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At least 19 recordsLinked to original sources
PubMed1994

Carotid artery disease.

Carotid artery disease is often implicated in primary ischemic stroke secondary to thrombosis or embolism and may indicate concurrent cardiovascular disease. Atherosclerosis is the underlying cause of the majority of strokes. It is highly correlated with carotid artery disease because it occurs most often at the bifurcation of the common carotids. Transient ischemic attacks are an important clinical syndrome in the diagnostic evaluation of patients with carotid insufficiency. Amaurosis fugax is typically the most common ocular symptom. In addition to a careful history and physical examination, definitive diagnosis and appropriate management of carotid disease mandates defining the location and extent of stenosis. Noninvasive duplex scanning is an ideal technique for determining which patients should proceed with invasive arteriography and carotid endarterectomy. Clinical trials have now officially established the value of endarterectomy in patients with carotid artery disease.

Carotid Arteries↗
PubMed1980

Carotid artery disease, carotid endarterectomy, and behavior.

Thirty-five carotid endarterectomy patients and 17 peripheral vascular surgery controls were evaluated psychologically preoperatively and postoperatively. The endarterectomy sample was restricted to patients with transient ischemic attacks. Neuropsychological tests included measures of language, attention, memory, problem solving, and sensory and motor skills. Personality tests included measures of general psychopathology, with specific evaluation of anxiety and depression. Mean scores of the endarterectomy and control groups were not statistically significantly different preoperatively for any test. Postoperatively, only the endarterectomy group showed mean improvement on measures of memory and verbal fluency. Both groups showed improvement on several other neuropsychological measures, and in reduction in state anxiety and on another indicator of psychopathology. Endarterectomy patients whose cognition improved postoperatively were younger, better educated, and had lower admitting systolic blood pressure; they also tended to have a lesser incidence of generalized vascular disease.

Anxiety↗
PubMed1984

Internal carotid artery disease.

Internal carotid artery disease is a challenge to the optometrist because of its full spectrum of manifestations. A detailed case history and a thorough evaluation of the ocular and visual signs and symptoms are invaluable in the appropriate management of the patient. The optometric practitioner must consider this disease in middle-aged or elderly patients who present with suggestive signs and/or symptoms. Appropriate diagnosis and management of the disease will, it is hoped, result in the continued visual health and longevity of these patients.

Aged↗
PubMed1995

Carotid artery duplex scanning in preoperative assessment for coronary artery revascularization: the association between peripheral vascular disease, carotid artery stenosis, and stroke.

PURPOSE: The purpose of this study was to identify high-risk populations for severe carotid artery disease (SCD) and neurologic events (NE) after nonemergency isolated coronary artery bypass graft procedures (CABG). METHODS: Between February 1989 and July 1992, 387 patients underwent preoperative carotid artery duplex scanning as part of a preoperative assessment for nonemergency cardiac procedures. Of these patients, 376 had isolated CABG, and 11 had combined carotid endarterectomy (CEA) and CABG. Patient demographics, risk factors, and preoperative neurologic symptoms were recorded and analyzed. Severe carotid artery disease was defined as a 80% or greater stenosis of either internal carotid artery by carotid artery duplex scanning. Patients were evaluated for neurologic events (cerebrovascular accident, transient ischemic attack, amaurosis fugax, or reversible ischemic neurologic deficits) during the in-hospital postoperative period. RESULTS: The prevalence of SCD was 8.5% (33 patients). The 33 patients with SCD were significantly older (65.6 +/- 6.5 years vs 62.5 +/- 10.4 years, p = 0.02), had previous CEA (27.3% vs 2.0%, p = 0.00001), had preoperative neurologic symptoms (21.2% vs 5.9%, p = 0.002), and had peripheral vascular disease (PVD) (63.6% vs 16.9%, p = 0.00001). The sensitivity of PVD for SCD is 63.6% (n = 21/33) (specificity 83.1%, positive predictive value 25.9%, negative predictive value 96.1%). In patients undergoing CABG alone, those who had postoperative NE were older (69.6 +/- 6.7 years vs 62.5 +/- 10.3 years, p = 0.036) and more likely to have PVD (50% vs 19.7%, p = 0.034), SCD (40% vs 4.9%, p = 0.001) and previous CEA (40% vs 2.7%, p = 0.0002). The incidence of postoperative NE in patients with SCD was 18.2% vs 1.7% in patients without SCD (p = 0.001). The sensitivity of SCD for NE was 40% (n = 4/10) (specificity 95.1%, positive predictive value 18.2%, negative predictive value 98.3%). CONCLUSIONS: PVD may be helpful to identify patients at high risk for severe carotid artery stenosis. Postoperative NE in patients with CABG are associated with increasing age, carotid artery stenosis greater than 80%, previous CEA, and PVD.

Adult↗
PubMedDate not supplied

Selection of treatment for patients with carotid artery disease: medication, carotid endarterectomy, or carotid artery stenting.

Patients presenting with atherosclerosis of the extracranial carotid arteries may be offered carotid endarterectomy (CEA), carotid artery stenting (CAS), or medical therapy to reduce their risk of stroke. In many cases, the choice between treatment modalities remains controversial. An algorithm based on patients' neurologic symptoms, comorbidities, limiting factors for CAS and CEA, and personal preferences was developed to determine the optimal treatment in each case. This algorithm was then employed to determine therapy in 308 consecutive patients presenting to a single institution during one calendar year. Ninety-five (30.8%) patients presented with an asymptomatic carotid stenosis of more than 80% and 213 (69.2%) with a symptomatic stenosis of more than 50%. According to our algorithm, 59 (62.1%) of the 95 asymptomatic patients received CAS, 20 (21.1%) received CEA, and 16 (16.8%) received medical therapy. All symptomatic patients underwent intervention; 153 (71.8%) were treated with CAS and 60 (28.2%) with CEA. Combined 30-day stroke and death rates after CAS were 1.7% in asymptomatic patients and 2.6% in symptomatic patients. After CEA, these rates were 0% and 3.3%, respectively. Careful selection of treatment modality according to predetermined criteria can result in improved outcomes.

Algorithms↗
PubMed1994

Objective tinnitus in patients with atherosclerotic carotid artery disease.

Atherosclerotic carotid artery disease (ACAD) as a cause of objective-pulsatile tinnitus has not been adequately addressed in the literature. This report presents the authors' experience in 12 patients with pulsatile tinnitus arising from ACAD. Ipsilateral carotid bruit was detected in all patients and objective tinnitus was present in eight cases. The intensity of the carotid bruit was louder than the objective tinnitus in all patients. Carotid artery stenosis was confirmed in all patients with noninvasive vascular flow mapping. Atherosclerotic carotid artery disease should be highly suspected in patients with pulsatile-objective tinnitus who are older than 50 years and have associated cardiovascular risk factors. Pulsatile tinnitus in these patients can be the first manifestation of ACAD. Duplex ultrasound study of the carotid arteries can confirm the diagnosis. Consultation with a vascular surgeon is essential in selected cases.

Aged↗
PubMed1994

Extracranial carotid arterial disease.

Carotid duplex ultrasonography is the noninvasive procedure of choice for evaluating ECAD. However, carotid angiography should be performed before doing carotid endarterectomy. Multivariate logistic regression analysis showed that significant prognostic variables for ECAD in an elderly population are (1) cigarette smoking, (2) serum total cholesterol, (3) serum HDL cholesterol (inverse association), (4) diabetes mellitus, and (5) prior CAD. Patients with 80-100% ECAD develop a higher incidence of ABI and TIA than patients with 40-80% ECAD. Patients with 40-80% ECAD develop a higher incidence of ABI and TIA than patients with 0-40% ECAD. Patients with ECAD have a higher prevalence of prior CAD and develop a higher incidence of new coronary events than patients without ECAD. In patients with ECAD, significant prognostic variables for new coronary events are (1) silent ischemia, (2) prior CAD, (3) serum HDL cholesterol (inverse association), and (4) cigarette smoking. Risk factors for ECAD and CAD should be treated in patients with ECAD. Cigarette smoking must be stopped. Hypertension, dyslipidemia, and diabetes mellitus should be treated. Aspirin, 325 mg/d, should be administered to patients with ECAD. Ticlopidine hydrochloride, 250 mg two times per day should be considered in patients with ECAD who are unable to tolerate aspirin or who develop cerebrovascular events on aspirin. Carotid endarterectomy should be considered in symptomatic patients with 70-99% ECAD.

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PubMed1998

A transcranial Doppler study of basilar hemodynamics in progressive carotid artery disease.

In carotid artery disease (CAD) the basilar artery (BA) may act as an important intracranial collateral to supply hypoperfused middle cerebral artery (MCA) territories. Transcranial Doppler studies were performed to study the dependency between BA hemodynamics in relation to the MCA perfusion status. BA and MCA blood flow velocities (BFV), pulsatility indices (API) and cerebrovascular reactivity (CVR) were assessed in 40 patients with a progressive MCA hypoperfusion due to progressive CAD. All patients had patent cervical segments of their vertebral arteries with an antegrade vertebral flow profile. Duplex studies were performed to diagnose the severity of CAD. Hypoperfusion of the MCA was diagnosed by the degree of vasoparalysis assessed by a Diamox procedure. Analysis showed that the basilar BFV significantly increased in cases of progressive CAD, the basilar PI decreased but the basilar CVR remained unchanged. However, in cases of bilateral hemodynamic significant CAD and bilateral exhausted CVR in the MCA territory, the basilar artery did not exhibit an increase of BFVs or a decrease of the basilar PI, but the basilar CVR showed a significant decrease. Basilar artery CVR is not impaired if this artery has a function as intracranial collateral in CAD. However in cases of bilateral hypoperfused MCA territories the basilar artery does not function as a collateral pathway. The basilar CVR declines under these circumstances which merely reflects the exhausted hemodynamics in the anterior/posterior borderzones. This situation might lead to an increased stroke risk in the distal basilar supply zones.

Adult↗
PubMed2001

Improved quality of life among patients with symptomatic carotid artery disease undergoing carotid endarterectomy.

BACKGROUND: Few studies have examined how carotid endarterectomy affects patients' view of their quality of life. METHODS: Patients undergoing carotid endarterectomy from January 1996 to March 1997 at the John Radcliffe Hospital completed the United Kingdom Short Form 36 (SF-36) Health Survey Questionnaire before undergoing the procedure and again at 3 months afterward. Scores were compared with population normal values. RESULTS: In 50 patients with symptomatic carotid artery disease, there was significant improvement in the SF-36 overall "change in health" score after the procedure compared with beforehand (61.0 +/- 3.7 vs 44.5 +/- 3.4, P =.003, Wilcoxon signed rank test). There were, however, no statistically significant differences in the group's mean SF-36 subscores after operation compared with before the procedure. The physical subscores were below age-adjusted healthy population means but similar to those for chronically ill patients (physical function subscore P =.015 vs normal, P =.89 vs ill; role limitation-physical subscore P =.007 vs normal, P =.89 vs ill). Patients with postoperative complications did not have an improved change in health score (-12.5 vs 22.0, P =.03, Mann-Whitney U test). There was no effect on change in health score because of other risk factors or in patients with contralateral carotid artery occlusion or a history of preoperative stroke. CONCLUSIONS: Patients with symptomatic carotid artery disease undergoing an uncomplicated carotid endarterectomy perceive improved quality of life and overall health. There is no perception of worsened pain, energy, or physical or mental function after the procedure. These results confirm that patients believe that performance of carotid endarterectomy improves their overall health, supporting the surgical approach to carotid artery disease.

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PubMed2000

When to operate in carotid artery disease.

Carotid endarterectomy has proved to be beneficial in the prevention of stroke in selected patients. The procedure is indicated in symptomatic patients with carotid-territory transient ischemic attacks or minor strokes who have carotid artery stenosis of 70 to 99 percent. With a low surgical risk, carotid endarterectomy provides modest benefit in symptomatic patients with carotid artery stenosis of 50 to 69 percent. Platelet antiaggregants and risk factor modification are recommended in symptomatic patients with less than 50 percent stenosis. In the Asymptomatic Carotid Atherosclerosis Study, carotid endarterectomy was beneficial in patients who had asymptomatic carotid artery stenosis of 60 percent or greater and whose general health made them good candidates for elective surgery, provided that the arteriographic and surgical complication rates were low. However, in asymptomatic patients, surgery reduced the absolute risk of stroke by only 1 percent per year.

Carotid Stenosis↗
PubMedDate not supplied

Medical, surgical, and interventional treatment for carotid artery disease.

Internal carotid artery atherosclerosis is a major cause of ischemic stroke. Medical, surgical, and interventional options are available for stroke prevention in patients with carotid artery stenosis. Optimal management of the patient depends to a great degree on whether the individual is symptomatic or asymptomatic. Coexisting medical morbidities also greatly influence treatment decisions regarding carotid endarterectomy. This review highlights the current status of antiplatelet therapy and warfarin for stroke prevention in patients with carotid stenosis. The appropriate role of carotid endarterectomy for symptomatic and asymptomatic patients is also discussed. Finally, the current status of carotid angioplasty and stenting is outlined.

Angioplasty↗
PubMed1998

Factors modifying the prognosis in men with asymptomatic carotid artery disease.

OBJECTIVES: Carotid artery stenosis is associated with an increased prevalence and incidence of ischaemic heart disease (IHD). The aim of this study has been to assess whether, in men with carotid artery stenosis, survival and incidence of stroke and myocardial infarction is different in men with and men free from IHD; and to characterize probands with incident cerebrovascular (CBV) event in terms of smoking, hypertension and leg artery disease. DESIGN: Population-based cohort study, 'Men born 1914'. SETTING: Malmö, a city in southern Sweden. SUBJECTS: A total of 478 of 621 men born in 1914, who in 1982 participated in ultrasound examination of the carotid arteries. MAIN OUTCOME MEASURES: Morbidity and mortality during 10 years of followup. RESULTS: Asymptomatic carotid artery stenosis was, in men free from IHD, associated with reduced survival and an increased incidence of serious CBV events that occurred, on average, 3.6 years after the examination. In men with prevalent IHD, there was no relationship between carotid artery stenosis and incidence of CBV events. The main explanation to the lack of association seems to be the high vascular mortality rate in that group. CONCLUSIONS: It's our conclusion that in patients with asymptomatic carotid artery stenosis there is a great heterogeneity with regard to severity of disease and prognosis. Survival and incidence of stroke and myocardial infarction depends on whether patients have concomitant IHD.

Aged↗
PubMed1988

Operative strategy in combined coronary and carotid artery disease.

In the period between the opening of our heart center in November 1984 and May 1986, 2001 cardiac operations were performed with the aid of cardiopulmonary bypass. Almost three quarters (73.5%, n = 1471) of the patients had coronary artery disease and 20% (n = 359) had acquired valvular heart disease. In 47 of 1471 patients who underwent coronary artery bypass grafting, a simultaneous carotid endarterectomy was performed. They included 36 men and 11 women, aged between 51 and 78 years (mean 64 years). Preoperatively, 12 patients had cerebrovascular symptoms and 35 were neurologically asymptomatic. Twenty-three had unilateral carotid stenosis and 24 had bilateral or multiple vessel disease of the extracranial arteries. All except four patients had triple-vessel coronary artery disease. In three patients with aortic valve disease, coronary bypass, carotid endarterectomy, and aortic valve replacement were performed simultaneously. Cardiopulmonary bypass was instituted before carotid endarterectomy was performed, with mild hypothermia and hemodilution for added protection. Electroencephalographic monitoring was used throughout the operation. Forty-six of the 47 patients survived the operation without neurologic or cardiac complications. One patient had a neurologic deficit with hemiplegia and coma, which was lethal. We conclude that simultaneous endarterectomy of significant extracranial artery stenosis in candidates for coronary bypass is a method safe enough to justify its routine use.

Aged↗
PubMed1991

Perioperative stroke. Part I: General surgery, carotid artery disease, and carotid endarterectomy.

Although stroke, defined as a focal neurological deficit lasting more than 24 hr, is uncommon in the perioperative period, its associated mortality and long-term disability are high. No large-scale data are available to identify the importance of recognized risk factors for stroke in the perioperative period. A review of the literature shows that the incidence and mechanism of its occurrence are influenced by the presence of cardiovascular disease and the type of surgery. The most common cause of perioperative stroke is embolism. In non-cardiac surgery, the incidence of perioperative stroke is higher among the elderly. Properly administered, controlled hypotension is associated with minimal risk of stroke. Cerebral vasospasm may be the cause of focal cerebral ischaemia in eclamptic patients, and the aggressive treatment of hypertension may exacerbate the neurological damage. The risk of stroke associated with carotid endarterectomy is closely related to the preoperative neurological presentation, and the experience of the surgical/anaesthetic team. Symptomatic cerebrovascular disease, acute stroke, asymptomatic carotid lesions, preoperative assessment of risk, local and general anaesthesia, cerebral protection and monitoring during carotid endarterectomy are discussed with reference to reducing the risk of perioperative stroke. Adequate monitoring and protection have minimized the risk of ischaemia from carotid clamping, and the major mechanism of stroke is embolization.

Carotid Arteries↗
PubMedDate not supplied

Noninavasive angiography for the diagnosis of carotid artery disease using Doppler ultrasound (carotid artery Doppler).

To detect stenosis in the carotid artery with a bidirectional continuous-wave Doppler ultrasound device, the following noninvasive procedure, applied on 800 patients and compared with 249 angiograms of 186 patients, has proved to be about 90% reliable. Measurements of flow signals were taken over the terminal branches of the ophthalmic artery (supratrochlear and supraorbital arteries) and averaged. Compression of superficial temporal and facial arteries revealed flow direction and common carotid artery compression revealed the supplying blood vessel and the effectiveness of the circle of Willis. Measurements over the common carotid arteries were used to evaluate peripheral resistance. A set of eight criteria was used; the diagnostic value of each criterion was calculated by comparing 138 pathological Doppler findings in 123 patients with the angiograms. If reverse flow direction in supratrochlear or supraorbital artery was used alone, only 43% correct diagnoses would have resulted. A more severe stenosis is not necessarily correlated with a more weighted criterion; a subset of criteria is less efficient than the combination of all criteria. Application during 32 extracranial endarterectomies on 28 patients informed the surgeon immediately about the hemodynamic effect of the surgical intervention. Rethrombosis was diagnosed in two patients by postoperative Doppler examination.

Carotid Artery Diseases↗
PubMed1995

Left ventricular hypertrophy is more prevalent in patients with systemic hypertension with extracranial carotid arterial disease than in patients with systemic hypertension without extracranial carotid arterial disease.

The mechanism of the association between LV hypertrophy and ECAD is unknown and needs to be investigated. Whether LV hypertrophy in patients with systemic hypertension is a marker for ECAD or contributes to ECAD needs to be investigated. The association between LV hypertrophy and significant ECAD was independent of the level of blood pressure in our patients. Coronary atherosclerosis in our patients with signifciant ECAD may have contributed to the increased prevalence of LV hypertrophy. The association between LV hypertrophy and significant ECAD may contribute to the high incidence of stroke in patients with LV hypertrophy. This is currently under investigation by our group.

Aged↗