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carotid artery endarterectomy in patients with symptomatic non-stenotic carotid artery disease

Stroke & Vascular Neurology 2022年第3期7卷 251-257页

作者： Valentina Nardi John C Benson Anthony S Larson Waleed Brinjikji Luca Saba Fredric B Meyer Giuseppe Lanzino Amir Lerman Luis E Savastano Department of Cardiovascular Diseases Mayo ClinicRochesterMinnesotaUSA Radiology Mayo ClinicRochesterMinnesotaUSA Radiology Azienda Ospedaliero UniversitariaCagliariItaly Neurosurgery Mayo ClinicRochesterMinnesotaUSA

Object We sought to determine the safety and efficacy in secondary stroke prevention of carotid endarterectomy(CEA)in patients with symptomatic non-stenotic carotid artery disease(SyNC).Methods This was a single-centre retrospective case *** patients who underwent CEA for unilateral anterior circulation cerebrovascular events with ipsilateralcarotid stenosis from 2002 to 2020 were *** hallmarks including the degree of luminal stenosis and the presence of various vulnerable plaque characteristics(eg,intraplaque haemorrhage(IPH)on MR angiography,ulceration or low-density plaque on CT angiography)were *** presence of vulnerable plaque characteristics was compared between arteries ipsilateral to the ischaemic event and contralateral *** prevalence of perioperative/intraoperative complications,as well as recurrent ischaemic events at follow-up was *** Thirty-two patients were included in the analysis,of which 25.0%were *** arteries ipsilateral to an ischaemic event had a significantly higher prevalence of IPH when compared with contralateral arteries(80.0%vs 0.0%;p<0.001).There were no intraoperative *** patient(3.1%)developed symptoms of transient ipsilateral ischaemia 1 day following CEA which resolved without *** a median follow-up of 18.0 months(IQR 5.0-36.0),only one patient(3.1%)experienced a transient neurologic deficit with complete resolution(annualised rate of recurrent stroke after CEA of 1.5%for a total follow-up of 788 patient-months following CEA).All other patients(31/32,96.9%)were free of recurrent ischaemic *** CEA appears to be safe and well-tolerated in patients with *** studies with larger cohorts and longer follow-up intervals are needed in order to determine the role of CEA in this patient population.

关键词： patients carotid prevention

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carotid endarterectomy for treatment of carotid in-stent restenosis:longterm follow-up results and surgery experiences from one single centre

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Stroke & Vascular Neurology 2017年第3期2卷 140-146页

作者： Le-Bao Yu Wei Yan Qian Zhang Ji-Zong Zhao Yan Zhang Rong Wang Jun-Shi Shao Dong Zhang Department of Neurosurgery Beijing Tiantan HospitalCapital Medical UniversityBeijingChina China National Clinical Research Center for Neurological Diseases(NCRC-ND) BeijingChina Center of Stroke Beijing Institute for Brain DisordersBeijingChina Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease BeijingChina Department of Neurosurgery Beijing Mi Yun HospitalCapital Medical UniversityBeijingChina

Objective Few studies have reported the surgical treatment of carotid in-stent restenosis(ISR),more data and longer follow-up are *** describe the surgical treatment of ISR by standard carotid endarterectomy(CEA)with stent removal,including long-term follow-up in 10 patients from our *** Ten patients from our centre who underwent CEA with stent removal for ISR were retrospectively analysed,including nine symptomatic and one asymptomatic ISR of at least 70%with mean age 67.3,the median time between carotid artery stenting and CEA was 17 months(range,2-54 months).results Standard CEA with stent removal was performed in all 10 patients without much technical difficulty(9 male and 1 female,mean age 67.3).Two cases were performed in hybrid operation *** were a total of three complications that happened in three patients(30%)*** asymptomatic dissecting aneurysm was formed on the petrous internal carotid artery in one patient who was followed up without *** the second case,dissection occurred in the arterial wall distal to the site of the stent after stent removal revealed by intraoperative angiography,and another stent was *** patient sustained temporary hypoglossal nerve dysfunction *** third patient suffered cerebral hyperperfusion with complete recovery when *** neurological complications occurred in other seven *** follow-up of 25 months(range,11-54 months),one patient died of rectal cancer without ischaemic attack and restenosis 4 years postoperation;in one patient occurred recurrent symptomatic restenosis(90%)1 year later;all other patients remained asymptomatic and without recurrent restenosis(>50%)by follow-up carotid ultrasound or CT *** It seems that CEA with stent removal is a reasonable choice,by experienced hand,for symptomatic ISR with higher but acceptable *** indication of stent removal for asymptomatic ISR needs further observati

关键词： carotid restenosis sustained

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Effect of Plaque Composition on Biomechanical Performance of a carotid Stent: Computational Study

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Computer Modeling in Engineering & Sciences 2018年第9期116卷 455-469页

作者： Xinyang Cui Qingshuai Ren Zihao Li Kun Peng Gaoyang Li ZhaoyongGu Aike Qiao College of Life Science and Bioengineering Beijing University of TechnologyNo.100PingleyuanChaoyang DistrictBeijing100022China Institute of Mechanics Chinese Academy of ScienceNo.15BeiSiHuanWest RoadBeijing100190China Graduate School of Biomedical Engineering Tohoku UniversitySendaiMiyagiJapan

Clinical application of bare metal stents is constrained by the occurrence of instent restenosis,mainly due to the complex biomechanical environment in the *** simulation method was used to evaluate the effect of plaque composition on stent performance in a carotid *** angiography(CTA)data were used as a reference,and zero-load state of the carotid artery was used to establish a 3D stenotic artery *** plaque compositions,calcified and hypo-cellular were defined in Model 1 and Model 2,*** between the stents and arterial tissues within the stent crimping-expansion process were analyzed to explore the effects of plaque composition on the mechanical parameters of carotid *** diagram and fatigue safety factor(FSF)were analyzed to explore the effects of plaque composition on fatigue performance of a carotid stent in the stent service *** the stent crimping-expansion process,the von Mises stress in the stent and the dog-boning ratio in Model 1 were higher than that in Model *** calcified plaque prevented the stent from expanding the stenotic vessel to a pre-set ***,the risk of rupture in the calcified plaque was higher than that in the hypo-cellular *** also affected the stress/strain in the vessel wall,which was observed to be lower in Model 1 than in Model *** indicated that calcified plaque could decrease the stress-induced injury of arterial *** the stent service process,the stents used in these two models were predicted to not fail under fatigue rupture as calculated by the Goodman ***,the points closer to the fatigue limit were generally observed at the inner bend of the stent *** FSF of the stent in Model 1 was lower than that in Model *** stent operating in the presence of calcified plaques suffered high risk of *** and fatigue performance of the stent were found to be associated with plaque ***,this stud

关键词： Plaque composition biomechanical carotid stent

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The Analysis of Wall Shear Stress Modulated by Acute Exercise in the Human Common carotid Artery with an Elastic Tube Model

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Computer Modeling in Engineering & Sciences 2018年第8期116卷 127-147页

作者： Yanxia Wang Yu Wang Siqi Li Aziz ur Rehman Aziz Shutian Liu Kairong Qin Department of Engineering Mechanics State Key Laboratory of Structural Analysis for Industrial EquipmentDalian University of TechnologyNo.2Linggong RoadDalian116024China. School of Optoelectronic Engineering and Instrumentation Science Dalian University of TechnologyNo.2Linggong RoadDalian116024China. School of Biomedical Engineering Dalian University of TechnologyNo.2Linggong RoadDalian116024China.

Assessment of the magnitude and pattern of wall shear stress(WSS)in vivo is the prerequisite for studying the quantitative relationship between exercise-induced WSS and arterial endothelial *** the previous studies,the calculation of the WSS modulated by exercise training was primarily based upon the rigid tube model,which did not take non-linear effects of vessel elastic deformation into *** this study,with an elastic tube model,we estimated the effect of a bout of 30-minute acute cycling exercise on the WSS and the flow rate in the common carotid artery according to the measured inner diameter,center-line blood flow velocity,heart rates and the brachial blood pressures before and after exercise ***,the roles of exerciseinduced arterial diameter and blood flow rate in the change of WSS were also *** numerical results demonstrate that acute exercise significantly increases the magnitudes of blood flow rate and ***,the vessel elastic deformation is a non-negligible factor in the calculation of the WSS induced by exercise,which generates greater effects on the minimum WSS than the maximum ***,the contributions of exercise-induced variations in blood flow rate and diameter are almost identical in the change of the mean WSS.

关键词： Acute cycling exercise blood flow wall shear stress common carotid artery elastic tube model rigid tube model

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Association between coexisting intracranial artery and extracranial carotid artery atherosclerotic diseases and ipsilateral cerebral infarction: a Chinese Atherosclerosis Risk Evaluation (CARE- II) study

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Stroke & Vascular Neurology 2021年第4期6卷 595-602页

作者： Chunxiu Jiang Jing Zhang Jianbin Zhu Xianlong Wang Zhibo Wen Xihai Zhao Chun Yuan On behalf of CARE-II Investigators Department of Radiology Zhujiang HospitalSouthern Medical UniversityGuangzhouChina Department of Radiology Foshan Women and Children Hospital Affiliated to Southern Medical UniversityFoshanChina Center for Biomedical Imaging Research Department of Biomedical EngineeringTsinghua UniversityBeijingChina Department of Radiology University of WashingtonSeattleWashingtonUSA 不详

Background To evaluate the association between coexisting intracranial and extracranial carotid artery atherosclerotic diseases and ipsilateral acute cerebral infarct(ACI)in symptomatic patients by using magnetic resonance(MR)vessel wall *** Symptomatic patients were recruited from a cross-sectional,multicentre study of Chinese Atherosclerosis Risk Evaluation(CARE-II).All patients underwent MR imaging for extracranial carotid arterial wall,intracranial artery and *** intracranial stenosis≥50%and extracranial carotid artery mean wall thickness(MWT)≥1 mm and plaque compositions at the same side were evaluated and the ipsilateral ACI was *** association between coexisting atherosclerotic diseases and ACI was evaluated using logistic *** 351 patients were *** with ipsilateral ACI had significantly greater prevalence of coexisting intracranial stenosis≥50%and carotid MWT≥1 mm(20.5%vs 4.9%,pcarotid MWT≥1 mm(OR 5.043,95%CI 2.378 to 10.694;pcarotid MWT≥1 mm:OR 4.313,95%CI 1.937 to 9.601,pcarotid artery large burden and intraplaque components of calcification and LRNC are independently associated with ipsilateral *** registration number https://***/.Unique identifier:NCT02017756.

关键词： intracranial carotid cerebral

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carotid endarterectomies for relieving severe or moderate carotid stenosis

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Chinese Medical Journal 2004年第6期117卷 956-958页

作者：吕志前萧明第 Montagna Pietro Farhat Fadi Olivier Jegaden Department of Cardiovascular Surgery Shanghai First People's Hospital Department of Cardiovascular Surgery Lyon Cardiac Hospital

carotid artery stenosis is one of the major causes of ischemic strokes. To prevent or reduce the occurrences of ischemic strokes, carotid endarterectomies ( CEAs) were performed on 48 patients with carotid artery sten... 详细信息

关键词： carotid stenosis·endarterectomy carotid

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Association of atherosclerotic plaque features with collateral circulation status in elderly patients with chronic carotid stenosis

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Journal of Geriatric Cardiology 2020年第4期17卷 202-209页

作者： Hui-Min XU Ran HUO Rui-Jing XIN Dan-Dan YANG Ying LIU Ning LANG Xi-Hai ZHAO Tao WANG Hui-Shu YUAN Department of Radiology Peking University Third HospitalBeijingChina Department of Radiology Zhongda HospitalMedical School of Southeast UniversityNanjingChina Beijing Institute of Brain Disorders Laboratory of Brain DisordersMinistry of Science and TechnologyCollaborative Innovation Center for Brain DisordersCapital Medical UniversityBeijingChina Center for Biomedical Imaging Research Department of Biomedical EngineeringTsinghua University School of MedicineBeijingChina Department of Neurosurgery Peking University Third HospitalBeijingChina

Objective To determine the association of carotid plaque features with collateral circulation status in elderly patients with moderate to severe carotid *** Elderly patients(>60 years)with moderate to severe carotid stenosis were recruited and categorized into good and poor collateral circulation groups,and underwent magnetic resonance imaging and computed tomography *** carotid plaque features including lipid-rich necrotic core,intraplaque hemorrhage,calcification,and fibrous cap rupture(FCR)were evaluated,and maximum wall thickness,normalized wall index(NWI),and luminal stenosis were *** association between these variables and collateral circulation status was *** Of the 97 patients(78 males,mean age:69.0±6.1 years),19(19.6%)had poor *** poor collateral group had a significantly higher NWI(93.7%±5.0%vs.89.0%±7.9%,P=0.011),a greater extent of stenosis(80.0%±11.4%vs.75.3%±9.4%,P=0.036)and FCR(84.2%vs.55.1%,P=0.020)compared with good collateral *** NWI(OR=3.83,95%CI:1.36–10.82,P=0.011)and more FCR(OR=6.77,95%CI:1.35–33.85,P=0.020)were associated with poor collateral circulation after adjustment for the confounding *** combination of NWI,FCR,systolic blood pressure,and triglycerides had the highest area-under-the-curve(AUC=0.85)for detection of poor *** carotid plaque features,specifically NWI and FCR,are independently associated with poor collateral circulation,and the combination of carotid plaque features and traditional risk factors has a stronger predictive value for poor collateral circulation than plaque features alone.

关键词： Atherosclerosis carotid stenosis Collateral circulation Computed tomography angiography Magnetic resonance imaging

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Combined risk modelling approach to identify the optimal carotid revascularisation approach

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Stroke & Vascular Neurology 2021年第3期6卷 476-482,I0080-I0084页

作者： James Francis Burke Lewis B Morgenstern Nicholas H Osborne Rodney A Hayward Neurology University of Michigan Michigan MedicineAnn ArborMichiganUSA Vascular Surgery Univerity of Michigan MedicineAnn ArborMichiganUSA Internal Medicine University of Michigan Michigan MedicineAnn ArborMichiganUSA

Background carotid endarterectomy(CEA)results in fewer perioperative strokes,but more myocardial infarctions(MI)than carotid artery stenting(CAS).We explored a combined modelling approach that stratifies patients by baseline stroke and *** Baseline registry-based risk models for perioperative stroke and MI were identified via literature *** then selected treatment risk models in the carotid Revascularisation Stenting versus Endarterectomy(CREST)trial by serially adding covariates(baseline risk,treatment(CEA vs CAS),treatment-risk interaction and age-treatment interaction terms).Treatment risk models were externally validated using data from the Society for Vascular Surgery(SVS)Vascular Quality Initiative(VQI)CEA and carotid stenting registries and treatment models were recalibrated to the SVS-VQI *** net benefit was estimated by summing the predicted stroke and MI risk differences with CEA versus *** Perioperative treatment models had moderate predictiveness(c-statistic 0.69 for stroke and 0.68 for MI)and reasonable calibration across the risk spectrum for both stroke and MI within *** external validation in SVS-VQI,predictiveness was substantially reduced(c-statistic 0.61 for stroke and 0.54 for MI)and models substantially overpredicted *** patients(86.7%)were predicted to have net benefit from CEA in CREST(97.0%of symptomatic patients vs 75%of asymptomatic patients).Discussion A combined modelling approach that separates risk elements has potential to inform optimal ***,our current approach is not ready for clinical *** data support guidelines that suggest that CEA should be the preferred revascularisation modality in most patients with symptomatic carotid stenosis.

关键词： carotid Surgery optimal

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Association between cumulative exposure to different lipid parameters and risk of newly developed carotid plaque

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Stroke & Vascular Neurology 2021年第3期6卷 359-365页

作者： Jianwei Wu Yu Wang Kaijiang Kang Anxin Wang Jie Xu Xingquan Zhao Department of Neurology Beijing Tiantan HospitalCapital Medical UniversityBeijingChina China National Clinical Research Center for Neurological Diseases BeijingChina Center of Stroke Beijing Institute for Brain DisordersBeijingChina Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease BeijingChina Department of Epidemiology and Health Statistics School of Public HealthCapital Medical UniversityBeijingChina Beijing Municipal Key Laboratory of Clinical Epidemiology BeijingChina

Background and purpose Both the magnitude and cumulative exposure of atherogenic lipoproteins have an impact on the atherosclerosis risk,and the exploration focus has shifted from one single lipoprotein assessment to the cumulative exposure of *** aim to investigate the relationship between cumulative exposure to different lipid parameters and the risk of newly developed carotid plaque in this *** In the Asymptomatic Polyvascular Abnormalities Community study,2947 participants were included with follow-up every 2 years from 2006 to *** parameters including total cholesterol(TC),triglycerides(TGs),low-density lipoprotein cholesterol(LDLC),high-density lipoprotein cholesterol(HDLC)and non-HDLC were *** exposure was calculated by adding the weighted sum of the difference between the measured value and the cut-off value of each *** developed carotid plaques were identified by carotid ultrasound performed at the third and fourth *** In the univariate analysis,non-HDLC burden had the highest ORs among the five lipid parameters for newly developed carotid plaque in each quartile,as 1.0(reference),1.35(1.09-1.67),1.68(1.36-2.08)and 2.74(2.22-3.38)from the lowest to the highest *** the multivariate analysis and sensitivity analysis,we obtained similar *** TC burden,TG burden,LDLC burden and non-HDLC burden are all independent risk factors for newly developed carotid plaque,especially for the vulnerable *** lipid parameters,non-HDLC burden is an optimal ***,the predictive value remained significant for participants under the age of 65 years old or free of hypertension,diabetes mellitus and hyperlipidaemia.

关键词： carotid Lipid cholesterol

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Comparison of carotid endarterectomy and repeated carotid angioplasty and stenting for in-stent restenosis(CERCAS trial):a randomised study

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Stroke & Vascular Neurology 2023年第5期8卷 399-404页

作者： Tomáš Hrbáč Jiří Fiedler Václav Procházka Tomáš Jonszta Martin Roubec David Pakizer Daniel Václavík David Netuka Tomáš Heryán David Školoudík Department of Neuroscience Faculty of MedicineUniverzity of OstravaOstravaCzech Republic Department of Neurosurgery University Hospital OstravaOstravaCzech Republic Department of Neurosurgery ČeskéBudějovice HospitalČeskéBudějoviceCzech Republic Department of Radiology University Hospital OstravaOstravaCzech Republic Department of Neurology University Hospital OstravaOstravaCzech Republic Center for Health Research Faculty of MedicineUniversity of OstravaOstravaCzech Republic Department of Neurology Vítkovice HospitalOstravaCzech Republic Department of Neurosurgery Military University Hospital PraguePrahaCzech Republic

Background and aim In-stent restenosis(ISR)belongs to an infrequent but potentially serious complication after carotid angioplasty and stenting in patients with severe carotid *** of these patients might be contraindicated to repeat percutaneous transluminal angioplasty with or without stenting(rePTA/S).The purpose of the study is to compare the safety and effectiveness of carotid endarterectomy with stent removal(CEASR)and rePTA/S in patients with carotid *** Consecutive patients with carotid ISR(≥80%)were randomly allocated to the CEASR or rePTA/S *** incidence of restenosis after intervention,stroke,transient ischaemic attack myocardial infarction and death 30 days and 1 year after intervention and restenosis 1 year after intervention between patients in CEASR and rePTA/S groups were statistically *** A total of 31 patients were included in the study;14 patients(9 males;mean age 66.3±6.6 years)were allocated to CEASR and 17 patients(10 males;mean age 68.8±5.6 years)to the rePTA/S *** implanted stent in carotid restenosis was successfully removed in all patients in the CEASR *** clinical vascular event was recorded periproceduraly,30 days and 1 year after intervention in both *** one patient in the CEASR group had asymptomatic occlusion of the intervened carotid artery within 30 days and one patient died in the rePTA/S group within 1 year after *** after intervention was significantly greater in the rePTA/S group(mean 20.9%)than in the CEASR group(mean 0%,p=0.04),but all stenoses werecarotid ISR and might be considered as a treatment option.

关键词： carotid restenosis angioplasty

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