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Asymptomatic Carotid Stenosis (asymptomatic + carotid_stenosis)
Selected AbstractsPrevalence and outcome of asymptomatic carotid stenosis: a population-based ultrasonographic studyEUROPEAN JOURNAL OF NEUROLOGY, Issue 4 2002P. P. Mineva The aims of this epidemiological population-based cohort study were to examine the prevalence and outcomes of asymptomatic carotid stenosis (ACS) detected by duplex scanning and its relations to other vascular risk factors. A total of 500 volunteers, 200 men and 300 women, without signs and symptoms of cerebrovascular disease, aged 50,79 years, were enrolled in the study. The prevalence of ACS of 50% or greater was 6.4%. Only severe carotid stenosis was detected in 0.4% of the subjects examined. Significant relationships between ACS and coronary heart disease (CHD) [odds ratio (OR)=8.00], peripheral arterial disease (PAD) (OR=3.66), cigarette smoking in men (OR=4.39) and obesity in women (OR=0.31) were found. The biennial incidence rate of cerebral ischaemic events was 9.4%. A progression of ACS was revealed in 14% and a regression in 6.25% of the subjects. The patients with progressing ACS to more than 70% diameter reduction reached the end-points. Follow-up with repeated duplex scans in patients with advancing ACS of 50% or greater, especially smokers with CHD and PAD, is recommended. [source] Stent-protected angioplasty in asymptomatic carotid artery stenosis vs. endarterectomy: SPACE2 , a three-arm randomised-controlled clinical trialINTERNATIONAL JOURNAL OF STROKE, Issue 4 2009T. Reiff Moderate to severe (,70%) asymptomatic stenosis of the extracranial carotid artery leads to an increased rate of stroke of approximately 11% in 5 years. Patients with asymptomatic carotid stenosis, however, are also at a higher risk of nonstroke vascular events. The estimated annual risks of such events in patients with asymptomatic stenosis are 7% for a coronary ischaemic event and 4,7% for overall mortality. The superiority of carotid endarterectomy compared with medical treatment in symptomatic carotid disease is established, provided that the surgical procedure can be performed with a perioperative morbidity and mortality of <6%. The advantage of carotid endarterectomy for asymptomatic patients is less established. An alternative treatment, carotid artery stenting, has been developed. This treatment is used frequently in both symptomatic and asymptomatic patients. In the last decade, major advantages in medical primary prevention of cerebrovascular and cardiovascular disease have been accomplished. The control groups in the large trials for asymptomatic carotid artery disease (ACAS and ACST) originate from more than a decade ago and, for the most part, have not received a medical primary prevention strategy that would now be considered the standard according to current national and international guidelines. For this reason, a three-arm trial (SPACE2; http://www.space-2.de) with a hierarchical design and a recruitment target of 3640 patients is chosen. Firstly, a superior trial of intervention (carotid artery stenting or carotid endarterectomy) vs. state-of-the-art conservative treatment is designed. In case of superiority of the interventions, a noninferiority end-point will be tested between carotid artery stenting and carotid endarterectomy. This trial is registered at Current Controlled Trials ISRCTN 78592017. [source] Guidelines for patient selection and performance of carotid artery stentingANZ JOURNAL OF SURGERY, Issue 6 2010The Carotid Stenting Guidelines Committee Abstract Background:, The endovascular treatment of carotid atherosclerosis with carotid artery stenting (CAS) remains controversial. Carotid endarterectomy remains the benchmark in terms of procedural mortality and morbidity. At present, there are no consensus Australasian guidelines for the safe performance of CAS. Methods:, We applied a modified Delphi consensus method of iterative consultation between the College representatives on the Carotid Stenting Guidelines Committee (CSGC). Results:, Selection of patients suitable for CAS needs careful consideration of clinical and patho-anatomical criteria and cannot be directly extrapolated from clinical indicators for carotid endarterectomy (CEA). Randomized controlled trials (including pooled analyses of results) comparing CAS with CEA for treatment of symptomatic stenosis have demonstrated that CAS is more hazardous than CEA. On current evidence, the CGSC therefore recommends that CAS should not be performed in the majority of patients requiring carotid revascularisation. The evidence for CAS in patients with symptomatic severe carotid stenosis who are considered medically high risk is weak, and there is currently no evidence to support CAS as a treatment for asymptomatic carotid stenosis. The use of distal protection devices during CAS remains controversial with increased risk of clinically silent stroke. The knowledge requirements for the safe performance of CAS include an understanding of the evidence base from randomized controlled trials, carotid and aortic arch anatomy and pathology, clinical stroke syndromes, the differing treatment options for stroke and carotid atherosclerosis, and recognition and management of periprocedural complications. It is critical that all patients being considered for a carotid intervention have adequate pre-procedural neuro-imaging and an independent, standardized neurological assessment before and after the procedure. Maintenance of proficiency in CAS requires active involvement in surgical/endovascular audit and continuing medical education programs. These standards should apply in the public and private health care settings. Conclusion:, These guidelines represent the consensus of an inter-collegiate committee in order to direct appropriate patient selection and the range of cognitive and technical requirements to perform CAS. Advances in endovascular technologies and the results of randomized controlled trials will guide future revisions of these guidelines. [source] Cost-effectiveness analysis of general anaesthesia versus local anaesthesia for carotid surgery (GALA Trial)BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 8 2010M. Gomes Background: Health outcomes and costs are both important when deciding whether general (GA) or local (LA) anaesthesia should be used during carotid endarterectomy. The aim of this study was to assess the cost-effectiveness of carotid endarterectomy under LA or GA in patients with symptomatic or asymptomatic carotid stenosis for whom surgery was advised. Methods: Using patient-level data from a large, multinational, randomized controlled trial (GALA Trial) time free from stroke, myocardial infarction or death, and costs incurred were evaluated. The cost-effectiveness outcome was incremental cost per day free from an event, within a time horizon of 30 days. Results: A patient undergoing carotid endarterectomy under LA incurred fewer costs (mean difference £178) and had a slightly longer event-free survival (difference 0·16 days, but the 95 per cent confidence limits around this estimate were wide) compared with a patient who had GA. Existing uncertainty did not have a significant impact on the decision to adopt LA, over a wide range of willingness-to-pay values. Conclusion: If cost-effectiveness was considered in the decision to adopt GA or LA for carotid endarterectomy, given the evidence provided by this study, LA is likely to be the favoured treatment for patients for whom either anaesthetic approach is clinically appropriate. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Prospective analysis of carotid artery flow in breast cancer patients treated with supraclavicular irradiation 8 or more years previously,CANCER, Issue 2 2008No increase in ipsilateral carotid stenosis after radiation noted Abstract BACKGROUND. To the authors' knowledge, the effects of supraclavicular fossa radiation on the carotid artery are not well described. In the current study, the authors performed a prospective study to examine the long-term risk of carotid artery stenosis after supraclavicular irradiation for breast cancer. METHODS. A total of 46 breast cancer patients who were treated with adjuvant radiation to the supraclavicular fossa with >8 years of follow-up underwent bilateral Doppler imaging of the carotid artery. Two independent cardiologists interpreted each ultrasound study with no knowledge of which side was treated. RESULTS. The median follow-up from the date of diagnosis was 14.6 years and the mean patient age at the time of ultrasound was 55 years. The median prescribed dose to the supraclavicular fossa was 50 grays. Four patients were found to have clinically relevant, asymptomatic carotid stenosis, for which a cardiology referral was necessary. Only 1 of these 4 patients had stenosis involving the irradiated carotid artery only; 1 patient had bilateral stenosis and 2 patients had only contralateral stenosis. There was no difference noted with regard to isolated ipsilateral versus contralateral medial intimal thickening of the carotid artery (5 patients vs 6 patients, respectively). Furthermore, there were no differences noted with regard to ipsilateral versus contralateral peak systolic flow in the internal (83.5 vs 85.6 cm/seconds; P = .522 by the Student t test and P = .871 by the signed rank test) or common (74.4 vs 77.0 cm/seconds; P = .462 by the Student t test and P = .246 by the signed rank test) carotid artery. CONCLUSIONS. In this prospective study of breast cancer patients with long follow-up, there was no evidence of late, clinically relevant stenosis, increased intimal thickening, or increased peak systolic carotid artery flow secondary to supraclavicular irradiation. Cancer 2008. © 2007 American Cancer Society. [source] | ||||||||||||||||||||||