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Xu S, Yu S, Mao B, Yang J, Jiang P, Wan S, Fu F. Cholinergic hyperintensity pathways are associated with cognitive performance in patients with asymptomatic carotid artery stenosis. Clin Neurol Neurosurg 2024; 241:108278. [PMID: 38631155 DOI: 10.1016/j.clineuro.2024.108278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 04/01/2024] [Accepted: 04/05/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVES We aimed to determine whether asymptomatic carotid artery stenosis (ACS) induced cognitive impairments were related to the cholinergic hyperintensity pathway. METHODS This cross-sectional study included patients with moderate-to-severe ACS, who were categorized into mild cognitive impairment (MCI) and normal cognition groups on the basis of Montreal Cognitive Assessment (MoCA) scores. The cholinergic pathway hyperintensity scale (CHIPS), Fazekas, and medial temporal atrophy (MTA) scores were assessed. SPSS software was used for statistical analyses. RESULTS A total of 117 ACS patients (70.89 ± 8.81 years) and 105 controls (67.87 ± 9.49 years) were evaluated (t = 2.46, p = 0.015). The ACS group showed a worse median Mini-Mental Status Examination (MMSE) score (z = -2.41, p = 0.016) and MoCA score (z = -3.51, p < 0.001), and a significantly higher median total CHIPS score (z = 4.88, p < 0.001) and mean Fazekas score (t = 2.39, p = 0.018). In the correlation analysis, the MoCA score showed a significant negative correlation with the CHIPS score (ρ = -0.41, p < 0.001) and Fazekas score (ρ = -0.31, p < 0.001) in ACS group. Logistic regression analyses suggested that CHIPS scores were risk factors for MCI in patients with ACS (odds ratio [OR] = 1.07, 95% Confidence Interval [CI]1.01-1.13 and controls (OR = 1.09, 95%CI 1.01-1.17), while the MTA and Fazekas scores showed no predictive power. The receiver operating characteristic curve showed that the area under the curve of the CHIPS score for predicting MCI was 0.71 in ACS group, but was only 0.57 in controls. CONCLUSIONS Patients with ACS showed poorer cognitive performance and higher CHIPS and Fazekas scores. CHIPS, but not Fazekas, scores were risk factors for cognitive impairment and were a valuable factor to predict MCI in patients with ACS.
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Affiliation(s)
- Shanhu Xu
- Department of Neurology, Zhejiang Hospital, Hangzhou, China; Zhejiang Province Engineering Research Center for Precision Medicine in Cerebrovascular Diseases, Hangzhou, China
| | - Susu Yu
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
| | - Baojie Mao
- Department of Brain Centre, Zhejiang Hospital, Hangzhou, China
| | - Jiahu Yang
- Department of Radiology, Zhejiang Hospital, Hangzhou, China
| | - Peiyi Jiang
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
| | - Shu Wan
- Zhejiang Province Engineering Research Center for Precision Medicine in Cerebrovascular Diseases, Hangzhou, China; Department of Brain Centre, Zhejiang Hospital, Hangzhou, China.
| | - Fengli Fu
- Department of Radiology, Zhejiang Hospital, Hangzhou, China.
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Paraskevas KI, Nicolaides AN, Spence JD, Mikhailidis DP, Lanza G, Liapis CD, Goudot G, Faggioli G, Pini R, Musiałek P, Suri JS, Silvestrini M, Fernandes E Fernandes J, Eckstein HH, Jawien A, Spinelli F, Stilo F, Myrcha P, Rundek T, Kakkos SK, Di Lazzaro V, Svetlikov A, Antignani PL, Poredos P, Saba L, Jezovnik MK, Blinc A, Sultan S, Knoflach M, Jezovnik MK, Capoccia L, Proczka RM, Fraedrich G, Zeebregts CJ, Davies AH, Geroulakos G, Ricco JB, Mansilha A, Dardik A, Gloviczki P. Clarifying the rationale supporting selective screening for asymptomatic carotid artery stenosis. Int J Cardiol 2023; 376:174-5. [PMID: 36681248 DOI: 10.1016/j.ijcard.2023.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 01/16/2023] [Indexed: 01/19/2023]
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Aspalter M, Enzmann FK, Hölzenbein TJ, Hitzl W, Primavesi F, Algayerova L, Nierlich P, Kartnig C, Seitelberger R, Linni K. Preoperative anxiety as predictor of perioperative clinical events following carotid surgery: a prospective observational study. Perioper Med (Lond) 2021; 10:53. [PMID: 34876216 PMCID: PMC8653535 DOI: 10.1186/s13741-021-00223-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 09/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Psychological factors like anxiety and depression are recognised to play a causal role in the development of cardiovascular disease and they may also influence outcome after vascular surgery procedures. The aim of this study was to investigate the association of anxiety and depression with postoperative outcome following elective carotid surgery. METHODS Single centre prospective observational study of patients treated for asymptomatic carotid artery stenosis at an academic vascular surgery centre. Preoperative anxiety and depression were evaluated using self-reporting questionnaires: Spielberger State-Trait Anxiety Inventory (STAI-S/-T) and Hospital Anxiety and Depression Scale (HADS-A/-D). Postoperative morbidity and mortality were assessed with the primary composite endpoint of stroke, myocardial infarction (MI) and death. Standard reporting guidelines for carotid disease were applied. RESULTS From June 2012 to November 2015, 393 carotid endarterectomies (CEA) were performed at our institution. Out of those, 98 asymptomatic patients were available for analysis (78% male; median age, 71.1 years). Median scores of self-reporting questionnaires did not differ from published data of the general population (STAI-T, trait component, median, 36; IQR, 31-42.75; STAI-S, state component, median, 38; IQR, 32-43; HADS-A median, 6; IQR, 3-8; HADS-D median, 4; IQR, 2-7). Cardiovascular risk factors were similar in anxious and non-anxious patients. The composite endpoint of stroke, MI and death occurred significantly more often in patients presenting with a preoperative HADS-A score higher than 6 (10.5%, 95% CI, 3-25; p =.020). CONCLUSIONS The present study indicates that preoperative anxiety is associated with the occurrence of intra- and postoperative neurological events in patients undergoing CEA. Patients who had a preoperative HADS-A score of 6 or less had a very low probability of experiencing these complications.
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Affiliation(s)
- Manuela Aspalter
- Department of Cardiac, Vascular and Endovascular Surgery, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria.
| | - Florian K Enzmann
- Department of Cardiac, Vascular and Endovascular Surgery, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Thomas J Hölzenbein
- Department of Cardiac, Vascular and Endovascular Surgery, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Wolfgang Hitzl
- Research Office, Biostatistics, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria.,Department of Ophthalmology and Optometry, Paracelsus Medical University Salzburg, Müllner Hauptstr. 48, 5020, Salzburg, Austria.,Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
| | - Florian Primavesi
- Department of Cardiac, Vascular and Endovascular Surgery, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Lucia Algayerova
- Department of Cardiac, Vascular and Endovascular Surgery, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Patrick Nierlich
- Department of Cardiac, Vascular and Endovascular Surgery, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Christoph Kartnig
- Department of Psychiatry, Division of Psychosomatic Medicine, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Reinald Seitelberger
- Department of Cardiac, Vascular and Endovascular Surgery, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Klaus Linni
- Department of Cardiac, Vascular and Endovascular Surgery, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
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Yin Y, Cheng Z, Fu X, Ji S. MicroRNA-375-3p is implicated in carotid artery stenosis by promoting the cell proliferation and migration of vascular smooth muscle cells. BMC Cardiovasc Disord 2021; 21:518. [PMID: 34702176 PMCID: PMC8549333 DOI: 10.1186/s12872-021-02326-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 10/13/2021] [Indexed: 01/15/2023] Open
Abstract
Background Atherosclerosis is the main cause of carotid artery stenosis (CAS) which mostly occurs in the elderly. In this paper, the expression level of miR-375-3p in asymptomatic CAS patients and its diagnostic value for asymptomatic CAS were investigated, and the effects of miR-375-3p on the cell proliferation and migration of vascular smooth muscle cells (VSMCs) was further explored. Methods
98 healthy subjects and 101 asymptomatic CAS patients were participated in this study. qRT-PCR was used to measure the expression level of serum miR-375-3p, and the ROC curve was established to evaluate the predictive value of miR-375-3p for asymptomatic CAS. After transfection with miR-375-3p mimic or inhibitor in vitro, cell proliferation and migration were detected by CCK-8 assay, colony formation assay, and Transwell assay, respectively. The levels of TNF-α, IL-1β, IL-6 were detected by ELISA. Western blot was used to detect the protein expression of XIAP. Finally, luciferase reporter gene assay was applied to assess the interaction of miR-375-3p with target genes. Results The expression level of serum miR-375-3p in asymptomatic CAS patients was significantly higher than that in healthy controls, and the AUC value of ROC curve was 0.888. The sensitivity and specificity were 80.2 and 86.7%, respectively, indicating that miR-375-3p had high diagnostic value for asymptomatic CAS. In vitro cell experiments showed that up-regulation of miR-375-3p significantly promoted the proliferation and migration of VSMCs, and also promoted the generation of inflammatory factors and phenotypic transformation of VSMCs. Luciferase reporter gene assay confirmed that XIAP was a target gene of miR-375-3p and was negatively regulated by miR-375-3p. Conclusions In this study, miR-375-3p may have a clinical diagnostic value for asymptomatic CAS patients which need further validation. Increased miR-375-3p levels in CAS may be associated with increased proliferation and migration of VSMCs via downregulation of the apoptosis inducing gene XIAP. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02326-6.
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Affiliation(s)
- Yuxia Yin
- Department of Neurosurgery, Yidu Central Hospital of Weifang, No.4138, South Linglongshan Road, Weifang, 262500, Shandong, China
| | - Zhen Cheng
- Department of Neurosurgery, Yidu Central Hospital of Weifang, No.4138, South Linglongshan Road, Weifang, 262500, Shandong, China
| | - Xiaoling Fu
- Department of Neurosurgery, Yidu Central Hospital of Weifang, No.4138, South Linglongshan Road, Weifang, 262500, Shandong, China
| | - Shishun Ji
- Department of Neurosurgery, Yidu Central Hospital of Weifang, No.4138, South Linglongshan Road, Weifang, 262500, Shandong, China.
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Reiff T, Eckstein HH, Mansmann U, Jansen O, Fraedrich G, Mudra H, Hacke W, Ringleb PA. Successful implementation of best medical treatment for patients with asymptomatic carotid artery stenosis within a randomized controlled trial (SPACE-2). Neurol Res Pract 2021; 3:62. [PMID: 34666833 PMCID: PMC8524978 DOI: 10.1186/s42466-021-00153-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/24/2021] [Indexed: 11/11/2022] Open
Abstract
Background Asymptomatic carotid artery stenosis (ACS) can be treated with carotid endarterectomy (CEA), carotid artery stenting (CAS), or best medical treatment (BMT) only. For all treatment options, optimization of vascular risk factors such as arterial hypertension, hyperlipidemia, smoking, obesity, and insufficient physical activity is essential. Data on adherence to BMT and lifestyle modification in patients with ACS are sparse. The subject of this investigation is the implementation and quality of risk factor adjustment in the context of a randomized controlled trial. Methods A total of 513 patients in the prematurely terminated, randomized, controlled, multicenter SPACE-2 trial (ISRCTN 78592017) were analyzed within one year after randomization into 3 groups (CEA, CAS, and BMT only) for implementation of prespecified BMT recommendations and lifestyle modifications. Measurement time points were the screening visit and visits after one month (D30), 6 months (M6), and one year (A1). Differences between groups and follow-up visits (FUVs) relative to the screening visit were investigated. Findings For all FUVs, a significant increase in statin medication (91% at A1; p < 0.0001) was demonstrated to be associated with a significant decrease (p < 0.01) in cholesterol levels (median 167 mg/dl at A1) and LDL cholesterol levels (median 93 mg/dl at A1). The lowest cholesterol levels were achieved by patients in the BMT group. Seventy-eight percent of all patients reached predefined target cholesterol levels (< 200 mg/dl), with significantly better rates in the BMT group (p = 0.036 at D30). Furthermore, a significant decrease in arterial blood pressure at all FUVs (p < 0.05) was associated with a significant increase in antihypertensive medication (96% at A1, p < 0.0001). However, only 28% of patients achieved the predefined treatment goal of a systolic blood pressure of ≤ 130 mmHg. Forty-two of a total of 100 smokers at the screening visit quit smoking within one year, resulting in a significant increase in nonsmokers at all FUVs (p < 0.0001). Recommended HbA1c levels (< 7%) were achieved in 82% without significant changes after one year. Only 7% of obese (BMI > 25) patients achieved sufficient weight reduction after one year without significant changes at all FUVs (median BMI 27 at A1; p = 0.1201). The BMT group showed significantly (p = 0.024) higher rates of adequate physical activity than the intervention groups. Furthermore, after one year, the BMT group showed a comparatively significantly better implementation of risk factor modification (77%; p = 0.027) according to the treating physician. Interpretation SPACE-2 demonstrated sustained improvement in the noninterventional management of vascular risk factors in patients treated in a clinical trial by general practitioners, internists and neurologists. The best implemented treatment targets were a reduction in cholesterol and HbA1c levels. In this context, a significant increase in statin use was demonstrated. Blood pressure control missed its target but was significantly reduced by intensification of antihypertensive medication. Patients on BMT only had better adjusted lipid parameters and were more physically active. However, all groups failed to achieve sufficient weight reduction. Due to insufficient patient recruitment, the results must be interpreted cautiously. Trial registration: ISRCTN Registry, ISRCTN78592017, Registered 16 June 2007, https://www.isrctn.com/search?q=78592017. Supplementary Information The online version contains supplementary material available at 10.1186/s42466-021-00153-w.
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Affiliation(s)
- Tilman Reiff
- Department of Neurology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - Ulrich Mansmann
- Institute of Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Olav Jansen
- Department of Radiology and Neuroradiology, UKSH Campus Kiel, Kiel, Germany
| | - Gustav Fraedrich
- Department of Vascular Surgery, University Hospital of Innsbruck, Innsbruck, Austria
| | - Harald Mudra
- Department of Cardiology, Klinikum Neuperlach, München KlinikMunich, Germany
| | - Werner Hacke
- Department of Neurology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Peter Arthur Ringleb
- Department of Neurology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
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Reiff T, Eckstein HH, Mansmann U, Jansen O, Fraedrich G, Mudra H, Böckler D, Böhm M, Brückmann H, Debus ES, Fiehler J, Mathias K, Ringelstein EB, Schmidli J, Stingele R, Zahn R, Zeller T, Niesen WD, Barlinn K, Binder A, Glahn J, Ringleb PA. Contralateral Stenosis and Echolucent Plaque Morphology are Associated with Elevated Stroke Risk in Patients Treated with Asymptomatic Carotid Artery Stenosis within a Controlled Clinical Trial (SPACE-2). J Stroke Cerebrovasc Dis 2021; 30:105940. [PMID: 34311420 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/30/2021] [Accepted: 06/01/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Asymptomatic carotid artery stenosis (ACS) has a low risk of stroke. To achieve an advantage over noninterventional best medical treatment (BMT), carotid endarterectomy (CEA) or carotid artery stenting (CAS) must be performed with the lowest possible risk of stroke. Therefore, an analysis of risk-elevating factors is essential. Grade of ipsilateral and contralateral stenosis as well as plaque morphology are known risk factors in ACS. METHODS The randomized, controlled, multicenter SPACE-2 trial had to be stopped prematurely after recruiting 513 patients. 203 patients were randomized to CEA, 197 to CAS, and 113 to BMT. Within one year, risk factors such as grade of stenosis and plaque morphology were analyzed. RESULTS Grade of contralateral stenosis (GCS) was higher in patients with any stroke (50%ECST vs. 20%ECST; p=0.012). Echolucent plaque morphology was associated with any stroke on the day of intervention (OR 5.23; p=0.041). In the periprocedural period, any stroke was correlated with GCS in the CEA group (70%ECST vs. 20%ECST; p=0.026) and with echolucent plaque morphology in the CAS group (6% vs. 1%; p=0.048). In multivariate analysis, occlusion of the contralateral carotid artery (CCO) was associated with risk of any stroke (OR 7.00; p=0.006), without heterogeneity between CEA and CAS. CONCLUSION In patients with asymptomatic carotid artery stenosis, GCS, CCO, as well as echolucent plaque morphology were associated with a higher risk of cerebrovascular events. The risk of stroke in the periprocedural period was increased by GCS in CEA and by echolucent plaque in CAS. Due to small sample size, results must be interpreted carefully.
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Affiliation(s)
- Tilman Reiff
- Department of Neurology, University Hospital of Heidelberg, Heidelberg, Germany.
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
| | - Ulrich Mansmann
- Institute of Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany.
| | - Olav Jansen
- Department of Radiology and Neuroradiology, UKSH Campus Kiel, Kiel, Germany.
| | - Gustav Fraedrich
- Department of Vascular Surgery, University Hospital of Innsbruck, Innsbruck, Austria.
| | - Harald Mudra
- Department of Cardiology, München Klinik, Klinikum Neuperlach, Munich, Germany.
| | - Dittmar Böckler
- Department of Vascular and Endovascular Surgery, University Hospital of Heidelberg, Heidelberg, Germany.
| | - Michael Böhm
- Department of Internal Medicine, University Hospital of Homburg/Saar, Homburg, Germany.
| | - Hartmut Brückmann
- Department of Neuroradiology, Ludwig-Maximilians-Universität München, Munich, Germany.
| | - E Sebastian Debus
- Department of Vascular Surgery, University Hospital of Hamburg, Hamburg, Germany.
| | - Jens Fiehler
- Department of Neuroradiology, University Hospital of Hamburg, Hamburg, Germany.
| | - Klaus Mathias
- Department of Radiology, Klinikum Dortmund, Germany.
| | | | - Jürg Schmidli
- Department of Vascular Surgery, University Hospital of Bern, Bern, Switzerland.
| | - Robert Stingele
- Department of Neurology, DRK-Kliniken Berlin, Berlin, Germany.
| | - Ralf Zahn
- Department of Internal Medicine, Klinikum Ludwigshafen, Ludwigshafen, Germany.
| | - Thomas Zeller
- Department of Angiology, University Heart-Center Freiburg-Bad Krozingen, Bad Krozingen, Germany.
| | - Wolf-Dirk Niesen
- Department of Neurology, University Hospital Freiburg, Freiburg, Germany.
| | - Kristian Barlinn
- Department of Neurology, University Hospital of Dresden, Dresden, Germany.
| | - Andreas Binder
- Department of Neurology, UKSH Campus Kiel, Kiel, Germany.
| | - Jörg Glahn
- Department of Neurology, Johannes Wesling Klinikum, Minden, Germany.
| | - Peter Arthur Ringleb
- Department of Neurology, University Hospital of Heidelberg, Heidelberg, Germany.
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Gray VL, Desikan SK, Khan AA, Barth D, Sikdar S, Sorkin JD, Lal BK. Revascularization for asymptomatic carotid artery stenosis improves balance and mobility. J Vasc Surg 2021:S0741-5214(21)00736-9. [PMID: 34019991 DOI: 10.1016/j.jvs.2021.04.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 04/17/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Balance and mobility function worsen with age, more so for those with underlying chronic diseases. We recently found that asymptomatic carotid artery stenosis (ACAS) restricts blood flow to the brain and might also contribute to balance and mobility impairment. In the present study, we tested the hypothesis that ACAS is a modifiable risk factor for balance and mobility impairment. Our goal was to assess the effect of restoring blood flow to the brain by carotid revascularization on the balance and mobility of patients with high-grade ACAS (≥70% diameter-reducing stenosis). METHODS Twenty adults (age, 67.0 ± 9.4 years) undergoing carotid endarterectomy for high-grade stenosis were enrolled. Balance and mobility assessments were performed before and 6 weeks after revascularization. These included the Short Physical Performance Battery, the Berg Balance Scale, the Four Square Step Test, the Dynamic Gait Index (DGI), the Timed Up and Go test, gait speed, the Mini-Balance Evaluation Systems Test (Mini-BESTest), and the Walking While Talking complex test. RESULTS Consistent with our previous findings, patients demonstrated reduced scores on the Short Physical Performance Battery, Berg Balance Scale, DGI, and Timed Up and Go test and in gait speed. Depending on the outcome measure, 25% to 90% of the patients had scored in the impaired range at baseline. After surgery, significant improvements were observed in the outcome measures that combined walking with dynamic movements, including the DGI (P = .02) and Mini-BESTest (P = .002). The proportion of patients with Mini-BESTest scores indicating a high fall risk had decreased significantly from 90% (n = 18) at baseline to 40% (n = 8) after surgery (P = .02). We used Pearson's correlations to examine the relationship between balance and mobility before surgery and the change after surgery. Patients with lower baseline DGI and Mini-BESTest scores demonstrated the most improvement after surgery (r = -0.59, P = .006; and r = -0.70, P = .001, respectively). CONCLUSIONS Carotid revascularization improved patients' balance and mobility, especially for measures that combine walking and dynamic movements. The greatest improvements were observed for the patients who had been most impaired at baseline.
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Gresele P, Paciullo F, Migliacci R. Antithrombotic treatment of asymptomatic carotid atherosclerosis: a medical dilemma. Intern Emerg Med 2020; 15:1169-1181. [PMID: 32405817 DOI: 10.1007/s11739-020-02347-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/15/2020] [Indexed: 12/24/2022]
Abstract
Carotid artery atherosclerosis (CAAS) is a common finding in asymptomatic subjects evaluated for cardiovascular (CV)-risk stratification. Besides the careful control of CV-risk factors, antithrombotic agents, and in particular aspirin, may be considered for primary prevention in patients at CV-risk. However, there is strong controversy on the use of aspirin in primary prevention. Even if several studies confirmed the association between CAAS and CV-events, CAAS is not universally recognized as an independent risk factor and the choice to use aspirin as primary prevention in these patients remains a medical dilemma. Here we review the available evidence on the prognostic value of asymptomatic CAAS for major CV-events and on the utility of antithrombotic agents in this population. We conclude that the detection of asymptomatic CAAS can not be considered as a direct indication to carry out primary prophylaxis with antithrombotic drugs, and the choice to use aspirin should be made only after the careful estimate of the individual's CV-and hemorrhagic risk.
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Affiliation(s)
- Paolo Gresele
- Section of Internal and Cardiovascular Medicine, Department of Medicine, University of Perugia, Strada Vicinale Via Delle Corse, S. Andrea della Fratte, 06132, Perugia, Italy.
| | - Francesco Paciullo
- Section of Internal and Cardiovascular Medicine, Department of Medicine, University of Perugia, Strada Vicinale Via Delle Corse, S. Andrea della Fratte, 06132, Perugia, Italy
| | - Rino Migliacci
- Division of Internal Medicine, Ospedale Della Valdichiana "S. Margherita", Cortona, Italy
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Quandt F, Fischer F, Schröder J, Heinze M, Kessner SS, Malherbe C, Schulz R, Cheng B, Fiehler J, Gerloff C, Thomalla G. Normalization of reduced functional connectivity after revascularization of asymptomatic carotid stenosis. J Cereb Blood Flow Metab 2020; 40:1838-1848. [PMID: 31510853 PMCID: PMC7446560 DOI: 10.1177/0271678x19874338] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Internal carotid artery stenosis is a risk factor for ischemic stroke. Even in the absence of visible structural brain changes, patients with asymptomatic stenosis are prone to cognitive impairment. On a neuronal level, it was suggested that stenosis may lead to disturbed functional brain connectivity. If so, carotid revascularization should have an effect on hypothesized brain network disturbances. We studied functional connectivity in a motor network by resting-state electroencephalography in 12 patients with high grade asymptomatic carotid stenosis before and after interventional or surgical revascularization as compared to 23 controls. In patients with stenosis, functional connectivity of neural oscillations was significantly decreased prior and improved returning to normal connectivity after revascularization. In a subgroup of patients, also studied by contrast perfusion magnetic resonance imaging, reduced connectivity was associated with decreased regional brain perfusion reflected by increased mean transit time in the middle cerebral artery borderzone. Cognitive testing revealed only minor differences between patients and controls. In summary, we identified oscillatory connectivity changes in patients with asymptomatic carotid stenosis correlating with regional hypoperfusion, which both normalized after revascularization. Hence, electrophysiological changes might be a reversible precursor preceding macroscopic structural brain damage and behavioral impairment in patients with asymptomatic carotid stenosis.
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Affiliation(s)
- Fanny Quandt
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Felix Fischer
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julian Schröder
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marlene Heinze
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Simon S Kessner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Caroline Malherbe
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Robert Schulz
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bastian Cheng
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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10
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Chen G, Gao J, Sheng Y, Han X, Ji X, Zhao M, Wu J. Diagnostic value of miR-92a in asymptomatic carotid artery stenosis patients and its ability to predict cerebrovascular events. Diagn Pathol 2020; 15:74. [PMID: 32522208 PMCID: PMC7285548 DOI: 10.1186/s13000-020-00987-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 05/28/2020] [Indexed: 03/13/2023] Open
Abstract
Background Early diagnosis of asymptomatic carotid artery stenosis (ACAS) is important to prevent the incidence of cerebrovascular events. This study aimed to investigate the circulating expression of microRNA-92a (miR-92a) in ACAS patients and evaluate its diagnostic value for ACAS and predictive value for cerebrovascular events. Methods Circulating expression of miR-92a was measured using quantitative real-time PCR. Chi-square test was used to analyze the association of miR-92a with ACAS patients’ clinical characteristics. A receiver operating characteristic (ROC) was used to evaluate the diagnostic value of miR-92a, and the Kaplan-Meier method and Cox regression analysis were used to assess the predictive value of miR-92a for cerebrovascular events. Results Serum expression of miR-92a was higher in ACAS patients than that in the healthy controls (P < 0.001), and associated with patients’ degree of carotid stenosis (P = 0.013). The elevated miR-92a expression could distinguish ACAS patients from healthy individual, and was an independent predictive factor for the occurrence of cerebrovascular events (P = 0.015). Conclusion The data from this study indicated that circulating increased miR-92a may serve as a noninvasive diagnostic biomarker for ACAS and a potential risk factor for the future onset of cerebrovascular events.
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Affiliation(s)
- Gang Chen
- Department of Vascular Interventional, Binzhou Medical University Hospital, Binzhou, 256603, China
| | - Jianwei Gao
- Department of Vascular Interventional, Binzhou Medical University Hospital, Binzhou, 256603, China
| | - Yuguo Sheng
- Department of Vascular Interventional, Binzhou Medical University Hospital, Binzhou, 256603, China
| | - Xinqiang Han
- Department of Vascular Interventional, Binzhou Medical University Hospital, Binzhou, 256603, China
| | - Xingang Ji
- Department of Vascular Interventional, Binzhou Medical University Hospital, Binzhou, 256603, China
| | - Mengpeng Zhao
- Department of Vascular Interventional, Binzhou Medical University Hospital, Binzhou, 256603, China
| | - Jian Wu
- Department of Vascular Interventional, Binzhou Medical University Hospital, Binzhou, 256603, China.
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11
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Gray VL, Goldberg AP, Rogers MW, Anthony L, Terrin ML, Guralnik JM, Blackwelder WC, Lam DFH, Sikdar S, Lal BK. Asymptomatic carotid stenosis is associated with mobility and cognitive dysfunction and heightens falls in older adults. J Vasc Surg 2020; 71:1930-1937. [PMID: 31699511 PMCID: PMC7196504 DOI: 10.1016/j.jvs.2019.09.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 09/02/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND Atherosclerosis of the carotid bifurcation with plaque formation causes asymptomatic carotid artery stenosis (ACAS), which may also be associated with cerebral hypoperfusion. Cerebral hypoperfusion adversely affects multiple aspects of mobility and cognition. This study tests the hypothesis that community-dwelling older adults with a 50% or greater diameter-reducing ACAS will have mobility and cognitive impairments that heighten their risk for falls. METHODS Eighty community-dwelling adults completed a mobility assessment (Short Physical Performance Battery, Berg Balance Scale, Four Square Step Test, Dynamic Gait Index, Timed Up and Go, and gait speed), self-reported physical function (Activities-Specific Balance Confidence, SF-12 Physical Function Component), and cognitive tests (Mini-Mental State Examination). Falls were recorded for the past 6 months. Standardized carotid ultrasound examination classified participants into no stenosis (<50% diameter reduction) (n = 54), moderate stenosis (50%-69%) (n = 17), and high-grade stenosis (70%-99%) (n = 9) groups. Linear and logistic regression analyses determined the associations between these measures and the degree of stenosis (three groups). RESULTS Logistic regression analysis showed their degree of stenosis was associated with reductions in mobility (Short Physical Performance Battery [P = .008], Berg Balance Scale [P = .0008], Four Square Step Test [P = .005], DGI [P = .0001], TUG [P = .0004], gait speed [P = .02]), perceived physical function (ABC [P < .0001], SF-12 Physical Function Component [P < .0001]), and cognition (MMSE [P = .003]). Adults with moderate- and high-grade stenosis had a greater incidence of falls compared with those without stenosis (relative risk, 2.86; P = .01). Results remained unchanged after adjustment for age, sex and cardiovascular risk factors. CONCLUSIONS ACAS is associated with impaired mobility and cognition that are accompanied with increased fall risk. These impairments increased with worsening severity.
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Affiliation(s)
- Vicki L Gray
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, Md
| | - Andrew P Goldberg
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine, and Department of Veterans Affairs Baltimore VA Geriatric Research Education and Clinical Center, Baltimore, Md
| | - Mark W Rogers
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, Md
| | - Laila Anthony
- Department of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md; Vascular Service, Veterans Affairs Medical Center, Baltimore, Md
| | - Michael L Terrin
- Department of Epidemiology and Public Health, and Department of Medicine, University of Maryland School of Medicine, Baltimore, Md
| | - Jack M Guralnik
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Md
| | | | - Diana F H Lam
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Md
| | | | - Brajesh K Lal
- Department of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md; Vascular Service, Veterans Affairs Medical Center, Baltimore, Md.
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12
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Misaki K, Uno T, Nambu I, Kimura R, Yoshikawa A, Kamide T, Hayashi Y, Uchiyama N, Iino K, Takemura H, Nakada M. Asymptomatic carotid intraplaque hemorrhage is associated with a high risk of cerebral infarction and death after cardiovascular surgery. J Neurol Sci 2020; 412:116801. [PMID: 32240969 DOI: 10.1016/j.jns.2020.116801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 02/29/2020] [Accepted: 03/23/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is a lack of information on the natural history of asymptomatic carotid artery stenosis (AsymCS) associated with cardiovascular diseases that require surgery. The aim of this study was to investigate risk factors for postoperative ipsilateral ischemic stroke and all-cause mortality after cardiovascular surgery in patients with AsymCS. METHODS Among 2158 patients who underwent cardiovascular surgery, 150 patients with AsymCS who didn't undergo carotid revascularization were included. The relationships between preoperative factors, including carotid intraplaque hemorrhage (IPH), and postoperative ipsilateral ischemic stroke and all-cause mortality were analyzed retrospectively. RESULTS During the median follow-up of 1087 days of 150 patients with 19 IPH, 12 (8.0%) and 21 (14.0%) encountered ipsilateral infarction and all-cause mortality, respectively. Multivariable Cox regression analyses indicated that IPH was significantly predictive of both ipsilateral infarction (hazard ratio [HR] 21.31, 95% confidence interval [CI], 4.98-91.17; P ≤.001) and all-cause mortality (HR 4.64, 95% CI, 1.61-13.34; P = .004). Another significant factor was peak systolic velocity for ipsilateral infarction with the cutoff velocity of 227 cm/s by the receiver-operating characteristic curve. CONCLUSIONS In this cohort of patients with AsymCS undergoing cardiovascular surgery, IPH had a close connection with a high risk of both postoperative ischemic stroke and mortality after cardiovascular surgery.
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Affiliation(s)
- Kouichi Misaki
- Department of Neurosurgery, Kanazawa University, Kanazawa, Japan.
| | - Takehiro Uno
- Department of Neurosurgery, Kanazawa University, Kanazawa, Japan
| | - Iku Nambu
- Department of Neurosurgery, Kanazawa University, Kanazawa, Japan
| | - Ryouken Kimura
- Department of Neurosurgery, Kanazawa University, Kanazawa, Japan
| | | | - Tomoya Kamide
- Department of Neurosurgery, Kanazawa University, Kanazawa, Japan
| | - Yasuhiko Hayashi
- Department of Neurosurgery, Kanazawa University, Kanazawa, Japan
| | - Naoyuki Uchiyama
- Department of Neurosurgery, Kanazawa University, Kanazawa, Japan
| | - Kenji Iino
- Department of Thoracic, Cardiovascular and General Surgery, Kanazawa University, Kanazawa, Japan
| | - Hirofumi Takemura
- Department of Thoracic, Cardiovascular and General Surgery, Kanazawa University, Kanazawa, Japan
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13
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Reiff T, Eckstein HH, Mansmann U, Jansen O, Fraedrich G, Mudra H, Böckler D, Böhm M, Brückmann H, Debus ES, Fiehler J, Lang W, Mathias K, Ringelstein EB, Schmidli J, Stingele R, Zahn R, Zeller T, Hetzel A, Bodechtel U, Binder A, Glahn J, Hacke W, Ringleb PA. Angioplasty in asymptomatic carotid artery stenosis vs. endarterectomy compared to best medical treatment: One-year interim results of SPACE-2. Int J Stroke 2019; 15:1747493019833017. [PMID: 30873912 PMCID: PMC7416333 DOI: 10.1177/1747493019833017] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 12/10/2018] [Indexed: 12/11/2022]
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.
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Affiliation(s)
- T Reiff
- Department of Neurology, University
Hospital of Heidelberg, Heidelberg, Germany
| | - HH Eckstein
- Department for Vascular and
Endovascular Surgery, Technical University of Munich, Munich, Germany
| | - U Mansmann
- Institute of Medical Informatics,
Biometry and Epidemiology, Ludwig Maximilian University Munich, Munich,
Germany
| | - O Jansen
- Department of Radiology and
Neuroradiology, UKSH Campus Kiel, Kiel, Germany
| | - G Fraedrich
- Department of Vascular Surgery,
University Hospital of Innsbruck, Innsbruck, Austria
| | - H Mudra
- Department of Internal Medicine,
Städtisches Klinikum München-Neuperlach, Munich, Germany
| | - D Böckler
- Department of Vascular Surgery,
University Hospital of Heidelberg, Heidelberg, Germany
| | - M Böhm
- Department of Internal Medicine,
University Hospital of Homburg/Saar, Homburg, Germany
| | - H Brückmann
- Department of Neuroradiology,
Ludwig-Maximilians-Universität, Munich, Germany
| | - ES Debus
- Department of Vascular Surgery,
University Hospital of Hamburg, Hamburg, Germany
| | - J Fiehler
- Department of Neuroradiology,
University Hospital of Hamburg, Hamburg, Germany
| | - W Lang
- Department of Vascular Surgery,
University Hospital Erlangen, Erlangen, Germany
| | - K Mathias
- Department of Radiology, Klinikum
Dortmund, Dortmund, Germany
| | - EB Ringelstein
- Department of Neurology,
University Hospital of Münster, Münster, Germany
| | - J Schmidli
- Department of Vascular Surgery,
University Hospital of Bern, Bern, Switzerland
| | - R Stingele
- Department of Neurology,
University of Kiel, Kiel, Germany
| | - R Zahn
- Department of Internal Medicine,
Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - T Zeller
- Department of Angiology,
University Hospital Freiburg, Bad Krozingen, Germany
| | - A Hetzel
- Department of Neurology,
University Hospital Freiburg, Freiburg, Germany
| | - U Bodechtel
- Department of Neurology,
University Hospital of Dresden, Dresden, Germany
| | - A Binder
- Department of Neurology, UKSH
Campus Kiel, Kiel, Germany
| | - J Glahn
- Department of Neurology, Johannes
Wesling Klinikum, Minden, Germany
| | - W Hacke
- Department of Neurology, University
Hospital of Heidelberg, Heidelberg, Germany
| | - PA Ringleb
- Department of Neurology, University
Hospital of Heidelberg, Heidelberg, Germany
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14
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Huang X, Wang A, Liu X, Chen S, Zhu Y, Liu Y, Huang K, Wu J, Chen S, Wu S, Zhao X. Association between high sensitivity C-Reactive protein and prevalence of asymptomatic carotid artery stenosis. Atherosclerosis 2015; 246:44-9. [PMID: 26752692 DOI: 10.1016/j.atherosclerosis.2015.12.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 12/12/2015] [Accepted: 12/15/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Inflammation plays a key role in the pathophysiology of atherosclerosis. Little is known about the association between high sensitivity C-reactive protein (hs-CRP) especially long-term hs-CRP and asymptomatic carotid artery stenosis (ACAS) in healthy Chinese adults. The aim of this study was to assess the relationship between hs-CRP levels and the prevalence of ACAS in a Chinese community-based cohort. METHODS A sample of 5349 participants aged ≥ 40 years (40.36% women) were enrolled in this study, all without preexisting stroke. Ultrasonography of the bilateral carotid arteries was performed for the evaluation of carotid stenosis. Participants were stratified into three groups according to hs-CRP levels. We used both baseline (hs-CRP levels analyzed during 2010) and average hs-CRP values for the last four years (the average of hs-CRP levels analyzed at the year of 2006, 2008 and 2010) in the analysis. Multivariable logistic regression models were used to analyze the association between hs-CRP levels and ACAS. RESULTS A total of 356 (6.66%) subjects showed evidence of ACAS. Multivariate analysis showed that both baseline and average hs-CRP values for the last four years were independent indicators for the presence of ACAS (P for trend = 0.007, 0.001, respectively). Stratified by age and sex, higher baseline hs-CRP levels were associated with ACAS in old adults (≥ 60 y) (multivariate-adjusted, odds ratio [OR] = 1.03, 95% confidence interval [CI]: 1.01-1.05) and male (multivariate-adjusted, OR = 1.03, 95%CI: 1.01-1.05), but not in middle-aged adults (40-59 y) and female. Similarly, higher average hs-CRP values for the last four years were associated with ACAS in old adults and male, but not in middle-aged adults and female. CONCLUSION Both baseline and chronic elevation of serum hs-CRP were associated with ACAS, especially in older or male adults. hs-CRP might be used as a useful marker and a potential therapeutic target for carotid atherosclerosis.
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Affiliation(s)
- Xiaoya Huang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China; Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Dongcheng District, Beijing, 100050, China.
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China; Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Dongcheng District, Beijing, 100050, China.
| | - Xiaoxue Liu
- Department of Cardiology, Tangshan People's Hospital Tangshan, North China University of Science and Technology, Tangshan, China
| | - Shengyun Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Ying Zhu
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China
| | - Yanfang Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Keyu Huang
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China
| | - Jianwei Wu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Shouhua Chen
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China.
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
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15
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Paraskevas KI, Nicolaides AN, Veith FJ. Carotid endarterectomy may be required in addition to best medical treatment for some patient subgroups with asymptomatic carotid stenosis. Vascular 2014; 23:62-4. [PMID: 25389280 DOI: 10.1177/1708538114560463] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Several guidelines recommend carotid endarterectomy for patients with severe asymptomatic carotid stenosis to reduce the risk of a future cerebrovascular event, as long as the perioperative stroke/death rate is <3%. Based on improvements in best medical treatment, it was argued that currently best medical treatment alone should comprise the treatment-of-choice for asymptomatic carotid stenosis patients and that no intervention is warranted in these individuals. While it is true that best medical treatment should be used for the management of all asymptomatic carotid stenosis patients, emerging evidence suggests that best medical treatment alone may not prevent disease progression and the development of symptoms in some asymptomatic carotid stenosis patient subgroups. This article analyzes the results of two recent independent studies demonstrating that medical therapy alone may not be adequate for stroke prevention in some asymptomatic carotid stenosis patient subgroups. These results suggest that besides best medical treatment, additional carotid endarterectomy should be considered for specific asymptomatic carotid stenosis patients.
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Affiliation(s)
| | - Andrew N Nicolaides
- St. George's London/Nicosia University Medical School, University of Nicosia, Cyprus
| | - Frank J Veith
- Divisions of Vascular Surgery, New York University Langone Medical Center and The Cleveland Clinic, New York and Cleveland, USA
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16
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Rogers RK, Gandhi S, Rosenfield K. Carotid Artery Stenting Versus Carotid Endarterectomy for Treatment of Asymptomatic Carotid Disease. Interv Cardiol Clin 2014; 3:63-72. [PMID: 28582156 DOI: 10.1016/j.iccl.2013.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In patients with asymptomatic carotid artery stenosis the optimal strategy to reduce the risk for stroke remains controversial. Although carotid endarterectomy was traditionally considered the gold standard for revascularization, emerging data suggest that carotid artery stenting is an appropriate alternative in many asymptomatic patients. This article summarizes the evidence base and related controversies regarding carotid endarterectomy versus carotid artery stenting for the revascularization of carotid disease in asymptomatic patients.
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