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Albricker ACL, Freire CMV, Santos SND, Alcantara MLD, Cantisano AL, Porto CLL, Amaral SID, Veloso OCG, Morais Filho DD, Teodoro JAR, Petisco ACGP, Saleh MH, Barros MVLD, Barros FS, Engelhorn ALDV, Engelhorn CA, Nardino ÉP, Silva MADM, Biagioni LC, Souza AJD, Sarpe AKP, Oliveira ACD, Moraes MRDS, Francisco Neto MJ, Françolin PC, Rochitte CE, Iquizli R, Santos AASMDD, Muglia VF, Naves BDL. Recommendation Update for Vascular Ultrasound Evaluation of Carotid and Vertebral Artery Disease: DIC, CBR and SABCV - 2023. Arq Bras Cardiol 2023; 120:e20230695. [PMID: 37991060 DOI: 10.36660/abc.20230695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
Affiliation(s)
- Ana Cristina Lopes Albricker
- Centro Universitário de Belo Horizonte (UniBH), Belo Horizonte, MG - Brasil
- IMEDE - Instituto Mineiro de Ultrassonografia, Belo Horizonte, MG - Brasil
| | - Claudia Maria Vilas Freire
- Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brasil
- Empresa Brasileira de Serviços Hospitalares (UBSERH), Brasília, DF - Brasil
| | | | | | | | | | | | - Orlando Carlos Glória Veloso
- Rede UnitedHealth Group (UHG), Rio de Janeiro, RJ - Brasil
- Hospital Pasteur, Rio de Janeiro, RJ - Brasil
- Hospital Américas, Rio de Janeiro, RJ - Brasil
- Hospital de Clínicas Mário Lioni, Rio de Janeiro, RJ - Brasil
| | | | | | | | | | | | | | | | | | - Érica Patrício Nardino
- Faculdade de Medicina do ABC Paulista, SP - Brasil
- Faculdade de Medicina Unoeste, Guarujá, SP - Brasil
| | | | | | | | | | | | | | | | - Peter Célio Françolin
- Instituto do Coração (InCor) da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | - Carlos Eduardo Rochitte
- Instituto do Coração (InCor) da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
- Hospital do Coração (Hcor), São Paulo, SP - Brasil
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Johansson E, Fox AJ. Carotid Near-Occlusion: A Comprehensive Review, Part 2--Prognosis and Treatment, Pathophysiology, Confusions, and Areas for Improvement. AJNR Am J Neuroradiol 2015; 37:200-4. [PMID: 26338908 DOI: 10.3174/ajnr.a4429] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In Part 1 of this review, the definition, terminology, and diagnosis of carotid near-occlusion were presented. Carotid near-occlusions (all types) showed a lower risk of stroke than other severe stenoses. However, emerging evidence suggests that the near-occlusion prognosis with full collapse (higher risk) differs from that without full collapse (lower risk). This systematic review presents what is known about carotid near-occlusion. In this second part, the foci are prognosis and treatment, pathophysiology, the current confusion about near-occlusion, and areas in need of future improvement.
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Affiliation(s)
- E Johansson
- From the Department of Pharmacology and Clinical Neuroscience (E.J.), Umeå University, Umeå, Sweden
| | - A J Fox
- Department of Neuroradiology (A.J.F.), Sunnybrook Heath Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Johansson E, Fox AJ. Carotid Near-Occlusion: A Comprehensive Review, Part 1--Definition, Terminology, and Diagnosis. AJNR Am J Neuroradiol 2015; 37:2-10. [PMID: 26316571 DOI: 10.3174/ajnr.a4432] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 04/08/2015] [Indexed: 12/28/2022]
Abstract
Carotid near-occlusion is distal ICA luminal collapse beyond a tight stenosis, where the distal lumen should not be used for calculating percentage stenosis. Near-occlusion with full ICA collapse is well-known, with a threadlike lumen. However, near-occlusion without collapse is often subtle and can be overlooked as a usual severe stenosis. More than 10 different terms have been used to describe near-occlusion, sometimes causing confusion. This systematic review presents what is known about carotid near-occlusion. In this first part, the foci are definition, terminology, and diagnosis.
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Affiliation(s)
- E Johansson
- From the Department of Pharmacology and Clinical Neuroscience (E.J.), Umeå University, Umeå, Sweden
| | - A J Fox
- Department of Neuroradiology (A.J.F.), Sunnybrook Heath Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Chang H, Yoon HJ, Hong JH, Kim CH, Sohn SI, Lee CY. A lotus root-like appearance in carotid stenosis on optical coherence tomography. J Neurointerv Surg 2015; 8:e21. [PMID: 25999379 DOI: 10.1136/neurintsurg-2015-011685.rep] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2015] [Indexed: 11/03/2022]
Abstract
An 82-year-old man visited the outpatient clinic of our stroke centre because of dizziness. He had a previous history of stroke without definite sequelae. Severe stenosis in the left proximal internal carotid artery (ICA) was seen on Doppler sonography. Conventional angiography revealed focal severe stenosis with 'string sign' in the left proximal ICA and delayed distal run off. Optical coherence tomography showed multiple channels surrounding a narrowed central lumen (lotus root-like appearance). Carotid stent placement with a protection device was done without complications. The patient was discharged in good condition 5 days after the procedure.
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Affiliation(s)
- Hyukwon Chang
- Department of Radiology, Keimyung University Hospital, Daegu, Republic of Korea
| | - Hyuck Jun Yoon
- Department Cardiology, Keimyung University Hospital, Daegu, Republic of Korea
| | - Jeong-Ho Hong
- Department of Neurology, Keimyung University Hospital, Daegu, Republic of Korea
| | - Chang-Hyun Kim
- Department of Neurosurgery, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Sung-Il Sohn
- Department of Neurology, Keimyung University Hospital, Daegu, Republic of Korea
| | - Chang-Young Lee
- Department of Neurosurgery, Keimyung University School of Medicine, Daegu, Republic of Korea
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Chang H, Yoon HJ, Hong JH, Kim CH, Sohn SI, Lee CY. A lotus root-like appearance in carotid stenosis on optical coherence tomography. BMJ Case Rep 2015; 2015:bcr-2015-011685. [PMID: 25979912 DOI: 10.1136/bcr-2015-011685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
An 82-year-old man visited the outpatient clinic of our stroke centre because of dizziness. He had a previous history of stroke without definite sequelae. Severe stenosis in the left proximal internal carotid artery (ICA) was seen on Doppler sonography. Conventional angiography revealed focal severe stenosis with 'string sign' in the left proximal ICA and delayed distal run off. Optical coherence tomography showed multiple channels surrounding a narrowed central lumen (lotus root-like appearance). Carotid stent placement with a protection device was done without complications. The patient was discharged in good condition 5 days after the procedure.
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Affiliation(s)
- Hyukwon Chang
- Department of Radiology, Keimyung University Hospital, Daegu, Republic of Korea
| | - Hyuck Jun Yoon
- Department Cardiology, Keimyung University Hospital, Daegu, Republic of Korea
| | - Jeong-Ho Hong
- Department of Neurology, Keimyung University Hospital, Daegu, Republic of Korea
| | - Chang-Hyun Kim
- Department of Neurosurgery, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Sung-il Sohn
- Department of Neurology, Keimyung University Hospital, Daegu, Republic of Korea
| | - Chang-Young Lee
- Department of Neurosurgery, Keimyung University School of Medicine, Daegu, Republic of Korea
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Carotid artery stenting: Clinical and procedural implications for near-occlusion stenosis. NEUROLOGÍA (ENGLISH EDITION) 2013. [DOI: 10.1016/j.nrleng.2013.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Son S, Choi DS, Kim SK, Kang H, Park KJ, Choi NC, Kwon OY, Lim BH. Carotid artery stenting in patients with near occlusion: A single-center experience and comparison with recent studies. Clin Neurol Neurosurg 2013; 115:1976-81. [DOI: 10.1016/j.clineuro.2013.06.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 04/10/2013] [Accepted: 06/04/2013] [Indexed: 12/20/2022]
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Ruiz-Salmerón RJ, Gamero MA, Carrascosa C, Pérez S, de Araujo D, Marcos F, Rodríguez de Leiras S, Vizcaíno M, Caparrós C, Izquierdo G. Carotid artery stenting: clinical and procedural implications for near-occlusion stenosis. Neurologia 2013; 28:535-42. [PMID: 23465685 DOI: 10.1016/j.nrl.2013.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 12/21/2012] [Accepted: 01/04/2013] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES The advisability of implanting a stent in carotid near-occlusion stenosis is a controversial topic. We have assessed procedural and clinical implications of stent implantation for carotid artery disease with near occlusion. METHODS We included 205 patients who underwent carotid artery revascularisation with a stent. The group of patients with near-occlusion stenosis (n=54)was compared to the rest of the population (n=151). RESULTS No differences were found between groups for age, sex, and the percentage of symptomatic patients (three-quarters of the population). Carotid stent revascularisation for near-occlusion stenosis presented a high procedural success rate (96%) similar to that of revascularisation processes for other lesions (98%). Stenting in cases of near-occlusion stenosis required increased use of proximal protection (54% vs. 20.5%, P<.001) and predilation (33% vs. 17%, P=.01). The process to repair near-occlusion stenosis cause increased detachment of plaque, as shown by higher percentages of macroscopic plaque captured by protection devices (18.5% vs. 7%, P=.01) and of perioperative ischaemic brain lesions (47% vs 31%, P = .07). At 30 days of follow-up, the tendency toward adverse neurological events (death, major and minor stroke) was higher in the near-occlusion group (9.2% vs. 3.2%, P=.08). CONCLUSIONS Stent revascularisation for near-occlusion carotid stenosis has a high procedural success rate; however, its higher plaque load was responsible for the increased rate of ischaemic brain lesions and adverse neurovascular events at 30 days post-procedure.
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Affiliation(s)
- R J Ruiz-Salmerón
- Unidad de Gestión Clínica Endovascular, Hospital Virgen Macarena y Área, Sevilla, España.
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