Forskning
Udskriv Udskriv
Switch language
Region Hovedstaden - en del af Københavns Universitetshospital
Udgivet

Clinical and imaging features associated with an increased risk of late stroke in patients with asymptomatic carotid disease

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  1. Ensuring Competency in Open Aortic Aneurysm Repair - Development and Validation of a New Assessment Tool

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  2. Cutdown Technique is Superior to Fascial Closure for Femoral Artery Access after Elective Endovascular Aortic Repair

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  3. EJVES, the Leading Journal in Vascular Surgery, is One of the Numerous Scientific Pillars of the ESVS

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  1. Full-Volume Assessment of Abdominal Aortic Aneurysms by 3-D Ultrasound and Magnetic Tracking

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  2. Vascular function in adults with cyanotic congenital heart disease

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  3. In Situ Vein Bypass Is Superior to Endovascular Treatment of Femoropopliteal Lesions in Chronic Limb-Threatening Ischemia

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  4. Carotid atherosclerosis markers and adverse cardiovascular events

    Publikation: Bidrag til tidsskriftLetterForskningpeer review

Vis graf over relationer

BACKGROUND: The 2011 American Heart Association Guidelines on the management of asymptomatic carotid disease recommends that carotid endarterectomy (CEA) (with carotid artery stenting (CAS) as an alternative) may be considered in highly selected patients with 70-99% stenoses. However, no guidance was provided as to what "highly selected" meant. This caveat is, however, important as up to 95% of asymptomatic individuals undergoing prophylactic CEA or CAS will ultimately undergo an unnecessary procedure. Even if the procedural risk following CEA or CAS could be reduced to 0%; 93% of patients would still undergo an unnecessary intervention. This, coupled with growing awareness that the risk of stroke in medically treated patients appears to be diminishing, has led to a renewed drive towards identifying patients with the highest risk of suffering a stroke whilst on medical therapy in whom to target CEA/CAS.

METHODS: Review of clinical and/or imaging based scoring systems, predictive algorithms and imaging parameters that may be associated with an increased (or decreased) risk of stroke in patients with asymptomatic carotid disease.

RESULTS: Parameters associated with an increased risk of late stroke include: (a) silent infarction on CT/MRI; (b) stenosis progression; (c) hypoechoic plaques or GSM <15; (d) irregular plaques; (e) evidence of spontaneous embolization on TCD; (f) AHA plaque types IV-V, VI; (g) MR diagnosed IPH; (h) plaque area >80 mm(2); (i) juxta-luminal black area >10 mm(2); and (j) tandem intracranial disease.

CONCLUSIONS: A number of imaging parameters have been shown to be predictive of an increased risk of late stroke in previously asymptomatic patients. None have been independently validated, but many could easily be evaluated in natural history studies or randomized trials in order to identify a "high risk for stroke" cohort in whom CEA/CAS could be prioritized.

OriginalsprogEngelsk
TidsskriftEuropean journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery
Vol/bind48
Udgave nummer6
Sider (fra-til)633-40
Antal sider8
ISSN1078-5884
DOI
StatusUdgivet - dec. 2014

Mest downloadede publikationer

Ingen data tilgængelig

ID: 44972195