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Background The most appropriate treatment for patients with asymptomatic carotid artery stenosis is being debated. The benefit of carotid endarterectomy or carotid artery stenting is uncertain since best medical care has progressed over time. We set out to compare CEA plus BMT with CAS+ BMT, but not with BMT alone. According to European Carotid Surgery Trial standards, we recruited participants aged 50-85 years with asymptomatic carotid artery stenosis at the distal common carotid artery or the extracranial internal carotid artery with a minimum of 70%. To first establish superiority of CEA and CAS to BMT, we did two-step hierarchical testing, first to determine non-inferiority of CAS to CEA. With CEA plus BMT, 42 percent with CAS+ BMT, and 31% with BMT alone, there were 278 percent in BMT with CEA+ BMT, 42 percent for ipsilateral ischaemic stroke within 5 years, and 31% with BMT alone. Comparison of CAS plus BMT versus BMT alone or mixed BMT versus BMT alone reveals no difference in risk for the primary safety endpoint for CEA plus BMT versus BMT alone or BMT alone. During the 5-year observation period, interpreter CEA plus BMT or CAS plus BMT were not found to be superior to BMT alone in terms of risk of any stroke or death within 30 days or ipsilateral stroke.
Source link: https://europepmc.org/article/MED/36115360
Ultrasonography in Carotid artery ultrasonography can determine or inferring the presence or absence of stenosis or occlusion of the internal carotid artery and vertebral artery, as well as the non-observable distal artery and basilar artery. The PSV of stenosis can be used to diagnose stenosis at the start of the VA or V1, and the mean flow velocity, mean ratio, and diameter ratio can be used to determine distal VA occlusion.
Source link: https://europepmc.org/article/MED/36175716
Atherosclerotic lesions and plaques are common in Carotid artery stenosis. Plaque rupture or stenosis may lead to the occlusion of the carotid artery. NOX4 mRNA expression in CAS patients with advanced atherosclerotic lesions, as well as advancing atherosclerotic lesions, has been hypothesized. In fact, NOX4 mRNA expression is reduced in patients with symptomatic CAS. A low NOX4 mRNA expression is correlated with an elevated risk of clinical disease development. NoX4 seems to be connected to plaque stability, apoptosis, and plaque hemorrhage, in fact. Even repairing a fractured plaque with NOX4 appears to be related to NOX4, since NOX4 mRNA expression correlates to fibrous cap collagen and is inversely related to MMP9 production. In conclusion, low intra-plaque NOX4 mRNA expression is linked to an elevated risk of symptomatic response and reduced plaque stabilizing strategies demonstrating the protective effects of NOX4 in human advanced atherosclerosis.
Source link: https://europepmc.org/article/MED/36182808
Aims: To determine the prevalence of progressive internal carotid artery stenosis by head and neck contrast-enhanced computed tomography in 45 patients who underwent neck dissection for oral squamous cell carcinoma, based on neck dissection. Conclusions Comparing the new CT with previously obtained head and neck contrast-enhanced CT photos revealed progressive ICAS in 3 patients with a mean age of 50. 0 years.
Source link: https://europepmc.org/article/MED/36138543
This report examines the occurrences of cavernous segment internal carotid artery stenosis in order to determine a novel radiographic method of differentiation. Methods A retrospective review of patients with pathology-confirmed meningioma and pituitary adenomas at Tufts Medical Center was done. The CS-ICA's diameter at the narrowest point inside the cavernous sinus was determined and compared to the ipsilateral petrous segment ICA and contralateral CS-ICA. The mean and a wide range of percent stenosis and frequency of stenosis in CS-ICA > 15% were established. All meningomas had a stenosis of 9. 3%, with rising World Health Organization grading increasing. Mean ICA stenosis for pituitary adenomas was -1. 8 percent, as indicated by -1. 4 percent. There were no reports of pituitary adenomas resulting in ICA stenosis > 15%. Conclusions differing pituitary adenomas and intractable meningioma tumors can have significant effects on surgical approach and result.
Source link: https://europepmc.org/article/MED/36117152
Sensorineural hearing loss raises the possibility of vasculature of the posterior circulatory system. The 58-year-old woman presented to the ear, nose, and throat clinic with an acute outbreak of right ear pulsations and high-pitched tinnitus. In the right ear, there was no sensorineural hearing loss. In the right, a repeat audiogram demonstrated an improvement in sensorineural hearing loss.
Source link: https://europepmc.org/article/MED/36116219
Background Cerebral blood flow can be correlated to the risk of neurological disease development. The aim of this research was to investigate the circulation pathways and flow volume in extracranial arteries in patients with 70% Internal carotid artery stenosis. A Doppler ultrasound exam was performed in both patients and determined blood flow volume in the internal carotid artery, external carotid artery, and vertebral artery. The cerebral blood flow was similar to the previously reported CBF values in the healthy population over 65 years old. Patients with elevated CBF, patients with CBF similar to, and patients with reduced CBF were found in the healthy, equally aged population. Patients with significant volumetric flow compensation were the highest in age groups 65-69 years old and > 80 years old, with the majority of patients with significant volumetric flow compensation being the highest in age groups 65-69 years old and > 80 years old. No patients were found without flow compensation in the oldest age group. The compensatory increased flow was observed in 3. 31 arteries in the mild compensation group's 2. 18 arteries, but not in the no compensation group in one artery. The volumetric flow rise was more apparent in patients with unilateral ICA stenosis in the ipsilateral ECAs than in the contralateral ones. Conclusions The discovery of collateral circulation and their evaluation in Doppler ultrasonography may lead to the development of a new and inexpensive method of identifying and monitoring patients with cerebrovascular disease.
Source link: https://europepmc.org/article/MED/36140616
Introduction It has been proposed that carotid artery stenosis may contribute to increased atrophy of subserved brain regions; however, prospective studies on the effect of CAS on brain atrophy are lacking. We investigated the connection between CAS and the development of hemispheric brain atrophy. Methods We recruited 654 patients of the SMART-MR study, a prospective cohort study of patients with manifest arterial disease. At baseline and after 4 years of follow-up, patients had baseline CAS duplex testing and a 1. 5T brain MRI at baseline and a 1. 5T brain MRI. Mean change in hemispheric brain volumes between baseline and follow-up CAS across three degrees of stenosis, adjusted for demographics, cerebrovascular risk factors, and brain infarcts was estimated between baseline and follow-up, with estimates of demographics, cerebrovascular risk factors, and brain infarcts. Conclusions: According to our results, severe CAS may be a risk factor for increased ipsilateral brain volume loss, independent of cerebrovascular risk factors, brain infarcts, or white matter hyperintensities on MRI.
Source link: https://europepmc.org/article/MED/36096114
Background and ambitions: This report discusses and demonstrates the applicability of a novel in silico method for modeling progressive carotid artery stenosis using the oscillatory shear index as the basis of stenosis. Result : 6 carotid models showed progressive stenosis in regions of high OSI with statistically significant rises in one of the cases, with potential carotid occlusion in one of the cases. Three models remained free or nearly free of increased OSI, while one model showed an overall decrease in high OSI areas and another trended in that direction, but not reach statistical significance.
Source link: https://europepmc.org/article/MED/36083843
Despite a lack of evidence from randomized trials, coronary artery disease and concomitant acute carotid stenosis have been common in patients with coronary artery disease and concomitant stenosis. Following CABG+CEA, we discovered that the risk of stroke or death within 30 days was elevated relative to CABG alone, according to a recent report. Here, we present long-term findings from CABG testing with or without CEA. Patients with asymptomatic severe carotid stenosis undergoing CABG were either CABG+CEA or CABG alone, and a follow-up was 5 years. Any nonfatal stroke or death, any suicide, and any nonfatal stroke were among the nonfatal end points for the nonfatal strokes. Nonfatal strokes occurred at any time during CABG+CEA's comparison to CABG's only. Conclusions: CABG+CEA combined concurrent CABG+CEA was associated with a higher but non-significant rate of stroke or death among CABG alone during 5-years follow-up, although statistically nonsignificant.
Source link: https://europepmc.org/article/MED/36082667
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