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A R Naylor - One of the best experts on this subject based on the ideXlab platform.
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clinical and imaging features associated with an increased risk of late stroke in patients with asymptomatic Carotid Disease
European Journal of Vascular and Endovascular Surgery, 2014Co-Authors: A R Naylor, Torben V Schroeder, Henrik SillesenAbstract: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 80 mm2; (i) juxta-luminal black area >10 mm2; 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.
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triaging tia minor stroke patients using the abcd2 score does not predict those with significant Carotid Disease
European Journal of Vascular and Endovascular Surgery, 2012Co-Authors: J Walker, J Isherwood, D Eveson, A R NaylorAbstract:Abstract Background ‘Rapid Access' TIA Clinics use the ABCD 2 score to triage patients as it is not possible to see everyone with a suspected TIA Methods Prospective study of correlation between Family Doctor (FD) or Emergency Department (ED) ABCD 2 score and specialist consultant Stroke Physician measured ABCD 2 score and prevalence of ≥50% ipsilateral Carotid stenosis or occlusion in patients presenting with ‘any territory' TIA/minor stroke or ‘Carotid territory' TIA/minor stroke. Results Between 1.10.2008 and 31.04.2011, 2452 patients were referred to the Leicester Rapid Access TIA Service. After Stroke Physician review, 1273 (52%) were thought to have suffered a minor stroke/TIA. Of these, both FD/ED referrer and Specialist Stroke Consultant ABCD 2 scores and Carotid Duplex ultrasound studies were available for 843 (66%). The yield for identifying a ≥50% stenosis or Carotid occlusion was 109/843 (12.9%) in patients with ‘any territory' TIA/minor stroke and 101/740 (13.6%) in those with a clinical diagnosis of ‘Carotid territory' TIA/minor stroke. There was no association between ABCD 2 score and the likelihood of encountering significant Carotid Disease and analyses of the area under the receiver operating characteristic curve (AUC) for FD/ED referrer and stroke specialist ABCD 2 scores showed no prediction of Carotid stenosis (FD/ED: AUC 0.50 (95%CI 0.44–0.55, p = 0.9), Specialist: AUC 0.51 (95%CI 0.45–0.57, p = 0.78). Conclusions The ABCD 2 score was unable to identify TIA/minor stroke patients with a higher prevalence of clinically important ipsilateral Carotid Disease.
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Triaging TIA/minor stroke patients using the ABCD2 score does not predict those with significant Carotid Disease.
European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery, 2012Co-Authors: J Walker, J Isherwood, D Eveson, A R NaylorAbstract:Abstract Background ‘Rapid Access' TIA Clinics use the ABCD 2 score to triage patients as it is not possible to see everyone with a suspected TIA Methods Prospective study of correlation between Family Doctor (FD) or Emergency Department (ED) ABCD 2 score and specialist consultant Stroke Physician measured ABCD 2 score and prevalence of ≥50% ipsilateral Carotid stenosis or occlusion in patients presenting with ‘any territory' TIA/minor stroke or ‘Carotid territory' TIA/minor stroke. Results Between 1.10.2008 and 31.04.2011, 2452 patients were referred to the Leicester Rapid Access TIA Service. After Stroke Physician review, 1273 (52%) were thought to have suffered a minor stroke/TIA. Of these, both FD/ED referrer and Specialist Stroke Consultant ABCD 2 scores and Carotid Duplex ultrasound studies were available for 843 (66%). The yield for identifying a ≥50% stenosis or Carotid occlusion was 109/843 (12.9%) in patients with ‘any territory' TIA/minor stroke and 101/740 (13.6%) in those with a clinical diagnosis of ‘Carotid territory' TIA/minor stroke. There was no association between ABCD 2 score and the likelihood of encountering significant Carotid Disease and analyses of the area under the receiver operating characteristic curve (AUC) for FD/ED referrer and stroke specialist ABCD 2 scores showed no prediction of Carotid stenosis (FD/ED: AUC 0.50 (95%CI 0.44–0.55, p = 0.9), Specialist: AUC 0.51 (95%CI 0.45–0.57, p = 0.78). Conclusions The ABCD 2 score was unable to identify TIA/minor stroke patients with a higher prevalence of clinically important ipsilateral Carotid Disease.
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stroke after cardiac surgery and its association with asymptomatic Carotid Disease an updated systematic review and meta analysis
European Journal of Vascular and Endovascular Surgery, 2011Co-Authors: A R Naylor, M J BownAbstract:Abstract Objectives (i) Prevalence of stroke in neurologically symptomatic/asymptomatic patients with unilateral/bilateral Carotid Disease (including occlusion) undergoing cardiac surgery without prophylactic Carotid endarterectomy (CEA) or Carotid stenting (CAS). (ii) Prevalence of stroke in asymptomatic patients with unilateral/bilateral Carotid Disease (excluding occlusion) who underwent isolated cardiac surgery. (iii) Prevalence of stroke in the hemisphere ipsilateral to a non-operated asymptomatic stenosis in patients with severe bilateral Carotid Disease undergoing a synchronous unilateral CEA + cardiac procedure. Methods Systematic Review and meta-analysis. Results Cardiac surgery patients with a symptomatic/asymptomatic 50–99% stenosis or occlusion incurred a 7.4% stroke risk (95%CI 4.8–9.9), increasing to 9.1% (95%CI 4.8–16) in those with 80–99% stenoses or occlusion. After excluding patients with a history of stroke/TIA and those with isolated/bilateral occlusions, the stroke risk fell to 3.8% (95%CI 2.0–4.8) in patients with asymptomatic 50–99% stenoses and 2.0% in those with 70–99% stenoses (95%CI 1.0–5.7). The prevalence of ipsilateral stroke in patients with a unilateral, asymptomatic 50–99% stenosis was 2.0% (1.0–3.8), while the risk of any stroke was only 2.9% (2%–5.7%). These risks did not increase with stenosis severity (70–99%, 80–99%). Patients with bilateral, asymptomatic 50–99% stenoses or a 50–99% stenosis + contralateral occlusion incurred a 6.5% stroke risk following cardiac surgery, while the risk of death/stroke was 9.1% (3.8%–20.6%). Patients with bilateral 80–99% stenoses undergoing a unilateral synchronous cardiac/Carotid revascularisation incurred a 5.7% risk of stroke in the hemisphere ipsilateral to the non-operated, contralateral stenosis. Conclusions There is no compelling evidence supporting a role for prophylactic CEA/CAS in cardiac surgery patients with unilateral asymptomatic Carotid Disease. Prophylactic CEA/CAS might still be considered in patients with severe, bilateral asymptomatic Carotid Disease, but such a strategy would only benefit 1–2% of all cardiac surgery patients.
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Does the risk of post-CABG stroke merit staged or synchronous reconstruction in patients with symptomatic or asymptomatic Carotid Disease?
The Journal of cardiovascular surgery, 2009Co-Authors: A R NaylorAbstract:The management of patients undergoing coronary arterybypass grafting (CABG) who are found to have co-existentCarotid artery Disease remains controversial. Managementoptions include performing an isolated CABG, synchro-nous Carotid endarterectomy (CEA) plus CABG, stagedCEA-CABG, reverse staged CABG-CEA, synchronousCEA+CABG off bypass (OFFCAB) and staged Carotid angio-plasty with stenting (CAS) followed by CABG. For any ofthese combined or staged interventions to be clinicallyeffective, the following conditions must be met; (1) CABGmust be a proven intervention for ischaemic heart dis-ease, (2) stroke must be an important cause of peri-oper-ative morbidity and mortality, (3) the incidence of post-CABG stroke must be high enough to justify a programmeof prevention, (4) Carotid Disease must be an importantcause of post-CABG stroke, (5) CEA (CAS) must be aproven intervention in Carotid artery Disease and (6)prophylactic CEA (CAS) should reduce the risk of post-CABG stroke. This paper reviews the literature and con-cludes that conditions 1, 2 and 5 are met and that con-dition 3 can be achieved provided ‘high risk’ subgroupsare targeted. However, there is limited evidence to sup-port the contention that Carotid Disease is a major causeof post-CABG stroke and any potential benefit conferredby prophylactic intervention (whether by CAS or CEA)may be offset by the relatively high procedural risksobserved in systematic reviews. Prophylactic Carotidintervention is justified in CABG patients with a priorhistory of stroke or TIA. Debate continues about the roleof CEA (CAS) in patients with asymptomatic bilateralCarotid Disease, but there seems to be little evidence to jus-tify prophylactic CEA or CAS in CABG patients with uni-lateral asymptomatic Carotid Disease.K
Peter L. Faries - One of the best experts on this subject based on the ideXlab platform.
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The role of Carotid stenting for the treatment of Carotid Disease.
Angiologiia i sosudistaia khirurgiia = Angiology and vascular surgery, 2013Co-Authors: Chung C, Peter L. FariesAbstract:Carotid artery occlusion is one of the most frequent and treatable causes of ischemic strokes. Although Carotid endarterectomy (CEA) is recognized as the gold standard for treating symptomatic, severe Carotid stenosis, investigations have sought to demonstrate the efficacy of Carotid angioplasty and stenting (CAS) as a potential alternative to surgical management. Patient selection is crucial in the judicious application of CAS and CEA. Recent investigations have emphasized the potential of endovascular procedures to complement rather than replace surgical techniques for treating a wide spectrum of Carotid Disease.
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updated society for vascular surgery guidelines for management of extracranial Carotid Disease executive summary
Journal of Vascular Surgery, 2011Co-Authors: John J Ricotta, Peter L. Faries, Ali Aburahma, Enrico Ascher, Mark K Eskandari, Brajesh K LalAbstract:In 2008, the Society for Vascular Surgery published guidelines for the treatment of Carotid bifurcation stenosis. Since that time, a number of prospective randomized trials have been completed and have shed additional light on the best treatment of extracranial Carotid Disease. This has prompted the Society for Vascular Surgery to form a committee to update and expand guidelines in this area. The review was done using the GRADE methodology.[corrected] The perioperative risk of stroke and death in asymptomatic patients must be below 3% to ensure benefit for the patient. Carotid artery stenting (CAS) should be reserved for symptomatic patients with stenosis 50% to 99% at high risk for CEA for anatomic or medical reasons. CAS is not recommended for asymptomatic patients at this time. Asymptomatic patients at high risk for intervention or with <3 years life expectancy should be considered for medical management as first line therapy. In this Executive Summary, we only outline the specifics of the recommendations made in the six areas evaluated. The full text of these guidelines can be found on the on-line version of the Journal of Vascular Surgery at http://journals.elsevierhealth.com/periodicals/ymva.
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updated society for vascular surgery guidelines for management of extracranial Carotid Disease executive summary
Journal of Vascular Surgery, 2011Co-Authors: John J Ricotta, Ali Aburahma, Enrico Ascher, Mark K Eskandari, Peter L. FariesAbstract:In 2008, the Society for Vascular Surgery published guidelines for the treatment of Carotid bifurcation stenosis. Since that time, a number of prospective randomized trials have been completed and have shed additional light on the best treastment of extracranial Carotid Disease. This has prompted the Society for Vascular Surgery to form a committee to update and expand guidelines in this area. The review was done using the GRADE methodology. The committee recommends Carotid endarterectomy (CEA) as first line treatment for most symptomatic patients with stenosis 50% to 99% and asymptomatic patients with stenosis 60% to 99%. The perioperative risk of stroke and death in asymptomatic patients must be below 3% to ensure benefit for the patient. Carotid artery stenting (CAS) should be reserved for symptomatic patients with stenosis 50% to 99% at high risk for CEA for anatomic or medical reasons. CAS is not recommended for asymptomatic patients at this time. Asymptomatic patients at high risk for intervention or with In this Executive Summary, we only outline the specifics of the recommendations made in the six areas evaluated. The full text of these guidelines can be found on the on-line version of the Journal of Vascular Surgery at http://journals.elsevierhealth.com/periodicals/ymva.
J Walker - One of the best experts on this subject based on the ideXlab platform.
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triaging tia minor stroke patients using the abcd2 score does not predict those with significant Carotid Disease
European Journal of Vascular and Endovascular Surgery, 2012Co-Authors: J Walker, J Isherwood, D Eveson, A R NaylorAbstract:Abstract Background ‘Rapid Access' TIA Clinics use the ABCD 2 score to triage patients as it is not possible to see everyone with a suspected TIA Methods Prospective study of correlation between Family Doctor (FD) or Emergency Department (ED) ABCD 2 score and specialist consultant Stroke Physician measured ABCD 2 score and prevalence of ≥50% ipsilateral Carotid stenosis or occlusion in patients presenting with ‘any territory' TIA/minor stroke or ‘Carotid territory' TIA/minor stroke. Results Between 1.10.2008 and 31.04.2011, 2452 patients were referred to the Leicester Rapid Access TIA Service. After Stroke Physician review, 1273 (52%) were thought to have suffered a minor stroke/TIA. Of these, both FD/ED referrer and Specialist Stroke Consultant ABCD 2 scores and Carotid Duplex ultrasound studies were available for 843 (66%). The yield for identifying a ≥50% stenosis or Carotid occlusion was 109/843 (12.9%) in patients with ‘any territory' TIA/minor stroke and 101/740 (13.6%) in those with a clinical diagnosis of ‘Carotid territory' TIA/minor stroke. There was no association between ABCD 2 score and the likelihood of encountering significant Carotid Disease and analyses of the area under the receiver operating characteristic curve (AUC) for FD/ED referrer and stroke specialist ABCD 2 scores showed no prediction of Carotid stenosis (FD/ED: AUC 0.50 (95%CI 0.44–0.55, p = 0.9), Specialist: AUC 0.51 (95%CI 0.45–0.57, p = 0.78). Conclusions The ABCD 2 score was unable to identify TIA/minor stroke patients with a higher prevalence of clinically important ipsilateral Carotid Disease.
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Triaging TIA/minor stroke patients using the ABCD2 score does not predict those with significant Carotid Disease.
European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery, 2012Co-Authors: J Walker, J Isherwood, D Eveson, A R NaylorAbstract:Abstract Background ‘Rapid Access' TIA Clinics use the ABCD 2 score to triage patients as it is not possible to see everyone with a suspected TIA Methods Prospective study of correlation between Family Doctor (FD) or Emergency Department (ED) ABCD 2 score and specialist consultant Stroke Physician measured ABCD 2 score and prevalence of ≥50% ipsilateral Carotid stenosis or occlusion in patients presenting with ‘any territory' TIA/minor stroke or ‘Carotid territory' TIA/minor stroke. Results Between 1.10.2008 and 31.04.2011, 2452 patients were referred to the Leicester Rapid Access TIA Service. After Stroke Physician review, 1273 (52%) were thought to have suffered a minor stroke/TIA. Of these, both FD/ED referrer and Specialist Stroke Consultant ABCD 2 scores and Carotid Duplex ultrasound studies were available for 843 (66%). The yield for identifying a ≥50% stenosis or Carotid occlusion was 109/843 (12.9%) in patients with ‘any territory' TIA/minor stroke and 101/740 (13.6%) in those with a clinical diagnosis of ‘Carotid territory' TIA/minor stroke. There was no association between ABCD 2 score and the likelihood of encountering significant Carotid Disease and analyses of the area under the receiver operating characteristic curve (AUC) for FD/ED referrer and stroke specialist ABCD 2 scores showed no prediction of Carotid stenosis (FD/ED: AUC 0.50 (95%CI 0.44–0.55, p = 0.9), Specialist: AUC 0.51 (95%CI 0.45–0.57, p = 0.78). Conclusions The ABCD 2 score was unable to identify TIA/minor stroke patients with a higher prevalence of clinically important ipsilateral Carotid Disease.
John J Ricotta - One of the best experts on this subject based on the ideXlab platform.
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updated society for vascular surgery guidelines for management of extracranial Carotid Disease executive summary
Journal of Vascular Surgery, 2011Co-Authors: John J Ricotta, Peter L. Faries, Ali Aburahma, Enrico Ascher, Mark K Eskandari, Brajesh K LalAbstract:In 2008, the Society for Vascular Surgery published guidelines for the treatment of Carotid bifurcation stenosis. Since that time, a number of prospective randomized trials have been completed and have shed additional light on the best treatment of extracranial Carotid Disease. This has prompted the Society for Vascular Surgery to form a committee to update and expand guidelines in this area. The review was done using the GRADE methodology.[corrected] The perioperative risk of stroke and death in asymptomatic patients must be below 3% to ensure benefit for the patient. Carotid artery stenting (CAS) should be reserved for symptomatic patients with stenosis 50% to 99% at high risk for CEA for anatomic or medical reasons. CAS is not recommended for asymptomatic patients at this time. Asymptomatic patients at high risk for intervention or with <3 years life expectancy should be considered for medical management as first line therapy. In this Executive Summary, we only outline the specifics of the recommendations made in the six areas evaluated. The full text of these guidelines can be found on the on-line version of the Journal of Vascular Surgery at http://journals.elsevierhealth.com/periodicals/ymva.
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updated society for vascular surgery guidelines for management of extracranial Carotid Disease executive summary
Journal of Vascular Surgery, 2011Co-Authors: John J Ricotta, Ali Aburahma, Enrico Ascher, Mark K Eskandari, Peter L. FariesAbstract:In 2008, the Society for Vascular Surgery published guidelines for the treatment of Carotid bifurcation stenosis. Since that time, a number of prospective randomized trials have been completed and have shed additional light on the best treastment of extracranial Carotid Disease. This has prompted the Society for Vascular Surgery to form a committee to update and expand guidelines in this area. The review was done using the GRADE methodology. The committee recommends Carotid endarterectomy (CEA) as first line treatment for most symptomatic patients with stenosis 50% to 99% and asymptomatic patients with stenosis 60% to 99%. The perioperative risk of stroke and death in asymptomatic patients must be below 3% to ensure benefit for the patient. Carotid artery stenting (CAS) should be reserved for symptomatic patients with stenosis 50% to 99% at high risk for CEA for anatomic or medical reasons. CAS is not recommended for asymptomatic patients at this time. Asymptomatic patients at high risk for intervention or with In this Executive Summary, we only outline the specifics of the recommendations made in the six areas evaluated. The full text of these guidelines can be found on the on-line version of the Journal of Vascular Surgery at http://journals.elsevierhealth.com/periodicals/ymva.
Vida Demarin - One of the best experts on this subject based on the ideXlab platform.
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Advanced asymptomatic Carotid Disease and cognitive impairment: an understated link?
Stroke research and treatment, 2012Co-Authors: Irena Martinić-popović, Arijana Lovrenčić-huzjan, Vida DemarinAbstract:Advanced Carotid Disease is known to be associated with symptomatic cerebrovascular Diseases, such as stroke or transient ischemic attack (TIA), as well as with poststroke cognitive impairment. However, cognitive decline often occurs in patients with advanced Carotid stenosis without clinically evident stroke or TIA, so it is also suspected to be an independent risk factor for dementia. Neurosonological methods enable simple and noninvasive assessment of Carotid stenosis in patients at risk of advanced atherosclerosis. Cognitive status in patients diagnosed with advanced Carotid stenosis is routinely not taken into consideration, although if cognitive impairment is present, such patients should probably be called symptomatic. In this paper, we discuss results of some most important studies that investigated cognitive status of patients with asymptomatic advanced Carotid Disease and possible mechanisms involved in the causal relationship between asymptomatic advanced Carotid Disease and cognitive decline.
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Cerebrovascular evoked response to repetitive visual stimulation in severe Carotid Disease--functional transcranial Doppler study.
Acta clinica Croatica, 2010Co-Authors: Marina Roje-bedeković, Arijana Lovrenčić-huzjan, Marijana Bosnar-puretić, Vida DemarinAbstract:Hemodynamic features of the posterior circulation were evaluated by assessing visual evoked response in posterior cerebral artery (PCA) by means of functional transcranial Doppler (fTCD) in 49 patients with high-grade (70%-99%) internal Carotid artery (ICA) stenosis or occlusion and 30 healthy subjects. Mean blood flow velocities (MBFV) and mean reaction time (time to peak velocities) (MRT) in each PCA were measured in the dark (closed eyes) and during white light stimulation (opened eyes, looking at the electric bulb), during three consecutive repetitive periods of 1 minute each. In the group of severe Carotid Disease patients, there was no difference in MRT in PCA during the white light stimulation (P=0.1), whereas in the dark MRT values showed a statistically significantly prolonged visual evoked response (P=0.02), but with no clinical relevance. MBFV values did not differ significantly during white light stimulation (P=0.1), whereas in the dark the difference was also statistically significant (P=0.03), but with no clinical relevance. On the contrary, in the group of healthy subjects, MRT values differed significantly both during white light stimulation (P=0.0005) and in the dark (P=0.00054), showing a significantly prolonged visual evoked response. During white light stimulation, MBFV showed significant decrease and prolonged vasoreactive response (P=0.004). Prolonged vasoreactive response in PCA in healthy subjects during repetitive measurements may indicate exhaustion of the vasoreactive mechanisms. In Carotid Disease patients, stable vasoreactive response may indicate that the compensatory mechanisms of the posterior circulation are always maximally engaged to compensate for Carotid insufficiency.
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The Contralateral Carotid Disease in Patients with Internal Carotid Artery Occlusion
Acta clinica Croatica, 2009Co-Authors: Arijana Lovrenčić-huzjan, Maja Strineka, Dražen Ažman, Sanja Štrbe, Darja Šodec-Šimičević, Vida DemarinAbstract:SUMMARY- The one-year incidence of Carotid occlusion is 6/100 000 inhabitants in gene ral population. Stroke incidence and mortality rate in these patients vary. Patients that underwent Carotid endarterectomy (CES) are at a higher risk of progression of contralateral Carotid stenosis. The aim of the study was to investigate the management and natural history of the contralateral internal Carotid artery Disease in patients with internal Carotid artery occlusion (ICAO). During one year, 297 patients with ICAO were investigated. Follow up examinations were retrospectively analyzed and patients were divided into groups according to contralateral Carotid Disease. Out of 297 patients, only one investigation was performed in 90 patients with Carotid occlusion. Thirty three patients were followed up due to postoperative ICAO. In 14 patients, ICAO developed during ultrasonographic follow up. In this group ofpatients, 9 had unchanged contralateral findings, whe reas in 5 patients Disease progression was observed. Out of44 patients with ICAO and contralateral subtotal stenosis at initial investigation, 42 underwent Carotid surgery. Postoperatively, 32 patients had normal findings, 6 developed mild Carotid stenosis, 2 developed moderate Carotid stenosis, and 2 had postoperative Carotid occlusion. Two patients were followed-up without intervention. Nine patients with bilateral ICAO were followed-up for years. Follow up was continued in 106 patients with ICAO and contralateral mild to moderate changes. The finding was unchanged in 68 patients. In 21 (30%) patients the Disease progressed to subtotal stenosis and 18 patients underwent Carotid surgery. Accordingly, contralateral Carotid Disease progression was observed in one third ofpatients with Carotid occlusion. Additional studies on the issue are needed.
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Visual evoked response in patients with severe Carotid Disease--functional transcranial doppler study of posterior circulation.
Collegium antropologicum, 2009Co-Authors: Marina Roje Bedeković, Marijana Bosnar Puretić, Arijana Lovrenčić Huzjan, Vida DemarinAbstract:The goal of this study was to evaluate the visual evoked response in posterior cerebral artery (PCA) by means of functional transcranial doppler in patients with severe Carotid Disease and to determine the hemodynamic effect of severe Carotid Disease on posterior circulation. Measurements were performed successively in the dark and during the white light stimulation in 49 patients with high-grade (70-99%) internal Carotid artery (ICA) stenosis or occlusion and compared with 30 healthy age and sex matched subjects. Mean blood flow velocities (MBFV) (cm/s +/- 2SD) and mean reaction time (MRT) (s +/- 2SD) during three consecutive repetitive periods of 1 minute each were analyzed. MBFV in PCA during the white light stimulation and in the dark between the two groups didn't differ. MRT in patients showed a significantly prolonged visual evoked response in both affected (light: patients 29.36 +/- 14.46, controls 19.67 +/- 11.25, respectively, p < 0.046; dark: patients 35.25 +/- 11.9 controls 21.89 +/- 10.31, respectively, p < 0.002 and unaffected side (dark: patients 33.13 +/- 11.12, controls 23.89 +/- 11.23, respectively, p < 0.032) of ICA. This data showed that MRT is the principal restrictive factor in the case of Carotid stenosis suggesting the independence of cerebral vascular reserve capacity of the posterior part of Willis circle that is necessary to be considered separately.
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EVALUATION OF RISK FACTORS IN STROKE POPULATION WITH OCCLUSIVE Carotid Disease
European Journal of Neurology, 2004Co-Authors: Iris Zavoreo, Arijana Lovrenčić-huzjan, Miljenka Kesić, Sandra Morović, Vlasta Vuković, Vida DemarinAbstract:Background: Stroke is the third leading cause of mortality and leading cause of disability in modern society. In order to recognize population under increased risk of cerebrovascular Disease we evaluated different risk factors in stroke population. Patients and methods: We calculated Framingham Risk Index (FRI) in 78 stroke patients (16% of all hospitalized stroke patients ; mean age 71p ; ; 10 ; 48 men, mean age 68p ; ; 12 and 30 women, mean age 74p ; ; 10) with severe Carotid stenosis (>75%) or occlusion hospitalized on Neurology Department with sex and age adjusted stroke population without atherosclerotic changes of the main head and neck arteries. Risk factors (sex, age, total blood plasma level of lipids, cholesterol, LDL, HDL, systolic and dyastolic blood pressure, diabetes and smoking) were evaluated. FRI was calculated and subjects were classified in 5 categories: very high, high, moderate, low and very low risk. Results: There were 80% patients with ischemic stroke (16% had occlusive Carotid Disease), 17% had intracerebral hemorrhage and 2, 8% had subarachnoidal hemorrhage. Patients with occlusive Carotid Disease were in the group with high (34% ; 16% men and 18% women) and very high risk (60% ; 34% men and 30% women), only few had moderate risk (6% ; 4% men and 2% women). Control subjects had very low (72% ; 37% men, 35% women) and low risk (23% ; 12% men and 11% women), only few had moderate risk (5% ; 1% men and 4% women). Conclusion: FRI can be used in screening of population under increased risk of occlusive Carotid Disease.