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Jiang H, Li ML, Zhao JL, Zhao Y. Antiphospholipid antibodies induced cerebrovascular occlusion without either arteriosclerosis or thrombosis. Int J Rheum Dis 2023; 26:2323-2325. [PMID: 37439583 DOI: 10.1111/1756-185x.14820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/19/2023] [Accepted: 06/25/2023] [Indexed: 07/14/2023]
Affiliation(s)
- Hui Jiang
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ming L Li
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jiu L Zhao
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, Beijing, China
- Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Yan Zhao
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, Beijing, China
- Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
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Tanyildizi Y, Keweloh S, Neu MA, Russo A, Wingerter A, Weyer-Elberich V, Stockinger M, Schmidberger H, Brockmann MA, Faber J. Radiation-induced vascular changes in the intracranial irradiation field in medulloblastoma survivors: An MRI study. Radiother Oncol 2019; 136:50-55. [PMID: 31015129 DOI: 10.1016/j.radonc.2019.03.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 03/10/2019] [Accepted: 03/14/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND PURPOSE While survival times after treatment of medulloblastoma are increasing, little is known about radiochemotherapy (RCT)-induced cerebrovascular changes. High resolution vessel wall imaging (VWI) sequences are an emerging tool for the evaluation of cerebrovascular diseases. We performed VWI in medulloblastoma long-term survivors to screen for late sequelae of RCT. MATERIAL AND METHODS Twenty-two pediatric medulloblastoma survivors (mean age 25.8 years (10-53 years); 16.3 years (mean) post primary RCT (range 1-45 years)) underwent 2D VWI-MRI. Vessel wall thickening, contrast enhancement and luminal narrowing were analyzed. The findings were correlated with the patients' radiation protocols. RESULTS Vessel wall changes were observed the intracranial internal carotid artery (ICA) and the vertebrobasilar circulation (VBC) in 14 of 22 patients (63.6%). In multivariate analysis, time after RCT (OR = 1.38, p < 0.05) was strongest independent predictor for development of vessel wall alterations. The dose of radiation was not a relevant predictor. CONCLUSIONS With longer follow-up time intracranial vessel wall changes are observed more frequently in medulloblastoma survivors. Thus VWI is a useful tool to monitor vessel wall alterations of cranially irradiated patients, creating the prerequisite for further treatment of late sequelae.
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Affiliation(s)
- Yasemin Tanyildizi
- Department of Neuroradiology, University Medical Center of the Johannes Gutenberg-University Mainz, Germany.
| | - Stefanie Keweloh
- Department of Neuroradiology, University Medical Center of the Johannes Gutenberg-University Mainz, Germany; Department of Diagnostic and Interventional Radiology, Bundeswehrzentralkrankenhaus Koblenz, Germany
| | - Marie A Neu
- Department of Pediatric Hematology/Oncology/Hemostaseology, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Alexandra Russo
- Department of Pediatric Hematology/Oncology/Hemostaseology, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Arthur Wingerter
- Department of Pediatric Hematology/Oncology/Hemostaseology, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Veronica Weyer-Elberich
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Marcus Stockinger
- Department of Radiation Oncology, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Heinz Schmidberger
- Department of Radiation Oncology, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Marc A Brockmann
- Department of Neuroradiology, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Joerg Faber
- Department of Pediatric Hematology/Oncology/Hemostaseology, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
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Renjen PN. Stroke in young. APOLLO MEDICINE 2013. [DOI: 10.1016/j.apme.2013.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Silva ESD, Giglio PN, Waisberg DR, Filho RGJ, Casella IB, Puech-Leão P. Obesity is a risk factor for significant carotid atherosclerosis in patients aged 39 to 55 years. Angiology 2013; 65:602-6. [PMID: 23847106 DOI: 10.1177/0003319713494753] [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] [Indexed: 11/16/2022]
Abstract
We compared the prevalence of risk factors between young and old individuals with significant carotid atherosclerosis. We retrospectively reviewed the records of patients aged 39 to 55 years (group I) and aged ≥ 60 years (group II) with significant atherosclerotic stenosis at the carotid bifurcation. Group I patients had significantly higher values for the following factors: weight, height, body mass index, diastolic pressure, prevalence of current smoking, total and low-density lipoprotein cholesterol and significant lower values for systolic pressure, creatinine, and prevalence of coronary artery disease. Group I patients were more symptomatic and showed higher rates of carotid occlusion and near occlusion. Atherosclerosis of the carotid bifurcation was more aggressive in the younger group, with a higher rate of occlusion and near occlusion. Obesity and smoking were significant risk factors for young patients in this sample.
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Affiliation(s)
- Erasmo Simão da Silva
- Department of Surgery, Vascular and Endovascular Division, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Pedro Nogueira Giglio
- Department of Surgery, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Daniel Reis Waisberg
- Department of Surgery, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | | | - Ivan Benaduce Casella
- Department of Surgery, Vascular and Endovascular Division, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Pedro Puech-Leão
- Department of Surgery, Vascular and Endovascular Division, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
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Carolei A, Pistoia F, Sacco S, Mohr JP. Temporary is not always benign: similarities and differences between transient ischemic attack and angina. Mayo Clin Proc 2013; 88:708-19. [PMID: 23809319 DOI: 10.1016/j.mayocp.2013.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 04/08/2013] [Accepted: 04/22/2013] [Indexed: 11/19/2022]
Abstract
The introduction of the tissue-based definition of transient ischemic attack (TIA), according to which TIA may be diagnosed only in the absence of an infarction on brain neuroimaging, prompts reflections about similarities and differences between TIA and angina. Both share transitory symptoms in the absence of tissue damage, whereas stroke and myocardial infarction are associated with tissue necrosis. Apart from this, TIA and angina are widely different with respect to pathophysiology, natural history, prognosis, and response to specific medical treatments. In general terms, it could be argued that TIA differs from angina as the brain differs from the heart in structure, physiology, metabolism, and performance. Most importantly, in TIA and angina, the reversible nature of symptoms cannot be assumed as a favorable prognostic indicator. In fact, reversibility of stable angina denotes a low-risk condition, whereas in TIA and unstable angina reversibility may suggest plaque instability and relevant risk of ischemic recurrences.
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Affiliation(s)
- Antonio Carolei
- Department of Neurology, University of L'Aquila, L'Aquila, Italy
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6
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Sacco S, Ricci S, Carolei A. Migraine and vascular diseases: a review of the evidence and potential implications for management. Cephalalgia 2012; 32:785-95. [PMID: 22711902 DOI: 10.1177/0333102412451361] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The higher-than-expected incidence of vascular diseases reported in migraineurs suggests that migraine may, in some cases, be a dangerous condition rather than just a distressing but harmless disorder. We provide a systematic review of data linking migraine to vascular diseases. MIGRAINE AND VASCULAR DISEASES Available data indicate an increased risk of ischemic stroke in subjects suffering from migraine with aura. In addition, evidence suggests an association between migraine with aura and cardiac disease, intracerebral hemorrhage, retinal vasculopathy and mortality that needs to be further corroborated; consequently, for those conditions, migraine with aura can be only considered among the less-well-documented risk factors. As the absolute risk of ischemic stroke in the overall migraineur population is low, subjects suffering from migraine with aura should be made aware of the possible link but not unduly alarmed. It is a common notion that the vascular risk of migraineurs may be further increased by the presence of easily treatable vascular risk factors such as arterial hypertension, cigarette smoking and oral contraceptive use. CONCLUSIONS Forthcoming guidelines should appropriately recommend supporting migraineurs not only with measures aimed at decreasing headache frequency, thus improving quality of life, but also with general measures and preventive strategies aimed to reduce the overall vascular risk. In fact, headache specialists should take care not only of relieving pain but also of assessing and treating concurrent vascular risk factors, while gynecologists, in particular, should routinely consider the presence and type of migraine before prescribing oral contraceptives.
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Affiliation(s)
- Simona Sacco
- Department of Neurology, University of L'Aquila, Italy.
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Meeske KA, Siegel SE, Gilsanz V, Bernstein L, Nelson MB, Sposto R, Weaver FA, Lavey RS, Mack MWJ, Nelson MD. Premature carotid artery disease in pediatric cancer survivors treated with neck irradiation. Pediatr Blood Cancer 2009; 53:615-21. [PMID: 19533651 PMCID: PMC4412314 DOI: 10.1002/pbc.22111] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND While carotid artery disease and strokes have been documented in adult cancer patients treated with neck irradiation, little information is available on pediatric patients. The purpose of this study is to determine if carotid disease is more prevalent among pediatric cancer survivors treated with neck irradiation than among healthy controls. PROCEDURE Thirty pediatric cancer survivors who received neck irradiation (2,000-6,660 cGy) and 30 healthy subjects underwent bilateral carotid ultrasounds. Study outcome measures were common carotid intima-media thickness (IMT) and plaque (present or absent). Multivariate methods were used to compare cases and controls and to identify risk factors related to carotid disease in childhood cancer survivors. RESULTS IMT was greater for cancer survivors than controls (0.46 mm (SD 0.12) vs. 0.41 mm (SD 0.06), P < 0.001). Plaque was present in 18% of irradiated vessels and 2% of non-irradiated vessels (P < 0.01). Among cancer survivors, IMT was positively associated with female gender (P < 0.05), non-white ethnicity (P < 0.01), positive family history of stroke/heart attack (P < 0.05), BMI (P < 0.001), total cholesterol (P < 0.01), cancer relapse (P < 0.001), and years off treatment (P < 0.0001). Plaque was positively associated with relapse (P < 0.05) and C-reactive protein (P < 0.01). There was no significant relationship between radiation dose at levels >or=2,000 cGy and IMT or plaque. CONCLUSIONS Carotid artery disease was more prevalent among cancer survivors treated with neck irradiation than among controls. Due to the high risk of stroke associated with advanced carotid disease, larger prospective studies are needed to better define disease risk in these long-term survivors.
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Affiliation(s)
- Kathleen A. Meeske
- Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California,Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California,Division of Hematology-Oncology, Childrens Hospital Los Angeles, Los Angeles, California,Correspondence to: Kathleen A. Meeske, Division of Hematology-Oncology, Childrens Hospital Los Angeles, 4650 Sunset Blvd. MS #54, Los Angeles, CA 90027.
| | - Stuart E. Siegel
- Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California,Division of Hematology-Oncology, Childrens Hospital Los Angeles, Los Angeles, California
| | - Vicente Gilsanz
- Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California,Division of Radiology, Childrens Hospital Los Angeles, Los Angeles, California
| | - Leslie Bernstein
- Department of Population Sciences, City of Hope, Duarte, California
| | - Mary B. Nelson
- Division of Radiology, Childrens Hospital Los Angeles, Los Angeles, California
| | - Richard Sposto
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California,Division of Hematology-Oncology, Childrens Hospital Los Angeles, Los Angeles, California
| | - Fred A. Weaver
- Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Robert S. Lavey
- Department of Radiation Oncology, University of Southern Florida, Gainesville, Florida
| | - M.P.H. Wendy J. Mack
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Marvin D. Nelson
- Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California,Division of Radiology, Childrens Hospital Los Angeles, Los Angeles, California
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Meeske KA, Nelson MB. The role of the long-term follow-up clinic in discovering new emerging late effects in adult survivors of childhood cancer. J Pediatr Oncol Nurs 2008; 25:213-9. [PMID: 18539912 DOI: 10.1177/1043454208320708] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Our understanding of late effects in long-term survivors of childhood cancer is continually evolving as significant numbers of survivors are entering middle to later adulthood. Effects of conventional treatment on premature aging are being recognized, as are long-term effects of newer therapies. Clinicians in long-term follow-up clinics are in a unique position to monitor for recognized late effects and to be alert to signs and symptoms of late effects that have not been previously reported in the pediatric cancer literature. This article presents 2 young adult survivors who displayed subtle signs of impaired cerebral blood flow due to carotid artery stenosis many years after being treated with neck irradiation. When the first patient presented nearly a decade ago in the clinic with symptoms, premature carotid artery disease was not a radiation-related late effect that had been reported previously in survivors of childhood cancer. These cases are used to illustrate the key role of long-term follow-up clinics in identifying new and emerging treatment-related late effects and underscore the importance of lifetime surveillance and the need for collaboration between pediatric and adult health care providers.
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Logason K, Karacagil S, Hårdemark HG, Boström A, Hellberg A, Ljungman C. Carotid artery endarterectomy solely based on duplex scan findings. Vasc Endovascular Surg 2002; 36:9-15. [PMID: 12704519 DOI: 10.1177/153857440203600103] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to review experience with carotid artery surgery based on findings obtained solely from duplex scanning with special regard to unexpected findings during surgery and the early outcome. From January 1993 through December 1999, 271 consecutive patients underwent 287 carotid endarterectomies (CEAs), 229 (80%) of which were performed solely based on duplex scan findings. During the study period 5,932 carotid artery duplex scans were performed in 4,466 patients. Of 589 patients with internal carotid artery (ICA) stenosis 70%, 246 underwent CEA compared to 25 of 156 with 50-69% ICA stenosis. The indications for CEA were transient ischemic attack (TIA) in 88 (30.7%), amaurosis fugax in 60 (20.9%), previous stroke in 91 (31.7%) and asymptomatic disease in 48 (16.7%) cases. There were no statistically significant differences between the groups operated on with and without preoperative angiography with respect to the indications for surgery, associated risk factors, or the degree of stenosis on the contralateral side. In patients undergoing surgery without angiography, there were no unexpected findings that influenced the performance of surgery, in all except 1. There were no significant differences in perioperative morbidity and mortality in patients undergoing surgery with and without conventional angiography. The combined mortality and major stroke rates were 3.4% and 2.2%, respectively. It is concluded that CEA can safely be performed without preoperative angiography in cases with conclusive duplex scan findings.
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Affiliation(s)
- Karl Logason
- Department of Surgery, University Hospital, Uppsala, Sweden
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10
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Rockman CB, Svahn JK, Willis DJ, Lamparello PJ, Adelman MA, Jacobowitz GR, Lee AM, Gagne P, Deutsch E, Landis R, Riles TS. Carotid endarterectomy in patients 55 years of age and younger. Ann Vasc Surg 2001; 15:557-62. [PMID: 11665441 DOI: 10.1007/s10016-001-0029-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Prior studies have suggested that young patients may be more prone to recurrent disease after carotid endarterectomy (CEA). The goal of this study was to review a series of CEAs performed on younger patients (< or = 55 years) and to determine if these patients are more likely to develop recurrent stenosis. A review was conducted of CEAs performed from 1985 through 1994. Analysis was performed on a study group of 94 young patients who underwent 109 CEAs during this time. A control group of 222 patients older than 55 years who underwent 256 CEAs during the years 1991 through 1993 was selected for comparison. During a mean of nearly 4 years of follow-up, younger patients were significantly more likely to experience a late failure of CEA, including total occlusion of the operated artery, or recurrent stenosis requiring redo surgery. Careful patient evaluation is important in choosing younger patients who require CEA. Implications of these data include mandating careful noninvasive follow-up examinations for younger patients undergoing CEA.
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Affiliation(s)
- C B Rockman
- Division of Vascular Surgery, New York University Medical Center, 530 First Avenue, Suite 6F, New York, NY 10016, USA.
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Abstract
This article reviews the literature about carotid disease in acute stroke. Several conclusions are drawn. First, carotid disease is an important cause of ipsilateral cortical strokes, with significant ipsilateral disease found in about one fourth of patients. Second, the role of carotid disease in lacunar stroke is less certain but probably causes a small number of lacunar infarcts. Third, the majority of infarcts that occur with severe carotid stenosis or acute carotid occlusion are caused by cerebral emboli, whereas most infarcts with preexisting occlusion are probably caused by hemodynamic factors. Fourth, the optimal timing of carotid surgery in acute stroke is uncertain. Clinical trials of endarterectomy in acute stroke are now required.
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Affiliation(s)
- G E Mead
- The Western General Hospital, Edinburgh, UK
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12
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Ballotta E, Da Giau G, Renon L. Early and late outcomes of young patients after carotid endarterectomy. Surgery 1999. [DOI: 10.1016/s0039-6060(99)70220-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hedblad B, Janzon L, Jungquist G, Ogren M. Factors modifying the prognosis in men with asymptomatic carotid artery disease. J Intern Med 1998; 243:57-64. [PMID: 9487332 DOI: 10.1046/j.1365-2796.1998.00250.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Carotid artery stenosis is associated with an increased prevalence and incidence of ischaemic heart disease (IHD). The aim of this study has been to assess whether, in men with carotid artery stenosis, survival and incidence of stroke and myocardial infarction is different in men with and men free from IHD; and to characterize probands with incident cerebrovascular (CBV) event in terms of smoking, hypertension and leg artery disease. DESIGN Population-based cohort study, 'Men born 1914'. SETTING Malmö, a city in southern Sweden. SUBJECTS A total of 478 of 621 men born in 1914, who in 1982 participated in ultrasound examination of the carotid arteries. MAIN OUTCOME MEASURES Morbidity and mortality during 10 years of followup. RESULTS Asymptomatic carotid artery stenosis was, in men free from IHD, associated with reduced survival and an increased incidence of serious CBV events that occurred, on average, 3.6 years after the examination. In men with prevalent IHD, there was no relationship between carotid artery stenosis and incidence of CBV events. The main explanation to the lack of association seems to be the high vascular mortality rate in that group. CONCLUSIONS It's our conclusion that in patients with asymptomatic carotid artery stenosis there is a great heterogeneity with regard to severity of disease and prognosis. Survival and incidence of stroke and myocardial infarction depends on whether patients have concomitant IHD.
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Affiliation(s)
- B Hedblad
- Department of Community Medicine, Malmö University Hospital, Lund University, Sweden
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Mingoli A, Sapienza P, Feldhaus RJ, di Marzo L, Sgarzini G, Burchi C, Modini C, Cavallaro A. Carotid endarterectomy in young adults: is it a worthwhile procedure? J Vasc Surg 1997; 25:464-70. [PMID: 9081127 DOI: 10.1016/s0741-5214(97)70256-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE The aim of the study was to investigate surgical indication and long-term outcome of carotid endarterectomy (CE) in young adults. METHODS Between 1973 and 1990, 1693 patients underwent CE. Forty-nine patients (group T) 35 to 45 years of age who had carotid artery stenosis greater than 70%, formed the basis for the analysis. They were compared with two additional groups of patients older than 45 years of age selected from the entire series. Group 2 was randomly chosen to determine differences in risk factors, associated diseases, operative indications, preoperative findings, and outcome. Group 3 was matched with patients in group 1 for sex, risk factors, associated diseases, preoperative findings, and operative indications to assess the importance of age in determining the short- and long-term outcome of CE. RESULTS Postoperative mortality, cerebrovascular accidents, and cardiac complications in patients of group 1 (2%, 2%, and 2%, respectively) were similar to those of the other groups (p = NS). During the follow-up (76.7 +/- 3.6 months; range, 1 to 120 months) the incidence of strokes and transient ischemic attacks in group 1 was lower than in group 2 (p < 0.05) but similar to group 3 (p = NS). Ten-year disease-free intervals were 75.7%, 58.7%, and 77.6%, respectively, for groups 1, 2, and 3. Mortality rate unrelated to cerebrovascular disease was similar between group 1 and group 3 (p = NS) but was higher in group 1 than in group 2 (p < 0.02). Ten-year survival rates were 46.1%, 71.7%, and 55.5%, respectively, for groups 1, 2, and 3. CONCLUSIONS CE in patients younger than 45 years of age is a safe procedure with low operative risks and good disease-free intervals. However, life expectancy is poor because of the high incidence of deaths resulting from complications of atherosclerosis.
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Jahangiri M, Rees GM, Edmondson SJ, Lumley J, Uppal R. A surgical approach to coexistent coronary and carotid artery disease. Heart 1997; 77:164-7. [PMID: 9068401 PMCID: PMC484667 DOI: 10.1136/hrt.77.2.164] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To assess the early results of combined coronary artery bypass graft surgery and carotid endarterectomy. DESIGN Retrospective and ongoing analysis of patients who underwent combined coronary artery bypass graft surgery and carotid endarterectomy. SETTING Cardiothoracic unit in a London teaching hospital. PATIENTS From June 1987 to March 1995, 64 patients were identified. They were patients who were scheduled to have coronary artery bypass graft surgery or required urgent coronary revascularisation and who were found to have significant coexistent carotid disease. (Unilateral carotid stenosis > 70%, bilateral carotid stenosis > 50%, or unilateral carotid stenosis > 50% with contralateral occlusion.) INTERVENTIONS Both procedures were performed during one anaesthesia: the carotid endarterectomy was performed first without cardiopulmonary bypass. After completion of carotid endarterectomy, coronary artery bypass graft surgery was performed. MAIN OUTCOME MEASURES The incidence of stroke, transient ischaemic attack, and myocardial infarction in the early postoperative period was analysed. RESULTS Myocardial revascularisation was successful in all 64 patients. There were no perioperative infarcts. In three patients (4.7%) a new neurological deficit developed postoperatively: two recovered fully before hospital discharge. CONCLUSIONS Combined coronary artery bypass graft surgery and carotid endarterectomy were performed safely and with good results.
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Affiliation(s)
- M Jahangiri
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London
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Levy PJ, Olin JW, Piedmonte MR, Young JR, Hertzer NR. Carotid endarterectomy in adults 50 years of age and younger: a retrospective comparative study. J Vasc Surg 1997; 25:326-31. [PMID: 9052567 DOI: 10.1016/s0741-5214(97)70354-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE Atherosclerotic carotid artery stenosis (CAS) is the most common cause of stroke in young adults. We retrospectively studied clinical characteristics of premature CAS and the safety and durability of carotid endarterectomy (CEA) in 56 patients 50 years of age or younger (mean, 46.4 years; 34 (60%) males; group I) who underwent primary CEA at the Cleveland Clinic between 1983 and 1993. METHODS The patients were identified from the Vascular Surgery Registry and were compared with 202 randomly selected patients 60 years of age and older (mean, 69.3 years; group II) who were frequency-matched by gender and the year of primary CEA. Carotid shunting was used routinely, and the arteriotomy was patched in the majority of cases. Patients were followed-up for mean of 47.2 months (group I) and 46.0 months (group II). RESULTS No significant differences were found in the indications for CEA (symptomatic CAS, 49% in group I vs 48% in group II) or the prevalence of diabetes, coronary diseases, and lower extremity arterial disease. Younger adults were more likely to have a history of smoking (93% vs 76%; p = 0.005), hypertension (71% vs 52%; p = 0.006), premature menopause (57% vs 18%; p < 0.001) and had lower levels of high-density lipoprotein cholesterol (p = 0.03). There were no in-hospital deaths. Perioperative strokes in the distribution of the operated artery occurred within 24 hours in one younger patient (1.8%) and in one older patient (0.5%). This was attributed to early carotid thrombosis in the young patient. Major late postoperative neurologic complications were documented in one young patient (1.8%) and six older patients (3%). Patients in group I were at significantly higher risk for recurrent carotid stenosis (risk ratio, 3.1; 95% confidence interval [CI], 1.3 to 7.3; p = 0.010); younger individuals remained at significantly higher risk for recurrent stenosis even after adjusting for smoking and hypertension (risk ratio, 3.7; 95% CI, 1.5 to 9.4; p = 0.006). By life-table analysis, younger adults tended to have a higher rate of late reoperations (p = 0.065). CONCLUSIONS CEA can be safely performed in young adults with premature CAS, although younger individuals appear to have higher rates of recurrent carotid stenosis compared with older counterparts.
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Affiliation(s)
- P J Levy
- Department of Vascular Medicine, Cleveland Clinic Foundation, OH 44195, USA
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Valentine RJ, Myers SI, Hagino RT, Clagett GP. Late outcome of patients with premature carotid atherosclerosis after carotid endarterectomy. Stroke 1996; 27:1502-6. [PMID: 8784120 DOI: 10.1161/01.str.27.9.1502] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND PURPOSE The durability of carotid endarterectomy (CEA) in young adults with premature carotid atherosclerosis has not been adequately assessed. This study examined the late recurrence and mortality rates in young adults undergoing CEA. METHODS We studied 42 young patients (mean age, 45.5 +/- 0.5 years) who underwent CEA and compared them with 110 older control subjects (mean age, 65.8 +/- 0.4 years) undergoing CEA during the same period. Data were collected regarding demographics, operative indications, follow-up carotid duplex studies, recurrent symptoms, and deaths. RESULTS Demographics and atherosclerotic risk factors were similar between the two groups. During a mean follow-up of 57.9 +/- 6.0 months, 10 (24%) young patients and 3 (3%) control subjects developed significant, recurrent ipsilateral stenoses (> or = 50% diameter loss) (P < .001). Six (14%) young patients and 1 control subject had recurrent ipsilateral symptoms (P = .002). Nine (21%) young patients and 26 (24%) older control subjects required contralateral CEA; 8 (18%) young patients and 18 (16%) older control subjects underwent lower extremity revascularization procedures. Cumulative 5-year survival by life-table analysis was 0.83 (95% confidence interval [CI], 0.71 to 0.95) for study patients and was 0.67 (95% CI, 0.58 to 0.77) for control subjects (P = .06). CONCLUSIONS These data demonstrate a trend toward more favorable survival in young versus older patients after CEA; however, survival differences did not achieve statistical significance. Young patients are far more likely to develop recurrent symptoms and recurrent carotid stenoses than older counterparts. Close follow-up with serial duplex ultrasound may be important in young patients after CEA.
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Affiliation(s)
- R J Valentine
- Division of Vascular Surgery, Department of Veterans Affairs Medical Center, Dallas, Tex., USA
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Carolei A, Marini C, De Matteis G. History of migraine and risk of cerebral ischaemia in young adults. The Italian National Research Council Study Group on Stroke in the Young. Lancet 1996; 347:1503-6. [PMID: 8684100 DOI: 10.1016/s0140-6736(96)90669-8] [Citation(s) in RCA: 231] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND A history of migraine has been proposed as a risk factor for cerebral ischaemia in women under 45. METHODS To investigate the association between history of migraine and cerebral ischaemia, we performed a case-control study of 308 patients aged 15-44, with either transient ischaemic attack (TIA) or stroke, and of 591 age- and sex-matched controls prospectively recruited in seven university hospitals. Crude and adjusted odds ratios were calculated using logistic regression analysis. FINDINGS A history of migraine was more frequent in patients than in controls (14.9% vs 9.1%; adjusted odds ratio 1.9, 95% confidence interval 1.1-3.1). In the prospectively designed subgroup analyses, a history of migraine reached the highest odds ratio (3.7, 95% CI 1.5-9) and was the only significant risk factor in women below age 35 (p=0.003); atherogenic risk factors were more relevant in men and in patients older than 35; previous migraine attacks with aura were more frequent in stroke patients (odds ratio 8.6, 95% CI 1-75). INTERPRETATION Our findings indicated that the rare association between migraine and cerebral ischaemia is limited to women below age 35, and suggest a need for careful clinical evaluation of comorbidity in the presence of migraine with aura.
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Affiliation(s)
- A Carolei
- Institute of Neurology, Department of Internal Medicine and Public Health, University of L'Aquila, L'Aquila-Collemaggio, Italy
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Goonetilleke A. Symptomatic carotid lesions in young adults. BMJ (CLINICAL RESEARCH ED.) 1995; 311:1436. [PMID: 8520300 PMCID: PMC2544394 DOI: 10.1136/bmj.311.7017.1436a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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