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Roberts, Charles Stewart. "Endarterectomy for Carotid Atherosclerosis." American Journal of Geriatric Cardiology 16, no. 4 (July 2007): 259–61. http://dx.doi.org/10.1111/j.1076-7460.2007.06224.x.
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Anysienkova, V. Ju. "Comparative characteristics of atherogenesis factors in patients with symptomatic and asymptomatic atherosclerotic carotid stenosis." PROBLEMS OF UNINTERRUPTED MEDICAL TRAINING AND SCIENCE 41, no. 1 (April 2021): 70–76. http://dx.doi.org/10.31071/promedosvity2021.01.070.
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To study a comparative assessment of risk factors for atherogenesis in patients with different clinical manifestations of carotid atherosclerotic stenosis. The study included 106 patients (men — 74, women — 32) aged 39 to 79 years (mean age 62.6 ± 0.9), which devided to 3 clinical groups: Group I — 35 patients with acute atherothrombotic stroke with ipsilateral carotid stenosis, group II — 41 patients after acute cerebrovascular events and carotid endarterectomy, group III — 30 patients with asymptomatic atherosclerotic carotid stenosis and the control group, which consisted of 20 relatively healthy individuals. The degree of stenosis of the internal carotid arteries was highest (> 70 %) in the group of patients who underwent carotid endarterectomy. In addition in this group was prevalence younger men, compared with the group of asymptomatic stenosis and women (p = 0.00300), there was an older age of patients and moderate stenosis of 50–69 % (p = 0.00647). In patients with stenotic atherosclerosis of the internal carotid artery, there was a significant increase in the level of Lp-PLA2 compared with the control. This confirms that Lp-PLA2 can be considered as a marker of carotid atherosclerosis and influence the development of ischemic stroke. The highest level of Lp-PLA2 was observed in the clinical group of patients who underwent carotid endarterectomy after ischemic stroke and there was a tendency to a more significant increase in total cholesterol. This suggests a more aggressive course of the atherosclerotic process in patients in this group.
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Jahromi, Babak S., Michael D. Hill, Kate Holmes, Stuart Hutchison, William S. Tucker, and Brian Chiu. "Chlamydia pneumoniae and Atherosclerosis following Carotid Endarterectomy." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 30, no. 4 (November 2003): 333–39. http://dx.doi.org/10.1017/s0317167100003048.
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Background:Seroepidemiological studies have shown an association between raised antibody titres against Chlamydia pneumoniae, and carotid atherosclerosis or stroke. However, direct evidence for a causal link between arterial infection with C. pneumoniae and carotid disease remains weak. We hypothesized that long-term follow-up of patients with pathologically-proven arterial C. pneumoniae infection might provide further insight into the role of C. pneumoniae in carotid atherosclerosis.Methods:We followed a cohort of 70 carotid endarterectomy patients for ipsilateral restenosis, contralateral progression, and all-cause mortality (four year median follow-up period). All patients had presence or absence of C. pneumoniae in their carotid plaques documented by immunohistochemistry after endarterectomy. A survival function was generated and the log-rank test was used to assess the difference in survival between subjects with and without documented chlamydial infection in their plaque.Results:Baseline demographic and cardiovascular risk factors were similar between the two groups, and survival analysis demonstrated no difference (p>0.05) in all-cause mortality, or all-cause mortality combined with restenosis and progression.Conclusion:Our data finds no causal role for C. pneumoniae in restenosis or progression of carotid disease or mortality in this patient population with advanced carotid atherosclerosis.
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Zakirov, I. R., I. R. Yagafarov, M. G. Khatypov, N. G. Sibagatullin, M. Kh Zakirzyanov, N. G. Faskhutdinov, R. F. Gaysin, A. A. Bikchantaev, M. N. Nadyrova, and D. V. Matveeva. "Long-term results of eversion surgeries for internal carotid artery stenosis due to atherosclerosis." Kazan medical journal 96, no. 3 (June 15, 2015): 337–40. http://dx.doi.org/10.17750/kmj2015-337.
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Aim. Analysis of long-term results of eversion carotid endarterectomy in patients with atherosclerotic carotid stenosis.Methods. 272 eversion carotid endarterectomy surgeries was performed from June 2008 to December 2014 in the department of cardiac surgery. Long-term results were studied in 198 (73%) patients, with follow-up term ranging from 6 to 48 months. The method of operation serves as a criterion separating Patients were allocated into two groups by the surgery method: in the first group, eversion endarterectomy was performed by Kieny, in the second - by DeBakey.Results. Reconstructed ipsilateral internal carotid artery was passable during the follow-up period in 100% of cases, as confirmed by ultrasonography. In the late period, the mortality in the first group was 2.3% (myocardial infarction and cancer), compared to 1.5% in the second group (myocardial infarction). Acute ischemic stroke occurred in 0.8% of the first group patients and in 1.5% of the second group patients. Restenosis of 50 to 69% were discovered in 3.7% of cases in first group and in 3% in the second group. Restenosis ≥70% were found in 1.5% in both groups of patients.Conclusion. The obtained data confirm that both methods of eversion carotid endarterectomy are safe and reliable in treatment of carotid arteries atherosclerosis and, thus, preventing stroke.
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Puglioli, M., R. Padolecchia, P. L. Collavoli, G. Parenti, G. Orlandi, and C. Paoli. "Angioplastica carotidea." Rivista di Neuroradiologia 11, no. 4 (August 1998): 431–42. http://dx.doi.org/10.1177/197140099801100402.
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L'endoarteriectomia, come confermano i risultati degli studi multicentrici NASCET (North American Symptomatic Carotid Endarterectomy Trial), ECST (European Carotid Surgery Trial) ed ACAS (Asymptomatic Carotid Atherosclerosis Study), rappresenta il trattamento di elezione delle stenosi aterosclerotiche interessanti il distretto extracranico dell'arteria carotide, sia nei pazienti sintomatici (stenosi > 70%) che asintomatici (stenosi > 60%). L'intervento chirurgico è gravato da un rischio cumulativo di morbilità-mortalità (stroke/morte) che il NASCET, l'ECST e l'ACAS segnalano, rispettivamente, nel 5,8%, 7,5% e 2,3%, insieme ad altre possibili complicanze: infarto miocardico (0,9%), paralisi di nervi cranici (7,6%), ematoma del collo (5,5%), infezioni (3,4%). Qualora, per ragioni cliniche od anatomiche, il rischio chirurgico sia troppo elevato, come nei pazienti cardiopatici, diabetici, con insufficienza polmonare o renale, con restenosi, con stenosi post-attiniche o fibrodisplastiche, con stenosi carotidee prossimali o distali, con lesioni «tandem», l'angioplastica transluminale percutanea (PTA) e/o lo Stenting carotideo possono rappresentare una valida alternativa terapeutica all'endoarteriectomia. In questo articolo presentiamo la nostra casistica relativa a 41 procedure (36 PTA; 5 Stenting), eseguite su 33 pazienti negli ultimi due anni. I trattamenti sono stati rivolti a 28 arterie carotidi interne, 4 arterie carotidi esterne, 2 arterie carotidi comuni, 2 tronchi anonimi; gli stents sono stati rilasciati in 4 arterie carotidi interne e in 1 arteria carotide comune. Le procedure regolarmente portate a termine sono state 37 (32 PTA; 5 Stents), con un ottimo risultato anatomico in 36 casi. Nei controlli a 6 mesi abbiamo riscontrato una ristenosi (< 60%), asintomatica. In questo articolo illustriamo il nostro protocollo, gli insuccessi tecnici, i risultati e le complicanze.
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Malkoff, Marc D., Linda S. Williams, and Jose Biller. "Advances in Management of Carotid Atherosclerosis." Journal of Intensive Care Medicine 12, no. 2 (March 1997): 55–65. http://dx.doi.org/10.1177/088506669701200201.
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Carotid artery stenosis is a common and potentially treatable cause of stroke. Stroke risk is increased as the degree of carotid stenosis increases, as well as in patients with neurological symptoms referable to the stenosed carotid artery. Carotid stenosis can be quantified by ultrasound imaging, magnetic resonance angiography, or conventional angiography. Medical treatment with platelet antiaggregants reduces stroke risk in some patients; other patients are best treated with carotid endarterectomy. Experimental treatments for carotid stenosis, including carotid angioplasty with or without stenting, are under investigation. We summarize the current literature and provide treatment recommendations for patients with atherosclerotic carotid artery disease.
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Yaşa, Haydar, Övünç Aslan, Barçın Özcem, Muhammet Akyuz, Ali Gürbüz, and Galip Akhan. "An Alternative Surgical Procedure for a Patient with Critically Restenosed and Kinked Carotid Artery: Graft Interposition." Case Reports in Surgery 2011 (2011): 1–3. http://dx.doi.org/10.1155/2011/572454.
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According to the literature data, the prevalence of restenosis after carotid endarterectomy ranges between 6 and 36%. The etiological factor is intimal hyperplasia for early period, whereas it is atherosclerosis for late period. A 67-year-old male patient admitted to our clinic with a history of headache and minor stroke. His medical history was significant for right carotid endarterectomy 8 years ago. Recent Doppler ultrasound and digital substraction angiography revealed 75% stenosis and kinking corresponding to the segment distal to the endarterectomy region. Surgical endarterectomy is the treatment of choice in critical carotid stenosis. Endovascular therapy is primarily considered for patients if there is restenosis after carotid endarterectomy. However, the treatment modality is controversial in cases with concomitant carotid stenosis and kinking of internal carotid artery. We present our surgical approach to a case with significant stenosis and kinking of internal carotid artery. We performed a 6-mm-PTFE graft interposition between common and internal carotid artery and resection of the kinking segment.
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Rancic, Zoran, Djordje Radak, and Dragan Stojanovic. "Early detection of asymptomatic carotid disease in patients with arteriosclerotic occlusive disease of the lower extremities." Srpski arhiv za celokupno lekarstvo 130, no. 7-8 (2002): 258–64. http://dx.doi.org/10.2298/sarh0208258r.
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Prevalence of asymptomatic carotid artery stenosis in patients with lower extremities atherosclerosis is relatively high. Limiting screening of specific subgroups for any demographic or medical characteristics is ineffective. Screening for asymptomatic carotid artery stenosis is indicated in all patients with lower extremities atherosclerosis except in whom prophylactic carotid endarterectomy is not recommended because of comorbid disease or extreme age.
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Debing, Erik, Els Peeters, William Duquet, Kris Poppe, Brigitte Velkeniers, and Pierre Van den Brande. "Endogenous sex hormone levels in postmenopausal women undergoing carotid artery endarterectomy." European Journal of Endocrinology 156, no. 6 (June 2007): 687–93. http://dx.doi.org/10.1530/eje-06-0702.
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Objective: To study the endogenous sex hormone levels in natural postmenopausal women and their association with the presence of internal carotid artery (ICA) atherosclerosis. Design: Case-control study Methods: We compared 56 patients with severe ICA atherosclerosis referred for carotid artery endarterectomy (CEA) with 56 age-matched control subjects free of severe atherosclerotic disease. The presence of atherosclerosis was determined by high-resolution B-mode ultrasound. Metabolic parameters and sex hormones were measured or calculated: total cholesterol, high-density lipoprotein, low-density lipoprotein, triglycerides, glucose, insulin, quantitative insulin sensitivity check index, insulin resistance index, IGF-I, DHEA, DHEA sulfate (DHEA-S), free testosterone, total testosterone, estrone, estradiol, androstenedione, and sex hormone-binding globulin. Results: The cases had statistically significant lower levels of both total testosterone (0.23 ± 0.12 vs 0.31 ± 0.20 μg/l, P = 0.043) and free testosterone (3.42 ± 1.94 vs 4.59 ± 2.97 ng/l, P = 0.009) and significantly lower levels of androstenedione (625.3 ± 168.7 vs 697.0 ± 211.9 ng/l, P = 0.017) when compared with controls. Multivariate linear regression analysis, adjusted for traditional cardiovascular risk factors, baseline and physiologic characteristics, showed a significant inverse relationship between both serum free testosterone (β = −0.234, P = 0.028) and androstenedione (β = −0.241, P = 0.028) levels with the presence of severe atherosclerosis of ICA. Conclusions: The study provides evidence of a positive association between low serum androgen levels and severe ICA atherosclerosis in postmenopausal women. It suggests that higher, but physiological, levels of androgens in postmenopausal women have a protective role in the development of atherosclerosis of ICA.
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Benitez, Ronald P., Rocco A. Armonda, James Harrop, Jeffrey E. Thomas, and Robert H. Rosenwasser. "Carotid angioplasty and stenting for recurrent and radiation-induced stenosis: preliminary experience." Neurosurgical Focus 5, no. 4 (October 1998): E16. http://dx.doi.org/10.3171/foc.1998.5.4.17.
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Carotid endarterectomy for atherosclerotic occlusive disease has become the standard of care for the treatment of symptomatic and asymptomatic occlusive disease of the carotid bifurcation, based on the results of the North American Symptomatic Carotid Endarterectomy Trial, as well as the Asymptomatic Carotid Atherosclerosis Study. For surgical treatment to be of benefit, the perioperative complication rate for neurological events should be 6% or less in the symptomatic population and 3% or less in the asymptomatic group. The performance of carotid endarterectomy for recurrent stenosis and radiation-induced stenosis has reported neurological events ranging from 4 to 10%. It is in this particular population that carotid angioplasty and stent placement may play a role. The authors performed a retrospective analysis of 11 patients who underwent carotid angioplasty and stent placement for recurrent or radiation-induced stenosis. One patient in whom endarterectomy was performed by the vascular surgery service had a critical stenosis distal to the endarterectomy site and awoke with a neurological deficit. This patient underwent reexploration and placement of a stent in the artery distal to the arteriotomy site. The follow-up period ranged from 7 to 12 months. Patient age ranged from 65 to 77 years (mean 75 years). Five of eight patients underwent angioplasty and stent placement for recurrent atherosclerotic disease. Two patients had radiation-induced stenosis, and one patient had a stent placed intraoperatively. All patients, with the exception of the one who underwent intraoperative stent placement, had posttreatment stenoses of less than 15%. The surgical patient had a 30% residual stenosis distally. There were no intra- or postoperative transient ischemic attacks, major or minor strokes, or deaths. Patients who have recurrent or radiation-induced stenosis are potential candidates for angioplasty and stent placement. Before this can be recommended as an alternative to surgical correction, a longer follow-up period is required.
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Culicchia, Frank, Robert F. Spetzler, and Richard A. Flom. "Failure of Transluminal Angioplasty in the Treatment of Myointimal Hyperplasia of the Internal Carotid Artery: Case Report." Neurosurgery 28, no. 1 (January 1, 1991): 148–51. http://dx.doi.org/10.1227/00006123-199101000-00021.
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Abstract Recurrent stenosis of the carotid arteries after a carotid endarterectomy for atherosclerosis can occur as a result of myointimal hyperplasia. This condition was treated by percutaneous transluminal angioplasty. Excellent dilatation of the vessel lumen was documented after balloon dilatation. A 6-month follow-up angiographic study, however, demonstrated recurrent high-grade stenosis at the same level in both carotid arteries. Presumably, the failure of percutaneous transluminal angioplasty and the treatment of myointimal hyperplasia of the internal carotid artery results in the same condition after the original endarterectomy, that is, additional myointimal hyperplasia.
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Dubenko, Olga, Tetyana Litovchenko, Victoria Anysienkova, Maryna Nessonova, and Liudmyla Kovalenko. "The prognostic value of the serum inflammatory biomarkers in patients with carotid atherosclerosis." EUREKA: Health Sciences, no. 4 (July 30, 2021): 26–33. http://dx.doi.org/10.21303/2504-5679.2021.001969.
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20 % of ischemic stroke appear to originate from carotid artery atherosclerotic disease. Serum biomarkers reflecting the activity of atherosclerotic process and may help for estimate risk of acute cerebrovascular events. Several serum inflammatory markers have been proposed for risk assessment, but their prognostic role less known.
The aim of this study is to clarify the prognostic value of biomarkers of atherosclerosis lipoprotein-associated phospholipase A2 (Lp-PLA2) and E-selectin in patients with symptomatic and asymptomatic carotid stenosis.
Materials and methods. The study involved 106 patients with atherosclerotic carotid stenosis >50 % (74 men and 32 women, mean age 62.6±0.9) from which 76 symptomatic (35 with acute ipsilateral atherothrombotic stroke and 41 after carotid endarterectomy) and 30 asymptomatic patients. The control group consisted of age- and sex-matched 20 healthy subjects. The level of serum Lp-PLA2 and E-selectin was determined using a commercially available enzyme-linked immunosorbent assay kit.
Results. The level of Lp-PLA 2 was in general significantly higher (p<0.05) in patients groups than in the control group and most high Lp-PLA2 concentration was in groups of symptomatic patients who underwent carotid endarterectomy. The level of E-selectin in the study patients was significantly higher than in the control group (p<0.05). The correlation of Lp-PLA 2 with E-selectin was significant for total patients (R=0.365664, p=0.00085) and group after carotid endarterectomy (R=0.429143, p=0.01796), but not for asymptomatic group (p>0.05). Receiver Operating Characteristics curves of logistic regression models which takes into joint both indicators was specificity and sensitive for predicting the occurrence of ischemic stroke.
Conclusion. Conducted study show that the levels of Lp-PLA 2 and E-selectin have a significant impact on the development of stroke in patients with atherosclerotic carotid stenosis and can be used to predict it. A multidimensional model of the dependence of the probability of stroke on a linear combination of Lp-PLA 2 and E-selectin allows to obtaining significantly higher characteristics of the accuracy of stroke prediction than models with each factor alone.
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Valentine, R. James, Stuart I. Myers, Ryan T. Hagino, and G. Patrick Clagett. "Late Outcome of Patients With Premature Carotid Atherosclerosis After Carotid Endarterectomy." Stroke 27, no. 9 (September 1996): 1502–6. http://dx.doi.org/10.1161/01.str.27.9.1502.
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Stankovic, Milos, Biljana Ljujic, Djordje Radak, Slobodanka Mitrovic, Srdjan Babic, Nebojsa Arsenijevic, Miodrag Lukic, and Nada Pejnovic. "Circulating IL-10 Levels in Carotid Artery Disease." Serbian Journal of Experimental and Clinical Research 20, no. 1 (March 1, 2019): 53–63. http://dx.doi.org/10.1515/sjecr-2017-0040.
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Abstract Carotid atherosclerosis may be associated with neurosymptoms including cerebral infarction. IL-10 exerts atheroprotective effects, but its role in carotid disease is not fully defined. We aimed to investigate serum IL-10 levels in patients undergoing endarterectomy and their relation to the degree of carotid stenosis, plaque types and neurosymptoms. Two hundred consecutive patients with atherosclerotic carotid stenosis and 29 healthy controls were enrolled in this study. Plaque types were classified according to AHA criteria. Serum IL-10 levels were determined by ELISA. Patients undergoing endarterectomy had significantly higher circulating IL-10 levels (18.7 ± 3.2 pg/ml) in comparison with healthy controls (7.2 ± 1.8pg/ml; P =0.0001) and IL- 10 has good discriminatory efficacy between these two groups (ROC curve, AUC = 0.723, P=0.0001). Patients with < 70% and those with > 70% of carotid stenosis did not differ in terms of age, sex, cardiovascular risk factors except hypertension, neurosymptoms and AHA plaque types. Circulating IL-10 levels differed significantly among patients with different carotid plaque types (P = 0.002). Patients with uncomplicated plaques had significantly higher serum levels of IL-10 (23.0 ± 6.1 pg/ml) compared to those with complicated plaques (13.0 ±1.4 pg/ml, P=0.035) and IL-10 can differentiate patients between these two groups (ROC curve, AUC = 0.413, P= 0.035). Our findings reveal an important role for IL-10 in carotid atherosclerosis. IL-10 might be a potential biomarker in discriminating patients with carotid disease from healthy controls. Decreased serum levels of IL-10 are related to complicated carotid plaques.
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Bobrikova, Ye E., V. Yu Ussov, N. V. Shcherban, V. B. Khaneev, T. A. Shelkovnikova, I. L. Bukhovets, M. P. Plotnikov, and V. M. Shipulin. "HIGH-RESOLUTION CONTRAST-ENHANCED MRI IN DIFFERENTIAL DIAGNOSIS OF TYPE OF CAROTID PLAQUE AND IT'S RELATIONSHIP TO THE ISCHEMIC BRAIN DAMAGE." Bulletin of Siberian Medicine 12, no. 3 (June 28, 2013): 97–105. http://dx.doi.org/10.20538/1682-0363-2013-3-97-105.
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Aim of the study. We have compared in patients with carotid atherosclerosis the patterns of contrast enhancement of atherosclerotic plaque with presence of cerebral stroke, by using of high-resolution contrast-enhanced carotid MRI.Material and methods. The patients 'population comprised 26 persons with either monolateral (14 pts) or bilateral (12 pts) stenosis of internal carotid artery for over 70% of lumen. In 15 (10-monolateral, 5 bilateral stenosis) there was recent stroke in acute or subacute stage, whereas 11 were symptom-free. In everybody contrast-enhanced study of atherosclerotic plaque was carried out with T1-w high-resolution MRI (paramagnetic as 2 ml of 0.5 mol solution per 10 kg of BW).Results and discussion. In control persons there was a mild increase in T1-w intensity of arterial wall of carotids? With IE not more than 1.08. In patients without stroke there was moderate increase in plaque T-1w intensity up to 1.14 ± 0.07. In ishaemic stroke patients there was significant rise in intensity of T1-w of homolateral plaque (IE = 1.35 ± 0.06), and also of T1-w of arterial wall as whole (IE = 1.19 ± 0.05).Conclusion. Further detailed study of high-resolution MRI of carotids is worth in order to obtain better imaging of atherosclerotic lesions and also better evaluation of risk of stroke in patients suitable for carotid endarterectomy.
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Byrnes, Kelly R., and Charles B. Ross. "The Current Role of Carotid Duplex Ultrasonography in the Management of Carotid Atherosclerosis: Foundations and Advances." International Journal of Vascular Medicine 2012 (2012): 1–10. http://dx.doi.org/10.1155/2012/187872.
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The management of atherosclerotic carotid occlusive disease for stroke prevention has entered a time of dramatic change. Improvements in medical management have begun to challenge traditional interventional approaches to asymptomatic carotid stenosis. Simultaneously, carotid artery stenting (CAS) has emerged as an alternative to carotid endarterectomy (CE). Finally, multiple factors beyond degree of stenosis and symptom status now mitigate clinical decision making. These factors include brain perfusion, plaque morphology, and patency of intracranial collaterals (circle of Willis). With all of these changes, it seems prudent to review the role of carotid duplex ultrasonography in the management of atherosclerotic carotid occlusive disease for stroke prevention. Carotid duplex ultrasonography (CDU) for initial and serial imaging of the carotid bifurcation remains an essential component in the management of carotid bifurcation disease. However, correlative axial imaging modalities (computer tomographic angiography (CTA) and contrast-enhanced magnetic resonance angiography (CE-MRA)) increasingly aid in the assessment of individual stroke risk and are important in treatment decisions. The purpose of this paper is twofold: (1) to discuss foundations and advances in CDU and (2) to evaluate the current role of CDU, in light of other imaging modalities, in the clinical management of carotid atherosclerosis.
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Leon, Martin B. "Cervical Carotid Atherosclerosis: Medicine Versus Surgery; Endarterectomy Versus Stents." Journal of Vascular and Interventional Radiology 10, no. 2 (February 1999): 176. http://dx.doi.org/10.1016/s1051-0443(99)71081-x.
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Sevostyanova, V. V., A. V. Mironov, L. V. Antonova, and R. S. Tarasov. "VASCULAR PATCHES FOR ARTERIAL RECONSTRUCTION, CHALLENGES AND ADVANCED TECHNOLOGIES." Complex Issues of Cardiovascular Diseases 8, no. 3 (September 26, 2019): 116–29. http://dx.doi.org/10.17802/2306-1278-2019-8-3-116-129.
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High prevalence of internal carotid atherosclerosis and recent advances in its diagnosis result in an increase in the annual number of carotid endarterectomy procedures to restore carotid patency. Various randomized prospective studies as well as meta-analyses show a decrease in the number of perioperative and postoperative complications following carotid endarterectomy using patches compared with primary arterial closure. Despite the fact that the autologous vein is the material of choice for carotid patch angioplasty, xenogenic and synthetic patches are also widely used in the clinical practice. Furthermore, tissue engineering technologies and the development of novel biomaterials have recently emerged and may encourage manufacturing of vascular patches capable to promote a regenerative potential of the body and restore vascular wall tissues.
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Farsak, Bora, Aylin Yildirir, Yakut Akyön, Ahmet Pinar, Mehmet Öç, Erkmen Böke, Sirri Kes, and Lale Tokgözoğlu. "Detection of Chlamydia pneumoniae andHelicobacter pylori DNA in Human Atherosclerotic Plaques by PCR." Journal of Clinical Microbiology 38, no. 12 (2000): 4408–11. http://dx.doi.org/10.1128/jcm.38.12.4408-4411.2000.
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Chlamydia pneumoniae and Helicobacter pylori can cause persistent infections of the respiratory and gastrointestinal tract, respectively. It has been suggested that persistent infection of arteries with these bacteria can contribute to the development of atherosclerosis. The aims of this study were to determine the presence of C. pneumoniae and H. pylori DNA in atherosclerotic plaque samples by PCR and to evaluate the correlation between clinical status and DNA positivity of these bacteria. Eighty-five consecutive patients (mean age, 59 ± 10; 75 male, 10 female) undergoing coronary artery bypass grafting, carotid endarterectomy, and surgery of the abdominal aorta for atherosclerotic obstructive lesions were included in the study. Forty-six endarterectomy specimens from the atherosclerotic lesions and 39 specimens from healthy regions of the ascending aorta, which were accepted as the control group, were excised. The presence of microorganism DNA in endarterectomy specimens was assessed by PCR.C. pneumoniae DNA was found in 12 (26%) of 46 endarterectomy specimens and none of the healthy vascular-wall specimens (P < 0.001), while H. pyloriDNA was found in 17 (37%) of 46 endarterectomy specimens and none of the controls (P < 0.001). Either C. pneumoniae or H. pylori DNA was positive in 23 (50%) of 46 patients and none of the controls (P < 0.001). Six of the atherosclerotic lesions showed coexistence of both of the microorganism DNAs. The presence of C. pneumoniae andH. pylori DNA in a considerable number of atherosclerotic plaques but their absence in healthy vascular wall supports the idea that they may have a role in the development of atherosclerosis, especially in countries where infection is prevalent and where conventional risk factors fail to explain the high prevalence of atherosclerotic vascular disease.
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Huber, Thomas S., Kevin G. Wheeler, John K. Cuddeback, Douglas A. Dame, Timothy C. Flynn, and James M. Seeger. "Effect of the Asymptomatic Carotid Atherosclerosis Study on Carotid Endarterectomy in Florida." Stroke 29, no. 6 (June 1998): 1099–105. http://dx.doi.org/10.1161/01.str.29.6.1099.
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Zurnic, Irena, Tamara Djuric, Igor Koncar, Aleksandra Stankovic, Dragan Dincic, and Maja Zivkovic. "Apolipoprotein E gene polymorphisms as risk factors for carotid atherosclerosis." Vojnosanitetski pregled 71, no. 4 (2014): 362–67. http://dx.doi.org/10.2298/vsp1404362z.
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Background/Aim. Atherosclerosis is still the leading cause of death in Western world. Development of atherosclerotic plaque involves accumulation of inflammatory cells, lipids, smooth muscle cells and extracellular matrix proteins in the intima of the vascular wall. Apolipoprotein E participates in the transport of exogenous cholesterol, endogenouly synthesized lipids and triglycerides in the organism. Apolipoprotein E gene has been identified as one of the candidate genes for atherosclerosis. Previous studies in different populations have clearly implicated apolipoprotein E genetic variation (? polymorphisms) as a major modulator of low density lipoprotein cholesterol levels. Data considering apolipoprotein E polymorphisms in relation to carotid atherosclerosis gave results that are not in full compliance. The aim of present study was to investigate the apolipoprotein E polymorphisms in association with carotid plaque presence, apolipoprotein E and lipid serum levels in patients with carotid atherosclerosis from Serbia. Methods. The study group enrolled 495 participants: 285 controls and 210 consecutive patients with carotid atherosclerosis who underwent carotid endarterectomy. Genotyping of apolipoprotein E polymorphisms were done using polymerase chain reaction and restriction fragment length polymorphism methods. Results. Patients had significantly decreased frequency of the ?2 allele compared to controls. Patients who carry at least one ?2 allele had a significantly higher level of serum apolipoprotein E and significantly lower low density lipoprotein cholesterol levels compared to those who do not carry this allele. Conclusion. Our results suggest protective effect of apolipoprotein E ?2 allele on susceptibility for carotid plaque presence as well as low density lipoprotein cholesterol lowering effect in Serbian patients with carotid atherosclerosis. Further research of multiple gene and environmental factors that contribute to the appearance and the progression of atherosclerosis should be continued with respect to different populations.
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Kolaković, Ana, Maja Živković, Djordje Radak, Tamara Djurić, Igor Končar, Lazar Davidović, Dragan Dinčić, Dragan Alavantić, and Aleksandra Stanković. "The association of ACE I/D gene polymorphism with severe carotid atherosclerosis in patients undergoing carotid endarterectomy." Journal of the Renin-Angiotensin-Aldosterone System 13, no. 1 (October 7, 2011): 141–47. http://dx.doi.org/10.1177/1470320311423271.
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Introduction: The ACE I/D polymorphism was mostly investigated in association with intima-media thickness, rarely with severe atherosclerotic phenotype. Materials and methods: We investigated the association of I/D polymorphism with severe carotid atherosclerosis (CA) (stenosis > 70%) in asymptomatic and symptomatic patients undergoing carotid endarterectomy. The 504 patients subjected to endarterectomy and 492 healthy controls from a population in Serbia were investigated as a case-control study. Results: The univariate logistic regression analysis revealed ACE DD as a significant risk factor for severe CA (odds ratio [OR] = 1.3, 95% confidence interval [CI] 1.0–1.7, p = 0.04). After adjustment for the common risk factors (age, hypertension, smoking, and HDL) ACE was no longer significant. However, we found a significant independent influence of DD genotype on plaque presence in a normotensive subgroup of patients (OR 1.8, CI 1.2–3.0, p = 0.01, corrected for multiple testing). In symptomatic patients D allele carriers were significantly more frequent compared with asymptomatic patients (OR 1.6 CI 1.0–2.6, p = 0.05). Conclusions: Our data suggests that ACE I/D is not an independent risk factor for severe CA. On the other hand, a significant independent genetic influence of ACE I/D appeared in normotensive and symptomatic patients with severe CA. This should be considered in further research toward resolving the complex genetic background of severe CA phenotype.
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Gagliardi, Rubens J., Denise R. Silveira, Roberto A. Caffaro, Vanessa Prado dos Santos, and Hélio H. Caiaffa-Filho. "Chlamydia pneumoniae and symptomatic carotid atherosclerotic plaque: a prospective study." Arquivos de Neuro-Psiquiatria 65, no. 2b (June 2007): 385–89. http://dx.doi.org/10.1590/s0004-282x2007000300004.
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OBJECTIVE: To investigate the possible link between symptomatic carotid atherosclerotic plaque and Chlamydia pneumoniae. BACKGROUND: Recently, several studies have demonstrated that there may be a possible link between Chlamydia pneumonia and carotid atherosclerosis, however the real role of Chlamydia pneumoniae is not completely understood. METHOD: This is a prospective study with a total of 52 patients analyzed. All patients had been submitted to endarterectomy, and had suffered thrombotic ischemic stroke or transient ischemic attack up to 60 days prior to the surgery. Every patient presented carotid stenosis over 70%. The plaque was removed during the surgery and the laboratory exams were immediately done. Evaluation of Chlamydia pneumoniae DNA was done using polymerase chain reaction (PCR). RESULTS: The PCR analyses of all 52 patients were negative for Chlamydia pneumoniae. CONCLUSION: These initial results do not show a relationship between Chlamydia pneumoniae and symptomatic carotid atherosclerotic plaque.
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Nguyen, Thelinh Q., Linda Lind, and E. John Harris. "Selective Shunting during Carotid Endarterectomy." Vascular 13, no. 1 (January 2005): 23–27. http://dx.doi.org/10.1258/rsmvasc.13.1.23.
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Carotid endarterectomy (CEA) is an effective treatment for significant carotid atherosclerosis. Perioperative stroke, a devastating complication, may be partially circumvented by shunting. However, routine shunt use is not without complications and does not benefit every patient. Our study is designed to determine whether CEA under general anesthesia, without cerebral monitoring, can be safely done with shunting only in the presence of poor internal carotid artery back-bleeding or contralateral carotid occlusion or critical stenosis. The medical records of 995 carotid operations were reviewed. A subset of 117 operations was performed on 112 patients using selective shunting. Data were analyzed and outcomes compared. For the selective shunt group, indications for redo operations ( n = 13) were recurrent asymptomatic high-grade stenosis in 69% and amaurosis fugax or transient ischemic attack in 31%. Indications for primary CEA ( n = 104) were asymptomatic high-grade stenosis in 59%, amaurosis fugax or transient ischemic attack in 36%, previous stroke in 3%, and global ischemia in 2%. A selective shunt was used in 29% of all symptomatic and 11% of all asymptomatic patients. No cerebral monitoring was used. There were no perioperative deaths and no permanent cranial nerve injuries, and there was one stroke (0.8%) from postoperative carotid thrombosis in a shunted patient. The average length of stay was 1.6 days for the non-shunt group and 2.2 days for the shunt group. The routine shunt group ( n = 878) had an overall stroke rate of 0.7%, no permanent cranial nerve deficits, and a mean hospital stay of 2.6 days. CEA under general anesthesia with selective shunting can be performed safely without cerebral monitoring.
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Ecker, Robert D., Tsz Lau, Elad I. Levy, and L. Nelson Hopkins. "Thirty-day morbidity and mortality rates for carotid artery intervention by surgeons who perform both carotid endarterectomy and carotid artery angioplasty and stent placement." Journal of Neurosurgery 106, no. 2 (February 2007): 217–21. http://dx.doi.org/10.3171/jns.2007.106.2.217.
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Object There is no known standard 30-day morbidity and mortality rate for high-risk patients undergoing carotid artery (CA) angioplasty and stent (CAS) placement. The high-risk registries and the Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy, Carotid Revascularization using Endarterectomy or Stenting Systems, and European Long-term Carotid Artery Stenting trials report different rates of morbidity and mortality, and each high-risk cohort has a different risk profile. The applicability of carotid endarterectomy (CEA) results from North American Symptomatic Carotid Endarterectomy Trial/Asymptomatic Carotid Atherosclerosis Study (NASCET/ACAS) remains uncertain, as most clinical CAS placement series reported to date typically included patients who would not have qualified for those studies. At the University at Buffalo, the same neurosurgeons perform triage in patients with CA disease and perform both CEA and CAS insertion. The authors review morbidity and mortality rates in this practice model. Methods Diagnosis-related group codes were used to search the authors’ practice database for patients who had undergone a completed CA intervention solely for the indication of atherosclerotic disease. One hundred twenty patients (129 vessels) treated with CAS surgery and 95 patients (100 vessels) treated with CEA met these criteria. In the CAS placement group, 78% of the patients would not have met NASCET/ACAS inclusion criteria. Demographic and clinical data for both groups were recorded on a spreadsheet for analysis. At 30 days, one patient in the CEA group and two in the CAS group had died. Stroke occurred in one patient in the CAS group and none in the CEA group. Myocardial infarction (MI) occurred in one patient who underwent CAS surgery compared with three undergoing CEA. Composite incidence of stroke/death/MI was 3.3% in the CAS group and 3.2% in the CEA group. Conclusions In a practice in which surgeons perform both CEA and CAS surgery, the event rates for the CAS surgery equivalent to NASCET and ACAS rates for CEA can be achieved, even in high-risk NASCET/ACAS-ineligible patients in 78% of the CAS cases.
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Brennan, James J., and Christopher M. Loftus. "Carotid endarterectomy: current indications for surgery." Neurosurgical Focus 5, no. 6 (December 1998): E3. http://dx.doi.org/10.3171/foc.1998.5.6.4.
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The study of carotid artery occlusive disease interventions can be divided clinically into the treatment of asymptomatic and symptomatic diseases. Clinical trials that have studied or are currently studying asymptomatic disease include: the Carotid Artery Stenosis with Asymptomatic Narrowing Operation Versus Aspirin study; the Mayo Asymptomatic Carotid Endarterectomy trial; Veterans Administration Cooperative Trial on Asymptomatic Carotid Stenosis; and the Asymptomatic Carotid Atherosclerosis Study. Trials for the treatment of symptomatic disease include: the North American Symptomatic Carotid Endarterectomy Trial; the European Carotid Surgery Trial; and the Veterans Administration Cooperative Study. In the earliest trials conducted to study asymptomatic disease medical therapy was slightly favored; on close scrutiny these studies were flawed and the findings appeared to be equivocal. The more scientific and appropriate trial, which was ended due to ethical concerns, revealed a clear advantage in patients who underwent surgery for greater than 60% stenosis and when the surgical center demonstrated less than 3% surgical risks. All trials studying symptomatic disease found a significant decrease in subsequent stroke when surgical intervention was performed. It is now judged that patients with greater than 50% stenosis receive significant benefit. In this paper the authors review the data from all of these studies. They also review data for special circumstances, such as critical stenosis and patients with symptomatic and asymptomatic Hollenhorst plaques. It is their opinion that these data have allowed surgeons to make much more educated decisions when considering the treatment of patients with carotid artery occlusive disease.
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Meyer, Fredric B., David G. Piepgras, and Nicolee C. Fode. "Surgical treatment of recurrent carotid artery stenosis." Journal of Neurosurgery 80, no. 5 (May 1994): 781–87. http://dx.doi.org/10.3171/jns.1994.80.5.0781.
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✓ Ninety-two surgical procedures were performed in 82 patients for recurrent carotid artery stenosis. The etiology was recurrent atherosclerosis in 45 cases, myointimal hyperplasia in 20, organized thrombus without a significant underlying plaque in 20, and scarring along the proximal arteriotomy site in seven. The operations included a repeat endarterectomy in 66 cases and reconstruction with an interposition graft in 22. All five major neurological complications occurred in symptomatic patients, and included three instances of intraoperative embolization during exposure of the carotid artery. The majority of neurological complications occurred in symptomatic patients who had intraluminal thrombus confirmed at surgery. There were four perioperative deaths, due to cerebral hemorrhage in two patients and myocardial infarction in two. In the patients whose original surgery was performed at the Mayo Clinic, the risk of recurrent carotid artery stenosis was 3.1% with a primary closure compared to 1.6% when a patch graft was used. These results indicate that surgery for recurrent carotid artery stenosis is technically more difficult and carries a significantly higher risk than surgery for primary disease. The difficulty is due to the friable recurrent plaque associated with intraluminal thrombus, which increases the risk of embolization during carotid artery exposure. In the majority of patients with recurrent atherosclerosis, a repeat endarterectomy can be achieved. However, in some patients, there is scarring without a definite plane of cleavage between the recurrent disease and the underlying media, making an endarterectomy difficult. In these cases, excision of the diseased segment and reconstruction with an interposition graft is the best treatment. The findings presented here also suggest that closure of the original arteriotomy with a patch graft decreases the risk of recurrent carotid artery stenosis.
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Aguiar, Eduardo Toledo de, Alex Lederman, and Patrícia Matsunaga. "Ring-stripping retrograde common carotid endarterectomy: case report." Sao Paulo Medical Journal 120, no. 5 (July 2002): 154–57. http://dx.doi.org/10.1590/s1516-31802002000500007.
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CONTEXT: Total occlusion of the common carotid is rare and the indications and techniques for surgical treatment are still a matter of controversy. OBJECTIVE: To demonstrate the feasibility of retrograde common carotid endarterectomy. DESIGN: Retrospective case report study. SETTING: Tertiary care private hospital. PARTICIPANTS: Three patients underwent ring-stripping retrograde common carotid endarterectomy. Their ages were 81, 68 and 65 years. All were hypertensive with generalized atherosclerosis, two had diabetes mellitus, and one had undergone coronary artery bypass some years earlier and had non-dialytic chronic renal insufficiency. Symptoms of brain ischemia were present in two patients. All patients had total occlusion of the common carotid, extending from the origin to the bifurcation and localized in the right common carotid in two cases. In two cases the internal carotid artery was also occluded. MAIN MEASUREMENTS: Postoperative early mortality and stroke rate, and the medium and long-term endarterectomy patency. RESULTS: There were no deaths. One patient had a transient ischemic attack. All endarterectomies were patent after eight months, four years and seven years of follow-up. CONCLUSION: There is low mortality, and the procedure can be done through only one cervical incision. Tandem lesions of the carotid arteries can be treated together. It is suitable for long total occlusions of the common carotid, and long-term patency.
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Kolos, Igor, Alexandr Troitskiy, Tatiana Balakhonova, Merab Shariya, Denis Skrypnik, Tatiana Tvorogova, Alexandr Deev, et al. "Modern medical treatment with or without carotid endarterectomy for severe asymptomatic carotid atherosclerosis." Journal of Vascular Surgery 62, no. 4 (October 2015): 914–22. http://dx.doi.org/10.1016/j.jvs.2015.05.005.
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Sangha, N., M. Singh, and N. R. Gonzales. "Treatment for routine symptomatic carotid bulb atherosclerosis: Carotid endarterectomy is better than stenting." Neurology: Clinical Practice 2, no. 1 (March 1, 2012): 76–79. http://dx.doi.org/10.1212/cpj.0b013e31824c6cfe.
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Jensen, M. E., and D. V. Heck. "Treatment for routine, symptomatic, carotid bulb atherosclerosis: Carotid endarterectomy and stenting are comparable." Neurology: Clinical Practice 2, no. 1 (March 1, 2012): 72–75. http://dx.doi.org/10.1212/cpj.0b013e31824cb0bd.
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Pavlic, Verica, Dejan Peric, Ivana Stosovic Kalezic, Marwa Madi, Subraya G. Bhat, Zlata Brkic, and Danijela Staletovic. "Identification of Periopathogens in Atheromatous Plaques Obtained from Carotid and Coronary Arteries." BioMed Research International 2021 (June 17, 2021): 1–7. http://dx.doi.org/10.1155/2021/9986375.
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Increasing attention has been paid to the possible link between periodontal disease and atherosclerosis over the past decade. The aim of this study is to investigate the presence of five periopathogens: Porphyromonas gingivalis (P.g.), Aggregatibacter actinomycetemcomitans (A.a.), Tannerella forsythia (T.f.), Treponema denticola (T.d.), and Prevotella intermedia (P.i.) in atheromatous plaques obtained from the carotid and coronary arteries in patients who underwent coronary artery bypass graft surgery and carotid endarterectomy. Group I (carotid arteries) consisted of 30 patients (mean age: 54.5 ± 14.8 ), and group II (coronary arteries) consisted of 28 patients (mean age: 63 ± 12.1 ). Clinical periodontal examinations consisted of plaque index, gingival index, sulcus bleeding index, and periodontal probing depth and were performed on the day of vascular surgery. The presence of periopathogens in periodontal pockets and atherosclerotic vessels was detected using polymerase chain reaction. In both subgingival plaque and atherosclerotic plaque of carotid arteries, P.g., A.a., T.f., T.d., and P.i. were detected in 26.7%, 6.7%, 66.7%, 10.0%, and 20.0%, respectively, while for coronary arteries, P.g. was detected in 39.3%, A.a. in 25%, T.f. in 46.4%, T.d. in 7.1%, and P.i. in 35.7%. The presence of five periopathogens in carotid and coronary atherosclerotic vessels showed correlation in regard to the degree of periodontal inflammation. The present study suggests the relationship between periodontal pathogenic bacteria and atherogenesis. Further studies are necessary in relation to the prevention or treatment of periodontal disease that would result in reduced mortality and morbidity associated with atherosclerosis.
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Dempsey, R. J., R. G. Buice, W. C. Symons, and R. A. Lodder. "Near-infrared Imaging in Stroke Research." Microscopy and Microanalysis 3, S2 (August 1997): 829–30. http://dx.doi.org/10.1017/s143192760001103x.
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Accurate and nondestructive measurement of different lipoproteins simultaneously in carotid plaque in stroke patients using near-infrared (IR) imaging spectrometry seems possible for research. The lipoprotein composition of the plaque appears to have an impact on the outcome of the disease process. Carotid atherosclerosis without associated thrombosis is frequently a benign disease that is asymptomatic, although TIAs may be present in other cases. Many patients with carotid atherosclerosis can be treated surgically by endarterectomy with high initial success and favorable long-term prognosis. The acute manifestation of carotid atherosclerosis - stroke - arises when thrombus or ulceration develop. This potentially life-threatening complication probably develops at the site of plaque fissure or rupture. Recent research by others indicates that it is not the severity of stenosis (plaque volume) that determines the outcome: it is the type of stenosis (plaque chemical composition) and the extent of collateral growth.
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Sapa-Wojciechowska, Agnieszka, Alina Rak-Pasikowska, Kornel Pormańczuk, Bartłomiej Czapla, and Iwona Bil-Lula. "Extracellular Matrix Remodeling Factors as Markers of Carotid Artery Atherosclerosis." Cardiology Research and Practice 2020 (August 12, 2020): 1–11. http://dx.doi.org/10.1155/2020/9036157.
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Background and Objectives. The atherosclerotic plaque formation is a complex and multifactorial process. A key process underlying the formation of atherosclerotic lesion is extracellular matrix (ECM) remodeling. We chose proteins representing related aspects of ECM remodeling. In this study, we evaluated the plasma concentration and the tissue content of MMP-2 and MMP-9, osteoprotegerin (OPG), and fibronectin (FN) in atheromatous artery wall. We aimed to elucidate if the local changes have systemic reflection and to assess their clinical utility in patients with carotid atherosclerosis. Materials and Methods. 20 patients undergoing routine carotid endarterectomy and 40 healthy volunteers were enrolled in this study. MMPs activity and OPG and FN concentrations were measured in atherosclerotic plaques and nonchanged contiguous tissue after homogenization as well as in plasma from patients and reference group. The activity of MMPs was evaluated by gelatin zymography, and the concentration of OPG and FN was assessed by ELISA. Results. OPG concentration and MMP-9 activity showed differences between plaque and nonchanged tissue; OPG was higher in adjacent tissue P=0.0009, whereas MMP-9 was higher in plaque (proMMP-9 P=0.0003; MMP-9 P<0.0001). The OPG plasma concentration and both MMPs plasma activity were higher in patients (OPG P<0.001; proMMP-2 P=0.0292; and proMMP-9 P=0.0374), while FN plasma concentration was lower in patients than in the reference group P=0.0004. The ROC curves analysis showed the highest AUC for OPG (0.943) with 85.0% sensitivity and 92.1% specificity. Conclusions. The atherosclerotic plaque and the contiguous artery wall are biochemically different. OPG shows the highest potential to be a marker of advanced carotid atherosclerosis.
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Djuric, Tamara, Ana Djordjevic, N. Lukic, Magdalena Andjelevski, Maja Zivkovic, and Aleksandra Stankovic. "eNOS Glu298Asp polymorphism is associated with development of complicated plaques in patients from Serbia with advanced carotid atherosclerosis." Archives of Biological Sciences 65, no. 1 (2013): 143–49. http://dx.doi.org/10.2298/abs1301143d.
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Nitric oxide inhibits adhesion of thrombocytes, proliferation and migration of smooth muscle cells and restricts oxidation of atherogenic low-density lipoproteins. Therefore, decreased production or activity of NO may play a role in the initiation, progression or complications of atherosclerosis. The aim of this study was to estimate the effect of Glu298Asp eNOS gene polymorphism on the individual risk for development of complicated carotid atherosclerotic plaque in patients from Serbia with advanced carotid atherosclerosis (CA) who had undergone endarterectomy. The study population included 233 patients. eNOS G894T gene polymorphism was identified by PCR and RFLP methods. Multivariate logistic regression analysis showed that Asp298Asp is an independent risk factor for the presence of complicated plaques in CA patients. Patients who were homozygous for the Asp298 allele had an adjusted OR of 4.36 for the development of complicated plaques compared to those that carry the Glu298 allele. Further validation and replication studies are needed.
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Kontrimavičiūtė, Eglė, Vilma Kuzminskaitė, and Jūratė Šipylaitė. "Noninvasive cerebral oximetry during carotid endarterectomy: application and results." Acta medica Lituanica 22, no. 2 (August 24, 2015): 55–60. http://dx.doi.org/10.6001/actamedica.v22i2.3120.
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Background. Cerebral monitoring during carotid endarterectomy allows to detect brain hypoperfusion following carotid clamping and hyperperfusion after restoring the blood flow. Immediate corrections of these changes have the potential in reducing adverse neurologic outcomes. In this study we share our experience using cerebral oximetry in carotid endarterectomy surgery, as well as finding a connection between comorbidities and baseline cerebral oxygenation values. Materials and methods. A non-randomised perspective study was performed at Vilnius University Hospital Santariškių Clinics. During 2012–2013 all consecutive elective patients undergoing carotid surgery were enrolled in the study. Results. No difference was found in the baseline values on the operative and control sides (71.15% vs 76.76%, p = 0.15). After carotid clamping regional brain saturation decreased by 4.34% of the baseline on the operative side. During the clamping cerebral oxygenation was lower on the operative side (68.06% vs 77.32%, p = 0.03). Following carotid declamping the difference between operative and control side oxygenation diminished (73.57% vs 79.30%, p = 0.16). Neither diabetes nor peripheral atherosclerosis had influence on baseline cerebral oxygen saturation values. There was a tendency towards the lower cerebral oxygenation baseline for smokers (70.12% vs 76.54%, p = 0.103). Conclusions. Cerebral oximetry is a valuable method of cerebral monitoring reflecting changes in brain perfusion during carotid endarterectomy. Certain comorbidities might have a role in affecting baseline oximetry values.
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Chelyshev, Yury, Marat Gafurov, Igor Ignatyev, Alexey Zanochkin, Georgy Mamin, Boris Sorokin, Alexandra Sorokina, et al. "Paramagnetic Manganese in the Atherosclerotic Plaque of Carotid Arteries." BioMed Research International 2016 (2016): 1–7. http://dx.doi.org/10.1155/2016/3706280.
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The search for adequate markers of atherosclerotic plaque (AP) instability in the context of assessment of the ischemic stroke risk in patients with atherosclerosis of the carotid arteries as well as for solid physical and chemical factors that are connected with the AP stability is extremely important. We investigate the inner lining of the carotid artery specimens from the male patients with atherosclerosis (27 patients, 42–64 years old) obtained during carotid endarterectomy by using different analytical tools including ultrasound angiography, X-ray analysis, immunological, histochemical analyses, and high-field (3.4 T) pulse electron paramagnetic resonance (EPR) at 94 GHz. No correlation between the stable and unstable APs in the sense of the calcification is revealed. In all of the investigated samples, the EPR spectra of manganese, namely, Mn2+ions, are registered. Spectral and relaxation characteristics of Mn2+ions are close to those obtained for the synthetic (nano) hydroxyapatite species but differ from each other for stable and unstable APs. This demonstrates that AP stability could be specified by the molecular organization of their hydroxyapatite components. The origin of the obtained differences and the possibility of using EPR of Mn2+as an AP stability marker are discussed.
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Lukanova, Detelina Valchkova, Nadelin Krasimirov Nikolov, Kameliya Zaharieva Genova, Mario Draganov Stankev, and Elisaveta Valcheva Georgieva. "The Accuracy of Noninvasive Imaging Techniques in Diagnosis of Carotid Plaque Morphology." Open Access Macedonian Journal of Medical Sciences 3, no. 2 (March 27, 2015): 224–30. http://dx.doi.org/10.3889/oamjms.2015.039.
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BACKGROUND: The stroke is leading cause of death and severe disability worldwide. Atherosclerosis is responsible for over 30% of all ischemic strokes. It has been recently discovered that plaque morphology may help predict the clinical behavior of carotid atherosclerosis and determine the risk of stroke. The noninvasive imaging techniques have been developed to evaluate the vascular wall in an attempt to identify “vulnerable plaques”.AIM: The purpose is to investigate the diagnostic accuracy of ultrasound, multidetector computed tomography and magnetic resonance imaging in the identification of plaque components associated with plaque vulnerability.MATERIAL AND METHODS: One hundred patients were admitted for carotid endarterectomy for high grade carotid stenosis. We defined the diagnostic value of B-mode ultrasound of carotid plaque in a half, and the accuracy of multidetector computed tomography and magnetic resonance imaging, in the other group, for detection of unstable carotid plaque. The reference standard was histology.RESULTS: Sensitivity of ultrasound, multidetector computed tomography and magnetic resonance imaging is 94%, 83% and 100%, and the specificity is 93%, 73% and 89% for detection of unstable carotid plaque.CONCLUSION: The ultrasound has high accuracy for diagnostics of carotid plaque morphology, magnetic resonance imaging has high potential for tissue differentiation and multidetector computed tomography determines precisely degree of stenosis and presence of ulceration and calcifications. The three noninvasive imaging modalities are complementary for optimal evaluation of the morphology of carotid plaque. This will help to determine the risk of stroke and to decide on the best treatment – carotid endarterectomy or carotid stenting.
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Tasic, Nebojsa, Danijela Tasic, Petar Otasevic, Mirjana Veselinovic, Vladimir Jakovljevic, Dragan Djuric, and Djordje Radak. "Copper and zinc concentrations in atherosclerotic plaque and serum in relation to lipid metabolism in patients with carotid atherosclerosis." Vojnosanitetski pregled 72, no. 9 (2015): 801–6. http://dx.doi.org/10.2298/vsp140417074t.
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Background/Aim. Some oligoelements are now investigated as possibly having a role in atherosclerosis. The aim of this study was to compare the concentrations of copper and zinc in the serum and carotid plaque and parameters of lipid metabolism in patients with different morphology of carotid atherosclerotic plaque. Methods. Carotid endarterectomy due to the significant atherosclerotic stenosis was performed in 91 patients (mean age 64 ? 7). The control group consisted of 27 patients (mean age 58 ? 9), without carotid atherosclerosis. Atheroscletoric plaques were divided into four morphological groups, according to ultrasonic and intraoperative characteristics. Copper and zinc concentrations in the plaque, carotid artery and serum were measured by atomic absorption spectrophotometry. Results. Serum copper concentrations were statistically significantly higher in the patients with hemorrhagic in comparison to those with calcified plaque (1.2 ? 0.9 ?mol/L vs 0.7 ? 0.2 ?mol/L, respectively; p = 0.021). Zinc concentrations were statistically significantly lower in plaques of the patients with fibrolipid in comparison to those with calcified plaques (22.1 ? 16.3 ?g/g vs 38.4 ? 25.8 ?g/g, respectively; p = 0.024). A negative significant correlation was found for zinc and triglycerides in the serum in all the patients (r = -0.52, p = 0.025). In the control group we also demonstrated a positive significant correlation for low-density lipoprotein cholesterol and copper in the serum (r = 0.54, p = 0.04). Conclusion. The data obtained in the current study are consistent with the hypothesis that high copper and lower zinc levels may contribute to atherosclerosis and its sequelae as factors in a multifactorial disease. Further studies are necessary in order to conclude whether high concentration of copper and zinc in the serum could be risk factors for atherosclesrosis.
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Zybin, A. V., I. E. Timina, A. V. Pokrovsky, and A. F. Harazov. "Immediate results of carotid endarterectomy in patients receiving statin therapy." I.P.Pavlov Russian Medical Biological Herald 25, no. 3 (October 15, 2017): 404–14. http://dx.doi.org/10.23888/pavlovj20173404-414.
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Given the retrospective analysis of the immediate result of carotid endarterectomy in patients with atherosclerotic hemodynamically significant unilateral lesion of the internal carotid artery on statins therapy. 262 carotid endarterectomy in 262 patients are executed. The postoperative period averaged 7.8 days, survival after surgical treatment of 98.86%. The initial condition of the carotid arteries was determined data by duplex scanning, the presence of risk factors and level of lipid profile that have a statistically significant influence on the development of complications in patients receiving statins therapy (p<0.05). Each risk factor did not have a statistically significant impact, however the presence of three or more factors reliably more often aggravated the course of atherosclerosis and increased the incidence of complications (p=0.04). Defined the reliable interrelation of dependence of a lipid profile level (a cholesterol and low density lipoproteins (LDL)) and weight of a course of initial atherosclerotic changes. The maximal values of cholesterol level 5.39±1.13 mmol/l were determined in patients with stenosis of internal carotid artery from 70 to 89% (р=0.05). In all cases of a stenosis of 90% there was increase in level of triglycerides to 1.75±1.05 mmol/l (р=0.05). LDL in all patients registered above the recommended values of 3.45±1.19 mmol/l. However, it is worth noting against the background of statin therapy, the level of high density lipoproteins in the average values did not decrease below 1.46±0.46 mmol/l (p=0.05). Statin therapy has a different degree of influence on the achievement of recommended values of lipid metabolism and the development of complications. In one case (0.38%) there were recorded stroke, transient ischemic attack and myocardial infarction. So effective is the use of synthetic statins III and IV generations: atorvastatin and rosuvastatin. Statin therapy in the preoperative period and continued after surgical important for achieve the surgery to prevent complications. Correction risk factors, such as hypertension, diabetes, smoking, dyslipidemia and other, helps to improve treatment outcomes.
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Kotfis, Katarzyna, Jowita Biernawska, Małgorzata Zegan-Barańska, Piotr Gutowski, and Maciej Żukowski. "Characteristics of peripheral immune cell subsets in patients with carotid atherosclerosis undergoing carotid endarterectomy." Archives of Medical Science - Atherosclerotic Diseases 3, no. 1 (2018): 129–36. http://dx.doi.org/10.5114/amsad.2018.79537.
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Dempsey, Robert J., Raghu Vemuganti, Tomy Varghese, and Bruce P. Hermann. "A Review of Carotid Atherosclerosis and Vascular Cognitive Decline." Neurosurgery 67, no. 2 (August 1, 2010): 484–94. http://dx.doi.org/10.1227/01.neu.0000371730.11404.36.
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Abstract This review encourages the reader to consider cerebral vascular disease beyond the traditional clinical end points of major motor and speech strokes and to consider the possible impact of embolic cerebral vascular disease on vascular cognitive decline. This article examines the issue of “silent” strokes in the relationship between the structural stability of atherosclerotic carotid plaque and the development of nonmotor symptomatology, including cognitive decline. It addresses the question of the role of carotid emboli in silent stroke and their cognitive sequelae. In a study of endarterectomy patients, we relate plaque elasticity and its development of mechanical strain features and thinning of stabilizing fibrous cap at the point of these mechanical strain features. The possibility that microemboli from such mechanically unstable carotid plaques could contribute to silent strokes led to a study of cognitive function in such patients. A linear relationship between the process of mechanically unstable areas of carotid plaques and cognitive decline suggests a contributory role for such a process in silent strokes.
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Akhmedov, Shamil, Sergey Afanasyev, Marina Trusova, Pavel Postnikov, Yulia Rogovskaya, Elena Grakova, Kristina Kopeva, et al. "Chemically Modified Biomimetic Carbon-Coated Iron Nanoparticles for Stent Coatings: In Vitro Cytocompatibility and In Vivo Structural Changes in Human Atherosclerotic Plaques." Biomedicines 9, no. 7 (July 12, 2021): 802. http://dx.doi.org/10.3390/biomedicines9070802.
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Atherosclerosis, a systematic degenerative disease related to the buildup of plaques in human vessels, remains the major cause of morbidity in the field of cardiovascular health problems, which are the number one cause of death globally. Novel atheroprotective HDL-mimicking chemically modified carbon-coated iron nanoparticles (Fe@C NPs) were produced by gas-phase synthesis and modified with organic functional groups of a lipophilic nature. Modified and non-modified Fe@C NPs, immobilized with polycaprolactone on stainless steel, showed high cytocompatibility in human endothelial cell culture. Furthermore, after ex vivo treatment of native atherosclerotic plaques obtained during open carotid endarterectomy surgery, Fe@C NPs penetrated the inner structures and caused structural changes of atherosclerotic plaques, depending on the period of implantation in Wistar rats, serving as a natural bioreactor. The high biocompatibility of the Fe@C NPs shows great potential in the treatment of atherosclerosis disease as an active substance of stent coatings to prevent restenosis and the formation of atherosclerotic plaques.
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Szulc, Malgorzata, Wojciech Kustrzycki, Dariusz Janczak, Dagmara Michalowska, Dagmara Baczynska, and Malgorzata Radwan-Oczko. "Presence of Periodontopathic Bacteria DNA in Atheromatous Plaques from Coronary and Carotid Arteries." BioMed Research International 2015 (2015): 1–6. http://dx.doi.org/10.1155/2015/825397.
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Objectives. Interest in periodontitis as a potential risk factor for atherosclerosis and its complications resulted from the fact that the global prevalence of periodontal diseases is significant and periodontitis may induce a chronic inflammatory response. Many studies have analyzed the potential impact of thePorphyromonas gingivalis, major pathogen of periodontitis, on general health. The purpose of this study was to find the presence of thePorphyromonas gingivalisDNA in the atherosclerotic plaques of coronary and carotid arteries and in the periodontal pockets in patients with chronic periodontitis, who underwent surgery because of vascular diseases.Methods and Results. The study population consisted of 91 patients with coronary artery disease or scheduled for carotid endarterectomy. The presence ofPorphyromonas gingivalisDNA in atheromatous plaques and in subgingival samples was determined by PCR. Bacterial DNA was found in 21 of 91 (23%) samples taken from vessels and in 47 of 63 (74.6%) samples from periodontal pockets.Conclusions.Porphyromonas gingivalisDNA is frequently found in atheromatous plaques of patients with periodontitis. That is why more research should be conducted to prove if this periopathogen may have an impact on endothelium of patients at risk of atherosclerosis.
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Banerjee, Chirantan, and Tanya Turan. "Large Artery Atherosclerosis: Extracranial and Intracranial." Seminars in Neurology 37, no. 03 (June 2017): 307–15. http://dx.doi.org/10.1055/s-0037-1603588.
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AbstractLarge vessel atherosclerotic disease (affecting both intracranial and extracranial arteries) is a highly prevalent cause of stroke. In this review, the authors describe the epidemiology, evaluation, diagnosis, and therapeutic aspects of large-vessel atherosclerotic disease. Endarterectomy and stenting have proven to be effective methods for carotid artery revascularization and stroke prevention, although some of the clinical trials demonstrating this benefit predated the advances in modern medical therapy. Randomized clinical trials comparing aggressive management with surgical and endovascular stenting plus aggressive medical management have shown medical management alone to be safer and more effective for preventing stroke in intracranial and vertebrobasilar stenosis.
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Radak, Djordje J., Nenad S. Ilijevski, Dragoslav Nenezic, Petar Popov, Goran Vucurevic, Predrag Gajin, Dario Jocic, et al. "Temporal Trends in Eversion Carotid Endarterectomy for Carotid Atherosclerosis: Single-Center Experience with 5,034 Patients." Vascular 15, no. 4 (August 1, 2007): 205–10. http://dx.doi.org/10.2310/6670.2007.00046.
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The aim of this article is to review our experience in surgical treatment of carotid atherosclerosis using eversion carotid endarterectomy (ECEA) in 5,034 patients, with particular attention to temporal changes in patients' characteristics, diagnostic approach, surgical technique, medical therapy, and outcome in the early (group A, 1991–1997) versus late (group B 1998–2004) period of ECEA. From January 1991 to December 2004, 5,034 primary ECEAs were performed for high-grade carotid stenosis. Patients treated for restenosis after previous carotid surgery were excluded from the analysis. Group A consisted of 1,714 patients who underwent surgery between 1991 and 1997, and group B consisted of 3,320 patients who underwent surgery between 1998 and 2004. Follow-up included routine clinical evaluation and noninvasive surveillance, with duplex scanning at 1 month after surgery, after 6 months, and annually afterward. Only 3% of patients in group A and 0.6% in group B were asymptomatic, with 23% and 47% of them having preoperative stroke, respectively. In group A, angiography was used for the final diagnosis in 78% of patients. In group B, duplex scanning was performed in 82% of patients and angiography in only 18% ( p < .001). Clamping time was shorter in the latter group (12.4 ± 3.1 vs 14.5 ± 4.1 min, p < .01). Introperative shunting and regional anesthesia were rarely performed in both groups (1.4% vs. 0.4%, p < .01, and 2% vs 0.3%, p < .001). Total and neurologic morbidity was significantly higher in group A than in group B (6.41% ± 0.47% vs 4.81% ± 0.53%, p < .001, and 2.14% ± 0.31% vs 1.23% ± 0.29%, p < .001, respectively). Total mortality was also higher in group A than in group B (1.92% ± 0.24% vs 1.36% ± 0.50%, p < .05), but although there was a trend toward lower neurologic mortality, it did not reach statistical significance (1.04% ± 0.5% vs 0.57% ± 0.25%, p = .074). There was a lower rate of nonsignificant restenosis (< 50%) in group B (2% vs 5%, p < .01), but the incidence of restenosis ≥ 50% was identical between the groups (5.5% for both). Our data show that ECEA is a reliable surgical technique for the treatment of atherosclerotic carotid disease. Temporal trends in our patients demonstrated a decline in periopertive mortality and morbidity, despite a higher incidence of preoperative stroke.
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Lušic, Radonic, Pavelin, and Bilic. "Is C-reactive protein a better predictor of recurrent carotid disease following carotid endarterectomy than established risk factors for atherosclerosis?" Vasa 35, no. 4 (November 1, 2006): 221–25. http://dx.doi.org/10.1024/0301-1526.35.4.221.
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Background: The study was undertaken to identify possible relations between established and novel risk factors for atherosclerosis (gender, age, diabetes mellitus, hypertension, smoking and C-reactive protein) and the possibility of carotid restenosis following carotid endarterectomy (CEA). Patients and methods: A prospective study of 193 consecutive patients, admitted electively for carotid endarterectomy during 68 months, was conducted. 131 patients had symptomatic and 62 asymptomatic carotid disease. An attempt was made to follow-up on all operated arteries with duplex sonography at 2 months, 6 months, 12 months, and 24 months postoperatively. The correlation of previously mentioned variables (gender, age, diabetes mellitus, hypertension, smoking and average values of C-reactive protein) with progressive or recurrent disease was determined by chi-square analysis and analysis of variance. Results: Of all 193 examined patients 29 demonstrated increasing degree of artery stenosis, while recurrent artery stenosis of > 69% was diagnosed in 11 patients. Age, gender, hypertension, and diabetes did not play a significant role in the presence of progressive (or recurrent) disease, while active smokers and patients with preoperative and average C-reactive protein (CRP) levels over 3.0 mg/L had a greater propensity to develop progression (or recurrence) of carotid disease. Conclusions: Increased levels of CRP in serum may be a better predictor of carotid restenosis after CEA than other established risk factors for vascular disease – except active smoking.
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Rockman, Caron B., Juan Castillo, Mark A. Adelman, Glenn R. Jacobowitz, Paul J. Gagne, Patrick J. Lamparello, Ronnie Landis, and Thomas S. Riles. "Carotid endarterectomy in female patients: Are the concerns of the Asymptomatic Carotid Atherosclerosis Study valid?" Journal of Vascular Surgery 33, no. 2 (February 2001): 236–41. http://dx.doi.org/10.1067/mva.2001.111804.
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Huber, Thomas S. "Effect of the Asymptomatic Carotid Atherosclerosis Study on Carotid Endarterectomy in Veterans Affairs Medical Centers." Archives of Surgery 132, no. 10 (October 1, 1997): 1134. http://dx.doi.org/10.1001/archsurg.1997.01430340088016.
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Assadian, Eidher, Senekowitsch, Rotter, Löchli, Hagmüller, and Knöbl. "Antiplatelet therapy prior to carotid endarterectomy – still room for improvement." Vasa 35, no. 2 (May 1, 2006): 96–100. http://dx.doi.org/10.1024/0301-1526.35.2.96.
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Background: Antiplatelet therapy is one of the most important modalities for secondary prevention of ischemic events. The aim of this prospective study was to evaluate the current practice of antiplatelet therapy in patients with high grade stenosis of the internal carotid artery (ICA), who were referred by neurologists, stroke physicians and cardiologists for carotid endarterectomy. Patients and methods: Patients referred to our department for carotid endarterectomy with ICA stenosis (> 70% according to NASCET criteria) were prospectively evaluated regarding atherosclerosis risk factors and current antiplatelet therapy. During a 7 month period, 235 patients were scheduled for carotid endarterectomy. Their mean age was 70 years (range 42 years to 95 years), 91 patients were female (39%), 144 male (61%). 122 patients (52%) had a symptomatic ICA stenosis, 113 (48%) an asymptomatic ICA stenosis. Results: Of the 235 patients, 29 were either on low molecular weight heparin or vitamin K antagonists for reasons other than ICA stenosis and were therefore excluded from analysis. Therefore, 206 patients (88%) were evaluated for antiplatelet therapy prescribed by their admitting physicians. Of these patients, 77 (37%) (42 (41%) symptomatic and 35 (34%) asymptomatic patients) did not receive any antithrombotic therapy prior to admission for surgery. The majority of patients received aspirin preoperatively (106 patients, 51.5%) 13 (6%) patients were on clopidogrel and 10 (5%) on dual therapy with Aspirin and clopidogrel. Conclusions: More than one third of patients awaiting carotid endarterectomy did not receive any antiplatelet therapy, despite high grade ICA stenosis. Since this practice does not meet the current guidelines, campaigns to increase the awareness of this problem are urgently needed.