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Peter A Ringleb - One of the best experts on this subject based on the ideXlab platform.

  • asymptomatic extracranial vertebral Artery disease in patients with internal Carotid Artery Stenosis
    Neurosurgery, 2017
    Co-Authors: Adnan I Qureshi, Saqib A Chaudhry, Henning Eckstein, Olav Jansen, Peter A Ringleb
    Abstract:

    BACKGROUND Extracranial vertebral Artery disease is seen in patients with internal Carotid Artery Stenosis, although the clinical significance is not well understood. OBJECTIVE To determine the prevalence and natural history of extracranial vertebral Artery disease in patients with recently symptomatic internal Carotid Artery Stenosis. METHODS We analyzed data collected for patients with recently symptomatic internal Carotid Artery Stenosis in the Stent-Protected Angioplasty vs Carotid Endarterectomy trial. We used Cox proportional hazards analysis to compare the relative risk of various endpoints (any stroke, ipsilateral stroke, and death) between the 3 categories of extracranial vertebral Artery disease (normal/hypoplastic, moderate/severe Stenosis, occlusion) adjusting for age, gender, severity of internal Carotid Artery Stenosis at baseline (<70% and ≥70%), allocated procedure (Carotid angioplasty and stent placement or Carotid endarterectomy) and hypertension. RESULTS Moderate to severe Stenosis and occlusion of 1 of both extracranial vertebral arteries were diagnosed in 152 (12.9%) and 57 (4.8%) of 1181 subjects, respectively. Comparing subjects with normal or hypoplastic vertebral Artery, there was nonsignificant 30%, 40%, and 50% higher risk of any stroke (hazard ratio [HR] 1.3, 95% confidence interval [CI] 0.7-2.3), ipsilateral stroke (HR 1.4, 95% CI 0.7-2.5), and death (HR 1.5, 95% CI 0.7-3.1) among subjects with moderate to severe vertebral Artery Stenosis after adjusting for potential confounders. CONCLUSIONS There may be an increased risk of stroke and death in patients with symptomatic internal Carotid Artery Stenosis with concurrent asymptomatic extracranial vertebral Artery Stenosis.

  • prevalence risk factors and clinical significance of asymptomatic extracranial vertebral Artery disease in patients with symptomatic internal Carotid Artery Stenosis analysis of stent protected angioplasty versus Carotid endarterectomy space trial s4
    Neurology, 2016
    Co-Authors: Adnan I Qureshi, Saqib A Chaudhry, Olav Jansen, H H Eckstein, Peter A Ringleb
    Abstract:

    Background: Extracranial vertebral Artery disease is seen in patients with internal Carotid Artery Stenosis although the clinical significance not well understood. Methods: We analyzed data that was collected as part of the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) trial which recruited patients with recently symptomatic internal Carotid Artery Stenosis. We used Cox proportional hazards analysis to compare the relative risk of various endpoints (any stroke, ipsilateral stroke, and death) between the three categories of extracranial vertebral Artery disease (normal/hypoplastic, moderate/severe Stenosis, and occlusion) adjusting for age, gender, severity of internal Carotid Artery Stenosis at baseline (<70[percnt] and ≥70[percnt]), allocated procedure (Carotid angioplasty and stent placement or Carotid endarterectomy) and hypertension. Results: Moderate to severe Stenosis and occlusion of one of both extracranial vertebral arteries were diagnosed in 152 (12.9[percnt]) and 57 (4.8[percnt]) of 1181 subjects, respectively. Compared with subjects with normal or hypoplastic vertebral Artery, there was a non-significant 30[percnt], 40[percnt] and 50[percnt] higher risk of any stroke (relative risk [RR] 1.3, 95[percnt] confidence interval [CI] 0.7-2.3), ipsilateral stroke (RR 1.4, 95[percnt] CI 0.7-2.5), and death (RR 1.5, 95[percnt] CI 0.7-3.1) among subjects with moderate to severe vertebral Artery Stenosis after adjusting for potential confounders. The estimated 1 year stroke free survival rates (standard error) were 88[percnt] (2.6[percnt]) and 92.5[percnt] (0.8[percnt]) for subjects with moderate to severe vertebral Artery Stenosis and those with normal or hypoplastic vertebral Artery, respectively. Conclusions: There appears to be an increased risk of stroke and death in patients with symptomatic internal Carotid Artery Stenosis with concurrent asymptomatic extracranial vertebral Artery Stenosis. Key words: Extracranial vertebral Artery; Carotid Stenosis; vertebral Artery Stenosis; vertebral Artery occlusion; stroke; death. Disclosure: Dr. Qureshi has nothing to disclose. Dr. Chaudhry has nothing to disclose. Dr. Jansen has nothing to disclose. Dr. Eckstein has nothing to disclose. Dr. Ringleb has nothing to disclose.

  • abstract tp127 prevalence and clinical significance of asymptomatic extracranial vertebral Artery disease in patients with symptomatic internal Carotid Artery Stenosis analysis of stent protected angioplasty versus Carotid endarterectomy space trial
    Stroke, 2016
    Co-Authors: Adnan I Qureshi, Saqib A Chaudhry, Peter A Ringleb
    Abstract:

    Background: Extracranial vertebral Artery disease is seen in patients with internal Carotid Artery Stenosis although the clinical significance not well understood. Methods: We analyzed data that was collected as part of the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) trial which recruited patients with recently symptomatic internal Carotid Artery Stenosis. We used Cox proportional hazards analysis to compare the relative risk of various endpoints between the three categories of extracranial vertebral Artery disease (normal/hypoplastic, moderate/severe Stenosis, and occlusion). The multivariate analyses were adjusted for age, gender, basic demographics and severity of Carotid Stenosis. Results: Of the 1181 subjects who had extracranial vertebral Artery ultrasound evaluation, moderate to severe Stenosis and occlusion of one of both extracranial vertebral arteries was diagnosed in 152(12.9%) and 57(4.8%) subjects, respectively. During the mean follow up period (±SD) of 22.1±7.1 months 102(8.6%) and 60(5.1%) experienced a stroke or died, respectively. Compared with subjects with normal or hypoplastic vertebral Artery, there was a non-significant 30% higher risk of any stroke among subjects with moderate to severe vertebral Artery Stenosis (relative risk [RR]1.3, 95% confidence interval [CI]0.7-2.3) after adjusting for potential confounders. There was a 40% and 50% higher risk of ipsilateral stroke (RR 1.4, 95% CI0.7-2.5) and death (RR 1.5, 95% CI 0.7-3.1) among subjects with moderate to severe vertebral Artery Stenosis after adjusting for potential confounders. In Kaplan Meir analysis, the estimated 1 and 2 year stroke free survival for subjects with moderate to severe vertebral Artery Stenosis was 88% (standard error [SE]2.6%). In comparison, the estimated 1 and 2 year stroke free survival for subjects with normal or hypoplastic vertebral Artery was 92.5%(SE0.8%)and 91.6%(SE0.9), respectively. Conclusions: There appears to be an increased risk of stroke and death in patients with symptomatic internal Carotid Artery Stenosis with concurrent asymptomatic extracranial vertebral Artery Stenosis.

  • safety of endovascular treatment of Carotid Artery Stenosis compared with surgical treatment a meta analysis
    Journal of Vascular Surgery, 2008
    Co-Authors: Peter A Ringleb, H H Eckstein, Gilles Chatellier, Werner Hacke, Jeanpierre Favre, Jeanmichel Bartoli, Jeanlouis Mas
    Abstract:

    BACKGROUND AND PURPOSE: Since publication of previous meta-analyses comparing endovascular and surgical treatment of patients with Carotid Artery Stenosis, two further large-scale trials have been conducted, almost doubling the number of patients available for analysis. Therefore, it is justified to update these meta-analyses. METHODS: Relevant trials were identified by a search of the literature using an electronic database. Trials with a nonrandomized patient allocation were not included. We focused on events within 30 days after intervention and made two sets of analysis: one with all trials and one with large trials exclusively including symptomatic patients. RESULTS: Only Endarterectomie Versus Angioplastie chez les patients ayant une Stenose Carotide Symptomatique Serree (EVA3S) and Stent-Supported Percutaneous Angioplasty of the Carotid Artery versus Endarterectomy (SPACE) were identified to be included in the updated meta-analysis. In total, 2985 patients were included in eight trials of which 89% were symptomatic. In contrast to previous analyses, this meta-analysis found a significant difference between the odds ratios of any stroke or death within 30 days after treatment with a disadvantage of endovascular treatment when analysing all trials (odds ratio [OR], 1.38; 95% confidence interval [CI] 1.04-1.83; P = .024). Significant heterogeneity was found for this analysis (P = .03). The increase of the odds of suffering from disabling stroke or death in the endovascular compared with the surgical group was not significant in the analysis of all trials (OR, 1.37; 95% CI, 0.92-2.04; P = .12); no heterogeneity was found for this analysis (P = .27). In the analysis of the large trials with symptomatic patients, the OR for the endpoint any stroke or death was 1.29 (95% CI 0.94-1.76; P = .11); with a hint for heterogeneity (P = .10). For the endpoint disabling stroke or death, the OR was 1.33 (95% CI 0.89-1.93; P =.17) without any heterogeneity (P = .58). CONCLUSION: The expressiveness of this meta-analysis is limited by the heterogeneity of some tests. The main result is that surgical treatment still remains the gold standard for treatment of patients with symptomatic Carotid Artery Stenosis, who do not have an increased surgical risk. Carotid Artery stenting is neither safer than nor as safe as Carotid endarterectomy in large clinical trials when short-term stroke and death rates are taken into account. Further recruitment into ongoing randomized trials is strongly recommended.

Adnan I Qureshi - One of the best experts on this subject based on the ideXlab platform.

  • asymptomatic extracranial vertebral Artery disease in patients with internal Carotid Artery Stenosis
    Neurosurgery, 2017
    Co-Authors: Adnan I Qureshi, Saqib A Chaudhry, Henning Eckstein, Olav Jansen, Peter A Ringleb
    Abstract:

    BACKGROUND Extracranial vertebral Artery disease is seen in patients with internal Carotid Artery Stenosis, although the clinical significance is not well understood. OBJECTIVE To determine the prevalence and natural history of extracranial vertebral Artery disease in patients with recently symptomatic internal Carotid Artery Stenosis. METHODS We analyzed data collected for patients with recently symptomatic internal Carotid Artery Stenosis in the Stent-Protected Angioplasty vs Carotid Endarterectomy trial. We used Cox proportional hazards analysis to compare the relative risk of various endpoints (any stroke, ipsilateral stroke, and death) between the 3 categories of extracranial vertebral Artery disease (normal/hypoplastic, moderate/severe Stenosis, occlusion) adjusting for age, gender, severity of internal Carotid Artery Stenosis at baseline (<70% and ≥70%), allocated procedure (Carotid angioplasty and stent placement or Carotid endarterectomy) and hypertension. RESULTS Moderate to severe Stenosis and occlusion of 1 of both extracranial vertebral arteries were diagnosed in 152 (12.9%) and 57 (4.8%) of 1181 subjects, respectively. Comparing subjects with normal or hypoplastic vertebral Artery, there was nonsignificant 30%, 40%, and 50% higher risk of any stroke (hazard ratio [HR] 1.3, 95% confidence interval [CI] 0.7-2.3), ipsilateral stroke (HR 1.4, 95% CI 0.7-2.5), and death (HR 1.5, 95% CI 0.7-3.1) among subjects with moderate to severe vertebral Artery Stenosis after adjusting for potential confounders. CONCLUSIONS There may be an increased risk of stroke and death in patients with symptomatic internal Carotid Artery Stenosis with concurrent asymptomatic extracranial vertebral Artery Stenosis.

  • prevalence risk factors and clinical significance of asymptomatic extracranial vertebral Artery disease in patients with symptomatic internal Carotid Artery Stenosis analysis of stent protected angioplasty versus Carotid endarterectomy space trial s4
    Neurology, 2016
    Co-Authors: Adnan I Qureshi, Saqib A Chaudhry, Olav Jansen, H H Eckstein, Peter A Ringleb
    Abstract:

    Background: Extracranial vertebral Artery disease is seen in patients with internal Carotid Artery Stenosis although the clinical significance not well understood. Methods: We analyzed data that was collected as part of the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) trial which recruited patients with recently symptomatic internal Carotid Artery Stenosis. We used Cox proportional hazards analysis to compare the relative risk of various endpoints (any stroke, ipsilateral stroke, and death) between the three categories of extracranial vertebral Artery disease (normal/hypoplastic, moderate/severe Stenosis, and occlusion) adjusting for age, gender, severity of internal Carotid Artery Stenosis at baseline (<70[percnt] and ≥70[percnt]), allocated procedure (Carotid angioplasty and stent placement or Carotid endarterectomy) and hypertension. Results: Moderate to severe Stenosis and occlusion of one of both extracranial vertebral arteries were diagnosed in 152 (12.9[percnt]) and 57 (4.8[percnt]) of 1181 subjects, respectively. Compared with subjects with normal or hypoplastic vertebral Artery, there was a non-significant 30[percnt], 40[percnt] and 50[percnt] higher risk of any stroke (relative risk [RR] 1.3, 95[percnt] confidence interval [CI] 0.7-2.3), ipsilateral stroke (RR 1.4, 95[percnt] CI 0.7-2.5), and death (RR 1.5, 95[percnt] CI 0.7-3.1) among subjects with moderate to severe vertebral Artery Stenosis after adjusting for potential confounders. The estimated 1 year stroke free survival rates (standard error) were 88[percnt] (2.6[percnt]) and 92.5[percnt] (0.8[percnt]) for subjects with moderate to severe vertebral Artery Stenosis and those with normal or hypoplastic vertebral Artery, respectively. Conclusions: There appears to be an increased risk of stroke and death in patients with symptomatic internal Carotid Artery Stenosis with concurrent asymptomatic extracranial vertebral Artery Stenosis. Key words: Extracranial vertebral Artery; Carotid Stenosis; vertebral Artery Stenosis; vertebral Artery occlusion; stroke; death. Disclosure: Dr. Qureshi has nothing to disclose. Dr. Chaudhry has nothing to disclose. Dr. Jansen has nothing to disclose. Dr. Eckstein has nothing to disclose. Dr. Ringleb has nothing to disclose.

  • abstract tp127 prevalence and clinical significance of asymptomatic extracranial vertebral Artery disease in patients with symptomatic internal Carotid Artery Stenosis analysis of stent protected angioplasty versus Carotid endarterectomy space trial
    Stroke, 2016
    Co-Authors: Adnan I Qureshi, Saqib A Chaudhry, Peter A Ringleb
    Abstract:

    Background: Extracranial vertebral Artery disease is seen in patients with internal Carotid Artery Stenosis although the clinical significance not well understood. Methods: We analyzed data that was collected as part of the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) trial which recruited patients with recently symptomatic internal Carotid Artery Stenosis. We used Cox proportional hazards analysis to compare the relative risk of various endpoints between the three categories of extracranial vertebral Artery disease (normal/hypoplastic, moderate/severe Stenosis, and occlusion). The multivariate analyses were adjusted for age, gender, basic demographics and severity of Carotid Stenosis. Results: Of the 1181 subjects who had extracranial vertebral Artery ultrasound evaluation, moderate to severe Stenosis and occlusion of one of both extracranial vertebral arteries was diagnosed in 152(12.9%) and 57(4.8%) subjects, respectively. During the mean follow up period (±SD) of 22.1±7.1 months 102(8.6%) and 60(5.1%) experienced a stroke or died, respectively. Compared with subjects with normal or hypoplastic vertebral Artery, there was a non-significant 30% higher risk of any stroke among subjects with moderate to severe vertebral Artery Stenosis (relative risk [RR]1.3, 95% confidence interval [CI]0.7-2.3) after adjusting for potential confounders. There was a 40% and 50% higher risk of ipsilateral stroke (RR 1.4, 95% CI0.7-2.5) and death (RR 1.5, 95% CI 0.7-3.1) among subjects with moderate to severe vertebral Artery Stenosis after adjusting for potential confounders. In Kaplan Meir analysis, the estimated 1 and 2 year stroke free survival for subjects with moderate to severe vertebral Artery Stenosis was 88% (standard error [SE]2.6%). In comparison, the estimated 1 and 2 year stroke free survival for subjects with normal or hypoplastic vertebral Artery was 92.5%(SE0.8%)and 91.6%(SE0.9), respectively. Conclusions: There appears to be an increased risk of stroke and death in patients with symptomatic internal Carotid Artery Stenosis with concurrent asymptomatic extracranial vertebral Artery Stenosis.

Saqib A Chaudhry - One of the best experts on this subject based on the ideXlab platform.

  • asymptomatic extracranial vertebral Artery disease in patients with internal Carotid Artery Stenosis
    Neurosurgery, 2017
    Co-Authors: Adnan I Qureshi, Saqib A Chaudhry, Henning Eckstein, Olav Jansen, Peter A Ringleb
    Abstract:

    BACKGROUND Extracranial vertebral Artery disease is seen in patients with internal Carotid Artery Stenosis, although the clinical significance is not well understood. OBJECTIVE To determine the prevalence and natural history of extracranial vertebral Artery disease in patients with recently symptomatic internal Carotid Artery Stenosis. METHODS We analyzed data collected for patients with recently symptomatic internal Carotid Artery Stenosis in the Stent-Protected Angioplasty vs Carotid Endarterectomy trial. We used Cox proportional hazards analysis to compare the relative risk of various endpoints (any stroke, ipsilateral stroke, and death) between the 3 categories of extracranial vertebral Artery disease (normal/hypoplastic, moderate/severe Stenosis, occlusion) adjusting for age, gender, severity of internal Carotid Artery Stenosis at baseline (<70% and ≥70%), allocated procedure (Carotid angioplasty and stent placement or Carotid endarterectomy) and hypertension. RESULTS Moderate to severe Stenosis and occlusion of 1 of both extracranial vertebral arteries were diagnosed in 152 (12.9%) and 57 (4.8%) of 1181 subjects, respectively. Comparing subjects with normal or hypoplastic vertebral Artery, there was nonsignificant 30%, 40%, and 50% higher risk of any stroke (hazard ratio [HR] 1.3, 95% confidence interval [CI] 0.7-2.3), ipsilateral stroke (HR 1.4, 95% CI 0.7-2.5), and death (HR 1.5, 95% CI 0.7-3.1) among subjects with moderate to severe vertebral Artery Stenosis after adjusting for potential confounders. CONCLUSIONS There may be an increased risk of stroke and death in patients with symptomatic internal Carotid Artery Stenosis with concurrent asymptomatic extracranial vertebral Artery Stenosis.

  • prevalence risk factors and clinical significance of asymptomatic extracranial vertebral Artery disease in patients with symptomatic internal Carotid Artery Stenosis analysis of stent protected angioplasty versus Carotid endarterectomy space trial s4
    Neurology, 2016
    Co-Authors: Adnan I Qureshi, Saqib A Chaudhry, Olav Jansen, H H Eckstein, Peter A Ringleb
    Abstract:

    Background: Extracranial vertebral Artery disease is seen in patients with internal Carotid Artery Stenosis although the clinical significance not well understood. Methods: We analyzed data that was collected as part of the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) trial which recruited patients with recently symptomatic internal Carotid Artery Stenosis. We used Cox proportional hazards analysis to compare the relative risk of various endpoints (any stroke, ipsilateral stroke, and death) between the three categories of extracranial vertebral Artery disease (normal/hypoplastic, moderate/severe Stenosis, and occlusion) adjusting for age, gender, severity of internal Carotid Artery Stenosis at baseline (<70[percnt] and ≥70[percnt]), allocated procedure (Carotid angioplasty and stent placement or Carotid endarterectomy) and hypertension. Results: Moderate to severe Stenosis and occlusion of one of both extracranial vertebral arteries were diagnosed in 152 (12.9[percnt]) and 57 (4.8[percnt]) of 1181 subjects, respectively. Compared with subjects with normal or hypoplastic vertebral Artery, there was a non-significant 30[percnt], 40[percnt] and 50[percnt] higher risk of any stroke (relative risk [RR] 1.3, 95[percnt] confidence interval [CI] 0.7-2.3), ipsilateral stroke (RR 1.4, 95[percnt] CI 0.7-2.5), and death (RR 1.5, 95[percnt] CI 0.7-3.1) among subjects with moderate to severe vertebral Artery Stenosis after adjusting for potential confounders. The estimated 1 year stroke free survival rates (standard error) were 88[percnt] (2.6[percnt]) and 92.5[percnt] (0.8[percnt]) for subjects with moderate to severe vertebral Artery Stenosis and those with normal or hypoplastic vertebral Artery, respectively. Conclusions: There appears to be an increased risk of stroke and death in patients with symptomatic internal Carotid Artery Stenosis with concurrent asymptomatic extracranial vertebral Artery Stenosis. Key words: Extracranial vertebral Artery; Carotid Stenosis; vertebral Artery Stenosis; vertebral Artery occlusion; stroke; death. Disclosure: Dr. Qureshi has nothing to disclose. Dr. Chaudhry has nothing to disclose. Dr. Jansen has nothing to disclose. Dr. Eckstein has nothing to disclose. Dr. Ringleb has nothing to disclose.

  • abstract tp127 prevalence and clinical significance of asymptomatic extracranial vertebral Artery disease in patients with symptomatic internal Carotid Artery Stenosis analysis of stent protected angioplasty versus Carotid endarterectomy space trial
    Stroke, 2016
    Co-Authors: Adnan I Qureshi, Saqib A Chaudhry, Peter A Ringleb
    Abstract:

    Background: Extracranial vertebral Artery disease is seen in patients with internal Carotid Artery Stenosis although the clinical significance not well understood. Methods: We analyzed data that was collected as part of the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) trial which recruited patients with recently symptomatic internal Carotid Artery Stenosis. We used Cox proportional hazards analysis to compare the relative risk of various endpoints between the three categories of extracranial vertebral Artery disease (normal/hypoplastic, moderate/severe Stenosis, and occlusion). The multivariate analyses were adjusted for age, gender, basic demographics and severity of Carotid Stenosis. Results: Of the 1181 subjects who had extracranial vertebral Artery ultrasound evaluation, moderate to severe Stenosis and occlusion of one of both extracranial vertebral arteries was diagnosed in 152(12.9%) and 57(4.8%) subjects, respectively. During the mean follow up period (±SD) of 22.1±7.1 months 102(8.6%) and 60(5.1%) experienced a stroke or died, respectively. Compared with subjects with normal or hypoplastic vertebral Artery, there was a non-significant 30% higher risk of any stroke among subjects with moderate to severe vertebral Artery Stenosis (relative risk [RR]1.3, 95% confidence interval [CI]0.7-2.3) after adjusting for potential confounders. There was a 40% and 50% higher risk of ipsilateral stroke (RR 1.4, 95% CI0.7-2.5) and death (RR 1.5, 95% CI 0.7-3.1) among subjects with moderate to severe vertebral Artery Stenosis after adjusting for potential confounders. In Kaplan Meir analysis, the estimated 1 and 2 year stroke free survival for subjects with moderate to severe vertebral Artery Stenosis was 88% (standard error [SE]2.6%). In comparison, the estimated 1 and 2 year stroke free survival for subjects with normal or hypoplastic vertebral Artery was 92.5%(SE0.8%)and 91.6%(SE0.9), respectively. Conclusions: There appears to be an increased risk of stroke and death in patients with symptomatic internal Carotid Artery Stenosis with concurrent asymptomatic extracranial vertebral Artery Stenosis.

Michiel L Bots - One of the best experts on this subject based on the ideXlab platform.

  • prevalence of asymptomatic Carotid Artery Stenosis in the general population an individual participant data meta analysis
    Stroke, 2010
    Co-Authors: Marjolein De Weerd, Jacoba P Greving, Bo Hedblad, Matthias W Lorenz, Ellisiv B Mathiesen, Daniel H Oleary, Maria Rosvall, Matthias Sitzer, Erik Buskens, Michiel L Bots
    Abstract:

    Background and Purpose—Because of a low prevalence of severe Carotid Stenosis in the general population, screening for presence of asymptomatic Carotid Artery Stenosis (ACAS) is not warranted. Possibly, for certain subgroups, screening is worthwhile. The present study aims to develop prediction rules for the presence of ACAS (>50% and >70%). Methods—Individual participant data from 4 population-based cohort studies (Malmo Diet and Cancer Study, Tromso Study, Carotid Atherosclerosis Progression Study, and Cardiovascular Health Study; totaling 23 706 participants) were pooled. Multivariable logistic regression was performed to determine which variables predict presence of ACAS (>50% and >70%). Calibration and discrimination of the models were assessed, and bootstrapping was used to correct for overfitting. Results—Age, sex, history of vascular disease, systolic and diastolic blood pressure, total cholesterol/high-density lipoprotein ratio, diabetes mellitus, and current smoking were predictors of Stenosis (...

  • prevalence of asymptomatic Carotid Artery Stenosis in the general population an individual participant data meta analysis
    Stroke, 2010
    Co-Authors: Marjolein De Weerd, Jacoba P Greving, Bo Hedblad, Matthias W Lorenz, Ellisiv B Mathiesen, Daniel H Oleary, Maria Rosvall, Matthias Sitzer, Erik Buskens, Michiel L Bots
    Abstract:

    Background and Purpose—Because of a low prevalence of severe Carotid Stenosis in the general population, screening for presence of asymptomatic Carotid Artery Stenosis (ACAS) is not warranted. Poss...

  • prevalence of asymptomatic Carotid Artery Stenosis according to age and sex systematic review and metaregression analysis
    Stroke, 2009
    Co-Authors: Marjolein De Weerd, Jacoba P Greving, Erik Buskens, Anne W F De Jong, Michiel L Bots
    Abstract:

    Background and Purpose— In the discussion on the value of population-wide screening for asymptomatic Carotid Artery Stenosis (ACAS), reliable prevalence estimates are crucial. We set out to provide reliable age- and sex-specific prevalence estimates of ACAS through a systematic literature review and meta-regression analysis. Methods— We searched PubMed and EmBase until December 2007 for studies that reported the prevalence of ACAS in a population free of symptomatic Carotid Artery disease. Data were extracted with use of a standardized form on participants’ characteristics, assessment method, study quality, and prevalence estimates for moderate (≥50% Stenosis) and severe (≥70% Stenosis) ACAS. Metaregression was used to investigate sources of heterogeneity. Results— Forty studies fulfilled the inclusion criteria. There was considerable variation among studies with respect to demographics, methods of grading Stenosis, and Stenosis cutoff point used. The pooled prevalence of moderate Stenosis was 4.2% (95% C...

Giuseppe Lanzino - One of the best experts on this subject based on the ideXlab platform.

  • management of Carotid Artery Stenosis in patients with coexistent unruptured intracranial aneurysms
    Journal of Neurosurgery, 2020
    Co-Authors: Tiziano Tallarita, Fredric B Meyer, Thomas J Sorenson, Lorenzo Rinaldo, Gustavo S Oderich, Thomas C Bower, Giuseppe Lanzino
    Abstract:

    OBJECTIVE: Concomitant unruptured intracranial aneurysms (UIAs) are present in patients with Carotid Artery Stenosis not infrequently and result in unique management challenges. Thus, we investigated the risk of rupture of an aneurysm after revascularization of a Carotid Artery in a contemporary consecutive series of patients seen at our institution. METHODS: Data from patients who underwent a Carotid revascularization in the presence of at least one concomitant UIA at our institution from 1991 to 2018 were retrospectively reviewed. Patients were evaluated for the incidence of aneurysm rupture within 30 days (early period) and after 30 days (late period) of Carotid revascularization, as well as for the incidence of periprocedural complications from the treatment of Carotid Stenosis and/or UIA. RESULTS: Our study included 53 patients with 63 concomitant UIAs. There was no rupture within 30 days of Carotid revascularization. The overall risk of rupture was 0.87% per patient-year. Treatment (coiling or clipping) of a concomitant UIA, if pursued, could be performed successfully after Carotid revascularization. CONCLUSIONS: Carotid Artery revascularization in the setting of a concomitant UIA can be performed safely without an increased 30-day or late-term risk of rupture. If indicated, treatment of the UIA can take place after the patient recovers from the Carotid procedure.

  • racial and insurance based disparities in the treatment of Carotid Artery Stenosis a study of the nationwide inpatient sample
    Journal of NeuroInterventional Surgery, 2015
    Co-Authors: Waleed Brinjikji, Giuseppe Lanzino, Abdulrahman M Elsayed, David F Kallmes, Harry J Cloft
    Abstract:

    Background and purpose Minorities and uninsured/underinsured patients have poorer access to healthcare system resources, especially preventative treatments. We sought to determine whether racial and insurance based disparities existed in the treatment of Carotid Artery Stenosis. Methods Using the Nationwide Inpatient Sample, hospitalizations for Carotid Artery stenting and Carotid endarterectomy for symptomatic and asymptomatic Carotid Artery Stenosis from 2005 to 2011 were identified. We calculated χ 2 tests, and bivariate and multivariable logistic regression models were fit to assess differences in the characteristics of patients receiving Carotid revascularization for asymptomatic compared with symptomatic Carotid Artery Stenosis. Demographic characteristics studied included race/ethnicity (white, black, Hispanic, Asian/Pacific Islander) and primary payer status (Medicare, Medicaid, private insurance, self-pay and no charge). Results Between 2005 and 2011, 890 680 patients underwent Carotid revascularization for the treatment of Carotid Artery Stenosis (92.1% asymptomatic and 7.9% symptomatic). Multivariate logistic regression analysis demonstrated that Medicaid (OR=0.87, 95% CI 0.83 to 0.92, p Conclusions Minorities and self-pay/Medicaid patients were less likely to receive Carotid revascularization when asymptomatic—rather they were more likely to have treatment only after symptoms had developed. These findings suggest possible disparities in the degree of morbidity related to Carotid Artery Stenosis, the likelihood of early detection, and/or the likelihood of treatment conditional on indication.

  • internal Carotid Artery Stenosis natural history and management
    Seminars in Neurology, 2010
    Co-Authors: Giuseppe Lanzino, Tiziano Tallarita, Alejandro A Rabinstein
    Abstract:

    : Extracranial internal Carotid Artery Stenosis is an important cause of ipsilateral stroke. The natural history of the disease is related to the presence or absence of ipsilateral hemispheric symptoms and the severity of Stenosis. Doppler ultrasound is commonly used as a screening test, with more advanced noninvasive imaging studies such as computerized tomography angiography (CTA) and magnetic resonance angiography (MRA) utilized as confirmatory tests if invasive treatment is contemplated. With less-invasive imaging techniques, traditional catheter angiography is rarely indicated for the diagnosis of Carotid Stenosis. Medical therapy remains the mainstay of treatment in patients with asymptomatic Stenosis. Invasive treatment of asymptomatic internal Carotid Artery Stenosis is indicated in a selected group of patients with severe Stenosis and life expectancy exceeding 5 years. Invasive treatment is indicated for symptomatic patients with Stenosis greater than 70% and in selected patients with recent symptoms and moderate (50% to 69%) Stenosis. The risk of ipsilateral stroke is highest in the first few weeks following a presenting symptomatic event. Therefore, when indicated, invasive treatment of symptomatic disease should be considered soon after presenting symptoms to maximize the benefit of the procedure. Carotid endarterectomy (CEA) remains the gold standard for invasive treatment of internal Carotid Artery disease (symptomatic and asymptomatic). However, based on recent evidence, Carotid angioplasty and stenting (CAS) is a valid alternative to CEA in an increasing percentage of patients in need of invasive treatment. Regardless of treatment modality, proper patient selection for invasive treatment remains the single most important factor to insure proper use of available technology.

  • treatment of Carotid Artery Stenosis medical therapy surgery or stenting
    Mayo Clinic Proceedings, 2009
    Co-Authors: Giuseppe Lanzino, Alejandro A Rabinstein, Robert D Brown
    Abstract:

    With the aging of the general population and the availability of noninvasive imaging studies, Carotid Artery Stenosis is a disease commonly seen in general medical practice. Differentiation between symptomatic and asymptomatic disease is critical to the treatment course because the natural history differs markedly between them. Antiplatelet therapy and aggressive treatment of vascular risk factors are the mainstays of medical therapy. Class I evidence shows that Carotid endarterectomy (CEA) is effective in preventing ipsilateral ischemic events in patients with symptomatic moderate- and high-grade Stenosis. The procedure is also effective in selected patients with asymptomatic Stenosis, but the benefit is marginal. In the past decade, Carotid angioplasty and stenting has been proposed as a valid alternative to CEA. Currently, it is unclear whether Carotid angioplasty and stenting is as safe as CEA in patients with Carotid Artery Stenosis who need invasive treatment. Large clinical trials are under way to answer this question.

  • percutaneous transluminal angioplasty and stent placement for recurrent Carotid Artery Stenosis
    Journal of Neurosurgery, 1999
    Co-Authors: Giuseppe Lanzino, Robert A Mericle, Demetrius K Lopes, Ajay K Wakhloo, Lee R Guterman, L N Hopkins
    Abstract:

    Object. Treatment consisting of percutaneous transluminal angioplasty (PTA) and stent placement has recently been proposed as an alternative to surgical reexploration in patients with recurrent Carotid Artery Stenosis following endarterectomy. The authors retrospectively reviewed their experience after performing 25 procedures in 21 patients to assess the safety and efficacy of PTA with or without stent placement for Carotid Artery reStenosis. Methods. The mean interval between endarterectomy and the endovascular procedures was 57 months (range 8–220 months). Seven arteries in five patients were treated by PTA alone (including bilateral procedures in one patient and repeated angioplasty in the same vessel in another). Early suboptimum results and recurrent Stenosis in some of these initial cases prompted the authors to combine PTA with stent placement in the treatment of 18 arteries over the past 3 years. No major periprocedural deficits (neurological or cardiac complications) or death occurred. There was...