Stenosis Carotid artery

Remonda L, Held O, Schroth G. Carotid artery stenosis, occlusion, and pseudoocclusion first-pass, gadolinium-enhanced, three-dimensional MR angiography— preliminary study. Radiology 1998 209 95-102 [see comment]. 

Aleksic M, Rueger MA, Lehnhardt EG, Sobesky J, Matoussevitch V, Neveling M, Heiss WD, Bmnkwall J, Jacobs AH. Primary stroke unit treatment followed by very early carotid endarterectomy for carotid artery stenosis after acute stroke. Cerebrovasc Dis 2006 22 276-281. 

McPherson CM, Woo D, Cohen PL, Panciob AM, Kissela BM, CarrozzeUa JA, Tomsick TA, ZuccareUo M. Early carotid endarterectomy for critical carotid artery stenosis after thrombolysis therapy in acute ischemic stroke in the middle cerebral artery. Stroke 2001 32 2075-2080. 

Gasecki AP, Eerguson GG, EUasziw M, Clagett GP, Pox AJ, Hachinski V, Barnett HJ. Early endarterectomy for severe carotid artery stenosis after a nondisabling stroke Results from the North American symptomatic carotid endarterectomy trial. J Vase Surg 1994 20 288-295. 

Markus H, Mac Kinnon A. Asymptomatic embolization detected by Doppler ultrasound predicts stroke risk in symptomatic carotid artery stenosis. Stroke 2005 36 971-975. 

Suwanwela N, Can U, Furie KL, Southern JF, Macdonald NR, Ogilvy CS, Hansen CJ, Buonanno FS, Abbott WM, Koroshetz WJ, Kistler JR Carotid Doppler ultrasound criteria for internal carotid artery stenosis based on residual lumen diameter calculated from en bloc carotid endarterectomy specimens. Stroke 1996 27(11) 1965-1969. 

Pan XM, Saloner D, Reilly LM, Bowersox JC, Murray SP, Anderson CM, Gooding GA, Rapp JH. Assessment of carotid artery stenosis by ultrasonography, conventional angiography, and magnetic resonance angiography correlation with ex vivo measurement of plaque stenosis. J Vase Surg 1995 21(l) 82-88 [discussion 88-89]. 

Henderson RD, Steinman DA, Ehasziw M, Barnett HJ. Effect of contralateral carotid artery stenosis on carotid ultrasound velocity measurements. Stroke 2000 31(ll) 2636-2640. 

Polak IF, Dobkin GR, O Leary DH, Wang AM, Cutler SS. Internal carotid artery stenosis accuracy and reproducibility of color-Doppler-assisted duplex imaging. Radiology 1989 173(3) 793-798. 

The benefit of carotid endarterectomy for prevention of recurrent stroke has been studied previously in major trials.25,26 A recent meta-analysis has been completed that has combined these clinical trials to evaluate 6,092 patients.27 Carotid endarterectomy has been shown to be beneficial for preventing ipsilateral stroke in patients with symptomatic carotid artery stenosis of 70% or greater and is recommended in these patients. In patients with symptomatic stenosis of 50% to 69%, a moderate reduction in risk is seen in clinical trials. In all patients with stenosis of 50% to 69% and a recent stroke, carotid endarterectomy is appropriate. In other patients, surgical risk factors and surgeon skill should be considered prior to surgery. The patient should have, at a minimum, a life expectancy of 5 years, and the surgical risk of stroke and/or death should be less than 6%. Carotid endarterectomy is not beneficial for symptomatic carotid stenosis less than 50% and should not be considered in these patients. 

There are data to suggest that patients with asymptomatic carotid artery stenosis of 60% or more benefit from carotid endarterectomy if it is performed by a qualified surgeon with low complication rates (less than 3%). At this time, there is considerable controversy over how this information can be applied to clinical practice. A current review recommends considering carotid endarterectomy in patients with carotid artery stenosis... 

Growing clinical data also points to the importance of IL-8 in atherogenesis. IL-8 has been found in atheromatous lesions from patients with atherosclerotic disease including carotid artery stenosis (103), CAD (118), abdominal aortic aneurysms (AAA) (103,104,114), and peripheral vascular disease (PVD) (104). Furthermore, studies using plaque explant samples have yielded more direct evidence for IL-8 involvement. Media from cultured AAA tissue induced IL-8-dependent human aortic endothelial cell (HAEC) chemotaxis (122). Homocysteine, implicated as a possible biomarker for CAD, is also capable of inducing IL-8 (123-125) by direct stimulation of endothelial cells (123,124) and monocytes (125). When patients with hyperhomocysteinemia were treated with low-dose folic acid, decreases in homocysteine levels correlated with decreases in IL-8 levels (126). Statins significantly decrease serum levels of IL-6, IL-8, and MCP-1, as well as expression of IL-6, IL-8, and MCP-1 mRNA by peripheral blood monocytes and HUVECs (127). Thus, IL-8 may be an underappreciated factor in the pathogenesis of atherosclerosis. 

We next investigated the effects of PJ consumption by patients with carotid artery stenosis (CAS) on carotid lesion size in association with changes in oxidative stress.31 Ten patients were supplemented with PJ for up to 1 year, and nine CAS patients who did not consume PJ served as a control group. Blood samples were collected before treatment and after 3,6, 9, and 12 months of PJ consumption. Patients carotid... 

The Effect of Pomegranate Juice on Carotid Intima Media Thickness (1MT) and on End Diastolic Velocity (EDV) in Carotid Artery Stenosis (CAS) Patients... 

Figure 8.1 Therapeutic effect of pomegranate juice on atherosclerotic lesion area in E° mice (A-C) or in patients with carotid artery stenosis (D and E). Thirty E° mice and 10 patients with severe CAS were supplemented with PJ concentrate (12.5 pL/mouse/day and 50 mL/day, respectively) for 9 weeks or for 1 year, respectively. Photomicrographs of typical foam cells from unsupplemented 4-month-old E° mice and from 6-month-old E° mice administered a placebo (B) or PJ (C) are presented. Mean ( SEM) effect of PJ consumption on human common carotid artery IMT (D) and end diastolic velocity (EDV) (E) are shown. = p < 0.01 (after vs. before PJ consumption).

All these antioxidative and anti-atherogenic effects of pomegranate polyphenols were clearly demonstrated in vitro, as well as in vivo in humans, and in the atherosclerotic apolipoprotein E-deficient mice. Dietary supplementation of pomegranate juice rich in polyphenols to patients with severe carotid artery stenosis or to atherosclerotic mice resulted in a significant inhibition in the development of the... 

Aviram, M. et al., Pomegranate juice consumption for 3 years by patients with carotid artery stenosis reduces common carotid intima-media thickness, blood pressure and LDL oxidation, Clin. Nutr., 23,423, 2004. 

The risk of stroke due to carotid artery stenosis treated conservatively is primarily dependent on two features ( ) Angiographic lesion severity (if) patient symptom status... 

Decision-making in the management of carotid artery stenosis based upon symptom status, lesion severity, and estimated procedural risks. The conventional paradigm for treatment assignment is depicted in the top panel. The proposed new paradigm in the bottom panel. Abbreviation CEA, carotid endarterectomy. 

Endarterectomy for asymptomatic carotid artery stenosis. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. JAMA 1995 273 1421-1428. 

Bockenheimer SA, Mathias K. Percutaneous transluminal angioplasty in arteriosclerotic internal carotid artery stenosis. AJNRAmJ Neuroradiol 1983 4 791-792. 

Anderson CM, Lee RE, Levin DL et al. (1994) Measurement of internal carotid artery stenosis from source MR angiograms. Radiology 193 219-226... 

Steele SR, Martin MJ, Mullenix PS et al. (2004) Focused high-risk population screening for carotid arterial stenosis after radiation therapy for head and neck cancer. Am J Surg 187 594-598... 

Sundgren PC, Sun den P, Lindgren A et al. (2002) Carotid artery stenosis contrast-enhanced MR angiography with two different scan times compared with digital subtraction angiography. Neuroradiology 44 592-599... 

Fig. 15.2. Diffusion-weighted imaging in a 54-year-old patient with acute onset of severe left-sided hemiplegia shows a territorial infarction in the right middle cerebral artery territory, as well as additional bilateral hemodynamic lesions. Ultrasound examination in this patient showed high-grade internal carotid artery stenosis on both sides...

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