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1
Johansson, Elias. "Carotid stenosis." Doctoral thesis, Umeå universitet, Institutionen för folkhälsa och klinisk medicin, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-46396.
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Carotid stenosis is one of several causes of ischemic stroke and entails a high risk of ischemic stroke recurrence. Removal of a carotid stenosis by carotid endarterectomy results in a risk reduction for ischemic stroke, but the magnitude of risk reduction depends on several factors. If the delay between the last symptom and carotid endarterectomy is less than 2 weeks, the absolute risk reduction is >10%, regardless of age, sex, or if the degree of carotid stenosis is 50–69% or 70–99%. Thus, speed is the key. However, if many patients suffers an ischemic stroke recurrence within the first 2 weeks of the presenting event, an additional benefit is likely be obtained if carotid endarterectomy is performed even earlier than within 2 week after the presenting event. Carotid endarterectomy for asymptomatic carotid stenoses carries a small risk reduction for stroke. Screening for asymptomatic carotid stenosis requires a prevalence of >5% in the examined population, i.e., higher than in the general population; however, directed screening in groups with a prevalence of >5% is beneficial. The aims of this thesis were to investigate the length of the delay to carotid endarterectomy, determine the risk of recurrent stroke before carotid endarterectomy, and determine if a calcification in the area of the carotid arteries seen on dental panoramic radiographs is a valid selection method for directed ultrasound screening to detect asymptomatic carotid stenosis. Consecutive patients with a symptomatic carotid stenosis who underwent a preoperative evaluation aimed at carotid endarterectomy at Umeå Stroke Centre between January 1, 2004–March 31, 2006 (n=275) were collected retrospectively and between August 1, 2007–December 31, 2009 (n=230) prospectively. In addition, 117 consecutive persons, all preliminarily eligible for asymptomatic carotid endarterectomy and with a calcification in the area of the carotid arteries seen on panoramic radiographs, were prospectively examined with carotid ultrasound. The median delay between the presenting event and carotid endarterectomy was 11.7 weeks in the first half year of 2004, dropped to 6.9 weeks in the first quarter year of 2006, and had dropped to 3.6 weeks in the second half year of 2009. The risk of ipsilateral ischemic stroke recurrence was 4.8% within 2 days, 7.9% within 1 week, and 11.2% within 2 weeks of the presenting event. For patients with a stroke or transient ischemic attack as the presenting event, this risk was 6.0% within 2 days, 9.7% within 1 week, and 14.3% within 2 weeks of the presenting event. For the 10 patients with a near-occlusion, the risk of ipsilateral ischemic stroke recurrence was 50% at 4 weeks after the presenting event. Among the 117 persons with a calcification in the area of the carotid arteries seen on panoramic radiographs, eight had a 50–99% carotid stenosis, equalling a prevalence of 6.8% (not statistically significantly over the pre-specified 5% threshold). Among men, the prevalence of 50–99% carotid stenosis was 12.5%, which was statistically significantly over the pre-specified 5% threshold. In conclusion: The delay to carotid endarterectomy was longer than 2 weeks. Additional benefit is likely to be gained by performing carotid endarterectomy within a few days of the presenting event instead of at 2 weeks because many patients suffer a stroke recurrence within a few days; speed is indeed the key. The finding that near-occlusion entails an early high risk of stroke recurrence stands in sharp contrast to previous studies; one possible explaination is that this was a high-risk period missed in previous studies. The incidental finding of a calcification in the area of the carotid arteries on a panoramic radiograph is a valid indication for carotid ultrasound screening in men who are otherwise eligible for asymptomatic carotid endarterectomy.
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Kragsterman, Björn. "Carotid Artery Stenosis : Surgical Aspects." Doctoral thesis, Uppsala University, Department of Surgical Sciences, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-6834.
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Randomised controlled trials (RCT) have demonstrated a net benefit of carotid endarterectomy (CEA) in stroke prevention for patients with severe carotid artery stenosis as compared to best medical treatment. Results in routine clinical practice must not be inferior to those in the RCTs. The carotid arteries are clamped during CEA which may impair the cerebral perfusion.
The aim of this thesis was to assess population-based outcomes from CEA, investigate risk factors for perioperative complications/late mortality and to evaluate effects of carotid clamping during CEA. In the Swedish vascular registry 6182 CEAs were registered during 1994-2003. Data on all CEAs were retrieved, analysed and validated. In the validation process no death or disabling stroke was unreported. The perioperative stroke or death rate was 4.3% for those with symptomatic and 2.1% for asymptomatic stenosis (the latter decreasing over time). Risk factors for perioperative complications were age, indication, diabetes, cardiac disease and contralateral occlusion. Median survival time was 10.8 years for the symptomatic and 10.2 years for the asymptomatic group.
Tolerance to carotid clamping during CEA under general anaesthesia was evaluated in 62 patients measuring cerebral oximetry, transit time volume flowmetry and stump pressure. High internal carotid artery flow before clamping and low stump pressure was associated with decreased oxygenation after clamping suggesting shunt indication.
In 18 patients undergoing CEA, jugular bulb blood samples demonstrated significantly altered levels of marker for inflammatory activation (IL-6) and fibrinolytic activity (D-dimer and PAI-1) during carotid clamping as compared to radial artery levels. This indicates a cerebral ischaemia due to clamping although clinically well tolerated.
In conclusion, the perioperative outcome after CEA in Sweden compared well with the RCTs results. Tolerance to carotid clamping may be evaluated by combining stump pressure and volume flow measurements. Although clinically tolerated clamping may induce a cerebral ischaemic response.
3
Kragsterman, Björn. "Carotid artery stenosis : surgical aspects /." Uppsala : Acta Universitatis Upsaliensis : Univ.bibl. [distributör], 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-6834.
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Garoff, Maria. "Carotid calcifications in panoramic radiographs in relation to carotid stenosis." Doctoral thesis, Umeå universitet, Institutionen för odontologi, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-119794.
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Calcifications in carotid atheromas can be detected in a panoramic radiograph (PR) of the jaws. A carotid artery calcification (CAC) can indicate presence of significant (≥ 50%) carotid stenosis (SCS). The aim of this thesis was to (1) determine the prevalence of SCS and burden of atherosclerotic disease among patients revealing CACs in PRs, (2) determine the prevalence of CACs in PRs among patients with SCS, (3) analyze whether the amount of calcium and/or (4) the radiographic appearance of the CACs, can improve the positive predictive value (PPV) for SCS detection among patients with CACs in PRs. The thesis is based on four cross-sectional studies. Two patient groups were prospectively and consecutively studied. Group A represented a general adult patient population in dentistry examined with PR presenting incidental findings of CACs. These patients were examined with carotid ultrasound for presence or absence of SCS and their medical background regarding atherosclerotic related diseases and risk factors was reviewed. An age and gender matched reference group was included for comparisons. Group B comprised patients with ultrasound verified SCS, examined with PR prior to carotid endarterectomy. The PRs were analysed regarding presence of CACs. The extirpated plaques were collected and examined with cone-beam computed tomography (CBCT) to determine the amount of calcium. The radiographic appearance of CACs in PRs from Group A and B were evaluated for possible association with presence of SCS. In Group A, 8/117 (7%) of patients with CAC in PRs revealed SCS in the ultrasound examination, all were found in men (8/64 (12%)). Patients with CACs in PRs revealed a higher burden of atherosclerotic disease compared to participants in the reference group (p <0.001). In Group B, where all patients had SCS, 84% revealed CACs in PRs and 99% of the extirpated plaques revealed calcification. CACs with volumes varying between 1 and 509 mm3 were detected in the PRs. The variation in volume did not correlate to degree of carotid stenosis. The radiographic appearance that was most frequently seen in neck sides with SCS (65%) was also frequently found in neck sides without SCS (47%) and therefore the PPV did not improve compared to the PPV solely based on presence of CACs. CACs in PRs are more associated with SCS in men than in a general population and patients with CACs in PRs have a higher burden of atherosclerotic disease. The majority of patients with SCS show CACs in PRs and the majority of extirpated carotid plaques reveal calcification. The volume of CAC and specified radiographic appearance does not increase the PPV for SCS in patients with CACs in PRs. In conclusion patients with CACs in PRs, and without previous record of cardiovascular disease, should be advised to seek medical attention for screening of cardiovascular risk factors.Bakgrund Inom ramen för specialist- och allmäntandvård utförs panoramaröntgen-undersökningar dagligen på såväl barn som vuxna. En panoramaröntgenbild (PB) är en översiktsbild som är specifikt anpassad till att återge området för tänder och käkar. Utöver det, avbildas även delar av halsen och som bifynd ibland förkalkningar belägna i området för halspulsådern (karotiskärlet). Dessa förkalkningar kallas för karotisförkalkningar och är ett tecken på åderförkalkning. Åderförkalkning består i huvudsak av en fettrik plackansamling i kärlväggen. Placket kan med tiden förkalkas till varierande grad. Det är dessa förkalkningar vi kan se i PB. När en åderförkalkning ökar i volym kan den utgöra en förträngning i kärlet. Då förträngningen av kärldiametern är ≥ 50% benämns åderförkalkningar belägna i karotiskärlet för ”signifikanta karotisstenoser” (SKS). Graden av förträngning bedöms som regel med ultraljudsundersökning av halskärlen. Bitar av SKS kan lossna varvid det bildas små blodproppar. Eftersom halspulsådern försörjer främre hjärnhalvan med blod så kan dessa bitar täppa till ett av hjärnans blodförsörjande kärl och leda till stroke (slaganfall). För att minska risken att drabbas av stroke kan man ibland operera bort SKS (karotisplacket). Syfte Syftet med denna avhandling var att ta reda på (1) hur många av de patienter som blir undersökta med PB inom tandvården som uppvisar karotisförkalkningar, hur stor andel som har SKS samt utreda om patienter med förkalkningar i PB i större utsträckning är drabbade av hjärtkärlsjukdomar/risk faktorer, (2) hur ofta utopererade karotisplack innehåller kalk och hur ofta patienter med känd SKS uppvisar karotisförkalkningar i PB, (3) huruvida förkalkningsmängden i utopererade karotisplack är korrelerad till förträngningsgrad, och (4) huruvida det finns något specifikt radiografiskt utseende på karotisförkalkningar i PB som kan användas för att identifiera en större andel patienter med SKS bland patienter som uppvisar karotisförkalkningar i PB, det vill säga minska risken för att skicka patienter utan SKS på ultraljudsundersökning. Material och metoder Materialet bestod av två huvudgrupper av patienter. Grupp A bestod av patienter undersökta inom tandvården med PB som uppvisat karotisförkalkningar. Alla dessa patienter undersöktes med ultraljud för att bedöma förekomst av SKS. Den medicinska journalen granskades avseende tidigare förekomst av åderförkalkningsrelaterade sjukdomar och risk faktorer. En köns- och åldersmatchad kontrollgrupp utan karotisförkalkningar i PB analyserades på motsvarande sätt för jämförelse. Grupp B bestod av patienter med känd SKS som före operativt avlägsnande av karotisplack undersöktes med PB. PB granskades avseende förekomst av karotisförkalkning och utopererade karotisplack avseende kalkinnehåll. Förkalkningsmängden i de utopererade karotisplacken korrelerades dels till möjlighet att identifiera karotisförkalkning i PB samt till förträngningsgraden i kärlen. Karotisförkalkningarnas utseende delades in i grupper för att utvärdera om vissa utseenden i större utsträckning kunde associeras till förekomst av SKS. Resultat I Grupp A uppvisade 8/117 (7%) patienter SKS, alla var män, 8/64 (12%). Patienter med karotisförkalkningar i PB hade oftare åderförkalkningsrelaterade sjukdomar och risk faktorer (p < 0,001). I Grupp B hade 84% av patienterna med SKS karotisförkalkning i PB. Bland de utopererade karotisplacken innehöll 99% förkalkningar och förkalkningsvolymen varierade från 1-509 mm3. Möjligheten att upptäcka karotisförkalkning i PB var oberoende av om förkalkningsvolymen var stor eller liten. Förkalkningsvolymen var heller inte korrelerad till hur stor förträngning av kärlet en SKS (≥ 50%) orsakat. Ett radiografiskt utseende på karotisförkalkningar i PB noterades i 65% av de halssidor som hade en SKS. Detta specifika radiografiska utseende återfanns dock även i 47% av halssidor utan SKS. Andelen falskt positiva patienter var således fortsatt hög. Slutsats Vi fann att 12% män med karotisförkalkningar i PB, undersökta i en generell population inom tandvården, uppvisar SKS. Patienter med karotisförkalkningar i PB uppvisar fler riskfaktorer och är oftare drabbade av hjärt-kärlsjukdomar än patienter utan karotisförkalkningar i PB. Majoriteten av patienter med SKS uppvisar karotisförkalkningar i PB och nära 100% av utopererade karotisplack innehåller kalk. Förkalkningsmängden påverkar inte möjligheten att upptäcka karotisförkalkning i PB. Förkalkningsmängd och specificerade radiografiska utseenden hos karotisförkalkningar i PB förutsäger inte SKS bättre än definitionen ”förkalkning ja eller nej”. Dessa parametrar kan således inte användas till att förfina urvalet bland patienter som uppvisar karotisförkalkning i PB mot högre andel patienter med SKS. Individer med karotisförkalkningar i PB bör uppmanas konsultera vården för undersökning av eventuella risk faktorer för hjärt-kärlsjukdom.
5
Gift, Jason Ayres 1981. "Carotid collar : a device for auscultory detection of carotid artery stenosis." Thesis, Massachusetts Institute of Technology, 2003. http://hdl.handle.net/1721.1/16679.
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Thesis (M. Eng.)--Massachusetts Institute of Technology, Dept. of Electrical Engineering and Computer Science, 2003.Includes bibliographical references (leaves 110-111).
This electronic version was submitted by the student author. The certified thesis is available in the Institute Archives and Special Collections.
The carotid collar is a hardware device designed to aid in detecting carotid artery stenosis, a disease that increases the risk of stroke. This device consists of three electronic stethoscopes that record heart and carotid artery sounds and an electrocardiograph. A software application, ccrec, was written to make the device easy to use by displaying real-time waveforms and storing the recorded signals in files for later analysis. The results of some preliminary tests of the device's ability to make accurate recordings, including the performance of the software and a test of the frequency response of the stethoscope sensors, are presented. The results suggest that this inexpensive device has considerable promise for rapid screening for carotid artery stenosis.
by Jason Ayres Gift.
M.Eng.
6
Crawley, F. A. M. "Carotid artery stenosis : the role of angioplasty and surgery." Thesis, University of Cambridge, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.598140.
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Dionisio, Kathie L. (Kathie Lynn). "Ex-vivo 3D assessment of carotid stenosis with ultrasound." Thesis, Massachusetts Institute of Technology, 2005. http://hdl.handle.net/1721.1/32364.
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Thesis (S.M.)--Massachusetts Institute of Technology, Dept. of Mechanical Engineering, 2005.Includes bibliographical references (p. 71-74).
Atherosclerosis causes heterogeneous remodeling of arterial structure and composition in the carotid vessel wall. It has been shown that the progression of the disease can be monitored by tracking changes in the carotid intima-media thickness (IMT). Non-invasive peripheral vascular ultrasound (U/S) of the carotid artery is a non-invasive, cost effective, accepted means of measuring IMT. Traditionally, evaluation of IMT in the carotid has been limited to 2D U/S scans. This method is disadvantageous as 2D scans are scan plane dependent, limiting the area over which one can evaluate the extent of the disease. Reproducing the identical scan plane on subsequent scans is also difficult. Evaluation of the carotid vessel wall in 3D will allow for a more complete and reproducible assessment of disease through IMT measurements. We have constructed a fully 3D image processing scheme for analyzing carotid U/S volumes to extract the inner and outer vessel wall boundaries. Sequences of 2D B-mode U/S cross sections of ex-vivo carotid specimens are collected and voxelized to create 3D U/S volumes. By applying a 3D directionally sensitive, edge preserving filter to the U/S volumes, we obtain 3D edge fields that are more distinct than traditional gradient edge fields. Initial point selection of the boundaries, together with these enhanced 3D edge fields, are used with a deformable surface to extract the final inner and outer vessel boundaries. Through intra- and inter-observer tests on IMT differences, we show that the 3D boundaries extracted using our automatic technique are more reproducible than boundaries extracted from manual point selection.
by Kathie L. Dionisio.
S.M.
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Gin, Ronald. "Numerical modelling of the carotid artery bifurcation with a mild stenosis." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape4/PQDD_0021/MQ58037.pdf.
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Miyachi, Shigeru, Takashi Izumi, Noriaki Matsubara, Osamu Hososhima, Yuko Tsurumi, and Arihito Tsurumi. "Virtual Histology Analysis of Carotid Atherosclerotic Plaque: Plaque Composition at the Minimum Lumen Site and of the Entire Carotid Plaque." Wiley-Blackwell, 2013. http://hdl.handle.net/2237/17694.
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Balu, Niranjan. "Quantitative characterization of carotid arterial remodeling by high-resolution serial MRI /." Thesis, Connect to this title online; UW restricted, 2007. http://hdl.handle.net/1773/8112.
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Wanby, Pär W. "On certain genetic and metabolic risk factors for carotid stenosis and stroke." Doctoral thesis, Linköpings universitet, Institutionen för medicin och hälsa, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-7467.
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The present study evaluated genetic and metabolic factors influencing the risk of acute cerebrovascular disease (CVD) and internal carotid artery stenosis (ICA stenosis) in a Swedish community. The threonine (T) containing protein of the FABP2 A54T gene polymorphism has a greater affinity for long chain fatty acids (FFAs) than the alanine (A) containing protein. This altered affinity for FFAs has been shown to affect the intestinal absorption of fatty acids and consequently the fatty acid composition of serum lipids, in particularly postprandially. Endothelium derived NO is a potent vasodilator and antiatherogenic agent. Asymmetric dimethyl arginine (ADMA) is an endogenous competitive inhibitor of endothelial nitric oxide synthase (eNOS). ADMA has been shown to be involved in the pathogenesis of atherosclerotic disease, and ADMA inhibits eNOS by displacement of L-arginine from the enzyme, which in turn is believed to affect the amount of NO available within the endothelium. The FABP2 A54T gene polymorphism was analyzed in 407 patients with acute CVD and also in a subset of these patients whose carotids had been evaluated with ultrasound. Both the FABP2 polymorphism and a common polymorphism of the eNOS gene, Glu298Asp, were analyzed in a different population consisting of 54 matched pairs of patients with ICA stenosis and controls. ADMA levels were measured in both study populations. We found that the T54 allele was more frequent in patients with transient ischaemic attacks (TIA), and that the TT genotype was more prevalent in young, non-smoking patients with CVD than in controls. Increased concentrations of ADMA were observed in cardio-embolic infarction and TIA, but not significantly in non-cardio-embolic infarction nor in haemorrhagic stroke. In multivariate logistic regression models, CVD increased across quartiles of ADMA in all subgroups, but this association was only significant in the TIA group. A decreased arginine/ADMA ratio, a measure of NO availability was associated with CVD in the entire study population. Patients with severe carotid stenosis had significantly higher ADMA levels than the controls. Allele and genotype frequencies of the FABP2 and eNOS polymorphisms did not differ between patients with ICA stenosis and controls. Our results indicate that ADMA is a strong marker for TIA and severe ICA stenosis, and that relative defiency of arginine, measured as L-arginine/ADMA, is present in acute CVD. We also conclude that a common polymorphism of the FABP2 gene increases susceptibility to ischaemic stroke and TIA.Figure 4 on page 17 is publshed with kind permisson from The Journal of Physiology (http://jp.physoc.org/).
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Wanby, Pär W. "On certain genetic and metabolic risk factors for carotid stenosis and stroke /." Linköping : Kalmar : Linköping University ; Department of Internal Medicine, County Hospital of Kalmar, 2006. http://www.bibl.liu.se/liupubl/disp/disp2006/med942s.pdf.
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Kostulas, Konstantinos. "Genetic analysis of ischemic stroke and predisposing carotid artery stenosis : a stroke carol /." Stockholm : Karolinska institutet, 2007. http://diss.kib.ki.se/2007/978-91-7357-395-5/.
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RIGAMONTI, FABIO. "Serum lipoprotein(a) predicts acute coronary syndromes in patients with severe carotid stenosis." Doctoral thesis, Università degli studi di Genova, 2020. http://hdl.handle.net/11567/1011317.
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Atherosclerotic cardiovascular disease (CVD) represents a significant health issue in the present and future worldwide populations, thus implying a crucial role in their risk assessment in primary and secondary prevention. Among the classical risk factors, lipids and lipoproteins serum concentrations are used to estimate the risk of CVD and guide therapeutic decision-making. In the present study, we focused on the prognostic value of the lipoprotein (a) [Lp(a)], a < 70 nm diameter low-density lipoprotein (LDL) that can freely flux across the endothelial vascular barrier and settle within the arterial wall [1]. Both pathophysiological and prognostic values of Lp(a) remain unclear. Given his structural similarity to plasminogen and the oxidized phospholipid load, Lp(a) shows pro-coagulant and pro-inflammatory effects [2]. Lifelong exposure to higher Lp(a) levels were strongly and causally associated with an increased risk of atherosclerotic cardiovascular disease in Mendelian randomization studies [3, 4], but observational studies show a weaker association compared with LDL concentration and unclear cut-off [5, 6]. In the present study, the prognostic value of Lp(a) and its correlation with intraplaque features were assessed in patients with severe carotid artery stenosis undergoing endarterectomy (n=180). The cut-off value of 10 mg/dL for serum Lp(a) was selected to predict 24-month follow-up acute coronary syndrome (ACS). Besides, the association between serum Lp(a) and intraplaque lipids, collagen, inflammatory and vascular cells was assessed. Serum Lp(a) levels were measured by nephelometric assay. Patients with high Lp(a) had similar comorbidities, medications and laboratory parameters as compared to low Lp(a) levels. At 24-month follow-up, patients with high Lp(a) had more ACS as compared to low levels. Histological parameters within plaques were comparable in the study groups. No significant correlation between Lp(a) serum levels and intraplaque parameters was found, except for a weak positive association with smooth muscle cells in upstream plaque portions. When adjusted for gender, presence of dyslipidaemia and chronic coronary artery disease, Lp(a) ≥10 mg/dL remained predictive for ACS. In conclusion, Lp(a) determination could be useful to predict ACS in patients with severe carotid stenosis.
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WAKABAYASHI, T., T. NAITO, T. KINKORI, N. MATSUBARA, T. OHSHIMA, T. IZUMI, O. HOSOSHIMA, S. MIYACHI, and A. TSURUMI. "Can Periprocedural Hypotension in Carotid Artery Stenting Be Predicted ? : A Carotid Morphologic Autonomic Pathologic Scoring Model Using Virtual Histology to Anticipate Hypotension." Thesis, Centauro Srl, 2009. http://hdl.handle.net/2237/16865.
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Högberg, Dominika. "Screening for asymptomatic carotid atherosclerosis." Doctoral thesis, Uppsala universitet, Kärlkirurgi, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-328803.
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Ischemic stroke is the most common cause of handicap in adults and the third most common cause of death in Sweden. Internal carotid artery atherosclerosis is an important cause and accounts for 20% of ischemic strokes. Screening for carotid atherosclerosis has been debated over the past two decades. The aims of this thesis were (I) to study the prevalence of and risk factors associated with carotid artery atherosclerosis among 65 year old men, (II) to evaluate a simplified ultrasound protocol (the grayscale/mosaic method) for the exclusion of significant carotid artery stenosis for screening purpose, (III) to evaluate the required effect of primary preventive therapy in reducing risk of stroke among patients with asymptomatic carotid disease in order for screening to be cost-effective and (IV) to study natural history of carotid atherosclerosis and outcome five years after screening in 65-year old men. The prevalence of atherosclerotic plaques was high (25%), while the prevalence of >50% stenosis was relatively low (2.0%). Smoking, hypertension, diabetes mellitus and coronary artery disease were independent risk factors and individuals with several risk factors had a higher prevalence of stenosis. Most of those at risk were not on any preventive medication. A simplified grayscale/mosaic method was found to have a high negative predictive value for significant carotid stenosis. The minimum stroke risk reduction effect required for preventive intervention to be cost effective was 22%. Carotid atherosclerotic plaque and stenosis 50-79% has a relatively benign development during five years if treated with BMT and risk factor adjustment. Very few progressed to symptomatic disease. More severe stenosis (80-99%) had higher rate of neurological events, and may benefit from additional intervention. In conclusion, prevalence of silent atherosclerotic disease in carotid arteries was common among 65-year-old men. Most of those at risk had no secondary prevention. There is a simple DUS method that could be used for screening purpose. Screening for carotid disease is only cost-effective if the preventive strategy lowers the risk of stroke by 22%. Men with plaques and moderate stenosis have a good prognosis, but among those with severe stenosis there is a need for further intervention.Screening for asymptomatic carotid atherosclerosis
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Ehrensperger, Eric 1966. "Predictors of cerebral ischemic events in patients with asymptomatic carotid artery stenosis : systematic review." Thesis, McGill University, 2008. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=111568.
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Background. Carotid stenosis is an important cause of stroke. Carotid endarterectomy is a means of reducing the burden of stroke but is of marginal benefit in individuals with asymptomatic carotid stenosis. The identification of factors associated with increased risk of cerebral ischemic events would help select individuals who may obtain a greater benefit.Methods. A comprehensive search was performed to identify studies examining risk factors for cerebral ischemic events in patients with asymptomatic carotid stenosis. Inclusion criteria were defined a priori. Relevant studies were reviewed, assessed for quality, and data were extracted.
Results. Thirty-four studies met the inclusion criteria. There was a suggestion of increasing neurological events with increasing severity and progression of carotid stenosis. There was some evidence for an association with carotid plaque morphology. No consistent association was found with clinical factors, impaired cerebral vasoreactivity, or cerebral embolic signals.
Conclusions. The evidence is insufficient to reliably identify individuals with asymptomatic carotid stenosis who are at a higher risk of cerebral ischemic events.
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DELLA, ROSA FRANCESCO. "Impact of asymptomatic carotid stenosis on mid term outcome of transcatheter aortic valve replacement." Doctoral thesis, Università degli Studi di Milano-Bicocca, 2016. http://hdl.handle.net/10281/105574.
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Introduction Stroke is a potential major complication of aortic valve replacement (AVR), transcatheter aortic valve implantation (TAVI), and balloon aortic valvuloplasty (BAV). Although its occurrence is rare, stroke significantly affects survival and quality of life. Peripheral vascular disease and carotid artery disease are independent risk factors that have been identified as predictors of operative death according to surgical risk scores. The presence of a significant carotid stenosis may increase the surgical risk leading to the choice of a percutaneous transaortic valve implantation rather than a surgical AVR.
At present there is no evidence that describes the impact of asymptomatic significant carotid stenosis detected accidentally during preoperative evaluation on the onset of cerebrovascular periprocedural events after TAVI.
Population In this first analysis we considered 521 patients with severe aortic stenosis (AS) and cardiac symptoms (New York Heart Association [NYHA] class II function or worse). A score of at least 20 % on the EuroSCORE (European System for Cardiac Operative Risk Evaluation) and 10% on the risk model developed by the Society for Thoracic Surgeons (STS).,
Follow-up All patients underwent clinical surveillance, bio-chemical tests, electrocardiogram and echocardiogram before hospital discharge. The follow-up assessment included medical examination, electrocardiogram and echocardiogram to perform valve imaging and hemodynamic evaluation. It was performed at our Center or at the treating cardiologist ambulatory 30 days and one year after the procedure.
The events considered were mortality (by all-cause and cardiovascular death), myocardial infarction, stroke and transient ischemic attack (TIA), bleeding (minor and life-threatening bleeding), acute renal failure, vascular complications, disturb of conduction and arrhythmias and the combined criteria of safety, according to VARC and VARC 2 definitions.
Procedure The coexistence of carotid and peripheral artery diseases not only further increases risk and long-term mortality but influences also technical approaches since all centers adopt a policy of using the transfemoral approach first, with criteria for the use of non-transfemoral approaches that are based on the size and degree of tortuosity, calcifications, and atheroma of the aorto-iliofemoral arterial tree, as assessed by the multidisciplinary team.
In our Center, preventive measures have been taken to limit the risk associated to the procedure in our patients presenting carotid artery stenosis.
Results The main findings of the current study are the following: (a) no correlation has been observed about the presence of an asymptomatic carotid artery stenosis discovered before the TAVI procedure and mortality, rate of cerebrovascular events (stroke or TIA) and myocardial infarction during the first postoperative month; (b) no differences concerning all-causes and cardiovascular mortality and onset of cerebrovascular events (stroke/TIA) at long-term have been shown between patients with and without CAS.
Conclusion The presence of asymptomatic carotid stenosis is not a risk factor for cerebrovascular events after percutaneous aortic valve implantation at 30 days and one-year follow-up. Cerebrovascular events after TAVI occur in a vulnerability period extending to 1 month post-procedure. No difference exists in the CVE rate with regard to the type of valve or the access route.
Coronary, carotid, aortic, iliac and femoral artery disease are often found in elderly patients presenting with severe symptomatic AS undergoing TAVI. These patients are also affected by several clinical factors and frailty that correlate with the presence and severity of arterial pathologies and can impact on incidence of CVEs and longterm survival
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FARINA, LAURA. "Gene expression profiling of peripherial blood in patients with abdominal aortic aneurysm and carotid stenosis." Doctoral thesis, Università degli Studi di Milano-Bicocca, 2010. http://hdl.handle.net/10281/10626.
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Despite medical and surgical advances,
atherosclerotic and aneurysmatic diseases remain the leading cause of
death in the Western world. Presently, the factors responsible for the
onset and the development of the atherosclerotic plaque and the
aneurysmatic lesions are still unknown and only in some cases they
are related to the so called risk factors (hypertension, diabetes,
dyslipidemya, smoke, obesity, stress, inactivity, age, gender). Since
the incomplete understanding of the etiopathogenesis of these
pathologies, remains difficult to assess the optimal treatment
according to the disease state.
In order to reduce the percentages of death and disability caused by
rupture of the atherosclerotic or aneurysmatic lesions, would be useful
the identification of susceptibility genes and the correlation between
imaging data related to pathological factors (such as plaque
echolucency, and molecular data) in order to assess a presymptomatic
diagnosis and more specific treatments.
So, the aim of this work was to characterize patients gene profiles in
order to understand the genetic factors involved in the pathologies and
to identify new potential biomarkers and therapeutic target. We
studied the expression levels of some genes related to lipid
metabolism and inflammation. Our final goal was to try to develop a
Clinical Decision Support system to support the decision process
about the therapeutic strategy (surgical, pharmacological) by means of
statistical models of the pathology based on the analysis of the
heterogeneous data sources: molecular analysis, clinical analysis,
clinical imaging, patient anamnes.
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Rothwell, Peter M. "The aetiology and prevention of ischaemic stroke associated with recently symptomatic atherothrombotic carotid artery stenosis : lessons from a randomised controlled trial of carotid endarterectomy." Thesis, University of Edinburgh, 1999. http://hdl.handle.net/1842/22604.
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The cost-effectiveness of carotid surgery, which is questioned by many, would be increased considerably if it was possible to predict the risks and likely benefits for individual patients. This was the main aim of the work described in this thesis. This was achieved in five stages. Firstly, using carotid angiograms from 3007 patients randomised in the European Carotid Surgery Trial (ECST), I determined the equivalence, reproducibility and pathological correlation of the assessment of plaque surface morphology on angiograms. Secondly, using data on patients randomised to no-surgery in the ECST, I studied the relationship between the degree of carotid stenosis, plaque surface morphology and other clinical and angiographic characteristics and the risk of ipsilateral carotid territory ischaemic stroke on medical treatment. Using both a simple univariate approach and a multivariate Cox's proportional hazards approach, I was able to develop a number of prognostic models. Thirdly, I studied the risk of stroke and death due to carotid endarterectomy using a systematic review of the published literature. The absolute risk of stroke and death due to surgery was defined with narrow confidence limits and the relationship between various clinical and angiographic characteristics and the operative risk was determined. The validity of the risk factors for operative stroke and death were derived from the systematic review and the interaction with surgical and anaesthetic technique was assessed using data on patients randomised to surgery in the ECST. Fourthly, the potential benefit of selecting patients for carotid endarterectomy on the basis of the balance between their predicted individual risks of stroke on medical treatment and stroke and death due to surgery was assessed by stratifying the results of the ECST by baseline risk and by applying the same prognostic models to data from the North American Symptomatic Carotid Endarterectomy Trial. Finally, I designed and set up two large international collaborative studies which aim to further define the prognostic factors for major ischaemic stroke and other vascular outcomes in patients presenting with transient ischaemic attacks and minor ischaemic stroke and increase the cost-effectiveness of stroke prevention using carotid endarterectomy.
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MacKinnon, Andrew David. "Cerebral embolism in carotid stenosis : embolic signal detection with conventional and novel ambulatory transcranial Doppler ultrasound." Thesis, St George's, University of London, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.424769.
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Anderson, Glenn B. "The role of computed tomographic angiography in subarachnoid hemorrhage, and in the assessment of carotid stenosis." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape4/PQDD_0013/MQ60087.pdf.
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Stamou, Aikaterini. "Development and assessment of a haemodynamic based numerical model for stenosis growth in the carotid artery." Thesis, University of Portsmouth, 2016. https://researchportal.port.ac.uk/portal/en/theses/development-and-assessment-of-a-haemodynamic-based-numerical-model-for-stenosis-growth-in-the-carotid-artery(b2acd646-37fd-47b8-957b-70d75f7c653e).html.
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A model for stenosis development in the carotid artery, employing the lattice Boltzmann method, is presented and its suitability is investigated and demonstrated. The development of a stenosis is modelled based on the blood flow; and the subsequent changes in the flow are examined. The model is applied to investigate the role of different haemodynamic markers on stenosis development and also the importance of modelling the non-Newtonian nature of the blood. A stenosis growth model based on the time-averaged velocity magnitude at the wall is considered. The wall position where this marker has a minimum value is determined and the stenosis is allowed to develop at this point. The extent to which the stenosis develops is controlled by two parameters which are introduced. Simulations are then run based on the new geometry and a new position selected for stenosis development. The stenosis developed in this way was seen to be compatible with observations from the literature. Simulations of stenosis development are presented to investigate the effect of the introduced model parameters to determine suitable ranges for their application. A range of parameters are determined over which the stenosis develops in an independent manner. These parameters relate the extent to which the stenosis can grow in each development phase with no physical significance. It is important to find a variable which will describe the evolution in a manner which is independent of the model parameters. As well as the time-averaged velocity magnitude, a selection of alternative markers were applied to the model. The results show that a number of markers involving near-wall velocity, wall shear stress, residential time, stagnation index and second invariant of the strain rate tensor, all resulted in a realistic stenosis. The oscillatory shear index, which gives a measure of the oscillatory nature of the shear, was found to not be a suitable marker, unless it was combined with the wall shear stress in the form of a ratio. The effect of the non-Newtonian nature of blood on the stenosis development model is also considered. Here the non-Newtonian simulation showed noticeable differences compared to Newtonian; however both produced a realistic stenosis.
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Runck, Frank. "Magnetic resonance imaging : influence of imaging modality and post processing on measurement of internal carotid artery stenosis /." Erlangen, 2008. http://opac.nebis.ch/cgi-bin/showAbstract.pl?sys=000254444.
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Brightwell, Robert Edward. "A comparison of sub-clinical neurological effects caused by open and endovascular treatment of carotid artery stenosis." Thesis, Imperial College London, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.487992.
Full textAbstract:
Stroke is caused by atherosclerosis (furring up) of the carotid artery in up to 40% of cases. This area of narrowing'can be treated to reduce future stroke risk. Traditionally the narrowing has been treated by vascular surgeons performing an open operation on the artery - termed carotid endarterectomy (CEA) - which involves working on the artery under direct vision. The artery needs to have the flow of blood stopped within it for a variable period of time in order to completely remove the lesion. More recently a less invasive approach has gathered support. In carotid artery angioplasty and stenting (CAS - performed by vascular surgeons, radiologists and cardiologists) a wire is passed via the femoral artery across the narrowed segment of artery. A balloon is then used to stretch the artery and plaque, followed by the insertion of a stent - a sort of wire scaffold to support diseased area of the vessel and overcome the elastic recoil of the artery. Clinical outcome and complication rates for both procedures have been declining, prompting the search for more subtle and sensitive measures. This thesis describes what is known so far about the sub-clinical outcomes of each procedure, and analyses the results of each technique as performed at St Mary's Hospital, London. A multimodal approach has been used to achieve this aim. Trans-cranial Doppler has been performed to record the number of presumed emboli impacting on the brain, as well as measuring intra-operative changes in blood flow to the brain. Biomarkers of brain injury that are well recognised have been used, as have newer tests that are still under development by biomedical research companies. ELISA has formed the mainstay of this component of the comparison of CEA and CAS. Changes in the functional ability of the patient's brain have been assessed using a robust battery of . neuropsychometric tests performed before and after the surgical intervention. This has been studied previously, but never according to the consensus guidelines produced by cardiac surgeons investigating similar changes after various forms of coronary artery bypass grafting. Little is known about the effect of CEA versus CAS on the intra-cerebral blood flow. The imaging component of this study used specialist Computed Tomography Perfusion scans to take measurements, and note changes, in brain blood flow in the short and mid term post-operatively. In the various chapters each of these outcome measures have been correlated to the other. For example, determining whether a rise in biomarkers of brain injury can predict which patient may develop a post-operative neuropsychometric deficit, or whether those with enhanced neuropsychometric performance have improved brain perfusion. The later experimental chapters involve radiological and histopathological analysis of carotid plaques to try and help determine which ones pose a greater risk to the patient in terms of clinical and subclinical neurological deficit. Radiological appearances of carotid plaques are also correlated with electron microscopic findings of the filters used to catch debris dislodged during the CAS procedure, thereby preventing peri-operative stroke. The final chapter summarises some of the thesis' key findings and highlights some potential areas for exploitation by future research.
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Kurosaki, Yoshitaka. "Carotid artery plaque assessment using quantitative expansive remodeling evaluation and MRI plaque signal intensity." Kyoto University, 2019. http://hdl.handle.net/2433/242891.
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Afonso, Luís Henrique de Castro. "Estudo randomizado comparativo entre duas técnicas de proteção embólica cerebral no tratamento endovascular das estenoses carotídeas." Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/17/17140/tde-06102014-200228/.
Full textAbstract:
O acidente vascular cerebral (AVC) e a primeira causa de obito no Brasil e a principal de incapacidade no mundo. A doenca aterosclerotica carotidea esta associada a cerca de 15% dos AVC. A endarterectomia cirurgica e o tratamento padrao-ouro para as estenoses carotideas sintomaticas. A angioplastia carotidea com stent via endovascular (ACS) e uma alternativa terapeutica a endarterectomia. O desenvolvimento de dispositivos de protecao embolica levou a reducao das taxas de complicacao durante a ACS. A tecnica de protecao mais utilizada na pratica clinica e a protecao distal com filtro. As estrategias de protecao proximal, por bloqueio ou reversao do fluxo carotideo, tem revelado resultados promissores em relacao a protecao distal com filtro durante a ACS. Assim, o objetivo do estudo foi comparar a reversao de fluxo e o filtro de protecao durante a ACS. Os objetivos primarios foram a incidencia, o numero e o tamanho das lesoes cerebrais isquemicas por ressonancia magnetica pela sequencia diffusion-weighted-imaging (DWI) apos a ACS. Os objetivos secundarios foram as complicacoes cardiacas e eventos cerebrovasculares (CCEC), ataque isquemico transitorio (AIT) e as lesoes cerebrais isquemicas definitivas na imagem por ressonancia magnetica pela sequencia fluid-attenuated inversion recovery (FLAIR) no seguimento de tres meses. As lesoes isquemicas foram obtidas por ressonancia magnetica (RM) de campo 3 Tesla. Os pacientes foram avaliados quanto aos desfechos neurologicos atraves das escalas do National Institutes of Health Stroke Scale (NIHSS) e modified Rankin Scale (mRS). Quarenta pacientes foram incluidos randomicamente no estudo. Comparado a reversao de fluxo (n=21) o filtro de protecao (n=19) resultou em uma reducao significativa na incidencia (15,8% vs. 47,6%, p=0,03), no numero (0,73 vs. 2,6, p=0,05) e no tamanho (0,81 vs. 2,23 mm, p=0,05) das novas lesoes cerebrais isquemicas. Dois pacientes, um de cada grupo, apresentaram AIT no seguimento de tres meses. Nao foram observadas CCEC na internacao ou no seguimento de tres meses. Neste estudo, o filtro de protecao mais eficaz que a reversao de fluxo na protecao cerebral durante a angioplastia carotidea com stent por acesso femoral.Objectives: Carotid artery stenting (CAS) has become an alternative treatment for patients presenting symptomatic carotid artery stenosis. The improvement in clinical outcomes with CAS has been associated with the development of embolic protection devices. The trial aim is to compare flow-reversal versus filter protection during CAS through femoral access. Methods: Patients were randomly enrolled in CAS using flow-reversal or filter protection. The primary endpoints were the incidence, number and size of new ischemic brain lesions after CAS. The secondary endpoints included major adverse cardiac and cerebrovascular events (MACCE), transient ischemic attack (TIA) and definitive ischemic brain lesions on fluid-attenuated inversion recovery magnetic resonance image (FLAIR-MRI) at a three-month follow-up. Ischemic brain lesions were assessed by a 3T-MRI. Neurological outcomes were evaluated by means of the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS). Results: Forty consecutive patients were randomly assigned. Compared to flow-reversal (n=21), filter protection (n=19) resulted in a significant reduction in the incidence (15.8% vs. 47.6%, p=0.03), number (0.73 vs. 2.6, p=0.05) and size (0.81 vs. 2.23 mm, p=0.05) of new ischemic brain lesions. Two patients, one from each group, presented TIA at the three-month follow-up. There were no MACCE in the hospital or at the three-month follow-up. Conclusions: In this small sample size trial, filter protection was more effective than flow-reversal in reducing ischemic brain lesions during CAS through femoral approach.
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Siqueira, Letícia Cristina Dalledone 1981. "Avaliação da resposta hemodinâmica cerebral através da monitorização com a espectroscopia próxima ao infravermelho (NIRS) em pacientes com doença aterosclerótica submetidos à endarterectomia de carótida = Evaluation of the brain hemodynamic response by means of near-infrared spectroscopy (NIRS) monitoring in atherosclerotic patients who underwent carotid endarterectomy." [s.n.], 2015. http://repositorio.unicamp.br/jspui/handle/REPOSIP/312479.
Full textAbstract:
Orientador: Ana Terezinha GuillaumonDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
Made available in DSpace on 2018-08-28T09:17:18Z (GMT). No. of bitstreams: 1 Siqueira_LeticiaCristinaDalledone_M.pdf: 5041737 bytes, checksum: 615b5b4269f2f46490565662d28dfb21 (MD5) Previous issue date: 2015
Resumo: Introdução: A espectroscopia próxima ao infra-vermelho (NIRS) é uma técnica não invasiva e de baixo custo que detecta as alterações hemodinâmicas teciduais. O NIRS pode monitorar de forma contínua as informações fisiológicas vasculares intracranianas. Por ser portátil, ele pode ser utilizado a beira do leito e no centro cirúrgico. Objetivo: Avaliar o comportamento das possíveis alterações hemodinâmicas cerebrais, durante a endarterectomia, em pacientes com estenoses maiores que 70%, utilizando NIRS. Casuística e métodos: Foram avaliados 10 voluntários portadores de doença carotídea aterosclerótica com indicação de endarterectomia. Após a seleção dos pacientes que responderam um questionário com dados epidemiológicos e informações referentes a presença de comorbidades, a doença foi confirmada por métodos diagnósticos. No procedimento cirúrgico utilizou-se o NIRS para monitorização. Foram avaliadas as variáveis saturação de oxigênio (Sat O2) hemoglobina total (HbT), hemoglobina reduzida (HbR) e hemoglobina oxigenada (HbO) nos três tempos cirúrgicos pré, trans e pós-clampeamento carotídeo. Resultados: Utilizou-se p<0,05 como nivel de significância. A avaliação dos resultados obtidos através das medidas registradas pelo NIRS permite afirmar que as etapas da cirurgia diferem quanto ás variável HbR e SatO2. Durante a etapa do clampeamento, a variável HbR mostra valores mais elevados que nas outras duas etapas da cirurgia. De outra parte, a variável SatO2 mostra redução durante o clampeamento. Conclusão: O NIRS é um método viável e aplicável de monitorização intracerebral, não-invasivo e em tempo real, durante a endarterectomia carotídea, capaz de medir de forma precisa as mudanças das condições hemodinâmicas capilares intra-cerebrais
Abstract: Introduction: Near-infrared spectroscopy (NIRS) is a low-cost, non-invasive technique that detects tissue hemodynamic alterations. It enables continuous monitoring of the intracerebral vascular physiologic information. Due to its portable nature, NIRS may be used beside a bed or in the operating room. Objective: To evaluate the use of NIRS for intra-surgical monitoring of the brain hemodynamic response, during an endarterectomy procedure of the atherosclerotic carotid artery. Casuistry and Methods: 10 patients with atherosclerotic carotid disease and recommended endarterectomy were evaluated. They were identified in a survey which provided epidemiologic data and the presence of comorbidities. Disease was confirmed by diagnostic methods. NRIS monitoring was used during the surgical procedure. Oxygen saturation (O2 Sat), total hemoglobin (THb), reduced hemoglobin (RHb), and oxyhemoglobin (OHb) were the variables analyzed at the three carotid clamp stages: pre-, trans- and post-. Results: A p<0.05 value was considered statistically significant. The results obtained from the NIRS data reveal that the surgical stages differ in relation to the RHb and O2Sat variables. RHb presents higher levels during clamping when compared with the other two surgical stages. On the other hand, O2Sat is decreased during clamping. Conclusion: NIRS is a feasible, realtime and non-invasive intracranial monitoring method, during carotid endarterectomy, which measures accurately and reliably the changes of the intracerebral capillary hemodynamic conditions
Mestrado
Cirurgia
Mestra em Ciências
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Misonis, Nerijus. "Miego arterijų angioplastikos ir stentavimo ankstyvųjų bei vėlyvųjų rezultatų ir jiems poveikį darančių veiksnių tyrimas." Doctoral thesis, Lithuanian Academic Libraries Network (LABT), 2013. http://vddb.laba.lt/obj/LT-eLABa-0001:E.02~2013~D_20131004_095250-29569.
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Darbo tikslas – įvertinti miego arterijų angioplastikos ir stentavimo ankstyvuosius ir vėlyvuosius rezultatus bei poveikį darančius veiksnius.
Metodai. Tyrimo metu vertintos VMAS procedūros atliktos 2006-2013 metais. Iš viso buvo atliktos 227 procedūros 211 pacientų; iš jų 156 (75,3 proc.) vyrams ir 55 (24,7 proc.) moterims.
Rezultatai. Tyrimas atskleidė, kad esant 3 aortos lanko tipui VMAS procedūros trukmė buvo reikšmingai ilgesnė, o mikroembolai apsaugos sistemose buvo nustatyti dažniau. Mikroembolai apsaugos sistemose buvo nustatyti dažniau kai VMAS procedūra truko ilgiau. Apsaugos sistemos atliekant VMAS procedūrą buvo naudotos 70,9 proc. pacientų. Vyrams ir jaunesnio amžiaus pacientams VMAS procedūros metu apsauga buvo taikyta dažniau. Mikroembolai apsaugos sistemose buvo nustatyti 17,6 proc. pacientų ir dažniau buvo nustatyti naudojant FilterWire EZ ir Embo-shield-NAV apsaugos sistemas. Didesnė dešinės VMA stenozė buvo dažnesnė rūkantiems pacientams, o kairės VMA sirgusiems miokardo infarktu bei rūkantiems. Apsauga dažniau buvo taikyta pacientams kurie turėjo didelio laipsnio kairės VMA stenozę. Ankstyvuoju po procedūriniu periodu vyrų ir moterų mirštamumas atitinkamai buvo 1,2 proc. ir 1,8 proc., o 2 metų laikotarpyje buvo 18,7 proc. ir 28,6 proc. Pacientų mirštamumas 2 metų laikotarpyje, kuriems buvo naudotos apsaugos sistemos buvo mažesnis. Galimybę patirti komplikacijas (GSI ar PSIP) didino 3 aortos lanko tipas ir dešinės bendrosios miego arterijos stenozė, mažino... [toliau žr. visą tekstą]The aim - to assess the carotid artery angioplasty and stenting early and late results and influencing factors. Methods. The study assessed CAS procedures performed in 2006-2013. A total of 227 procedures performed in 211 patients, of which 156 (75.3%) males and 55 (24.7%) females. Results. The study revealed that CAS procedure duration among patient with 3 aortic arch type was significantly longer and the microemboli protection systems were used more frequently. Protection systems were used more frequently when the CAS procedure lasted longer. Protection systems in CAS procedure was used in 70.9% patients. In men and younger patients protection system has been used more frequently. Microemboli in the protection systems have been identified by 17.6% patients and were more determined using the EZ FilterWire and Emboshield-NAV protection system. Increased right ICA stenosis was more common in patients who smoke, and left ICA with a history of myocardial infarction and smoking. Protection system was often used in patients who have had severe left ICA stenosis. The lethality rate in the early post procedural period among men and women was 1.2% and 1.8%, and in 2-year period was 18.7% and 28.6%, respectively. The lethality rate during 2-year period, which have been used for protective systems have been lower. The possibility to experience complications (stroke or TIA) increased 3 aortic arch type and the right common carotid artery stenosis, reduced protection systems using. Focal... [to full text]
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Misonis, Nerijus. "Evaluation of early and late results and predetermining factors after carotid artery angioplasty and stenting." Doctoral thesis, Lithuanian Academic Libraries Network (LABT), 2013. http://vddb.laba.lt/obj/LT-eLABa-0001:E.02~2013~D_20131004_095338-94074.
Full textAbstract:
The aim - to assess the carotid artery angioplasty and stenting early and late results and influencing factors. Methods. The study assessed CAS procedures performed in 2006-2013. A total of 227 procedures performed in 211 patients, of which 156 (75.3%) males and 55 (24.7%) females. Results. The study revealed that CAS procedure duration among patient with 3 aortic arch type was significantly longer and the microemboli protection systems were used more frequently. Protection systems were used more frequently when the CAS procedure lasted longer. Protection systems in CAS procedure was used in 70.9% patients. In men and younger patients protection system has been used more frequently. Microemboli in the protection systems have been identified by 17.6% patients and were more determined using the EZ FilterWire and Emboshield-NAV protection system. Increased right ICA stenosis was more common in patients who smoke, and left ICA with a history of myocardial infarction and smoking. Protection system was often used in patients who have had severe left ICA stenosis. The lethality rate in the early post procedural period among men and women was 1.2% and 1.8%, and in 2-year period was 18.7% and 28.6%, respectively. The lethality rate during 2-year period, which have been used for protective systems have been lower. The possibility to experience complications (stroke or TIA) increased 3 aortic arch type and the right common carotid artery stenosis, reduced protection systems using. Focal... [to full text]Darbo tikslas – įvertinti miego arterijų angioplastikos ir stentavimo ankstyvuosius ir vėlyvuosius rezultatus bei poveikį darančius veiksnius. Metodai. Tyrimo metu vertintos VMAS procedūros atliktos 2006-2013 metais. Iš viso buvo atliktos 227 procedūros 211 pacientų; iš jų 156 (75,3 proc.) vyrams ir 55 (24,7 proc.) moterims. Rezultatai. Tyrimas atskleidė, kad esant 3 aortos lanko tipui VMAS procedūros trukmė buvo reikšmingai ilgesnė, o mikroembolai apsaugos sistemose buvo nustatyti dažniau. Mikroembolai apsaugos sistemose buvo nustatyti dažniau kai VMAS procedūra truko ilgiau. Apsaugos sistemos atliekant VMAS procedūrą buvo naudotos 70,9 proc. pacientų. Vyrams ir jaunesnio amžiaus pacientams VMAS procedūros metu apsauga buvo taikyta dažniau. Mikroembolai apsaugos sistemose buvo nustatyti 17,6 proc. pacientų ir dažniau buvo nustatyti naudojant FilterWire EZ ir Embo-shield-NAV apsaugos sistemas. Didesnė dešinės VMA stenozė buvo dažnesnė rūkantiems pacientams, o kairės VMA sirgusiems miokardo infarktu bei rūkantiems. Apsauga dažniau buvo taikyta pacientams kurie turėjo didelio laipsnio kairės VMA stenozę. Ankstyvuoju po procedūriniu periodu vyrų ir moterų mirštamumas atitinkamai buvo 1,2 proc. ir 1,8 proc., o 2 metų laikotarpyje buvo 18,7 proc. ir 28,6 proc. Pacientų mirštamumas 2 metų laikotarpyje, kuriems buvo naudotos apsaugos sistemos buvo mažesnis. Galimybę patirti komplikacijas (GSI ar PSIP) didino 3 aortos lanko tipas ir dešinės bendrosios miego arterijos stenozė, mažino... [toliau žr. visą tekstą]
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Benitez, Mendieta Jessica. "Patient-specific computational biomechanical analysis of carotid atherosclerotic plaques based on MRI." Thesis, Queensland University of Technology, 2021. https://eprints.qut.edu.au/213840/1/Jessica_Benitez%20Mendieta_Thesis.pdf.
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This thesis focuses on the biomechanical analysis of carotid atherosclerosis based on medical imaging. The rupture of carotid atherosclerotic plaques is the leading cause of acute cardiovascular events, such as stroke. For this analysis, patient-specific and image-based carotid models were developed for computational analysis to assess factors associated with plaque development and rupture. This study provided further knowledge in areas such as fluid dynamics of carotid arteries with stenosis, the role of the carotid plaque components, and a new technique for structural analysis of carotid plaques. These approaches will help clinicians in the diagnosis and treatment of carotid atherosclerosis.
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Pinto, Carlos Augusto Ventura. "Contraste por microbolhas em ultrassonografia no diagnóstico diferencial entre oclusão e pseudo-oclusão da artéria carótida interna: correlação com a angiotomografia." Universidade de São Paulo, 2010. http://www.teses.usp.br/teses/disponiveis/5/5151/tde-24112010-181156/.
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Objetivo: Avaliar a eficácia da ultrassonografia com contraste (US com contraste) de segunda geração no diagnóstico diferencial entre oclusão e pseudo-oclusão de artéria carótida interna cervical (ACI) comparativamente à ultrassonografia com Doppler (US Doppler) utilizando a angiotomografia computadorizada (angio-TC) como padrão-ouro. Materiais e Métodos: Estudo prospectivo realizado entre junho de 2006 e junho de 2008 com 72 pacientes sintomáticos (57; 15) e 78 com ACIs aparentemente ocluídas pela US Doppler. Esses pacientes foram submetidos inicialmente à US Doppler e, em seguida, à US com contraste. Todos os pacientes realizaram posteriormente a angio-TC, utilizada como padrão-ouro. A correlação entre os métodos foi feita através de estudo duplo cego. Resultados: A sensibilidade, a especificidade e a acurácia da US com contraste foram respectivamente de 100%; 90,5% e 97,4%. Quando comparada à angio-TC, a quantidade de falsas oclusões pela US Doppler foi de 26,9% (21/78), (p < 0,001), enquanto que pela US com contraste foi de 2,6% (2/78) (p = 0,500). A US com contraste obteve melhor resultado que a US Doppler, com diferença estatisticamente significante (p < 0,001). Conclusão: A US com contraste é tão eficaz quanto a angio-TC e superior à US Doppler no diagnóstico diferencial entre oclusão e pseudo-oclusão da ACIPurpose: Evaluate the efficacy of second-generation contrast ultrasound (CEUS) for distinguishing the diagnosis of cervical internal carotid artery (ICA) occlusion from the one of pseudo-occlusion when compared with Doppler Ultrasound (DUS) utilizing computerized angiotomography (CTA) as the gold standard. Material and Methods: A prospective study was performed between June 2006 and June 2008 with 72 symptomatic patients (57 males; 15 females) and 78 ICAs apparently occluded by DUS. These patients were initially subjected to DUS and then to CEUS. All patients went through CTA later on, used as the gold standard. Correlation between the methods was made by means of a double-blind study. Results: The sensitivity, specificity and accuracy of CEUS were taken as 100%, 90.5% and 97.4% respectively. When compared with CTA the amount of false occlusions by DUS was 26.9% (21/78), (p < 0.001) whereas by CEUS 2.6% (2/78) (p = 0.500) was seen. Far better results were obtained with CEUS than with DUS with a significant discrepancy (p < 0.001). Conclusion: CEUS shows to be as effective as CTA but better than DUS for distinguishing the diagnosis of ICA occlusion from the one of pseudo-occlusion
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Sobieh, Ahmed Mohammed Abdelaal Mohammed [Verfasser], and Uwe [Akademischer Betreuer] Klose. "Quantitative magnetic resonance angiography for flow quantification of carotid and intracranial stenosis / Ahmed Mohammed Abdelaal Mohammed Sobieh ; Betreuer: Uwe Klose." Tübingen : Universitätsbibliothek Tübingen, 2016. http://d-nb.info/1199615536/34.
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Sobieh, Ahmed [Verfasser], and Uwe [Akademischer Betreuer] Klose. "Quantitative magnetic resonance angiography for flow quantification of carotid and intracranial stenosis / Ahmed Mohammed Abdelaal Mohammed Sobieh ; Betreuer: Uwe Klose." Tübingen : Universitätsbibliothek Tübingen, 2016. http://d-nb.info/1199615536/34.
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Minuzzi, Rosângela da Rosa. "Proteína S-100ß do bulbo da jugular interna : um marcador de dano neuronal isquêmico em endarterectomia de carótida com clampeamento temporário." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2009. http://hdl.handle.net/10183/17757.
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A endarterectomia de carótida tem um papel bem estabelecido na prevenção de AVC ipsilateral em pacientes com mais de 50% de estenose sintomática da artéria carótida interna. No entanto, o dano cerebral isquêmico contribui significativamente para a morbidade e mortalidade perioperatórias aumentadas na endarterectomia de carótida com clampeamento intra-operatório temporário. Portanto a relação entre a gravidade do dano isquêmico neuronal durante o procedimento e o sistema de auto-regulação do funcionamento da relação oferta/consumo de oxigênio cerebral precisa ser explorado. Esta avaliação poderia ser feita usando-se um marcador sensível de estresse hipóxico, tal como a proteína S-100ß, que é liberada das células da astroglia que sofreram dano estrutural, para o interior da circulação sangüínea quando a permeabilidade da barreira hemato-encefálica está alterada. Isto é especialmente verdadeiro porque uma baixa pressão no coto distal ao clampeamento continua a ser o critério principal para shunt, embora ela possa estar normal em 6% a 30% dos pacientes que subseqüentemente desenvolvem sinais neurológicos, e anormal em 3% a 11% daqueles que não desenvolvem sinais de isquemia. Então, faz sentido investigar outros métodos para detectar dano cerebral isquêmico em endarterectomia de carótida, tais como a taxa de extração de oxigênio cerebral (ECO2) para permitir a otimização de variáveis acessíveis à intervenção médica, como: shunt, parâmetros ventilatórios e parâmetros hemodinâmicos. O objetivo deste trabalho foi avaliar a correlação entre um marcador de dano cerebral isquêmico, a proteína S-100ß sérica, com a fração de extração de oxigênio cerebral (ECO2) e com a pressão arterial de dióxido de carbono (PaCO2) em pacientes submetidos à endarterectomia de carótida para estenose sintomática, com clampeamento temporário. Este estudo transversal avaliou 33 pacientes, estado físico II e III e média de idade de 70 ± 8 anos que foram submetidos à anestesia geral endovenosa e inalatória . PaCO2 (mmHg) e % ECO2 foram medidas antes do clampeamento da carótida (T1), 5 minutos após o clampeamento (T2) e 5 minutos após o desclampeamento (T3) a partir de amostras sangüíneas retiradas da veia jugular interna. S-100ß foi determinada nos seguintes momentos: antes do clampeamento da carótida (T1), imediatamente antes do desclampeamento (T2) e 6 horas após o desclampeamento (T3). O tempo médio de isquemia cerebral foi de 16 minutos [(IQ25-75) 11,05 a 19,00]. Os coeficientes de correlação de Spearman (rs) para a relação entre os níveis de S-100β em 6 horas após a cirurgia e os níveis de ECO2 e PaCO2 durante o período do estudo foram rs = 0,59 (P = 0,00) e rs = -0,36 (P = 0,00) respectivamente. Em conclusão, os presentes achados sugerem que o dano neuronal isquêmico avaliado pela ECO2 durante o período isquêmico podem predizer um aumento de S-100ß. Contudo, futuros estudos são necessários para determinar o impacto clínico de tais achados.Carotid endarterectomy (CED) is a well established procedure to prevent ipsilateral stroke in patients with more than 50% symptomatic internal carotid artery (ICA) stenosis. However, ischemic brain injury persists as a significant contributing factor to increased perioperative morbidity and mortality in carotid endarterectomy with temporary intraoperative clamping. Hence, the relationship between the severity of neuronal ischemic damage during carotid endarterectomy (CED) and the autoregulation system of the functioning brain oxygen supply/consumption ratio needs to be further explored. This appraisal could be made using a sensitive marker of hypoxic stress, such as S-100ß released into de bloodstream when structural damage to astroglial cells alter the permeability of the blood-brain barrier. This methodological resource can be valuable since a low stump pressure is generally the main criterion for shunting, although normal in about 6-30% of patients who subsequently develop neurological signs and abnormal in 3-11% in those without signs of ischemia. Thus, it makes sense to search for additional subsidies to detect ischemic brain damage during carotid endarterectomy, such as the rate of brain oxygen extraction (ECO2). This earlier accessible variable at low cost could help medical decision-making such as shunt or changes in hemodynamic and ventilatory parameters. The aim of this study was, therefore, assess the correlation between a marker of neuronal ischemic damage, serum S-100ß, and brain oxygen extraction fraction (ECO2) and PaCO2 (arterial carbon dioxide tension) in patients undergoing carotid endarterectomy for symptomatic stenosis with temporary clamping. This cross-sectional study assessed 33 patients, physical status II-III, and mean age of 70 ± 8 years, who undergoing intravenous general anesthesia. PaCO2 (mmHg) and %ECO2 were measured prior to carotid clamping (T1), 5 min after carotid clamping (T2) and 5 min after carotid unclamping (T3) with blood drawn from the internal jugular vein. Serum S-100β was determined at T1 - prior to carotid clamping, T2 - immediately before carotid unclamping, and T3 - 6 h after carotid unclamping. The median time of brain ischemia was 16 min [(IQ25-75) 11.05 to 19.00]. Spearman correlation coefficients (rs) for the relationship between S-100ß level at 6 h after surgery and PaCO2 and ECO2 levels during the study period were rs = -0.36 (P < 0.01) and rs = 0.59 (P < 0.01), respectively. To conclude, the present findings suggest that brain ischemic neural damage monitored by ECO2 during the ischemic time may predict an increase in S-100ß. Further studies are warranted to assess the clinical impact of these results.
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Loizos, Savvas. "Duplex ultrasound assessment of carotid arterial atherosclerotic disease : investigation of direct stenosis measurement methods and image analysis for vulnerable plaque identification." Thesis, Imperial College London, 2012. http://hdl.handle.net/10044/1/9764.
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Purpose: Ultrasound assessment of carotid disease is currently based on stenosis haemodynamic effects. The accuracy of direct stenosis measurement remains unclear, while research on atherosclerosis suggests identification of other plaque characteristics beyond size. The aim of the study is to investigate whether direct stenosis measurement and plaque ultrasound image analysis could potentially be used for more accurate diagnostic investigation. Method and material: Eighty-seven patients with cardiovascular disease had a carotid duplex ultrasound scan and velocity and B-mode measurements data were recorded for direct diameter measurement evaluation. Forty patients were scanned for quantitative plaque analysis and association of several parameters with symptoms was investigated. Results: For the degree of stenosis, ECST method indicated greater agreement among direct measurement methods with velocity criteria, however in cases of mild stenosis difference was reported. ECST method measurements showed considerably better agreement with MRA stenosis calculations compared with other methods. Intima-media grey scale level was associated with plaque echogenicity but the correlation was not significant, however there was an association with blood cholesterol levels. Percentages of plaque area with grey scale value less than 35 and 40 showed good accuracy in identifying symptomatic patients. As far as fibrous cap is concerned, a thickness less than 300 μm was well correlated with symptomatic disease, however no association was noted for its echogenicity. Conclusion: ECST direct stenosis measurement method could potentially be used for better stenosis classification in cases with inconclusive haemodynamic estimations. Quantitative plaque analysis, such as fibrous cap thickness measurement and grey level analysis, shows promising results in association with symptomatic disease and particular plaque characteristics.
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Casas, Hernanz Laura. "Trastorno cognitivo en la estenosis carotídea: evaluación neuropsicológica y efecto del tratamiento quirúrgico." Doctoral thesis, Universitat Autònoma de Barcelona, 2017. http://hdl.handle.net/10803/454988.
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Introducción: el deterioro cognitivo tras un accidente cerebrovascular es frecuente. Alrededor del 55% de los pacientes que lo padece desarrollan déficits en la memoria episódica, un 40% en las funciones ejecutivas, y los déficits del lenguaje afectan a un 23% de ellos. La estenosis carotídea (EC) se identifica como etiología del 20-30% de los accidentes cerebrales isquémicos. El diagnóstico y el tratamiento quirúrgico de la EC han ocupado en los últimos años un papel relevante en la literatura médica. Sin embargo, la contribución de la EC por sí misma en la cognición de pacientes asintomáticos o sintomáticos es poco conocida. En este trabajo, proponemos: 1) estudiar si los pacientes con estenosis grave (>70%) de la arteria carótida, sin clínica cerebrovascular importante ni demencia, presentan un deterioro cognitivo superior a la población general; 2) describir qué funciones cognitivas se ven alteradas y analizar si existen diferencias cognitivas en base a la gravedad de la estenosis, el lado del que van a ser revascularizados o la presencia de clínica neurológica; 3) identificar el perfil clínico predictor de aquellos sujetos que desarrollará una mejor respuesta cognitiva tras la revascularización.
Estudio 1
Método: se incluyeron 106 sujetos: 53 pacientes con EC grave sin demencia y 53 controles extraídos de la población general emparejados uno a uno según edad, sexo, nivel de escolaridad y dominancia manual. La evaluación cognitiva se realizó mediante la Repeatable Battery Assessment for Neuropsychological Status (RBANS). Resultados: Observamos que los pacientes con EC obtuvieron un rendimiento cognitivo inferior a los controles en atención, memoria verbal, capacidad visuoespacial y fluencia verbal. El análisis según el grado de EC mostraba que los pacientes con mayor grado de EC total presentaban peores puntuaciones en aprendizaje y memoria. Además, hallamos que los pacientes con EC izquierda presentaban un peor rendimiento en tareas cognitivas frontales que los pacientes con EC derecha.
Estudio 2
Método: se incluyeron 70 pacientes candidatos a revascularización carotídea que fueron valorados en dos ocasiones, una semana antes de la cirugía y un año después de la intervención, mediante una extensa batería normalizada para la población española. Resultados: El 38.6% de los pacientes fueron clasificados como “respondedores” cognitivamente. Las variables preoperatorias relacionadas con un mejor resultado cognitivo fueron una menor edad, la ausencia de sintomatología neurológica previa y la no detección en las pruebas de neuroimagen de atrofia cerebral y lesiones de pequeño vaso. El rendimiento cognitivo de los pacientes tras 12 meses de la intervención se mantuvo estable en todas las áreas evaluadas excepto en lenguaje. Se observó un peor rendimiento a los 12 meses en los sujetos con sintomatología neurológica, en funciones visuoperceptivas y tareas ejecutivas respecto a los asintomáticos. Los pacientes revascularizados del lado izquierdo obtuvieron peores resultados cognitivos a los 12 meses de la revascularización en atención, tanto verbal como visual, y en fluencia fonética.
Conclusiones: Los pacientes con EC grave presentan una función cognitiva basal inferior a la población general de las mismas características. El deterioro cognitivo hallado se asoció con el grado de EC. Aquellos pacientes con EC sin síntomas neurológicos, jóvenes y sin lesiones periventriculares de la sustancia blanca ni atrofia cerebral, presentaron una mejor respuesta cognitiva al año de ser revascularizados.Introduction: Cognitive decline after an acute cerebrovascular event is frequent, and it has been estimated that around 55% of stroke subjects develop episodic memory deficits, 40% executive function deficits and up to 23% language function deficits. Carotid artery stenosis (CAS) causes between 20% and 30% of ischemic cerebral infarctions. In recent years, diagnosis and surgical treatment of CAS has been a relevant focus of interest in the medical literature. However, the contribution of CAS per se to cognitive function in asymptomatic patients or in patients with transient ischemic attacks is poorly understood. The objectives of the studies reported in the present Doctoral Thesis were as follows: 1) to assess whether persons with severe CAS (> 70%) without cerebrovascular symptoms and without dementia showed a greater cognitive decline as compared to healthy individuals; 2) to describe which cognitive functions were altered and whether there were cognitive differences according to severity of stenosis, side of surgical repair, and presence or absence of neurological symptoms; and 3) to identify a predictive clinical and neuropsychological profile for patients which will present a improvement of their cognitive profileg after revascularization. Study 1 Method: 106 subjects were included: 53 patients with severe CAS and without dementia and 53 healthy controls matched by age, sex, education level and manual dominance. Cognitive assessment was performed using the Repeatable Battery Assessment for Neuropsychological Status (RBANS). Results: It was found that patients with CAS showed a lower cognitive performance than controls in attention, verbal memory, visuospatial capacity and verbal fluency. Analysis according to the degree of stenosis showed that patients with higher degree of total CAS showed lower scores on learning and memory. Also, patients with left CAS showed lower performance on frontal cognitive tasks as compared to patients with right CAS. Study 2 Method: 70 patients who were scheduled for carotid revascularization were evaluated on two occasions, one week before the intervention (baseline) and one year after the surgical procedure using a large battery of neuropsychological tests normalized for the Spanish population. Results: 38.6% of patients were classified as “responders” as they presented an improvement of at least one standard deviation in at least two tests after the surgical procedure. Predictive factors of positive response were younger patient’s age as well as absence of neurological symptoms, and no detection of cerebral atrophy and small-vessel lesions on imaging studies. Cognitive performance at 12 months after surgery remained stable in all areas evaluated, except for language. A worse performance in visuospatial functions and executive tasks at 12 months was observed in patients with neurological symptoms as compared with asymptomatic patients. Patients undergoing revascularization procedures of the left side showed worse cognitive performance at 12 months after the surgical procedure in verbal and visual attention as well as in verbal fluency. Conclusions: Patients with severe CAS showed a lower baseline cognitive status as compared with a general population of the same sociodemographic characteristics. Cognitive decline was associated with the degree of CAS. Patients without neurological symptoms, of younger age and without white matter periventricular lesions and cerebral atrophy showed a better cognitive response at one year after carotid artery revascularization.
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Diaz, Duran Carles. "Història natural dels pacients intervinguts d’endoarteriectomia carotídia en una població mediterrània amb baixa incidència de malaltia coronària." Doctoral thesis, Universitat Autònoma de Barcelona, 2020. http://hdl.handle.net/10803/670480.
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Aquesta tesi doctoral és el fruit d’un projecte de recerca sobre la història natural del pacient sotmès a una EA carotídia. D’una banda, l’estudi de la supervivència a llarg termini del pacient intervingut en una població mediterrània caracteritzada per la baixa incidència de malaltia cardiovascular pot ajudar a determinar quins pacients tenen una esperança de vida major i influir en la presa de decisions terapèutiques, especialment en el pacient asimptomàtic. D’altra banda, l’anàlisi de la taxa de progressió de l’estenosi carotídia contralateral a una caròtida ja intervinguda proporcionarà una descripció més precisa d’aquestes lesions en el moment actual i podria determinar-ne nous esquemes de seguiment. Qualsevol estratègia terapèutica encaminada a millorar la història natural dels nostres pacients passa per un coneixement acurat d’aquesta, tant en el temps com en el lloc on hem de decidir .Esta tesis doctoral es fruto de un proyecto de investigación sobre la historia natural del paciente sometido a una endarterectomia carotídea. Por un lado, el estudio de la supervivencia a largo plazo del paciente intervenido en una población mediterránea caracterizada por la baja incidencia de enfermedad cardiovascular puede ayudar a determinar los pacientes con esperanza de vida mayor e influir en la toma de decisiones terapéuticas, especialmente en los pacientes asintomáticos.Por otro lado, el análisis de la tasa de progresión de la estenosis carotídea contralateral a una carótida ya intervenida proporcionará una descripción más precisa d'estas lesiones en el momento actual y podría determinar nuevos esquemas de seguimiento. Cualquier estrategia terapéutica encaminada a mejorar la historia natural de nuestros pacientes pasa por un conocimiento preciso de ésta, tanto en el tiempo como en el lugar donde decidir.
This doctoral thesis is the result of a research project on the natural history of the patients submitted to a carotid endarterectomy. Firstly, the study of the long-term survival of patients intervened in a Mediterranean population characterized by a low incidence of cardiovascular disease can help to identify patients with longer life expectancy and influence therapeutic decision-making, especially in asymtomatic patients. On the other hand, determining the rate of disease progression in the contralateral carotid artery in patients already submitted to a carotid endarterecromy, will provide a more accurate description of these lesions at the present time and could determine new follow-up regimens. Any therapeutic strategy aimed to describe the natural history of our patients requires a precise knowledge of it, both at the time and in the place where to decide.
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Roth, Claudia. "Wertigkeit der Digitalen Subtraktionsangiographie (DSA) gegenüber der Magnetresonanzangiographie (MRA) in der Diagnostik der hirnversorgenden Halsgefässe." Doctoral thesis, Humboldt-Universität zu Berlin, Medizinische Fakultät - Universitätsklinikum Charité, 2004. http://dx.doi.org/10.18452/15019.
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Das Ziel: der Arbeit war die Überprüfung der Aussagekraft der MRA in time-of-flight-technique der Arteria caroits bei 1,0 Tesla im Vergleich zur intaarteriellen DSA und der Wertigkeit in der Einsatzfähigkeit in der klinischen Routine bei der Diagnostik von Carotisstenosen. 101 Patienten wurden zur Abklärung einer Stenose der Arteria carotis vergleichend mittels TOF-MRA und i.a. DSA der Arteriae carotis untersucht. Morphologische Veränderungen wurden für sämliche Gefässe erfasst, wobei die Stenosen der Arteriae carotis entsprechend den NASCET-Kriterien graduiert wurden (geringgrade, mittelgradige,hochgradige Stenose oder Verschluss).Die Ergebnisse wurden mit folgenden drei verschiedenen statistischen Tests ausgewertet: Kappa Test, gewichteter Kappa Test und Intraklassenkorrelationskoeffizient. Von den 84 in die Auswertung eingebezogenen Gefässen wurden 66 Stenosen in der DSA als geringgradig klassifiziert. In dieser Kategorie wurden 60 dieser Stenosen von der MRA korrekt als geringgradig klassifiziert. In der DSA wurden 60 Stenosen der Arteria carotis als mittelgradig klassifiziert. 29 dieser Stenosen wurden von der MRA korrekt als mittelgradig eingeschätzt. 21 Stenosen wurden von der DSA als hochgradig klassifiziert. 20 dieser Stenosen wurden von der MRA korrekt als hochgradige Stenosen eingeschätzt. Die 16 kompletten Gefäsverschlüsse wurden alle von der MRA detektiert. Der Kappa Test ergab eine starke Korrelation der Ergebnisse. Insgesamt zeigte sich eine gute Überstimmung zwischen MRA und DSA. Aber gerade im Bereich der mittelgradigen Stenosen neigte die MRA dazu den Stenosegrad zu überschätzen. Das Ziel der Gefässdiagnostik ist eine präzise und reproduzierbare Bestimmung des Stenosegrades. Die Magnetresonanzangiographie kann als eine akkurate und zuverlässige Methode zur Bestimmung von Carotisstenosen angesehen werdenThe purpose was to evaluate the efficiacy of the time-of-flight MRA of the carotid artery with a 1.0 Tesla system in comparison to intraarterial digital subtraction angiography for the assessment of carotid artery disease. 101 patients with suspected stenosis of the carotid artery were examined with a 1.0 Tesla scanner in time-of-flight-technique and with the selective i.a. DSA in parallel. Morphological pathologies were registered for all arteries, stenosis of the internal carotid artery of both examinations were blindly graded by applying the NASCET criteria (mild, moderately, severely or occluded). Three different assessment methods were conducted for the MRA data. Kappa, weighted kappa, intraclass correlation were calculated for MRA results compared to DSA. Of the 84 common carotid bifurcation, 66 were classified as mild stenosis by DSA. In this category, MRA correctly identified 60 of these as mild stenosis. Among 60 common carotid artery bifurcation graded as moderate by DSA, 29 were correctly graded as moderate by MRA. Among 21 common carotid artery bifurcation graded as severe by DSA, 20 of these were correctly graded by the MRA. There were 16 complete occlusions which were all correctly graded by MRA. A good kappa value was calculated for the data. In general the MRA were considered to find a good agreement with the DSA, but tended to overestimate stenosis, especially in the range of moderate stenosis. The aim of diagnosis is exact grading of carotid stenosis. MRA with its high agreement with DSA can be regarded as an accurate screening method of the common carotid bifurcation.
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Oliveira, Germano da Paz 1982. "Análise comparativa dos parâmetros adquiridos com o US doppler transcraniano durante a endarterectomia carotídea por semi-eversão e a angioplastia carotídea." [s.n.], 2014. http://repositorio.unicamp.br/jspui/handle/REPOSIP/312480.
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Orientador: Ana Terezinha GuillaumonDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
Made available in DSpace on 2018-08-24T11:44:57Z (GMT). No. of bitstreams: 1 Oliveira_GermanodaPaz_M.pdf: 4750891 bytes, checksum: 517650637fcacb4ffebc12ad859189bb (MD5) Previous issue date: 2014
Resumo: Objetivos: Analisar a distribuição temporal de sinais de microembolias (SM) ao longo de diferentes estágios da endarterectomia carotídea (EC) e da angioplastia carotídea (AC) e as variáveis associadas com a ocorrência destes sinais, além de avaliar as mudanças na velocidade média aferida na artéria cerebral média (ACM) durante os dois tipos de intervenção. Material e métodos: Trinta e três pacientes com estenose carotídea foram submetidos ou a EC (17) ou a AC (16). Os SM bem como as velocidades médias na ACM foram adquiridas utilizando o US doppler transcraniano (DTC) e esses dados então analisados e associados a diferentes estágios cirúrgicos (pré-proteção, durante a proteção e pós-proteção), tipos de intervenção (EC ou AC) e diferentes variáveis para encontrar potenciais fatores de risco para embolização. Para análise estatística, foram usados os testes de Qui-quadrado, de Fisher e de Mann-Whitney, além de análise por medidas repetidas das variâncias com transformação por postos (ANOVA), seguido de teste de perfil por contrastes e análise de regressão linear múltipla ajustada para o grupo. Resultados: Uma diferença significativa foi encontrada para o número de SM em ambos os grupos. Houve, em média, 89,8 (± 171,4) sinais por procedimento no grupo EC, enquanto a média no grupo AC foi de 597,5 (± 343,3) sinais por procedimento. A média da velocidade média na ACM foi, em ambos os grupos, significantemente menor no estágio durante a proteção. Anestesia local correlacionou-se positivamente (p=0,003) com aumento dos SM, e, associado a isso, o histórico de tabagismo importante (desde que houvesse a cessação do vício há mais de um ano) correlacionou-se negativamente (0,014) com a ocorrência de SM. Conclusão: EC por semi-eversão, à luz do DTC, provocou uma menor incidência de SM por procedimento do que AC com filtro distal, em todos os estágios cirúrgicos. A média da velocidade média na ACM se comportou de maneira similar em ambos os grupos (EC e AC). Anestesia geral e histórico de tabagismo importante (desde que o paciente houvesse cessado por menos um anos antes da intervenção) foram as únicas duas variáveis no estudo que se correlacionaram significativamente (negativamente) com a ocorrência de SM
Abstract: Objectives: To analyze the temporal distribution of microembolic signals throughout the different stages of both the semi-eversion carotid endarterectomy (CEA) and the carotid artery stenting (CAS) procedures and the variables associated with occurrence of them and to evaluate changes in mean blood flow velocity, for both CAS and CEA, within the ipsilateral middle cerebral artery (MCA). Methods: Thirty three patients with carotid stenosis underwent either a CEA (17) or a CAS (16). Microembolic signals, as well as mean blood flow velocity, were acquired using a Transcranial Doppler scan (TCD) and these data were then analyzed and associated to different surgical stages (pre-protection, during protection, and post-protection), types of procedure (CAS or CEA) and different variables to find potential risk factors. To statistical analysis, chi-squared test, Fisher test, Mann-Whitney test, repeated measures analysis of variance with rank transformation (ANOVA) followed by contrast test and multiple linear regression analysis were used. Results: A significant difference was found for the number of microembolic signals in both groups. There were, on average, 89.8 (± 171.4) signals per procedure in the CEA group, while the average in the CAS group was 597.5 (± 343.3) signals per procedure. The average blood flow in the MCA was, in both groups, significantly lower during the stage of protection. Local anesthesia correlated positively (p= .003) with increase in microembolic signals and history of prolonged tobacco use having dropped the addiction for over a year correlated negatively (p= -.014) with the frequency of microembolic signals. Conclusion: Semi-eversion CEA, in light of our TCD findings, evoked a smaller incidence of hyperintense microemboli per procedure than CAS with a distal filter in all the protection stages. The average of the mean blood flow velocity within the MCA has behaved similarly between both groups (CAS and CEA). General anesthesia and the history of tobacco use (as long as the patient had quit for a year or more prior to surgery) were the only two variables in the study that correlated significantly (negatively) with the frequency of microembolic signals
Mestrado
Fisiopatologia Cirúrgica
Mestre em Ciências
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Hattori, Yorito. "Silent Information Regulator 2 Homolog 1 Counters Cerebral Hypoperfusion Injury by Deacetylating Endothelial Nitric Oxide Synthase." Kyoto University, 2015. http://hdl.handle.net/2433/199191.
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Mulatti, Grace Carvajal. "Caracterização e evolução clínica dos pacientes portadores de oclusão da artéria carótida interna: estudo comparativo." Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/5/5132/tde-30012018-102523/.
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INTRODUÇÃO: A estenose carotídea de origem aterosclerótica é um importante marcador de aterosclerose sistêmica avançada. A oclusão (obstrução completa da artéria) é rara e corresponde ao evento morfológico final da progressão da placa de ateroma na bifurcação carotídea. Muitos pacientes são sintomáticos no momento do diagnóstico e apresentam novos sintomas neurológicos na evolução apesar de tratamento clínico adequado. A literatura médica é escassa em determinar os principais fatores que podem levar a oclusão carotídea. A participação e intensidade das comorbidades e/ou fatores de risco, associados a dados demográficos peculiares foram pouco explorados. OBJETIVOS: Caracterizar o paciente com oclusão carotídea (OC) quanto a aspectos demográficos, doenças associadas e fatores de risco; detectar novos eventos neurológicos, cardiovasculares e óbitos no seguimento clínico destes pacientes. MÉTODO: Informações demográficas, clinicas e evolutivas de pacientes com oclusão carotídea e estenose carotídea não significativa foram recuperadas de um banco de dados compÍetado prospectivamente e complementadas com prontuário hospitalar e novos dados obtidos via convocação e/ou entrevista telefônica. RESULTADOS: No período de janeiro de 2005 a janeiro de 2013 foram analisados 213 pacientes portadores de OC e 172 portadores de estenose hemodinamicamente não significativa (ENS), ou abaixo de 50%. Foram analisados 4 dados demográficos e 9 fatores de risco, bem como sintomas neurológicos na apresentação e na evolução. No grupo OC predominaram indivíduos do sexo masculino, hipertensos, tabagistas, portadores de doença arterial obstrutiva periférica (DAOP), insuficiência renal crônica (IRC) com significância estatística em relação ao grupo ENS (p < 0,05).\\.Entre os pacientes com OC, 76,1% apresentaram sintomas neurológicos inicialmente contra 35,5% do grupo ENS (p = 0,000001). Quanto à evolução, os pacientes com OC apresentaram progressão significativa da estenose carotídea contralateral, quando comparada com a progressão da estenose nas carótidas do grupo ENS. (15,0% e 2,3%, p = 0,00011). O aparecimento de novos sintomas foi determinado pelo estado clínico de apresentação dos pacientes: 10,8% de novos sintomas nos inicialmente sintomáticos e 4,3% nos assintomáticos (p = 0,0218). Constatou-se maior número de óbitos na amostra OC (14,1%) do que na ENS (6,4%) com diferença significativa (p = 0,0150). CONCLUSÕES: OS pacientes portadores de OC apresentam maior prevalência de fatores de risco e comorbidades e maior mortalidade que o grupo ENS. No seguimento, os pacientes que se apresentavam sintomas neurológicos no momento do diagnóstico foram aqueles que mais desenvolveram novos eventos neurológicos. Este estudo representa um esforço em identificar uma amostra da população com estenose carotídea que pode necessitar de diagnóstico precoce e intervenção clínica vigorosa na prevenção de novos eventos e/ou óbitosINTRODUCTION: Carotid stenosis is an important marker of severe systemic atherosclerosis. Internal Carotid occlusion (ICO) is rare and represents the final event when it comes to atherosclerotic plaque progression at the carotid bifurcation. Many patients are symptomatic when diagnosed with this condition and some of them will present more neurologic symptoms despite proper clinical management. So far only few studies have investigated if more comorbidities andjor risk factors, associated to demographic characteristics can lead to ICO. OBJETIVES: To identify the patient with ICO as regard to his demographic data, associated diseases and risk factors. Primary end-points were new neurologic events, cardiovascular symptoms and deaths during follow-up. METHOD: A prospective database was completed with demographic data and clinical information from patients with ICO and from a control group of patients with a non-significant stenosis (NSS), ar below 50%. Information was collected retrospectively from clínical records and missing data were completed with a medical appointment or teJephone interview. RESULTS: From [anuary 2005 to [anuary 2013, 213 patients with ICO and 172 patients with NSS were studied. Demographic data, risk factors for atherosclerosis and neurological symptoms at diagnosis and during follow-up were verified. Among patients with [CO there were more men and those with history of smoking, and more patients presenting with peripheral arterial disease (PAD) and chronic renal failure (CRF) than those in the NSS group (p < 0,05). At the time of diagnosis 76.1% of patients with ICO were symptomatic, while 35.5% in the NSS group (p=0.000001). Patients in the ICO group presented significant progression of the contralateral stenosis when compared to progression on any side in the control grouP\'\"(15.0% versus 2.3%, p = 0.00011). New symptoms were determined by the patient\'s clinical status. As regard to new neurological symptoms during follow-up, 10.8% of those initially symptomatic (both groups combined), presented new symptoms, opposed to 4.3% of those initially asymptomatic (p=0.0218). Number of deaths was significantly higher among patients in the ICO group (14.1% versus 6.4%, p=0.0150). CONCLUSIONS: Patients presenting with ICO have more risk factors and higher mortality by any cause. Those initially symptomatic will likely present more neurological symptoms during follow up. This study aims to identify those who are more at risk before the occlusion and could benefit of earJy diagnosis and vigorous c1inical intervention before new neurological events andjor death
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Aleksandra, Lučić Prokin. "Procena cerebralne autoregulacije primenom apnea testa kod simptomatske karotidne stenoze pre i posle karotidne endarterektomije." Phd thesis, Univerzitet u Novom Sadu, Medicinski fakultet u Novom Sadu, 2015. http://www.cris.uns.ac.rs/record.jsf?recordId=94905&source=NDLTD&language=en.
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TCD apnea test kao neinvazivna i bezbedna neuroultrasonografska metoda pruža korisne informacije o vazomotornoj reaktivnosti (VMR) u procesu indirektnog sagledavanja funkcionisanja moždane autoregulacije. Vazomotorna reaktivnosti podrazumeva sposobnost dilatacije ili konstrikcije moždanih arteriola nastale kao odgovor na određeni vazoaktivni stimulus, najčešće ugljen dioksid. Cilj ove doktorske disertacije bio je ispitivanje i analiziranje promene karotidne hemodinamike kod bolesnika sa ishemijskim moždanim udarom (IMU) ili tranzitornim ishemijskim atakom (TIA) i simptomatskom karotidnom stenozom u preoperativnom i tromesečnom postoperativnom periodu, kao i procena revaskularizacionog efekta karotidne endarterektomije (KEA).U istraživanje je uključeno 60 hospitalizovanih bolesnika koji su doživeli prvi IMU i TIA u zoni vaskularizacije arterije cerebri anterior (ACA) i arterije cerebri medije (ACM), svi sa karotidnom stenozom, ACI ≥70%. Bolesnici su bili hospitalizovani na Klinici za neurologiju, Kliničkog Centra Vojvodine, Klinici za kardiovaskularnu hirurgiju, Instituta za kardiovaskularne bolesti Vojvodine i Klinici za vaskularnu hirurgiju, u Novom Sadu. U odnosu na kliničke manifestacije bolesni i su podeljeni u tri grupe: bolesnici sa TIA i amaurosis fugax, sa parcijalnim infarktom u zoni ACA ili ACM i sa lakunarnim infarktom. Istraživanje je analiziralo uticaj promenljivih i nepromenljivih vaskularnih faktora rizika na pojavu IMU i TIA, ali i na VMR, procenjivanu kroz indeks zadržavanja daha (Breath Holding Index, BHI) ipsilateralno i kontralateralno u odnosu na karotidnu stenozu. Analizirana je povezanost stepena karotidne stenoze sa vrednostima BHI preoperativno, povezanost BHI sa težinom kliničke slike, uticaj kolateralnog krvotoka na VMR, distribucija BHI u pojedinim tipovima IMU i TIA kao i komparacija BHI u pre i u postoperativnom periodu od 30 i 90 dana. Na osnovu sprovedenog istraživanja, došlo se do zaključaka da je redukovana VMR preoperativna karakteristika karotidne stenoze ipsilateralno kao i karakteristika različitih tipova IMU i TIA ipsilateralno; postoji negativna korela ija izmeĐu stepena karotidne stenoze i BHI vrednosti. Nije potvrđena hipoteza da veći roj razvijenih kolateralnih puteva uslovljava očuvanu VMR; utvrđena je pozitivna korelacija između BHI vrednosti u preoperativnom i postoperativnom periodu; redukovana VMR ima negativan uticaj na težinu kliničke slike. Prepoznavanje vrednosti TCD apnea testa, koji se može koristiti kao komplementarna metoda drugim vazoaktivnim testovima u praćenju karotidne hemodinamike, od posebne je važnosti neurologu i vaskularnom hirurgu. Time bi se doprinelo daljoj evaluaciji mehanizma nastanka IMU, planiranju terapijskog pristupa i determinisanju prognoze operisanih bolesnika. Činjenica da većina neuroloških odeljenja poseduje TCD aparat, apnea test postaje dostupan svakom neurologu u kliničkom radu, posebno u našim uslovima, kada se do drugih drugih, skupljih metoda, teško stiže ili nam ostaju nedostižne.TCD apnea test, as a noninvasive and safe neuroultrasonographic method, provides useful information about vasomotor reactivity (VMR) in the indirect evaluation of cerebral autoregulation. Vasomotor reactivity is the ability of cerebral arterioles to constrict or to dilate in response to a vasoactive stimulus, mainly carbon dioxide. The aim of this doctoral thesis was to investigate and analyze changes in carotid hemodynamics in patients with ischemic stroke (IS) or transient ischemic attack (TIA) and symptomatic carotid stenosis in the preoperative and three-month postoperative period as well as the assessment of revascularisation effect of carotid endarterectomy (CEA). The study included 60 hospitalized patients who experienced a first ischemic stroke or TIA in the vasularisation area of anterior cerebral artery (ACA) and middle cerebral artery (MCA), all with carotid stenosis ≥70% ACI. Patients were hospitalized at the Clinic of Neurology, Clinical Center of Vojvodina, Department of Cardiovascular Surgery, Institute of Cardiovascular Diseases and the Department of Vascular Surgery in Novi Sad. Considering clinical manifestations of stroke, the patients were divided into three groups: patients with TIA and amaurosis fugax, with partial infarction in area ACA or ACM and with lacunar infarct. The study analyzed the impact of variabile and unvariable vascular risk factors on the incidence of ischemic stroke and TIA, but also on VMR, evaluated through Breath Holding Index (Breath Holding Index, BHI) on the ipsilateral and contralateral side from carotid stenosis. We analysed the correlation between the degree of carotid stenosis with preoperative values of BHI, BHI correlation to the severity of clinical findings, the impact of collateral circulation to the VMR, distribution of BHI in certain types of ischemic stroke and TIA as well as comparison of BHI in the pre and postoperative period of 30 and 90 days. On the basis of this research came the conclusion that reduced VMR is characteristic of ipsilateral carotid stenosis in preoperative period as well as number of developed collateral characteristics of different types of ipsilateral ischemic stroke and TIA; there is a negative correlation between the degree of carotid stenosis and BHI values. The hypothesis that the greater pathways causes preservation of VMR was not confirmed, while the positive correlation between BHI values in the preoperative and postoperative period was established. Reduced VMR has a negative impact on the degree of clinical picture severity. Recognizing the importance of TCD apnea test method, that can be used as a complementary method to other vasoactive tests in monitoring of carotid hemodynamics, is of special importance to the neurologists and vascular surgeons. This would contribute to the further evaluation of mechanism of ischemic stroke, planning of therapeutic approach and determining the prognosis of treated patients. The fact that most of neurological department has TCD device, apnea test becomes available to every neurologist in clinical work, specially in our conditions, when other methods remain unattainable.
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Wang, Yan, and 王焱. "Atherosclerotic disease of the carotid, coronary and renal arteries: diagnosis, angioplasty and the effect ofstent surface on early thrombosis and restenosis." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2004. http://hub.hku.hk/bib/B31246060.
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Aleksandar, Milosavljević. "Prediktori ishoda operativnog lečenja pacijenata sa koronarnom i karotidnom arteriosklerozom." Phd thesis, Univerzitet u Novom Sadu, Medicinski fakultet u Novom Sadu, 2016. http://www.cris.uns.ac.rs/record.jsf?recordId=101257&source=NDLTD&language=en.
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Boljom prevencijom aterosklerotskih bolesti i uvođenjem invazivnih procedura endoluminalnim pristupom u lečenju koronarne bolesti i karotidne bolesti, hirurške procedure u poslednje dve decenije postaju sve kompleksnije i teže. Profil pacijenata podvrgnutih revaskularizaciji miokarda postaje sve rizičniji i procentualno se povećava broj polivaskularnih pacijenata za koje je neophodno uraditi dodatne procedure na karotidnim arterijama, bilo da su one urađene simultano, u dva ili tri akta. To su pacijenati koji imaju značajne aterosklerotske lezije na jednoj ili obe karotidne arterije zajedno sa značajnim suženjima koronarnih arterija. Algoritmi koji se nude u projektovanju operativne taktike ni danas nisu strogo definisani i vrlo često zavise od individualne procene i stava hirurga koji izvode ove procedure. Ishod operativnog lečenja ovih pacijenata često zavisi od hirurške taktike i ustanove u kojoj se oni operativno leče. Prediktori ishoda operativnog lečenja bi mogli biti važan faktor u selekcioniranju pacijenata u preporuci taktike operativnog lečenja. U tezi su analizirani klinički aspekti preoperativno i postoperativno, postoperativni mortalitet - 30 dana posle operacije i jednu godinu posle operacije. Analiziran je uticaj faktora: starost, pol, neurološka disfunkcija, infarkt miokarda do 90 dana pre operacije, nestabilna angina, diabetes mellitus, bilateralna stenoza karotidnih arterija kod 94 pacijenta koji su operisani u Klinici za kardiohirurgiju Instituta za kardiovaskularne bolesti Vojvodine u Sremskoj Kamenici u periodu 2007-2012g. Kod svih je, preoperativno, nađeno da imaju značajne promene na koronarnim i karotidnim arterijama. Pacijenti su podeljeni u dve grupe po tipu izvršene operacije. Prvu grupu su sačinjavali pacijenti koji su operisani u odvojenim operacijama karotidnih arterija i revakularizacije miokarda, a drugi su operisani simultano operacijom karotidnih arterija i revaskularizacijom miokarda. U metodologiji su korišćene metode retrospektivnog i prospektivnog istraživanja. Korišćena je elektronska baza podataka Instituta za kardiovaskularne bolesti Vojvodine, vođen je intervju sa pacijentima. Korišćeni su i pregledi doppler sonografije karotidnih arterija koji su rađeni u drugim ustanovama. Mortalitet-30 dana i jednu godinu posle operacije je bio prihvatljivo nizak, pacijenti su poboljšani u posmatranim parametrima. Neurološki morbiditet na 30 dana i jednu godinu posle je bio prihvatljivo nizak. Prediktori mortaliteta su bili pušenje 30 dana i godinu dana posle operacije u obe grupe. Prediktor morbiditeta 30 dana i jednu godinu nakon operacije bila je hiperlipoproteinemija. Ženski pol je bio nezavisni prediktor mortaliteta u grupi pacijenata operisanih u više aktova. Pacijenti operisini simultano su bili teži po simptomima ( NYHAklasi) i u većem riziku (EU2 score), ali nisu imali statistički značajno veću smrtnost u odnosu na grupu operisanu u više aktova.Surgical procedures have become more complex and difficult in the past two decades due to the better prevention of atherosclerotic diseases and the introduction of invasive procedures with endoluminal approach to treating coronary and carotid artery diseases. The profile of patients undergoing myocardial revascularization is becoming riskier. There is also increase in the percentage of patients with polyvascular disease who need additional procedures on the carotid arteries, whether they are done simultaneously or in two or three acts. These are the patients who have significant atherosclerotic lesions in one or both of the carotid arteries along with the significant narrowing of the coronary arteries. Algorithms that are offered to plan operative tactics are still not strictly defined and often depend on the individual assessment of surgeons and the attitude of certain institutions that perform the procedure. The outcome of surgical treatment of these patients often depends on surgical tactics and the institution in which they are treated. Predictors of surgical treatment outcome could be an important factor for the selection of patients and the recommendation of operative treatment tactics. The thesis analyzed pre- and postoperative clinical aspect as well as 30-day and one-year postoperative mortality. The influence of the following factors was analyzed: age, sex, neurologic dysfunction, myocardial infarction occurring 90 days after surgery, unstable angina, diabetes mellitus, and bilateral carotid artery stenosis in 94 patients that underwent cardiac surgery at the Clinic of Cardiovascular Surgery of the Institute of Cardiovascular Diseases of Vojvodina in Sremska Kamenica in the period from 2007 to 2012. All patients had significant changes on the coronary and carotid arteries. The patients were divided into two groups according to the type of surgery. The first group consisted of the patients who underwent carotid artery surgery and myocardial revascularization separately. The second group of patients underwent carotid artery surgery and myocardial revascularization at the same time. Methods of retrospective and prospective research were used in the methodology. Electronic data base of the Institute of Cardiovascular Diseases of Vojvodina was also used and the patients were interviewed. Doppler of carotid arteries performed both in our institution and in other institutions was used. Mortality, 30-day and one-year post surgery, was acceptably low. The patients were improved in the observed parameters. Neurologic morbidity 30 days and one year after surgery was acceptably low. Smoking 30 days and one year after surgery was predictor of mortality in both groups. Hyperlipoproteinemia 30 days and one year after surgery was predictor of morbidity. Female sex was independent predictor of mortality for the first group of patients. The second group of patients were more complex according to the symptoms (NYHA class) and with greater risk (EU2 score), but their mortality rate was not statistically significant in relation to the first group of patients.
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Khan, Tania N. "Design and Performance of a Localized Fiber Optic, Near-Infrared Spectroscopic Prototype Device for the Detection of the Metabolic Status of "Vulnerable Plaque": in-vitro Investigation of Human Carotid Plaque: a Dissertation." eScholarship@UMMS, 2003. http://escholarship.umassmed.edu/gsbs_diss/216.
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INTRODUCTION: The "vulnerable plaque" is defined as the "precursor lesion" that ultimately ends in acute coronary thrombi (clots) that create a heart attack. Macrophages and inflammatory cells, found preferentially in vulnerable plaque, sustain their activity in the plaque through anaerobic metabolism and lactate production. The ultimate goal is to assess anaerobic metabolism in-vivo by measuring tissue pH and lactate concentration in atherosclerotic plaques using optical spectroscopy. The proposed in-vitro optical probe design, experimental method, and spectroscopic data analysis methodology are established in this research.
METHODS: A fiber optic probe was designed and built based on both Monte Carlo simulations and bench testing with the goal to collect light from a small volume of tissue. A simulation of the depth penetration of the proposed probe was performed on normal and atherosclerotic aortic tissue, and the final probe was bench tested using normal aorta. A method was developed to preserve plaque metabolic status of tissue harvested from patients. Human atherosclerotic tissue obtained immediately after carotid endarterectomy was placed in Minimum Essential Medium (MEM) with non-essential amino acids supplement, bubbled with 75%O2/20%N2/5%CO2 at 37°C. Tissue pH, pCO2, pO2 and temperature with (n=7) and without (n=2) the media preparation over time were reviewed to assess plaque viability and maintenance of physiological conditions. Additional plaques placed in media were used for development of chemometric methods to measure pH and lactate. Areas of each plaque were randomly chosen for analysis. Reflectance spectra were collected with a dispersive spectrometer (400-1100 nm) and a Fourier-transform near-infrared spectrometer (1100-2400 nm) using the fiber optic probe. Reference measurements for tissue pH and lactate were made with glass microelectrodes and micro-enzymatic assay, respectively. Partial least-squares (PLS) data analysis was used to develop multivariate calibration models on an initial set of 5-6 plaques relating the optical spectra to the reference tissue pH (n=20) or the lactate concentration (n=21) to assess data quality. The coefficient of multiple determination (R2), the standard error of cross-validation (SECV), and the number of factors were used to assess the model performance. Additional points were collected from ~14 plaques and added to preliminary data. Pre-processing techniques were then used to see if preliminary data results could be improved by reducing different sources of variability with the introduction of more points.
RESULTS: Monte Carlo simulations and depth penetration tests with the final probe design showed light is collected from ~1 mm3 volume of tissue using a 50 micron source-receiver separation. Tissue pH, pCO2, pO2 and temperature values demonstrated that the plaques were viable and stable in the media preparation for a maximum of 4 hours. Data from the first six plaques collected for lactate analysis showed that for seventeen points, a six-factor model produced adequate results (R2=0.83 SECV=1.4 micromoles lactate/gram tissue). Data from the first five plaques collected for tissue pH analysis, showed for seventeen different points, a three-factor model produced adequate results (R2=0.75 SECV=0.09 pH units). When additional points were added to either data set, model results were degraded.
CONCLUSIONS: The in-vitro optical probe design and experimental procedures was established and the feasibility of the optical method demonstrated with preliminary data. However, with the addition of more data points, different sources of tissue and spectral variability were observed to affect calibration. The gross pathology type and mismatched optical volume to reference measurement volume limited the tissue pH determination. The reference measurement precision, the spatial resolution of the reference lactate measurement, and unmodeled tissue variability (water and proteins) limited the lactate determination. Large variability in all optical measurements was observed. Additional in-vitro data collection would be required such that the variability due to the tissue is reduced and any spectrometer variability adequately compensated to be able to use the optical calibration in-vivo.
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Avelar, Wagner Mauad 1976. "Avaliação das alterações da substância branca e cinzenta cerebral nos pacientes com doença carotídea assintomática." [s.n.], 2013. http://repositorio.unicamp.br/jspui/handle/REPOSIP/309281.
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Orientador: Fernando CendesTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: A prevalência da estenose carotídea assintomática (>50%) aumenta com a idade, sendo 10% nos homens acima de 80 anos. A conduta, nesses pacientes, quanto ao tratamento clínico ou correção por angioplastia ou endarterectomia ainda gera discussões. Os primeiros estudos com endarterectomia indicavam um benefício em diminuir o risco de evento cerebrovascular em 5 anos. Com a melhora do tratamento clínico, em que o risco absoluto caiu de 2,5 em meados da década de 80 para 1% ano, a correção de tais estenoses se tornou motivo de discórdia, visto que existe um risco de 2,5% para angioplastia e 1,4% para endarterectomia, como mostrado no estudo CREST, publicado em 2010. Portanto, o uso indiscriminado do procedimento não parece justificado nesse grupo de pacientes. Desta forma, o procedimento cirúrgico somente é recomendado em pacientes selecionados com base na idade, fatores de risco, expectativa de vida e risco peri-procedimento. Entretanto, há estudos que evidenciaram declínio cognitivo em pacientes com estenoses assintomáticas >70%, os quais tiveram melhora após a angioplastia, além de casos de distúrbios do movimento, em especial hemicoreia, os quais reverteram após correção da mesma. Nosso trabalho avaliou 25 pacientes com estenose de carótida/oclusão, assintomáticos quanto às possíveis alterações de substância branca e cinzenta. A estenose/oclusão foi definida pela angiotomografia e então todos os pacientes foram submetidos à ressonância magnética de encéfalo e as imagens foram analisadas através do método de morfometria baseada em voxel (VMB) e através de imagens de tensor de difusão (DTI). Para comparação estatística, usamos imagens de 25 indivíduos saudáveis, pareados por idade. Neste estudo, ambas as análises, de VBM e DTI, demonstraram anormalidades significativas da substância branca quando comparado com ao grupo controle. Tais achados foram difusos e simétricos em ambos os hemisférios (ipsilateral e contralateral a estenose). Diferentemente, a análise de VBM da substância cinzenta demonstrou assimetria da atrofia, predominantemente em áreas correspondendo a circulação anterior do hemisfério ipsilateral à estenose. Nossos achados sugerem que as estenoses/oclusões carotídeas assintomáticas estão associadas a alterações (atrofia) da substância cinzenta do hemisfério ipsilateral à estenose. Esse achado está em concordância com os dados prévios da literatura, como a existência de declínio cognitivo e os distúrbios de movimento, uma vez que estabelece uma associação entre estenose carotídea e perda de substância cinzenta, provavelmente secundária à alteração hemodinâmica. É o primeiro trabalho que pode justificar tais achados
Abstract: The prevalence of asymptomatic carotid stenosis (>50%) increases with age, affecting 10% of men 80 years or older. However there is still no consensus whether clinical, angioplasty or endarterectomy is the best therapeutic option. In earlier studies, endarterectomy showed a benefit in reducing the risk of event in 5 years. The advances in medical treatment though, decreased the absolute risk of stroke to 1% per year and surgical treatment was put in check, since both angioplasty and endarterectomy carry a stroke risk of 2,5 and 1,4 % respectively, as shown in the CREST study. Therefore, the indiscriminate use of the procedure does not seem justified in this group of patients and it should only be recommended in selected patients based on age, risk factors, life expectancy and the risks associated with the procedure. However, studies have demonstrated cognitive decline in patients with asymptomatic carotid stenosis >70%, which showed improvement after angioplasty, and case reports described patients with hemichorea contralateral to the stenosis, which reversed after the surgical procedure. We studied the white and grey matter changes in 25 patients with asymptomatic carotid stenosis/occlusion. The stenosis/occlusion was defined by angiography and all patients underwent brain MRI. Images were analyzed by the method of voxel-based morphometry (VBM) and through diffusion tensor images. Our control group involved 25 healthy subjects, matched for sex and age. We found that both DTI and VBM analyze showed significant abnormalities of white matter compared to controls, and these findings were diffuse and symmetrical in both hemispheres (ipsilateral and contralateral stenosis). Unlike DTI, the VBM analysis showed gray matter atrophy predominantly in areas corresponding to the anterior circulation in the hemisphere ipsilateral to the stenosis. Our findings suggest that the stenosis/occlusion is associated with asymptomatic alterations (atrophy) of the gray matter in the hemisphere ipsilateral to the stenosis. This finding is in agreement with previous clinical data in the literature, such as the existence of cognitive decline and movement disorders, since it establishes an association between carotid stenosis and loss of gray mater, probably secondary to hemodynamic changes
Doutorado
Neurociencias
Doutor em Fisiopatologia Medica
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Faccini, Felipe Puricelli. "Fatores de risco para acidente vascular cerebral no pós-operatório de cirurgia de revascularização do miocárdio." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2007. http://hdl.handle.net/10183/14055.
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Introdução: A indicação de endarterectomia carotídea (EAC) profilática em conjunto com revascularização miocárdica (CRM) permanece assunto indefinido. A cirurgia conjunta é amplamente difundida, mas seus resultados vêm sendo questionados. Método: Coorte retrospectiva de 691 pacientes submetidos à CRM, escolhidos aleatoriamente. Avaliação realizada para dados gerais, presença de lesão carotídea, ateromatose aórtica, desfechos neurológicos e óbito. Resultados: Dentre 691 pacientes submetidos à CRM, 16 pacientes apresentaram acidentes vasculares cerebrais (AVC). Dentre esses, 11 pacientes (68.75%) apresentaram AVC localizados em áreas não compatíveis com as lesões carotídeas, sendo três deles com lesões calcificadas na aorta ascendente. Os pacientes com estenose carotídea apresentaram taxa similar de eventos neurológicos totais, AVC e óbito, comparados com pacientes sem estenose carotídea. Um subgrupo de 35 pacientes com estenose carotídea foi submetido à cirurgia coronariana com (14 pacientes) ou sem (21 pacientes) cirurgia de carótida, obtendo-se taxa de eventos neurológicos totais, AVC e óbito estatisticamente semelhantes. Os pacientes com calcificações aórticas apresentaram risco maior de eventos neurológicos (14,58% versus 6.55%, p=0.011), AVC (3,12% versus 2,18%, p=0,47) e óbito (8,33% versus 4,37%, p=0.12). Discussão: Os eventos neurológicos após CRM correlacionam-se com ateromatose aórtica. Os AVC freqüentemente não têm relação linear com a estenose carotídea. Estratégias para minimizar embolia da aorta podem diminuir as taxas de intercorrências neurológicas.Introduction: The management of patients with simultaneous disease of carotid and coronary arteries is controversial. Studies showed that aortic calcifications might play a role in postoperative stroke at coronary artery bypass graft (CABG), carotid lesions may not be as important as previously considered. Method: A retrospective cohort of a randomly selected group (including elective and emergency operations) of 691 patients submitted to CABG was reviewed for general data, neurological complications and mortality. Results: Among 691 CABGs 16 patients had postoperative stroke. Among these, 11 patients (68.75%) had strokes not matching carotid lesions and anatomic presentation, three of those had detectable aortic calcifications. The patients with critical carotid stenosis had similar rates of neurological events, stroke and death as compared to patients without. The patients with aortic calcifications presented a higher risk of neurological events (14.58% versus 6.55%, p=0.011), stroke (3.12% versus 2.18%, p=0.47) and death (8.33% versus 4.37%, p=0.12). Discussion: The postoperative neurological events after CABG can be related to aortic calcifications. The strokes after coronary bypass may occur independently of the carotid lesions. Strategies to prevent aortic emboli may help preventing many post-operative strokes.
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Barros, Cristiano Ventorim de. "Estudo comparativo entre ultra-sonografia com Doppler colorido, angiografia por ressonância magnética, por subtração digital 2D e 3D na doença dos vasos carotídeos cervicais." Universidade de São Paulo, 2009. http://www.teses.usp.br/teses/disponiveis/5/5151/tde-24022010-140143/.
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INTRODUÇÃO: Os métodos diagnósticos não invasivos, como a ultra-sonografia com Doppler colorido (USDC) e a angiografia por ressonância magnética contrastada (ARMC) têm sido cada vez mais utilizados para o estudo da estenose das artérias carótidas internas (ACI). Nos testes comparativos a arteriografia por subtração digital bidimensional (ASD 2D) tem sido o padrão de referência, porém é um método caro, invasivo e com diversas complicações descritas, além disso, com a realização da arteriografia por subtração digital rotacional (ASD 3D), começou a se interrogar se a ASD 2D não estaria subestimando as estenoses. OBJETIVOS: Comparar as medidas de estenose obtidas pelos métodos não invasivos com a ASD 2D e 3D, utilizando o critério do North American Symptomatic Carotid Endarterectomy Trial (NASCET), além de comparar os dois métodos invasivos entre si, tentando identificar se os métodos não invasivos podem substituir a ASD 2D na rotina e se a ASD 2D tende subestimar a estenose em relação a ASD 3D. MÉTODOS: 92 pacientes que haviam sido indicados de maneira prospectiva e consecutiva para realização da ASD 2D, foram selecionados para o estudo, sendo encaminhados para realizar também a ASD 3D, a ARMC e o USDC. Os resultados das medidas da maior estenose, realizadas através das imagens fonte em estação de trabalho, por dois observadores em consenso, obtidas em cada um dos testes (USDC, ARMC) e dos resultados concordantes dos dois, foi comparada com os exames de referência (ASD 2D e ASD 3D). Foi feita também uma avaliação dos resultados dos exames invasivos entre si. RESULTADOS: 98 ACI foram incluídas no trabalho. Os resultados obtidos pelo coeficiente de correlação de Pearson e pelo coeficiente de correlação intraclasse, que variaram de 0,91 a 0,96, demonstraram respectivamente uma excelente correlação entre as modalidades diagnósticas e que há uma forte concordância entre os seus resultados (ambos com p <0,001). Os valores de sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo e acurácia das diversas comparações variaram respectivamente de 76 a 100%, de 92 a 100%, 79 a 100%, 90 a 100% e 90 a 100%. DISCUSSÃO: As comparações com maior sensibilidade, especificidade e acurácia foram respectivamente a (USDC+ARMC) x ASD 3D com 100%, 100% e 100%; ARMC x ASD 3D com 100%, 96% e 97% e ASD 2D x ASD 3D, com 89%, 94% e 93%. A ASD 2D categorizou as estenoses em 11 casos (11,3%) uma classe abaixo das obtidas na ASD 3D, além de classificar 4 estenoses a menos que a ASD 3D na classe de 70-94%. CONCLUSÕES: Os métodos não invasivos principalmente se avaliados em conjunto podem substituir a ASD 2D na avaliação da estenose da ACI. A ASD 2D tendeu a subestimar levemente as estenoses quando comparada com a ASD 3DINTRODUCTION: Noninvasive techniques such as Doppler ultrasound (DUS) and contrast enhanced magnetic resonance angiography (CEMRA) are each day more used in the evaluation of the internal carotid arteries (ICA). On comparison studies 2D digital subtraction angiography (2D DSA) has been considerate as the reference standard, however its an expensive and invasive method, with well known risks, besides the use of 3D digital subtraction angiography (3D DSA) showed that 2D DSA can potentially result in an underestimation of the stenosis. OBJECTIVES: Compare stenosis measurements of noninvasive methods with 2D and 3D DSA, using the North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria, compare the two noninvasive methods with each other, trying to identify if they can substitute 2D DSA on the daily basis and if that 2D DSA tends to underestimate the stenosis compared with 3D DSA. METHODS: 92 patients that were prospective and consecutive scheduled for 2D DSA were selected to participate in the study which included perform also a 3D DSA, CEMRA and DUS. The measurements of the greatest stenosis, made with the raw images in a workstation, by two observers in consensus, obtained with each modality (DUS, CEMRA) and the concordant results of both, were compared with the reference standard (2D and 3D DSA). Also a comparison between the invasive methods was made. RESULTS: 98 ICA were included. The results obtained by Pearson correlation coefficient and intraclass correlation coefficient, that range from 0.91 and 0.96, showed respectively a excellent correlation between the diagnostic modalities and that there are a great agreement between them (both with p<0.001). Sensitivity, specificity, positive and negative predictive values, and accuracy values of the different comparisons range respectively from 76% to 100%, 92 to 100%, 79 to 100%, 90 to 100% and 90 to 100%. DISCUSSION: Comparisons with higher sensitivity, specificity and accuracy were respectively (DUS+CEMRA) x 3D DSA, with 100%, 100% and 100%; CEMRA x 3D DSA with 100%, 96% and 97% and 2D DSA x 3D DSA with 89%, 94% and 93%. 2D DSA categorized 11 cases (11,3%) of ICA stenosis as one category lower than 3D DSA, including 4 less cases of the 70-94% class. CONCLUSIONS: The noninvasive methods, especially if evaluated together, can replace 2D DSA in the study of cervical carotid steno-occlusive disease. 2D DSA tends to lightly underestimate carotid stenosis when compared to 3D DSA
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Željko, Živanović. "Korelacija ultrazvučnih karakteristika ateroskleroze karotidnih arterija i prisustva kardiometaboličkih faktora rizika kod bolesnika sa ishemijskim moždanim udarom." Phd thesis, Univerzitet u Novom Sadu, Medicinski fakultet u Novom Sadu, 2015. http://www.cris.uns.ac.rs/record.jsf?recordId=94884&source=NDLTD&language=en.
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UVOD: Ateroskleroza je najčešća bolest karotidnih arterija i uzrok je oko 20% svih ishemijskih moždanih udara (IMU). Osim stepena stenoze i određene karakteristike karotidnog plaka označavaju povišen rizik za IMU. Ultrazvukom je moguće pouzdano evaluirati aterosklerotske promene na karotidnim arterijama. Iako su faktori rizika (FR) za aterosklerozu istovremeno i FR za IMU, prisustvo identičnih FR kod pacijenata sa IMU, ne znači i prisustvo istog stepena ateroskleroze na karotidnim arterijama. CILJ: Utvrđivanje povezanosti pojedinih ultrazvučnih karakteristika karotidne ateroskleroze, sa prisustvom različitih kardiometaboličkih FR i njihovih biomarkera, kod pacijenata sa IMU. MATERIJAL I METODE: U istraživanje je uključeno 120 pacijenata sa nekardioembolijskim IMU u karotidnom slivu koji su podeljeni u dve grupe; 60 sa lakunarnim i 60 sa nelakunarnim infarktom mozga. Svim pacijentima je određivano prisustvo FR, kao što su hipertenzija, dijabetes, hiperlipoproteinemija, pušenje, gojaznost, metabolički sindrom, hiperhomocisteinemija i inflamacija. Beležene su vrednosti krvnog pritiska, glikemije, glikoliziranog hemoglobina, parametara lipidskog statusa, apolipoproteina (Apo) A-I i B, lipoproteina a, indeksa telesne mase (BMI), homocisteina, C reaktivnog proteina (CRP). Pomoću karotidnog dupleks ultrazvuka određivane su vrednosti intima-medijalnog zadebljanja (IMT), morfologija plaka, površina plaka, stepen stenoze. Demografske karakteristike, FR i njihovi biomarkeri, te ultrazvučne karakteristike karotidne ateroskleroze, poređene su između dve grupe pacijenata. Korišćeni su hi-kvadrat test i t-test. Korelacije FR i vrednosti njihovih biomarkera sa različitim karakteristikama karotidnog plaka, određivane su upotrebom Pearsonovog koeficijenta korelacije r i Kramerovog V. Upotrebom regresionih analiza ispitivan je prediktivni značaj određenih FR i njihovih biomarkera u pojavi pojedinih karakteristika karotidnog plaka. REZULTATI: Više pacijenata sa lakunarnim infarktom je imalo hipertenziju (98.3% naspram 85%; p=0.021). Pacijenti sa lakunarnim infarktom imali su veće vrednosti BMI (27.6 kg/m2 naspram 25.9 kg/m2; p=0.029), dok su pacijenti sa nelakunarnim infarktom imali veće vrednosti CRP (16.4 mg/l naspram 6.8 mg/l; p=0.001). Demografske karakteristike, ostali FR i njihovi biomarkeri, kao i vrednosti karotidnog IMT se nisu značajno razlikovali između dve grupe pacijenata. Pacijenti sa nelakunarnim infarktom su imali veći stepen karotidne stenoze (79.7% naspram 33.2%; p=0,0001), kao i češće prisustvo heterogenog plaka (73.3% naspram 35%; p<0,001), hipoehogenog plaka (51.7% naspram 16.7%; p<0.001) i neravnog plaka (81.7% naspram 21.7%; p<0,001). Sa vrednostima IMT značajno (p<0.05) su korelirali životna dob pacijenata (r=0.276), dijabetes (Cramerovo V=0.236), metabolički sindrom (Cramerovo V=0.247), HDL holesterol (r=-0.254), LDL/HDL (r=0.306), ApoA-I (r=-0.386) i ApoB/ApoA-I (r=0.359). Sa prisustvom heterogenog plaka su korelirali metabolički sindrom (Cramerovo V=0.246), ApoB (r=0.213), ApoB/ApoA-I (r=0.207) i povišen CRP (Cramerovo V=0.266). Sa neravnom površinom plaka značajno je korelirao povišen CRP (Cramerovo V=0.283). Sa stepenom stenoze značajno su korelirali BMI (r=-0.180) i povišen CRP (Cramerovo V=0.301). Nezavisni prediktori povišenih vrednosti IMT bili su starija životna dob pacijenata (β=0.230; p=0.006), ApoA-I (β=-0.244; p=0.008) i ApoB/ApoA-I (β=0.247; p=0.007). Prediktori prisustva heterogenog plaka bili su muški pol (p=0.011; OR=3.425), ApoB (p=0.007; OR=8.972), BMI (p=0.0001; OR=0.380), metabolički sindrom (p=0.003; OR=4.555) i povišen CRP (p=0.018; OR=2.800). Prediktori prisustva hipoehogenog plaka bili su ApoB (p<0.001; OR=29.2), BMI (p=0.02; OR=0.514), metabolički sindrom (p<0.001; OR=9.224) i povišen CRP (p=0.046; OR=2.659). Povišen CRP bio je jedini prediktor prisustva neravnog plaka (p=0.002; OR=3.203), kao i prisustva većeg stepene karotidne stenoze (β=0.270; p=0.002). ZAKLJUČAK: Iako je karotidna stenoza znatno zastupljenija među pacijenatima sa nelakunarnim nego lakunarnim nekardioembolijskim IMU, prisustvo kardiometaboličkih FR, njihovih biomarkera i vrednosti IMT se bitno ne razlikuje između ove dve grupe pacijenata. Osim stenoze i prisustvo heterogenog, hipoehogenog i neravnog karotidnog plaka nosi povišen rizik za IMU. Među FR i njihovim biomarkerima ApoA-I i ApoB su najbolji prediktori karotidne ateroskleroze. Apolipoprotein B i metabolički sindrom su najjače povezani sa prisustvom heterogenog i hipoehogenog plaka. Povišen CRP kod pacijenata sa akutnim IMU može biti znak destabilizacije plaka i ukazivati na prisustvo signifikantne karotidne stenoze.INTRODUCTION: Atherosclerosis is the most common disease of carotid arteries, causing 20% of all ischemic strokes. Besides the degree of stenosis, certain characteristics of carotid plaques indicate an increased risk for stroke. Carotid ultrasound can reliably evaluate atherosclerotic changes in carotid arteries. Although the risk factors for atherosclerosis are the same as the risk factors for stroke, the presence of identical risk factors in patients with stroke does not necessarily mean the presence of the same degree of carotid atherosclerosis. AIM: To determine correlation of certain characteristics of carotid atherosclerosis detected by ultrasound with the presence of various cardiometabolic risk factors in patients with ischemic stroke. METHODS: The study included 120 patients with noncardioembolic ischemic stroke in the anterior circulation, who were divided into two groups; 60 with lacunar and 60 with nonlacunar brain infarction. The presence of cardiometabolic risk factors, such as hypertension, diabetes, hyperlipoproteinemia, smoking, obesity, metabolic syndrome, hyperhomocysteinemia, and inflammation, was evaluated in all patients. Data regarding blood pressure, glycemia, glycated hemoglobin, lipid status parameters, apolipoprotein (ApoAI and ApoB), lipoprotein a, body mass index (BMI), homocysteine, and C-reactive protein (CRP) were collected. Intima-media thickness (IMT), carotid plaque characteristics (morphology, surface) and the degree of stenosis were determined by carotid duplex ultrasound. Demographic characteristics, risk factors, biomarkers, as well as ultrasound characteristics of carotid atherosclerosis, were compared between patients with lacunar and nonlacunar stroke. Two-sample student t-test and χ2 test were used for comparisons. In order to assess the correlation of various risk factors and their biomarkers with different characteristics of carotid plaques, we used the Pearson correlation coefficient r and Cramer's V. Regression analysis was used to evaluate the association of risk factors and their biomarkers with various carotid atherosclerosis characteristics. RESULTS: More patients with lacunar stroke had hypertension (98.3% vs. 85%; p=0.021). Patients with lacunar stroke had higher BMI values (27.6 kg/m2 vs. 25.9 kg/m2; p=0.029), while patients with nonlacunar stroke had higher CRP values (16.4 mg/l vs. 6.8 mg/l; p=0.001). Demographic characteristics, other risk factors and their biomarkers, as well as carotid IMT were not significantly different between the two groups of patients. Patients with nonlacunar stroke had a higher degree of carotid stenosis (79.7% vs. 33.2%; p=0.0001) and a higher prevalence of heterogeneous plaques (73.3% vs. 35%; p<0.001), hypoechogenic plaques (51.7% vs. 16.7%; p<0.001), and plaques with irregular surface (81.7% vs. 21.7%; p<0,001). IMT was significantly (p<0.05) correlated with the age of patients (r=0.276), diabetes (Cramer’s V=0.236), metabolic syndrome (Cramer’s V=0.247), HDL cholesterol (r=-0.254), LDL/HDL (r=0.306), ApoA-I (r=-0.386) and ApoB/ApoA-I (r=0.359). The presence of a heterogeneous plaque was correlated with metabolic syndrome (Cramer’s V=0.246) ApoB (r=0.213), ApoB/ApoA-I (r=0.207) and elevated CRP (Cramer’s V=0.266). A plaque with irregular surface was correlated with elevated CRP (Cramer’s V=0.283). The degree of carotid stenosis was correlated with BMI (r=-0.180) and elevated CRP (Cramer’s V=0.301). The independent predictors of higher values of IMT were older age (β=0.230; p=0.006), ApoA-I (β=-0.244; p=0.008), and ApoB/ApoA-I (β=0.247; p=0.007). The predictors of the presence of a heterogeneous plaque were male gender (p=0.011; OR=3.425), ApoB (p=0.007; OR=8.972), BMI (p=0.0001; OR=0.380), metabolic syndrome (p=0.003; OR=4.555) and elevated CRP (p=0.018; OR=2.800). The predictors of the presence of a hypoechogenic plaque were ApoB (p<0.001; OR=29.2), BMI (p=0.02; OR=0.514), metabolic syndrome (p<0.001; OR=9.224) and elevated CRP (p=0.046; OR=2.659). Elevated CRP was the only independent predictor of a plaque with irregular surface (p=0.002; OR=3.203) and of a higher degree of carotid stenosis (β=0.270; p=0.002). CONCULSIONS: Although carotid stenosis is significantly more pronounced in patients with nonlacunar than those with lacunar noncardioembolic ischemic stroke, cardiometabolic risk factors, their biomarkers and carotid IMT do not differ significantly between the two groups of patients. In addition to stenosis, a presence of heterogeneous, hypoechogenic and irregular-surface carotid plaques indicates an increased risk for ischemic nonlacunar stroke. Among the cardiometabolic risk factors and their biomarkers, ApoAI and ApoB have the strongest association with carotid atherosclerosis. Apolipoprotein B and metabolic syndrome have the strongest association with a heterogeneous and hypoechogenic carotid plaque. Elevated CRP in patients with acute ischemic stroke may be a sign of carotid plaque destabilization and can indicate a significant carotid stenosis.