Endarterectomía carotídea, resultados a corto plazo

Objetivo: Analizar los factores de riesgo y resultados de la endarterectomía carotídea (EC) en el hospital Metropolitano de la Florida Dra. Eloísa Díaz Insunza. Materiales y métodos: Se trata de un estudio observacional, retrospectivo y descriptivo, donde se analizan 89 endarterectomías carotídea, en un período de 8 años (enero del 2015 a enero de 2023) realizadas en 85 pacientes, los pacientes fueron divididos en 2 grupos, sintomáticos y asintomáticos, con respecto a las complicaciones fueron clasificadas en mayores y menores. Resultados: Se realizaron 89 endarterectomías carotídeas desde enero del 2015 hasta enero del 2023. El grupo sintomático corresponde a 78 (87,64%) pacientes, el grupo asintomático 11 (12,35%). 62 en hombres (69,66%) y 27 en mujeres (30,33%). Hubo muerte en 1 (1,12%) solo paciente, perteneciendo éste al grupo sintomático. Accidentes vasculares perioperatorios en 3 (3,37%) pacientes, todos con secuelas neurológicas presentes a 30 días post-operatorios (uno de estos fallecido en post-operatorio inmediato). Hematomas en 5 (5,61%) casos, 4 (3,56%) que requirieron intervención quirúrgica para drenaje del mismo. Lesión neurológica periférica en 1 (1,12%) solo paciente que corresponde a lesión del laríngeo recurrente. 1 (1,12%) caso de infección superficial de herida operatoria. 1 (1,12%) caso de síndrome de reperfusión cerebral Discusión: Todas las grandes series y guías internacionales demuestran el amplio beneficio de la endarterectomía carotídea en la prevención de eventos neurológicos. Conclusión: La endarterectomía carotídea sigue siendo el tratamiento de elección en la estenosis carotídea sintomática, realizada en centros con experiencia presenta resultados excelentes en cuanto a la prevención de nuevos eventos neurológicos.

Objective: To analyze the risk factors and short-term results of the carotid endarterectomy in our hospital. Materials and method: The present is an observational, retrospective and descriptive study, where 89 carotid endarterectomies are analyzed in a period of 8 years (January 2015 to January 2023) performed in 85 patients, the patients were divided in to two groups, symptomatic and asymptomatics, as for the complications there were divided in minor and mayor. Results: 89 carotid endarterectomies where perform between January 2015 to January 2023. In the symptomatic group are 78 (87.64%) patients, in the asymptomatic group there are 11 patients (12.35%). 62 where male (69.66%) and 27 where women (30.33%). Only 1 (1.12%) patient died, this one from the symptomatic group. Perioperatory stroke in 3 (3.37%) patients, all of them with neurologic secuela at 30 days of post operatory. 5 (5.61%) cases of post operatory hematomas 4 of them requiring reintervention. There was 1 (1.12%) patient with neurologic affection. 1 (1.12%) case of superficial wound infection. Conclusion: The carotid endarterectomy remains as the gold standard to prevent strokes in symptomatic patients. Performed in high volume centers it has excellent results as for the prevention of new strokes.

Effects of acupuncture combined with Buyang Huanwu Decoction on the cerebral blood flow hypo perfusion model rats with carotid artery stenosis based on high-throughput sequencing / 国际中医中药杂志

Objective:To explore the effects of acupuncture combined with Buyang Huanwu Decoction on intestinal flora in cerebral blood flow hypo perfusion model rats with carotid artery stenosis.Methods:Totally 40 rats were randomly divided into sham-operation group, model group, TCM treatment group and acupuncture and drug combination treatment group, with 10 rats in each group. Except the sham-operation group, the other groups were prepared cerebral ischemia model by needle control and thread embolism method. TCM treatment group received Buyang Huanwu Decoction 100 mg/kg for gavage, once a day, and the intervention lasted for 2 weeks. In the acupuncture and drug combination group, based on the TCM treatment group, Baihui and its left and right sides of 2 mm were selected for acupuncture, once a day, and continuous intervention was performed for 2 weeks. Neurological function evaluation and behavioral function score were performed 7 and 14 days after administration, respectively. 16S rRNA sequencing was used to comprehensively characterize the structure and composition of fecal microflora of rats in each group. Linear discriminant analysis Effect Size (LEfSe) was used to analyze the difference of intestinal bacteria among groups.Result:On the 7th and 14th day after administration, compared with the model group, the neurological function score in the TCM treatment group and the acupuncture and drug combination group decreased ( P<0.05), and the behavioral function score increased ( P<0.05). Compared with model group, the Shannon index of TCM treatment group and acupuncture and drug combination group increased ( P<0.05). The abundance of Firmicutes increased ( P<0.05), and the abundance of Bacteroidetes and Proteobacteria decreased ( P<0.05); the abundance of Clostridia increased ( P<0.05), and the abundance of Gammaproteobacteria decreased ( P<0.05). The abundance of Escherichia-Shigella and Bacteroides decreased ( P<0.05); the abundance of lactobacillus significantly increased ( P<0.05). Conclusion:Acupuncture combined with Buyang Huanwu Decoction can improve the symptoms of cerebral hypoperfusion model rats with carotid artery stenosis, and the mechanism may be to increase the abundance of probiotics.

Diretrizes da Sociedade Brasileira de Angiologia e Cirurgia Vascular para o tratamento da doença cerebrovascular extracraniana / Brazilian Angiology and Vascular Surgery Society Guidelines for the treatment of extracranial cerebrovascular disease

Resumo A doença cerebrovascular extracraniana tem sido intensamente investigada em todo o mundo, sendo tema de suma importância para os cirurgiões vasculares. A presente Diretriz foi elaborada pela Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV) em sucessão à Diretriz de 2015. As doenças de etiologia não ateroscleróticas não foram incluídas nesse documento. O objetivo desta Diretriz é congregar as evidências mais robustas nessa área para auxiliar os especialistas no processo decisório do tratamento. Foi utilizada a metodologia AGREE II e o sistema da Sociedade Europeia de Cardiologia para as recomendações e níveis de evidências. As recomendações foram graduadas de I a III, e os níveis de evidência classificados em A, B e C. A presente Diretriz foi dividida em 11 capítulos, que tratam dos vários aspectos da doença cerebrovascular extracraniana: diagnóstico, tratamentos e complicações, de forma atualizada e com as recomendações propostas pela SBACV.

Abstract Extracranial cerebrovascular disease has been the subject of intense research throughout the world, and is of paramount importance for vascular surgeons. This guideline, written by the Brazilian Society of Angiology and Vascular Surgery (SBACV), supersedes the 2015 guideline. Non-atherosclerotic carotid artery diseases were not included in this document. The purpose of this guideline is to bring together the most robust evidence in this area in order to help specialists in the treatment decision-making process. The AGREE II methodology and the European Society of Cardiology system were used for recommendations and levels of evidence. The recommendations were graded from I to III, and levels of evidence were classified as A, B, or C. This guideline is divided into 11 chapters dealing with the various aspects of extracranial cerebrovascular disease: diagnosis, treatments and complications, based on up-to-date knowledge and the recommendations proposed by SBACV.

Accuracy of duplex ultrasonography versus angiotomography for the diagnosis of extracranial internal carotid stenosis / Acurácia da ultrassonografia duplex comparada à angiotomografia para o diagnóstico de estenose de carótida interna extracraniana

ABSTRACT Introduction: Internal carotid artery (ICA) stenosis causes about 15% of ischemic strokes. Duplex ultrasonography (DUS) is the first line of investigation of ICA stenosis, but its accuracy varies in the literature and it is usual to complement the study with another more accurate exam when faced with significant stenosis. There is a lack of studies that compare DUS with angiotomography (CTA) in the present literature. Methods: we performed an accuracy study, which compared DUS to CTA of patients in a tertiary hospital with a maximum interval of three months between tests. Patients were selected retrospectively, and two independent and certified vascular surgeons evaluated each image in a masked manner. When there was discordance, a third evaluator was summoned. We evaluated the diagnostic accuracy of ICA stenosis of 50-94% and 70-94%. Results: we included 45 patients and 84 arteries after inclusion and exclusion criteria applied. For the 50-94% stenosis range, DUS accuracy was 69%, sensitivity 89%, and specificity 63%. For the 70-94% stenosis range, DUS accuracy was 84%, sensitivity 61%, and specificity 93%. There was discordance between CTA evaluators with a change from clinical to surgical management in at least 37.5% of the conflicting reports. Conclusion: DUS had an accuracy of 69% for stenoses of 50-94% and 84% for stenoses of 70-94% of the ICA. The CTA analysis depended directly on the evaluator with a change in clinical conduct in more than 37% of cases.

RESUMO Introdução: a estenose da artéria carótida interna (ACI) causa cerca de 15% dos acidentes vasculares cerebrais isquêmicos. A ultrassonografia duplex (USD) é a primeira linha de investigação da estenose de ACI, mas sua acurácia varia na literatura e é comum complementar o estudo com outro exame de maior acurácia diante de estenose significativa. Há uma escassez de estudos que comparem a USD com a angiotomografia computadorizada (ATC) na literatura atual. Métodos: realizamos um estudo de acurácia, que comparou a USD à ATC de pacientes de um hospital terciário com um intervalo máximo de três meses entre os exames. Os pacientes foram selecionados retrospectivamente e dois cirurgiões vasculares independentes e certificados avaliaram cada imagem de maneira mascarada. Quando houve discordância, um terceiro avaliador foi convocado. Avaliou-se a precisão diagnóstica da estenose da ACI de 50-94% e 70-94%. Resultados: foram incluídos 45 pacientes e 84 artérias após a aplicação dos critérios de inclusão e exclusão. Para a faixa de estenose de 50-94%, a acurácia da USD foi 69%, sensibilidade 89% e especificidade 63%. Para a faixa de estenose de 70-94%, a acurácia da USD foi 84%, sensibilidade 61% e especificidade 93%. Ocorreu discordância entre avaliadores da ATC com mudança de conduta clínica para cirúrgica em pelo menos 37,5% dos laudos conflitantes. Conclusão: a USD teve uma acurácia de 69% para estenoses de 50-94% e de 84% para estenoses de 70-94% da ACI. A análise das ATC dependeu diretamente do avaliador com mudança de conduta clínica em mais de 37% dos casos.

Desfechos de curto prazo da cirurgia de carótida: experiência no "mundo real" em um centro único de formação profissional / Short term outcomes of carotid surgery: the real-world experience of a single teaching center

Resumo Contexto A abordagem cirúrgica para estenose carotídea sintomática está consolidada na literatura para a prevenção de eventos neurológicos, devendo seguir padrões ótimos de qualidade. Entretanto, há uma crescente preocupação relacionada à possibilidade ou não de replicar os dados dos trabalhos controlados no mundo real. Objetivos Avaliar a população com estenose carotídea sintomática submetida a cirurgia e seus desfechos de curto prazo em um contexto de mundo real em um centro de formação profissional. Métodos Tratou-se de um estudo observacional realizado por meio de coleta de dados em prontuário de janeiro de 2012 a janeiro de 2023. Foram excluídos pacientes operados por outras etiologias e com cirurgia cardíaca concomitante. Resultados Foram incluídos 70 pacientes submetidos a angioplastia ou endarterectomia carotídea. Os subgrupos populacionais submetidos a angioplastia ou endarterectomia foram semelhantes. Houve diferença estatisticamente relevante quanto à modalidade anestésica e ao tempo cirúrgico maior para o subgrupo de endarterectomia carotídea. Houve quatro casos de acidente vascular encefálico isquêmico, e três deles estavam relacionados à lesão, sendo dois menores e um maior. Dessa forma, a taxa de acidente vascular encefálico maior relacionado à lesão foi de 1,43% e de qualquer acidente vascular encefálico relacionado à lesão, de 4,29%. A taxa total de eventos adversos cardiovasculares maiores foi de 5,71%. Houve um caso de infarto agudo do miocárdio no grupo angioplastia e nenhum óbito. Não houve diferença estatística entre os grupos de endarterectomia e angioplastia quanto aos desfechos principais. Conclusões Os desfechos acidente vascular encefálico isquêmico, infarto agudo do miocárdio, óbito e eventos adversos cardiovasculares maiores neste centro são semelhantes aos encontrados em estudos clínicos randomizados, demonstrando viabilidade da manutenção deste tratamento em centros com programas de ensino.

Abstract Background Surgical treatment of symptomatic extracranial carotid stenosis is well established for preventing neurological events and should adhere to optimal quality standards. However, there is growing concern as to whether results of controlled trials are replicable in real-world settings. Objectives To assess a symptomatic carotid stenosis population that underwent surgery and its short-term outcomes in a real-world context at a professional training center. Methods Observational study using data collected from medical records from January 2012 to January 2023. Patients undergoing operations for other carotid diseases and with concomitant heart surgery were excluded. Results A total of 70 patients undergoing angioplasty or carotid endarterectomy were included. Population subsets undergoing angioplasty or endarterectomy were similar. Differences in anesthetic modality and a longer operative time in the carotid endarterectomy subgroup were statistically significant. There were 4 cases of stroke, only 3 of which (2 minor and 1 major) were related to the index lesion. Thus, the rate of major operation-related stroke was 1.43% and the rate of any lesion-related stroke was 4.29%. There was 1 case of AMI in the angioplasty group and there were no deaths in the sample. The overall rate of major adverse cardiovascular events was 5.71%. There were no statistical differences between the endarterectomy and angioplasty groups regarding the main outcomes. Conclusions The rates of outcomes of ischemic stroke, acute myocardial infarction, death, and major adverse cardiovascular events at this center are in line with the rates reported by randomized controlled trials, demonstrating the feasibility of carotid surgery in centers with teaching programs.

Endarterectomía carotídea en paciente con estenosis aórtica crítica. Importancia de la anestesia regional y del neuromonitoreo / Carotid endarterectomy in a patient with critical aortic stenosis. Importance of regional anesthesia and transoperative neurological monitoring

Resumen: La estenosis carotídea (EC) ocurre en 13% de los pacientes con estenosis valvular aórtica (EVA). El riesgo de evento vascular cerebral (EVC), en los pacientes con EC significativa sometidos a cirugía valvular cardíaca, puede aumentar hasta 11%. Someter a un paciente con EVA crítica y fracción de eyección del ventrículo izquierdo (FEVI) disminuida a endarterectomía carotídea es todo un reto anestésico, cuyo principal objetivo es evitar la hipotensión y el bajo gasto cardíaco. La anestesia regional es una opción para estos pacientes. Presentamos el caso de un hombre de 70 años con diagnóstico de EC significativa y EVA crítica con disfunción ventricular izquierda, al que se realizó endarterectomía carotídea con bloqueo del plexo cervical superficial por alto riesgo de colapso circulatorio. Dicha estrategia anestésica permitió mantener al paciente despierto durante la cirugía, al valorar continuamente su estado neurológico. Asimismo, se documentaron los cambios transoperatorios en el NIRS (Near-infrared spectroscopy) cerebral y Doppler transcraneal (DTC), los cuales se correlacionaron con el estado clínico del paciente. En un segundo tiempo se hizo cambio valvular aórtico sin complicaciones. En este caso destaca la importancia de la anestesia regional y el monitoreo neurológico con Doppler transcraneal, en pacientes sometidos a endarterectomía carotídea con alto riesgo quirúrgico por EVA crítica.

Abstract: Carotid stenosis occurs in 13% of patients with aortic valve stenosis. The risk of stroke in patients with significant carotid stenosis undergoing heart valve surgery may increase to 11%. Proposing a patient with critical aortic valve stenosis and left ventricular dysfunction to carotid endarterectomy is an anesthetic challenge, where the objective is to avoid hypotension and low cardiac output. Regional anesthesia is an option for these patients. Due to the high incidence of intraoperative stroke during carotid endarterectomy, continuous neurological monitoring is of relevance. We present the case of a 70-year-old man diagnosed with significant carotid stenosis and critical aortic valve stenosis and left ventricular dysfunction who underwent carotid endarterectomy with superficial cervical plexus block due to a high risk of circulatory collapse. In addition, this anesthetic strategy made it possible to keep the patient awake during surgery, and to continuously assess their neurological status. Likewise, transoperative changes in brain NIRS and transcranial Doppler were documented, which correlated with the patient's clinical status. In a second time, aortic valve replacement was performed without complications. This case highlights the importance of regional anesthesia and neurological monitoring in patients undergoing carotid endarterectomy with high surgical risk due to critical aortic valve stenosis.

Effect of eversion carotid endarterectomy on cognitive function in elderly patients with carotid artery stenosis / 中华老年心脑血管病杂志

Objective To explore the effect of eversion carotid endarterectomy(eCEA)on the cog-nitive function in elderly carotid artery stenosis patients with different ages.Methods A total of 56 elderly patients undergoing eCEA in Department of Vascular Surgery of No.920 Hospital of Joint Logistics Support Force from May 2019 to May 2022 were enrolled and divided into a 60-69 year old group(31 cases)and a 70-80 year old group(25 cases).Mini-mental state examination(MMSE)Scale was used to analyze the patients within 1 week before surgery and 1 and 6 months after surgery.Results In the 60-69 years old group,their MMSE scores in 1 and 6 months after surgery were significantly higher than those before surgery(24.71±3.67 vs 23.52±3.70,P＜0.05;25.48±3.19 vs 23.52±3.70,P＜0.01).For the 70-80 year old group,the MMSE score in 6 months after surgery was obviously higher than that before surgery and that in 1 month after sur-gery(25.44±3.42 vs 23.76±3.81,P＜0.01;25.44±3.42 vs 23.90±3.65,P＜0.01).The improve-ment of MMSE score between 1 month after surgery and before surgery was notably more obvi-ous in the 60-69 year old group than the 70-80 year old group,but the improvement between 6 months and 1 month after surgery was statistically declined in the 60-69 year old group than the 70-80 year old group(P＜0.05).Conclusion eCEA can significantly improve cognitive function in elderly patients with carotid artery stenosis,and obvious efficacy is observed in the early stage in the 60-69 years old patients.

Predictive value of coronary plaque burden for recurrent myocardial infarction after PCI in elderly patients with AMI / 中华老年心脑血管病杂志

Objective To explore the predictive value of coronary plaque burden for recurrent myo-cardial infarction in elderly patients with acute myocardial infarction(AMI)after PCI.Methods A retrospective study was conducted on 212 AMI patients undergoing PCI in our hospital from January 2019 to December 2021.All of them were followed up for 1 year after surgery,and were divided into a recurrent myocardial infarction group(32 cases)and a control group(180 cases)based on whether they had recurrent myocardial infarction or not.The clinical characteristics were compared between the two groups.ROC curve was plotted to analyze the predictive value of coro-nary plaque burden for recurrent myocardial infarction in elderly AMI patients.Results There was no statistical difference in the nutritional risk index between the two groups(P＞0.05).The carotid intima media thickness(1.44±0.17 mm vs 1.33±0.17 mm,P=0.000),non-calcified plaque burden[(15.45±3.08)％vs(9.72±2.69)％,P=0.000],calcified plaque burden[(22.07± 5.13)％vs(18.48±4.36)％,P=0.000],and total plaque burden[(37.52±6.18)％vs(28.20± 5.08)％,P=0.000]were significantly higher,while the LVEF value was lower[(58.09±7.16)％vs(66.50±7.83)％,P=0.000]in the recurrent group than the control group.Non-calcified plaque burden,calcified plaque burden,total plaque burden,carotid intima media thickness and LVEF were all valuable in predicting recurrent myocardial infarction in these patients after PCI(P＜0.05).The predictive value of non-calcified plaque burden was the highest,with an area under the curve of 0.906(95％CI:0.848-0.965,P=0.000).Conclusion Coronary plaque burden is of cer-tain value in predicting recurrent myocardial infarction in elderly AMI patients after PCI,and can be used to identify high-risk population for recurrent myocardial infarction.

A review on the safety and feasibility of stenting for carotid artery stenosis via the radial artery approach / 中华老年医学杂志

Conventional approaches for stent implantation for carotid artery stenosis are the radial and femoral approaches.The radial artery approach has the advantages of fewer puncture site complications, increased patient comfort, and shorter postoperative bed rest.Physicians conducting interventional procedures increasingly tend to choose the radial artery approach for interventional treatment.However, controversy remains concerning which of the two approaches should be preferred.Therefore, we aim to review the literature on carotid stent implantation through the radial versus femoral artery approaches to illustrate the advantages of the radial approach in terms of safety and feasibility.

Carotid stenting in coronary artery bypass grafting patients with asymptomatic severe carotid artery stenosis / 中华胸心血管外科杂志

Objective:To evaluate the perioperative and follow-up data of carotid artery stenting (CAS)+ coronary artery bypass grafting (CABG) and CABG alone, and to assess the safety and efficacy of CAS in the treatment of severe stenosis of the carotid artery in combination with asymptomatic carotid artery stenosis.Methods:A retrospective analysis of 700 CABG patients combined asymptomatic carotid artery severe stenosis at Beijing Anzhen Hospital, Beijing Chaoyang Hospital, and Beijing Tiantan Hospital from January 2018 to December 2022 was performed. According to whether or not underwent CAS treatment, they were divided into the CAS-CABG group(116 cases)and the CABG-only group(584 cases). The mean age of the CAS-CABG group was (64.8±7.3) years, and all of them underwent unilateral CAS surgery only; the mean age of the CABG only group was (65.5±7.6) years. The main results of the patients in the two groups were compared at 30 days after the operation and follow-up period.Results:The early postoperative stroke rate was significantly lower in the CAS-CABG group(2.6% vs. 9.1%, P=0.02), while the combined procedure did not increase the rates of mortality and adverse events during follow-up. Subgroup analysis revealed that there was no significant difference in stroke rates between the two procedures for asymptomatic unilateral carotid artery stenosis, advanced age, history of atrial fibrillation, and history of stroke were independent risk factors for early stroke in CABG for asymptomatic unilateral carotid artery stenosis. Conclusion:CAS-CABG is safe and effective in the treatment of coronary artery disease combined with asymptomatic carotid artery stenosis, and can reduce the incidence of early postoperative stroke in patients. CABG patients with asymptomatic carotid stenosis should be rationally screened for prophylactic CAS to reduce the risk of postoperative stroke in these patients.

Study on changes of blood brain barrier permeability in asymptomatic carotid artery stenosis patients / 中风与神经疾病杂志

@#Objective To investigate the changes and correlations of the permeability of blood brain barrier (BBB),the cerebral brain perfusion and the volume of gray matter in patients with asymptomatic carotid artery stenosis (ACAS) by arterial spin labeling (ASL) MRI,dynamic contrast-enhanced (DCE) MRI and artificial intelligence. Methods ASL-MRI,DCE-MRI and three-dimension brain volume (3D-BRAVO) imaging were performed respectively on 40 patients with ACAS,then transferred them to the workstation for image post-processing to obtain cerebral blood perfusion,BBB permeability (which was expressed by volume transport constant Ktrans) and gray matter volume of both side.The above data were statistically analyzed and tested. Results Compared with the contralateral side,the stenosed side had a significant lower cerebral brain perfusion(P<0.001) and higher Ktrans value (P<0.05) in patients with ACAS.The volume of gray matter of the stenosed side was significantly smaller than the contralateral side(P<0.001),there were significant differences between bilateral temporal lobe,frontal lobe,parietal lobe and insular lobe(all P<0.05).Correlation analysis shows there was a negative correlation between Ktrans value and CBF value on the stenosed side (r=-0.334,P<0.05). Conclusion In patients with ACAS,there are lower cerebral brain perfusion and higher BBB permeability in the stenosed side.The increase BBB permeability in the stenosed side in patients with ACAS is related to the decrease in cerebral brain perfusion.

Estimating risk of atherosclerotic stroke with nomogram based on multi parameter characteristics / 中风与神经疾病杂志

@#Objective To construct an nomogram model for predicting the risk of ischemic stroke in patients with carotid stenosis,and verify its predictive efficacy. Methods Retrospective collection of 720 patients hospitalized in the First Hospital of Jilin University and Xuanwu Hospital from August 2018 to January 2021.The patients were divided into symptomatic group and asymptomatic group according to their clinical manifestations and imaging examination.The clinical data and carotid ultrasound characteristics were collected,and the risk factors of ischemic stroke in patients with carotid artery stenosis were analyzed by LASSO regression analysis and multivariate Logistic regression analysis.The nomogram model for predicting the risk of ischemic stroke in patients with carotid stenosis was constructed using R4.2.2 "rms" package.Bootstrap method was used to repeatedly sample 1 000 times for internal verification.Consistency index,H-L goodness of fit test and calibration curve were used to evaluate the prediction efficiency of the nomogram model. Results Of 720 patients,295 were classified as symptomatic group,and 425 were classified as asymptomatic group.Multivariate logistic regression analysis showed that hypertension,diabetes,smoking,the degree of carotid stenosis,plaque echogenicity,morphology and thickness were independent risk factors for ischemic stroke in patients with carotid artery stenosis (P<0.05).The nomogram model was constructed based on the above seven risk factors.The ROC curve analysis results showed that the AUC of the nomogram model predicting the risk of ischemic stroke in patients with carotid stenosis was 0.801 (95%CI 0.769-0.833).Bootstrap method was used for internal verification,and the results showed that the consistency index was 0.793.The calibration curve analysis showed that the calibration curve of the nomogram model is close to the ideal curve. Conclusion The nomogram model based on vascular risk factors and carotid ultrasound characteristics in this study has a high degree of differentiation and calibration in predicting the risk of ischemic stroke in patients with carotid stenosis,which is helpful for clinicians to stratify the risk of patients.

Anesthesia types for carotid endarterectomy in patients with carotid stenosis / 国际脑血管病杂志

Carotid endarterectomy (CEA) is an important measure for stroke prevention in patients with asymptomatic severe carotid artery stenosis and symptomatic moderate to severe carotid artery stenosis. The anesthesia types of CEA include general anesthesia (GA) and regional anesthesia (RA). The existing low-quality evidence shows that there is no significant difference in the incidence of stroke and death within 30 days of operation between RA and GA. However, some recent studies have shown that the incidence of perioperative complications during CEA under RA is significantly lower than that under GA. Further high-quality research is needed to clarify the risks and benefits of CEA under RA and GA.

Carotid plaque and ischemic stroke / 国际脑血管病杂志

Carotid atherosclerosis is closely associated with ischemic stroke. Research shows that the rupture of vulnerable carotid plaque is an important reason for carotid atherosclerosis leading to thromboembolic events. Therefore, early identification of vulnerable carotid plaques is of great significance for the diagnosis, treatment, and prevention of ischemic stroke. This article reviews the pathophysiological features, imaging evaluation of carotid plaque and its relationship with ischemic stroke.

Radiation-induced carotid artery stenosis / 国际脑血管病杂志

Carotid artery stenosis is an important cause of ischemic stroke, and its mechanism is mainly associated with the formation of atherosclerotic plaques. Head and neck radiotherapy may accelerate plaque formation, leading to carotid artery stenosis. In addition, radiotherapy can also cause the damage to the intima and adventitia of blood vessels, exacerbating the degree of carotid artery stenosis. This carotid artery stenosis caused by radiotherapy is different from atherosclerotic carotid artery stenosis in etiology, pathogenesis, prevention and treatment. Therefore, a thorough understanding of the pathogenic mechanism is crucial for selecting appropriate prevention and treatment methods.

Correlation between cognitive impairment and cortical atrophy in elderly patients with asymptomatic carotid artery stenosis / 中华健康管理学杂志

Objective:To analyze the correlation between cognitive impairment and cortical atrophy in elderly patients with asymptomatic carotid artery stenosis (ACAS).Methods:In this cross-sectional study, 40 consecutive elderly patients with ACAS treated in the Department of Neurology, Northern Jiangsu People′s Hospital from July 1, 2020 to June 30, 2021 (ACAS group), and 40 elderly healthy controls who accepted physical examination during the same period (control group) were included. Cognitive assessment was performed using the Mental State Examination Scale (MMSE) and the Montreal Cognitive Assessment Scale (MoCA), and brain magnetic resonance imaging scanning was performed in the ACAS group. The artificial intelligence technique was applied for brain lobe segmentation and cortical volume calculation. The χ2-test, independent sample t-test and Wilcoxon non-parametric test were used to analyze the difference of clinical data and cognitive scores between the two groups. In the ACAS group, the cortical volumes of the side with carotid stenosis was compared with that of the normal side, and Spearman′s correlation analysis was used to assess the correlation between cognitive scores and cortical atrophy. Results:Compared with the control group, the ACAS group got significantly lower scores of MMSE and MoCA, as well as lower scores of visuospatial executive function, attention and calculation, language function, abstraction ability and delayed recall [(25.60±2.49) vs (27.18±1.01), (22.05±3.59) vs (25.60±1.43), (2.73±1.04) vs (4.08±0.62), (4.53±0.93) vs (5.03±0.66), 2.00 (0.00) vs 3.00 (0.00), 1.00 (1.00) vs 2.00 (0.00), and (2.95±0.96) vs (3.35±0.62)] (all P<0.05). There was not significant differences in naming and orientation ability between the two groups (both P>0.05). The volume of cortical, temporal lobe, frontal lobe, parietal lobe and insular lobe on the side with carotid stenosis in the ACAS group were significantly smaller than those on the normal side [186.23 (177.97, 202.53) vs 194.67 (185.65, 204.82) cm 3, 54.74 (50.66, 56.95) vs 55.61 (51.24, 58.49) cm 3, 72.98 (70.76, 78.34) vs 75.27 (72.34, 80.66) cm 3, 53.66 (51.11, 57.86) vs 56.59 (52.80, 60.09) cm 3, 6.57 (6.35, 7.07) vs 6.72 (6.46, 7.34) cm 3] (all P<0.05). The MoCA score in the ACAS group was positively related to the cortical volume ratio of the two sides ( r=0.427, P<0.01). The attention ( r=0.353) and abstraction ( r=0.226) ability scores were positively correlated with the temporal lobe volume ratios of the two sides (both P<0.05). The visuospatial executive ( r=0.187) and language ( r=0.373) ability scores were positively correlated with frontal lobe volume ratios of the two sides (both P<0.05), and visuospatial executive ( r=0.386), naming ( r=0.344), language ( r=0.517), abstraction ( r=0.335) and delayed recall ( r=0.333) ability scores were positively correlated with parietal lobe volume ratios of the two sides (all P<0.05). Conclusion:In elderly patients with ACAS, the cognitive impairment and cortical atrophy on the sides with carotid stenosis are significant and a positive correlation is detected between them.

Carotid endarterectomy for symptomatic carotid artery near-occlusion / 中华普通外科杂志

Objective:To investigate the effect of carotid endarterectomy(CEA) in the treatment of symptomatic carotid artery near-occlusion(CNO).Methods:Clinical symptoms, imaging examination, treatment and prognosis of 122 symptomatic CNO patients admitted to China-Japan Friendship Hospital from Jan 2014 to Jan 2020 undergoing CEA were retrospectively analyzed. Patients were divided into two groups based on the collapse condition,full collapse group(54 cases) and non-full collapse group(68 cases).Results:The difference was insignificant between the two groups at the 30-day and 12-month occurrence rate of primary endpoints(1.85% vs. 4.41%, P=0.629;7.41% vs. 4.41%, P=0.698).Postoperative re-stenosis occurred in one case in the non-full collapse group 8 months after CEA. Conclusions:CEA can achieve good curative effect for patients with CNO with recurrent symptoms, irrelevant to the existence of distal full collapse. The shunt can prevent intraoperative hypoperfusion and postoperative hyperperfusion.

Correlation between carotid atherosclerosis stenotic severity and myocardial infarction size assessed by carotid color ultrasonography / 心血管康复医学杂志

Objective:To study correlation between carotid atherosclerosis(AS)stenotic severity and myocardial infarction(MI)size assessed by carotid color ultrasonography.Methods:According to infarction size,a total of 180 MI patients trea-ted in our hospital were divided into focal necrosis group(n=92),small-medium size infarction group(n=45)and large size infarction group(n=43).Carotid artery stenosis,peak systolic flow velocity(PSV),end diastolic flow velocity(EDV),number of AS plaques and MI location were compared among all group.And correlation between carotid AS ste-notic severity and MI size was analyzed.Results:Compared with focal necrosis group,there were significant reductions in PSV[(101.43±23.16)cm/s vs.(154.35±65.73)cm/s vs.(325.19±105.27)cm/s]and EDV[(34.19±19.36)cm/s vs.(77.13±20.61)cm/s vs.(138.41±84.93)cm/s]in small-medium size infarction group and large size infarction group,and above indexes of large size infarction group were significantly higher than those of small-medium size infarction group(P=0.001 all).Compared with focal necrosis group and small-medium size infarction group,there were significant rise in percentages of severe carotid stenosis(4.35%,11.11%vs.37.27%),occlusion(1.09%,4.44%vs.27.91%),number of atherosclerotic plaque＞2(38.04%,40.00%vs.65.12%)and anterior infarction(32.61%,35.56%vs.69.77%),and significant reduction in percentage of posterior infarction(48.91%,44.44%vs.23.26%)in large size infarction group(P＜0.05 or＜0.01).Spearman correlation analysis indicated that carotid AS stenotic severity was significant positively cor-related with MI size(r=0.733,P=0.001).Conclusion:Incidence rates of severe carotid stenosis and occlusion are higher in patients with large size myocardial infarction.Carotid AS stenotic severity is significant positively correlated with myo-cardial infarction size,which possesses certain application value in detecting myocardial infarction.

Endovascular recanalization treatment of non-acute symptomatic internal carotid artery occlusion: a single center retrospective case series study / 国际脑血管病杂志

Objective:To investigate the influencing factors, periprocedural complications, and long-term outcomes of successful recanalization after endovascular treatment in patients with non-acute symptomatic internal carotid artery occlusion.Methods:Patients with non-acute internal carotid artery occlusion received endovascular treatment in the Nanjing Stroke Registration System between January 2010 and December 2021 were retrospectively enrolled. Clinical endpoint events were defined as successful vascular recanalization, periprocedural complications (symptomatic embolism and symptomatic intracranial hemorrhage), neurological function improvement, and recurrence of ipsilateral ischemic events. Multivariate logistic regression analysis was used to investigate the independent influencing factors of successful vascular recanalization. Cox proportional hazards regression analysis was used to investigate the correlation between endovascular treatment outcomes and neurological function improvement, as well as ipsilateral ischemic cerebrovascular events. Results:A total of 296 patients were included, of which 190 (64.2%) were successfully recanalized. Multivariate logistic regression analysis showed that symptoms manifest as ischemic stroke (odds ratio [ OR] 3.353, 95% confidence interval [ CI] 1.399-8.038; P=0.007), the time from the most recent symptom onset to endovascular therapy within 1 to 30 d ( OR 2.327, 95% CI 1.271-4.261; P=0.006), proximal conical residual cavity ( OR 2.853, 95% CI 1.242-6.552; P=0.013) and focal occlusion (C1-C2: OR 3.255, 95% CI 1.296-8.027, P=0.012; C6/C7: OR 5.079, 95% CI 1.334-19.334; P=0.017) were the independent influencing factors for successful vascular recanalization. Successful recanalization did not increase the risk of symptomatic intracranial hemorrhage within 7 d after procedure (3.2% vs. 0.9%; P=0.428). The median follow-up time after procedure was 38 months. Cox proportional hazards regression analysis showed that after adjusting for confounding factors, successful recanalization was significantly associated with postprocedural neurological improvement (hazard ratio 1.608, 95% CI 1.091-2.371; P=0.017), and significantly reduced the risk of recurrence of long-term ischemic events (hazard ratio 0.351, 95% CI 0.162-0.773; P=0.010). Conclusion:In patients with non-acute internal carotid artery occlusion, successful endovascular recanalization can effectively reduce the risk of long-term ischemic events without increasing the risk of symptomatic intracranial hemorrhage.

Predictors of restenosis after carotid endarterectomy and carotid artery stenting / 国际脑血管病杂志

Carotid artery stenosis is an important cause of ischemic stroke. Carotid endarterectomy and carotid artery stenting are the effective methods for treating carotid artery stenosis, but postoperative restenosis remains a challenge. The pathogenesis of postoperative restenosis is currently not fully understood. However, multiple factors, including biomarkers, imaging features, and surgical related factors, have been proven to be associated with postoperative restenosis and can predict the occurrence of postoperative restenosis. This article reviews the predictors of restenosis after carotid endarterectomy and carotid artery stenting.