed in this report are limited to studies published since the previous review to support the 2014 recommendation. RESULTS: No eligible studies were identified that directly examined the benefits or harms of screening for asymptomatic carotid artery stenosis. Since the last USPSTF recommendation on this topic, two limited, fair-quality, prematurely terminated trials reported mixed results for the comparative effectiveness of carotid revascularization (carotid endarterectomy [CEA] or carotid artery stenting [CAS]) plus best medical treatment (BMT) compared with BMT alone. The SPACE-2 trial (N=316 reported no difference in composite outcome of stroke or death (30 days) or ipsilateral ischemic stroke (1 year) after CEA (unadjusted hazard ratio [HR] 2.82 [95% CI, 0.33 to 24.07]) or CAS (unadjusted HR 3.50 [95% CI, 0.42, 29.11]) compared with BMT in the 1-year interim publication. The smaller AMTEC trial (N=55) reported a statistically significantly lower composite risk of nonfatal ipsilateral stroke or death among the carotid endarterectomy (CEA) arm at 3.3 median years of followup (calculated unadjusted HR 0.20 [95% CI, 0.06 to 0.65]). Since the previous report, two fair-quality trials, two national datasets, and three surgical registries met our inclusion criteria reporting harms associated with CEA (N=1,903,761) or carotid artery stenting (CAS) (N=332,103). Overall, the rates of most postoperative adverse events were highest among analyses of national databases (Medicare data and National Inpatient Sample [NIS]), with lower rates reported in trials and surgical registries. Within the national databases and surgical registries, rates of 30-day postoperative stroke or death following CEA ranged from as low as 1.4 percent in the Vascular Quality Initiative (VQI) to as high as 3.5 percent in the Medicare database. Thirty-day postoperative mortality ranged from 0.5 percent in the Vascular Study Group of New England (VSGNE) to as high as 1.1 percent in the Medicare database for CEA. Thirty-day postoperative stroke rates following CEA ranged from 0.5 percent in the VSGNE to 1.5 percent in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). For the CAS procedure, 30-day stroke or death ranged from 2.6 percent in the VQI to 5.1 percent in Medicare. Thirty-day postoperative mortality after CAS ranged from 1.1 percent in the VQI to 3.1 percent in the Medicare database. Thirty-day postoperative stroke rates following CAS were only reported in the VQI at 1.8 percent. Rates of postoperative harms within the trials were generally underpowered to detect outcomes such as postoperative mortality. Within the SPACE-2 trial, the composite of 30-day postoperative stroke or death was reported at 2.5 percent following both CAS and CEA. Perioperative stroke was reported in one patient (3.2%) following CEA in the AMTEC trial. The other most common harms reported within trials included hematoma, facial nerve lesion, and contrast agent incompatibility. LIMITATIONS: We identified no trials of screening versus no screening in unselected general populations or examining direct screening harms. There were few new trials, all with methodologic concerns, examining the important question of the comparative effectiveness and harms of revascularization plus best medical treatment compared with best medical treatment alone. Selection bias and measurement bias presented serious validity concerns for complication rates reported in the administrative databases and surgical registries. The procedural complication rates of patients categorized as "asymptomatic" in the harms studies may not be generalizable to the rates that may be expected in a population of screen-detected patients (who would be expected to have lower complication rates compared with populations with any neurologic symptoms or remote history of TIA or stroke) or procedures performed outside of trials by less-selected operators (who may be expected to have higher complication rates compared with highly selected operators at high volume centers). CONCLUSIONS: There are no population-based screening trials addressing the benefits and harms of screening for carotid artery stenosis. Limited new evidence has emerged to determine the benefits of carotid revascularization over contemporary best medical management in asymptomatic patients. The ongoing CREST-2 and ECST-2 trials will be the largest trials to address this issue. Large national administrative databases and surgery registries suggest that postoperative 30-day stroke/death rates vary widely--1.4 to 3.5 percent for CEA and 2.6 to 5.1 percent for CAS--suggesting that there may be a wide variation in complication rates likely attributable to patient and operator selection.