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Biomedical subjects

A F Aburahma

Publications and source records attributed to A F Aburahma.

At least 19 recordsLinked to original sources
PubMed2004

Systematic review of randomized controlled trials of patch angioplasty versus primary closure and different types of patch materials during carotid endarterectomy.

BACKGROUND: Patch angioplasty during carotid endarterectomy (CEA) may reduce the risk for perioperative or late carotid artery recurrent stenosis and subsequent ischemic stroke. We performed a systematic review of randomized controlled trials to assess the effect of routine or selective carotid patch angioplasty compared with CEA with primary closure, and the effect of different materials used for carotid patch angioplasty. METHODS: Randomized trials were included if they compared carotid patch angioplasty with primary closure in any patients undergoing CEA or use of one type of carotid patch with another. RESULTS: Thirteen eligible randomized trials were identified. Seven trials involving 1281 operations compared primary closure with routine patch closure, and 8 trials with 1480 operations compared different patch materials (2 studies compared both). Patch angioplasty was associated with a reduction in risk for stroke of any type (P = .004), ipsilateral stroke (P = .001), and stroke or death during both the perioperative period (P = .007) and long-term follow-up (P = .004). Patching was also associated with reduced risk for perioperative arterial occlusion (P = .0001) and decreased recurrent stenosis during long-term follow-up (P < .0001). Seven trials that compared different patch types showed no difference in the risk for stroke, death, or arterial recurrent stenosis either perioperatively or at 1-year follow-up. One study of 180 patients (200 arteries) compared collagen-impregnated Dacron (Hemashield) patches with polytetrafluoroethylene patches. There was a significant increase in risk for stroke (P = .02), combined stroke and transient ischemic attack (P = .03), and recurrent stenosis (P = .01) at 30 days, and an increased risk for late recurrent stenosis greater than 50% (P < .001) associated with Dacron compared with polytetrafluoroethylene. CONCLUSIONS: Carotid patch angioplasty decreases the risk for perioperative death or stroke, and long-term risk for ipsilateral ischemic stroke. More data are required to establish differences between various patch materials.

Angioplasty↗
PubMed2001

Endovascular caval interruption in pregnant patients with deep vein thrombosis of the lower extremity.

PURPOSE: The choice of therapy for deep vein thrombosis (DVT) of the lower extremity during pregnancy has been widely debated. Warfarin passes through the placenta to the fetus and may cause fetal complications and/or death. Heparin, in contrast, does not cross the placenta, but its long-term use may be impractical and may increase the risk of bleeding, osteoporosis, and neurologic complications. The use of inferior vena cava filters in pregnancy has only been described as case reports in the English medical literature; therefore, this study reviews our experience on this subject. METHODS: We analyzed 18 pregnant patients who had Greenfield filters (GFs) inserted for DVT of the lower extremity, pulmonary embolism (PE), or both. The DVT diagnosis was made by means of duplex imaging. Conventional full-dose intravenous heparin was initiated until the filter was inserted, followed by subcutaneous heparin until labor, and continued for 6 weeks postpartum in 13 patients who were breast-feeding. Warfarin was given postpartum in the other five patients. RESULTS: The mean age of the patients was 25 years. The indications for GF insertion included 3 patients who had a PE while on anticoagulation, 2 patients with significant bleeding caused by anticoagulation, 4 patients with free-floating iliofemoral DVT, 2 patients with heparin-induced thrombocytopenia, and 7 patients with iliofemoropopliteal DVT occurring 1 to 3 weeks before labor, for prophylactic reasons. Fourteen of 18 cases were diagnosed in the third trimester of the patient's pregnancy. Filters were inserted via the right internal jugular vein by means of a cut-down technique in the first four patients (stainless steel filters) and percutaneously in 14 patients. The mean fluoroscopy time during filter insertion was less than 2 minutes. There was no fetal or maternal morbidity or mortality. During long-term follow-up (mean, 78 months), no PE or filter-related complications were encountered. CONCLUSION: GF insertion in pregnant patients with DVT of the lower extremity is safe and effective. Its prophylactic use in pregnant patients who have extensive iliofemoral DVT right before labor may be justified.

Adult↗
PubMed2001

Selecting patients for combined femorofemoral bypass grafting and iliac balloon angioplasty and stenting for bilateral iliac disease.

PURPOSE: This study examines the selection of patients for combined femorofemoral bypass (FFB) grafting and iliac balloon angioplasty (IBA) and stenting for bilateral iliac occlusive disease (successively or simultaneously) and the correlation of the length and location of stenoses of the donor iliac artery to the success of FFB grafts. METHODS: Forty-one patients with long iliac occlusion and significant contralateral iliac stenosis were treated with combined FFB grafting and IBA and stenting, which were performed simultaneously or percutaneously within 1 to 2 days before surgery. Stenting was performed for suboptimal IBAs. IBA/graft patency was evaluated by duplex scanning/ankle-brachial index at 1, 3, 6, and 12 months and every 12 months thereafter. A life-table analysis of patency was performed, according to the length of stenosis as classified by the Society of Cardiovascular Interventional Radiology (group A, < 3 cm and 3-5 cm; group B, > 5 cm). RESULTS: Indications for surgery were limb salvage (22%), rest pain (44%), and claudication (34%). The mean follow-up time was 34.1 months. Perioperative complications were 7% for group A versus 62% for group B (P = .0007) with no perioperative deaths or amputations. Stenting was needed in 12 of 13 patients (92%) in group B versus four of 28 patients (14%) in group A (P < .0001) and in 11 of 12 external iliac artery lesions versus five of 29 common iliac artery lesions (P < .0001). The overall early success rate was 100% for group A and 62% for group B (P = .0028). The primary patency rates at 1, 2, and 3 years were 96%, 85%, and 85% for group A, respectively, and for group B were 46%, 46%, and 31%, respectively (P < .01). The secondary patency rates for group A at 1, 2, and 3 years were 100%, 96%, and 87%, respectively; and for group B were 62%, 54%, and 27%, respectively (P < .001). The overall primary and secondary patency rates for common iliac and external iliac artery lesions were similar (72% and 72% versus 67% and 75%, respectively). The overall limb salvage rates were 96% for group A and 85% for group B. Seven of 13 patients (54%) of group B, in contrast with 0 of 28 patients in group A, had to undergo a revision of the procedure within 30 days (P < .01). CONCLUSION: Combined use of IBA and stenting and FFB grafting is effective and durable and can be performed simultaneously, if the donor iliac stenosis length is 5 cm or less. Percutaneous transluminal angioplasty/stenting of stenoses of 5 cm or more fail to support FFB grafting in most patients; therefore, their combination should be questioned.

Aged↗
PubMed2001

Comparative study of operative treatment and percutaneous transluminal angioplasty/stenting for recurrent carotid disease.

PURPOSE: This study is a nonrandomized parallel comparison of the outcome for carotid endarterectomy (CEA) and percutaneous transluminal angioplasty (PTA)/stenting for recurrent carotid artery stenosis (RCS). METHODS AND PATIENTS: Between June 1996 and June 2000, 83 carotid procedures (58 reoperations, Group I, and 25 PTA/stentings, Group II) were done for RCS. Patients were followed at regular intervals with duplex ultrasound scanning. The outcome of the stented group (Group II) was divided into early experience (Group IIA, first 12 cases) and late experience (Group IIB, last 13 cases) for learning curve consideration, and each was compared with the reoperation group. A Kaplan-Meier life table analysis was used to estimate the stroke-free survival rates and freedom from > or =50% recurrent restenosis for both groups. RESULTS: The demographic and clinical characteristics and indications for intervention were similar for both groups. The mean time from the original CEA to reoperation was 41 months in Group I versus 43 months in Group II. Overall, stenting had higher 30-day stroke rates than reoperations-16% (3 major and 1 minor stroke) versus 3.4% (1 out of 2 [1.7%] was a major stroke, P <.05). However, Group IIB had similar major stroke rates to Group I (0% versus 1.7%). Cranial nerve injury was noted in 10 patients (17%) in Group I (only 1 [1.7%] was permanent) versus 0% in Group II (P <.05). Recurrent > or =50% restenosis was higher in Group II than in Group I (24% versus 0%, P <.001). Stroke-free survival rates at 6 months and 1, 2, and 3 years for Group I were 97%, 97%, 94%, and 82%, respectively, versus 79%, 79%, 79%, and 79%, respectively, for Group II (P =.059). Freedom from recurrent > or =50% restenosis rates at 6 months and 1, 2, and 3 years were 100%, 100%, 100%, and 100%, respectively, for Group I versus 100%, 94%, 65%, and 44%, respectively, for Group II (P <.0001). CONCLUSIONS: Carotid PTA/stenting has a similar 30-day stroke rate to that of reoperation for RCS once experience is established. However, PTA/stenting has a higher incidence of restenosis than reoperation, which is associated with a percentage of cranial nerve injuries. Therefore, PTA/stenting can be an alternative to reoperation, particularly in marginal surgical risk patients.

Aged↗
PubMed1999

Ruptured isolated true atherosclerotic aneurysm of the deep femoral artery.

Aneurysms isolated to the deep femoral artery are unusual. Thirty-five cases have been reported in the world literature, however many of these were associated with aneurysms occurring elsewhere. Spontaneous rupture of true isolated deep femoral artery aneurysms is rare, with only a few reported cases. This report presents a case of a ruptured isolated true aneurysm of the deep femoral artery that was diagnosed by duplex ultrasound and treated with resection and end-to-end grafting.

Aged↗
PubMed1999

Management of deep vein thrombosis of the lower extremity in pregnancy: a challenging dilemma.

This study reviews our experience in the management of deep vein thrombosis (DVT) of the lower extremity during pregnancy and analyzes the outcome of various treatment alternatives, including conventional full-dose heparin therapy and Greenfield filter insertion. Twenty-four patients treated over an 8-year period were reviewed. Fifteen patients were treated with conventional full-dose intravenous heparin therapy for 5 to 10 days, followed by subcutaneous low-dose heparin until labor, and continued for 6 weeks postpartum (Group A); Eleven patients had Greenfield filters inserted, followed by the same low-dose subcutaneous heparin regimen (Group B). There were 18 femoral or iliofemoral, 5 femoropopliteal, and 1 popliteal and below-knee DVT. The indications for Greenfield filter insertion included two patients in Group A (one with pulmonary embolism, despite adequate heparin therapy, and one with significant bleeding). Nine other patients had prophylactic indications: two for free-floating iliofemoral DVT, three with iliofemoral DVT (occurring just 1-2 weeks before labor), and four with femoropopliteal DVT. There were three immediate major complications (pulmonary embolism, bleeding, or death) in Group A; two with pulmonary embolism, one of which was fatal, and one with significant bleeding (3 of 15 patients; 20%). No major complications occurred in Group B. On long-term follow-up (mean, 61 months), 4 of 12 patients (33%) in Group A had significant leg swelling, with partial resolution of DVT in 2 patients and venous occlusion in 2 patients by duplex ultrasound. This is in contrast to 3 of 11 patients (27%) in Group B with significant leg swelling. There was no fetal morbidity or mortality in either group. Conventional full-dose heparin therapy for DVT of the lower extremity in pregnancy can carry significant morbidity and mortality. Greenfield filters may be used safely in some of these patients.

Adolescent↗
PubMed1996

Management options for post carotid endarterectomy stroke.

BACKGROUND: Management of acute thrombosis of the carotid artery has been controversial. This retrospective study reviews the etiology and analyzes the management options of post carotid endarterectomy stroke. METHODS: Diagnosis was made using oculopneumop-lethysmography (OPG/Gee), duplex ultrasound, computed tomography (CT) scanning, and carotid exploration. RESULTS: The cause of stroke was identified as carotid thrombosis in 19/32 patients (59%) and non-carotid thrombosis in 13. Management options included nine patients who underwent selective carotid exploration and all had a thrombosed carotid; mandatory exploration-six were explored and three had a thrombosed carotid artery; and 17 patients had no exploration (medical treatment). Fourteen patients had a positive OPG, 13 were confirmed to have carotid thrombosis. Eight patients had a negative OPG and all were confirmed. The OPG had an overall accuracy of 95% in detecting postoperative thrombosis (89% specificity and 100% sensitivity). Patients with thrombosed carotids and patients with positive OPGs had more severe neurological deficits than those with non-thrombosed carotids. The final neurological status of the 12 patients with carotid thrombosis who underwent thrombectomy and patch angioplasty was improved (7/12) in contrast to the seven patients who did not undergo a thrombectomy (1/7). Seven of nine patients had a complete or good recovery when thrombectomy was done within two hours of the stroke in contrast to 0/3 after two hours. Seven of ten patients with Grade II stroke (moderate) had a good recovery after carotid exploration and thrombectomy in contrast to 0/2 for Grade III (severe) stroke. CONCLUSIONS: Carotid artery thrombosis, the most common cause of post carotid endarterectomy stroke, can be detected by OPG/Gee. Immediate carotid exploration for patients with Grade I or II strokes, when thrombosis is demonstrated, can improve the results of carotid endarterectomy.

Aged↗
PubMed1995

A case study of abdominal angina secondary to celiac compression syndrome.

Celiac compression syndrome occurs when the median arcuate ligament of the diaphragm and/or periarterial neural tissue causes extrinsic compression of the celiac axis. In rare cases, this syndrome can cause upper abdominal angina. The classic triad of celiac compression syndrome consists of abdominal pain, an epigastric bruit, and angiographic evidence of celiac compression. Operative therapy consists of thorough exploration, transection of the median arcuate ligament, and either celiac dilatation or a bypass. This article describes a case of celiac compression syndrome which was treated successfully by transection of the median arcuate ligament and aortosplenic bypass.

Abdominal Pain↗
PubMed1993

Management of deep vein thrombosis of the lower extremity in pregnancy.

Deep vein thrombosis (DVT) of the lower extremity during pregnancy is infrequent, but its complication, pulmonary embolism, remains an important cause of maternal mortality. To evaluate the best method of caring for patients with DVT, we reviewed the records of patients at the Charleston Area Medical Center from 1987-1992 who were treated for this condition. Twelve patients were treated with conventional continuous intravenous heparin for 7 days-10 days followed by subcutaneous heparin until 6 weeks-8 weeks after delivery. The other group consisted of nine patients who were treated with lower dose subcutaneous heparin for 7 days-10 days and maintained as the first group, but a Greenfield filter was inserted for patients with iliofemoral DVT. The patients who received low-dose heparin and Greenfield filters tended to do better than those who received high-dose conventional heparin treatment. However, since there were so few patients evaluated, further verification is needed.

Adult↗
PubMed1992

Bronchial carcinoid tumor: experience over 20 years.

Nineteen cases of bronchial carcinoid tumor seen over 20 years in a 1,000-bed, tertiary medical center were retrospectively reviewed. They consisted of 0.4 per cent of all patients with lung tumors. Initial complaints were hemoptysis, persistent pulmonary infection, chest pain, and diarrhea. Two of the five patients with atypical carcinoid tumors came to the hospital with diarrhea as a result of their chemically active tumors. However, seven patients (36%) were asymptomatic and were diagnosed after an abnormal chest radiograph was noted incidentally. Of 13 patients receiving bronchoscopic examination, 9 (69%) had visible tumors. Bronchial biopsy was performed in 7 patients and led to a diagnosis in all seven. Significant bleeding was noted in 3 patients as a result of biopsy. Lobectomy was the most common surgical procedure in this series. Follow-up of these patients was from 6 months to 15 years. The general outcome for patients with typical carcinoid was good. However, all patients with atypical carcinoid died as a result of dissemination.

Academic Medical Centers↗
PubMed1992

Heparin-induced thrombocytopenia with thrombotic complications.

Heparin-induced thrombocytopenia with thrombotic complications is a serious clinical problem. The diagnosis is confirmed by a positive heparin-induced platelet aggregation test and/or detection of white clots upon pathological exam after a presumptive diagnosis based on these criteria: (1) Development of thrombocytopenia of less than 100,000 mm3 while receiving heparin therapy; (2) Normalization of the platelet count after an interruption in heparin therapy; (3) The presence of thrombotic complications; and (4) Exclusion of other causes of thrombocytopenia. Eight patients with heparin-induced thrombocytopenia were encountered at the Charleston Area Medical Center, Memorial Division, in a recent 20-month period. Various types of heparin, routes of administration, and indications were implicated. The mean platelet nadir was 25,750 mm3 and the mean time to onset of of heparin-induced thrombocytopenia was 4.9 days. Thrombotic complications included seven patients with arterial occlusions of the legs, six with deep-vein thrombosis of the legs (three had pulmonary embolism), and five with combined arterial and venous thrombosis. Treatment strategies included discontinuation of heparin in all patients; intravenous infusion of dextran in five patients, followed by arterial thrombectomy in three patients; urokinase therapy in two patients for arterial thrombotic complications; and insertion of Greenfield filters in four patients for venous thrombotic complications. All surviving patients were given warfarin. The mortality rate was 25 percent and the morbidity rate was 38 percent. In conclusion, an initial platelet count should be obtained on all patients prior to receiving heparin, followed by repeat platelet counts every two to three days. Once thrombocytopenia or thrombosis is diagnosed, heparin should be discontinued and other therapeutic modalities considered.

Adult↗
PubMed1992

Diagnosing giant cell temporal arteritis.

Arteritis is a complex and totally underestimated clinical entity that may present in several ways. Due to the diversity of clinical features and the frequent overlapping of clinical syndromes, many different classifications are available for arteritides, but the simplest classification for the practicing physician is the broad division of arteritis into giant cell arteritis and non-giant cell arteritis. Giant cell arteritis encompasses two distinct clinical entities that are pathologically indistinguishable from each other; but both involve arteritis of median and large-sized arteries characterized by an infiltration of giant cells. These include temporal arteritis and Takayasu's arteritis. The non-giant cell arteritis encompasses a greater variety of uncommon diseases that are often associated with other systemic processes such as systemic lupus erythematosus or periarteritis nodosa, and it generally results in ischemic organ dysfunction that is amenable only to medical treatment. Less commonly, however, non-giant cell arteritis may become manifested as acute arterial occlusion caused by circulating anticoagulants, abdominal apoplexy as intra-abdominal bleeding from rupture of micro aneurysms of artery branches, gastrointestinal bleeding from local necrosis of the gastrointestinal tract, or deep-vein thrombosis secondary to hypercoagulable states. Although temporal arteritis has generated a voluminous body of literature, its precise etiology remains elusive. This study summarizes our experience in 15 cases of temporal arteritis and one case is presented to increase knowledge about this disease entity.

Aged↗
PubMed1991

Early diagnosis and survival of ruptured abdominal aortic aneurysms.

The hospital records of patients treated with ruptured abdominal aortic aneurysm in a recent 5-year period were reviewed to collect data on factors which may be associated with mortality. Overall mortality was 62%. Patients with intraperitoneal rupture had a higher mortality (97%) than patients with retroperitoneal rupture (25%). Patients at increased risk were older than 80 years, presented with syncope, experienced a short duration of symptoms prior to emergency department (ED) arrival, had initial systolic blood pressure less than 90 mm Hg, and/or initial hemoglobin level less than eight on arrival at the ED and delay in beginning surgery. Multivariate analysis demonstrated preoperative blood pressure, preoperative hemoglobin, presence of syncope, and the amount of blood transfused were largely reflections of the type of rupture and had only slight independent relationship to mortality. The authors concluded that treating emergency physicians and surgeons have little control over the most important risk factors for mortality after aneurysm rupture, but may improve the prognosis by expediting diagnosis in the ED and surgical therapy.

Academic Medical Centers↗
PubMed1991

Axillary subclavian vein thrombosis. Changing patterns of etiology, diagnostic, and therapeutic modalities.

Fifty-two patients with axillary-subclavian vein thrombosis were treated in the last 10 years and were available for follow-up for at least 1 year. Eighteen of these were treated in the first 5 years, Group A, and 34 in the last 5 years, Group B. The causes in both Group A and Group B included respectively: effort or spontaneous 28 per cent and 29 per cent, catheter insertion related 17 per cent and 47 per cent, and malignancy or systemic disease 55 per cent and 24 per cent. None of the patients in Group A had noninvasive vascular testing (NIT). However, 27 patients in Group B had IPG/duplex imaging (NIT). All 18 cases in Group A and 27 cases in Group B were treated conventionally (anticoagulants). Seventy-three per cent of these had residual pain on exertion (venous claudication) and/or swelling. Fourteen of these cases had posttreatment NIT/venography. Four of these showed total resolution of the thrombus and all were symptom free. Ten had no resolution, and nine were symptomatic. Seven cases in Group B were treated with thrombolytic therapy. Five of these had total resolution of thrombus and were symptom free (71%). Two had no resolution with residual symptoms (29%) (statistically significant). In conclusion (1) More patients with axillary-subclavian vein thrombosis seen recently are catheter insertion related; 2) Diagnosis should be initiated with duplex imaging; and (3) Thrombolytic therapy significantly decreased residual symptoms and yielded better resolution than anticoagulants.

Adolescent↗
PubMed1990

Yag laser-assisted thermal balloon angioplasty. Our early experience at Charleston Area Medical Center.

Laser thermal balloon angioplasty was performed in 22 arteries, including iliac, superficial femoral, and popliteal arteries. The length of the lesion varied from less than two cm. to 12 cm. The yag laser was used initially, followed by conventional balloon angioplasty. Initial failure to recanalize was noted in 27 per cent, and nine per cent failed within 24 hours, i.e. a primary failure rate of 36 per cent. Initial failure was noted in 67 per cent of lesions greater than five cm. The primary failure rate was 100 per cent in lesions greater than 10 cm. and 82 per cent in lesions. Greater than five to 10 cm. There was no primary failure in lesions less than or equal to five cm. The successfully treated group (14 lesions, 65 per cent of the series), were followed three to 13 months (mean seven months) with a success rate of 86 per cent. The combined primary and secondary failure rate was 45 per cent. The overall success rate was zero per cent for lesions over five cm., and 92 per cent for lesions less than or equal to five cm. Six complications occurred (27 per cent). Two of these were major complications (nine per cent). In conclusion, the primary and secondary failure rate was unacceptable for lesions greater than five cm. LTBA probably should be confined to lesions less than or equal to five cm., and these patients should be followed closely for their long-term success. The widespread application of LTBA cannot be justified without further long-term clinical and laboratory investigation. Conversely, the potential of this technique should not be dismissed out of band.

Adult↗
PubMed1990

Role of thrombolytic therapy in axillary-subclavian vein thrombosis.

Axillary-subclavian vein thrombosis in young patients has produced long-term disability because of failure of the thrombosed vein to recanalize. In a review of 10 patients with axillary-subclavian vein thrombosis treated in our institution, four were effort vein thrombosis. All patients were diagnosed by venography. One patient received urokinase with complete resolution of symptoms and complete dissolution of the clot after two days of initial therapy, which was confirmed by venography and duplex imaging. Another patient received streptokinase with partial resolution of symptoms and dissolution of the clot, which was confirmed by venography. The other two patients were treated with conventional anticoagulant therapy with partial resolution of symptoms and no dissolution of the clot. Thrombolytic therapy appears to be superior to anticoagulation in dissolution of symptoms in effort vein thrombosis and should be considered in its management if the diagnosis is made early.

Adult↗
PubMed1989

Prospective clinicopathologic study of carotid intraplague hemorrhage.

A prospective study was conducted of 82 carotid endarterectomy plaques from 73 patients to determine the incidence of intraplaque hemorrhage, its relation to the production of cerebral ischemic symptoms, and the role of the antiplatelets. These included 42 with hemispheric transient ischemic attacks (TIA), nine with hemispheric stroke (Group A), and 31 with nonhemispheric TIA's or asymptomatic carotid stenosis (Group B). The plaques were evaluated for the presence of hemorrhage. Intraplaque hemorrhage was present in 63 (76.8%) of 82; 46 (90.2%) of 51 in Group A had hemorrhage, in contrast to 17 (54.8%) of 31 in Group B (P less than .001). Twenty-nine (56.86%) plaques from patients in Group A had multiple hemorrhages and 22 (43.14%) had single or no hemorrhages; in contrast to two (6.45%) that had multiple hemorrhages and 29 (93.55%) that had single or no hemorrhages in patients in Group B (P less than .0005). Forty-seven plaques were removed from patients receiving antiplatelets; 43 (91.48%) of these showed hemorrhages. Of the 35 plaques that were removed from patients not receiving antiplatelets, 26 (74.2%) showed hemorrhages (P = .071). However, when the plaques were studied for multiple hemorrhages, 28 (59.5%) of 47 had multiple hemorrhages in patients receiving antiplatelet agents in contrast to 3 (8.57%) of 35 in patients receiving antiplatelet agents (P less than .00001). The authors conclude that 1) the intraplaque hemorrhage is an important and common feature in symptomatic carotid disease, 2) antiplatelets increase the incidence of plaque hemorrhages, particularly multiple hemorrhages that carry higher incidence of symptoms. Therefore the use of antiplatelet agents in certain patients with carotid artery disease is questioned.

Carotid Arteries↗