Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 12 de 12
Filtrar
1.
Stroke ; 53(9): 2838-2846, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35674045

RESUMO

BACKGROUND: Moderate carotid artery stenosis is a poorly defined risk factor for ischemic stroke. As such, practice recommendations are lacking. In this study, we describe the long-term risk of stroke in patients with moderate asymptomatic stenosis in an integrated health care system. METHODS: All adult patients with asymptomatic moderate (50%-69%) internal carotid artery stenosis between 2008 and 2012 were identified, with follow-up through 2017. The primary outcome was acute ischemic stroke attributed to the ipsilateral carotid artery. Stroke rates were calculated using competing risk analysis. Secondary outcomes included disease progression, ipsilateral intervention, and long-term survival. RESULTS: Overall, 11 614 arteries with moderate stenosis in 9803 patients were identified. Mean age was 74.2±9.9 years with 51.4% women. Mean follow-up was 5.1±2.9 years. There were 180 ipsilateral ischemic strokes (1.6%) identified (crude annual risk, 0.31% [95% CI, 0.21%-0.41%]), of which thirty-one (17.2%) underwent subsequent intervention. Controlling for death and intervention as competing risks, the cumulative incidence of stroke was 1.2% (95% CI, 1.0%-1.4%) at 5 years and 2.0% (95% CI, 1.7%-2.4%) at 10 years. Of identified strokes, 50 (27.8%) arteries had progressed to severe stenosis or occlusion. During follow-up, there were 17 029 carotid studies performed in 5951 patients, revealing stenosis progression in 1674 (14.4%) arteries, including 1614 (13.9%) progressing to severe stenosis and 60 (0.5%) to occlusion. The mean time to stenosis progression was 2.6±2.1 years. Carotid intervention occurred in 708 arteries (6.1%). Of these, 66.1% (468/708) had progressed to severe stenosis. The overall mortality rate was 44.5%, with 10.5% of patients lost to follow-up. CONCLUSIONS: In this community-based sample of patients with asymptomatic moderate internal carotid artery stenosis followed for an average of 5 years, the cumulative incidence of stroke is low out to 10 years. Future research is needed to optimize management strategies for this population.


Assuntos
Estenose das Carótidas , Endarterectomia das Carótidas , AVC Isquêmico , Acidente Vascular Cerebral , Adulto , Idoso , Idoso de 80 Anos ou mais , Artéria Carótida Interna , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/epidemiologia , Constrição Patológica/complicações , Progressão da Doença , Endarterectomia das Carótidas/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/etiologia
3.
Stroke ; 48(4): 955-962, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28283609

RESUMO

BACKGROUND AND PURPOSE: In Germany, all surgical and endovascular procedures on the carotid bifurcation must be documented in a statutory nationwide quality assurance database. We aimed to analyze the association between procedural and perioperative variables and in-hospital stroke or death rates after carotid endarterectomy. METHODS: Between 2009 and 2014, overall 142 074 elective carotid endarterectomy procedures for asymptomatic or symptomatic carotid artery stenosis were documented in the database. The primary outcome of this secondary data analysis was in-hospital stroke or death. Major stroke or death, stroke, and death, each until discharge were secondary outcomes. Adjusted relative risks (RRs) were assessed by multivariable multilevel regression analyses. RESULTS: The primary outcome occurred in 1.8% of patients, with a rate of 1.4% in asymptomatic and 2.5% in symptomatic patients, respectively. In the multivariable analysis, lower risks of stroke or death were independently associated with local anesthesia (versus general anesthesia: RR, 0.85; 95% confidence interval [CI], 0.75-0.95), carotid endarterectomy with patch plasty compared with primary closure (RR, 0.71; 95% CI, 0.52-0.97), intraoperative completion studies by duplex ultrasound (RR, 0.74; 95% CI, 0.63-0.88) or angiography (RR, 0.80; 95% CI, 0.71-0.90), and perioperative antiplatelet medication (RR, 0.83; 95% CI, 0.71-0.97). No shunting and a short cross-clamp time were also associated with lower risks; however, these are suspected to be confounded. CONCLUSIONS: Local anesthesia, patch plasty compared with primary closure, intraoperative completion studies by duplex ultrasound or angiography, and perioperative antiplatelet medication were independently associated with lower in-hospital stroke or death rates after carotid endarterectomy.


Assuntos
Anestesia Local/estatística & dados numéricos , Estenose das Carótidas , Endarterectomia das Carótidas/estatística & dados numéricos , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Monitorização Intraoperatória/estatística & dados numéricos , Avaliação de Processos e Resultados em Cuidados de Saúde/estatística & dados numéricos , Inibidores da Agregação Plaquetária/uso terapêutico , Acidente Vascular Cerebral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/epidemiologia , Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas/métodos , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Risco
4.
Int J Food Sci Nutr ; 68(1): 90-96, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27537342

RESUMO

The present study investigated the associations between serum vitamin D levels and carotid intima-media thickness (CIMT), carotid plaque and atherosclerosis in 71 Korean adults. CIMT and the presence of carotid plaque were assessed with a high-resolution B-mode ultrasound system, and carotid atherosclerosis was defined as a mean CIMT value >0.9 mm or the presence of carotid plaque. A vitamin D deficiency was associated with the presence of carotid plaque (adjusted odds ratio [aOR]: 9.25, 95% confidence interval [CI]: 1.52-56.3; p = 0.016). As serum vitamin D levels increased, the presence of high-risk carotid plaque decreased (aOR: 0.84, 95%CI: 0.72-0.99; p = 0.039). Serum vitamin D levels was negatively associated with carotid atherosclerosis (aOR: 0.86, 95%CI: 0.76-0.97; p = 0.018). Further studies are needed to investigate whether vitamin D supplementation would be effective for the prevention of atherosclerosis and cardiovascular diseases.


Assuntos
Aterosclerose/etiologia , Estenose das Carótidas/etiologia , Estado Nutricional , Deficiência de Vitamina D/fisiopatologia , 25-Hidroxivitamina D 2/sangue , Aterosclerose/diagnóstico por imagem , Aterosclerose/epidemiologia , Aterosclerose/etnologia , Biomarcadores/sangue , Calcifediol/sangue , Espessura Intima-Media Carotídea , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/epidemiologia , Estenose das Carótidas/etnologia , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Estado Nutricional/etnologia , Prevalência , República da Coreia/epidemiologia , Fatores de Risco , Autorrelato , Índice de Gravidade de Doença , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/etnologia
5.
J Vasc Surg ; 58(4): 1129-39, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24075112

RESUMO

Carotid atheromatous disease is an important cause of stroke and represents a key target in stroke prevention. Randomized trials have shown the efficacy of carotid endarterectomy in secondary stroke prevention. Carotid stenting presents a less invasive alternative to surgical intervention. Advances in medical management, if compliance can be ensured, are leading to improvement in outcomes when implemented as sole therapy in the treatment of atherosclerotic carotid stenosis. This includes lifestyle modification, blood pressure control, and antiplatelet and statin therapy. Over the last 20 years, the annual rate of ipsilateral stroke associated with asymptomatic carotid stenosis has decreased from 2% to 4% to less than 1%. This is largely due to improvements in medical therapy. However, despite numerous trials and years of clinical research, the optimal management of symptomatic and asymptomatic carotid disease remains controversial. This article presents and summarizes the evidence supporting best medical treatment for carotid artery stenosis.


Assuntos
Fármacos Cardiovasculares/uso terapêutico , Estenose das Carótidas/terapia , Comportamento de Redução do Risco , Acidente Vascular Cerebral/prevenção & controle , Fármacos Cardiovasculares/efeitos adversos , Estenose das Carótidas/diagnóstico , Estenose das Carótidas/epidemiologia , Medicina Baseada em Evidências , Humanos , Cooperação do Paciente , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Resultado do Tratamento
6.
Cardiol J ; 17(3): 254-8, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20535715

RESUMO

BACKGROUND: Over the centuries, opium has been the most frequent substance abused in the Middle East. There are many controversial aspects about the effects of opioids on the atherosclerosis process, which is still unclear. METHODS: All patients who were candidates for coronary artery bypass graft in Tehran Heart Center were registered and evaluated for risk factors such as diabetes mellitus, hypertension, smoking status and duration, opium abuse, involved coronary arteries and left main branch lesion > 50%, carotid stenosis > or = 70%. RESULTS: A total of 1,339 patients were enrolled in the study, of whom 400 (29.9%) were female and the other 939 (70.1%) male. Female patients were omitted from analysis due to the low numbers of female opium addicts. Our study revealed that in the addicted population, the risk of diabetes and hypertension was lower than in the non-addicted group (p < 0.05 for each variable) and fasting blood sugar tended to be less in addicted ones, but the number of involved coronary arteries, left main stenosis > 50% and extent of carotid stenosis was not significantly different between the two groups. CONCLUSIONS: Our investigations demonstrate that opium is not cardioprotective, as has been claimed by some previous studies, and does not even decelerate atherosclerosis of carotid arteries in opium-addicted patients, but more evidence is still needed to completely prove the case.


Assuntos
Estenose das Carótidas/epidemiologia , Ponte de Artéria Coronária , Estenose Coronária/cirurgia , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Ópio/efeitos adversos , Idoso , Estenose das Carótidas/diagnóstico por imagem , Angiografia Coronária , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/epidemiologia , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Ultrassonografia Doppler
7.
Acta Biomed ; 79(2): 123-7, 2008 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-18788507

RESUMO

AIM: To assess the validity of a carotid endarterectomy (CEA) with a mini-invasive access via a 3-7 cm cutaneous incision in locoregional anaesthesia as a viable alternative to the traditional access with a cutaneous incision longer than 7 cm. MATERIALS AND METHODS: We carried out a retrospective analysis of 76 consecutive patients (Group A) who had undergone carotid CEA in locoregional anaesthesia with cervical mini-access (3-7 cm incision), compared to a preceding series of 95 patients (Group B) who had undergone the same operation through a traditional access (incision > 7 cm). All patients in Group A were examined solely by means of duplex ultrasound scanning. RESULTS: No mortality occurred in Group A and the morbidity rate was as follows: 1.3% strokes, 2.6% minor neurological events and 6.5% transitory deficit of peripheral nerves. In Group B, the mortality rate was 1%, with the following morbidity rate: 2% strokes, 1% minor neurological events and 7.3% transitory deficit of peripheral nerves. Statistical analysis revealed the two groups as being compatible for age, sex, associated pathologies and type of surgery. No statistically significant differences emerged between the two series of patients with regards to neurological morbidity or operative mortality. CONCLUSIONS: In addition to being more aesthetically pleasing, mini-invasive access is a viable alternative to the traditional access for patients undergoing carotid CEA in locoregional anaesthesia.


Assuntos
Anestesia Local/métodos , Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Idoso , Estenose das Carótidas/epidemiologia , Complicações do Diabetes/epidemiologia , Feminino , Humanos , Hipertensão/epidemiologia , Cuidados Intraoperatórios , Pneumopatias/epidemiologia , Masculino , Insuficiência Renal/epidemiologia , Fumar/epidemiologia
8.
J Am Coll Cardiol ; 52(6): 417-24, 2008 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-18672160

RESUMO

OBJECTIVES: We sought to examine whether marine-derived n-3 fatty acids are associated with less atherosclerosis in Japanese versus white populations in the U.S. BACKGROUND: Marine-derived n-3 fatty acids at low levels are cardioprotective through their antiarrhythmic effect. METHODS: A population-based cross-sectional study in 281 Japanese (defined as born and living in Japan), 306 white (defined as white men born and living in the U.S.), and 281 Japanese-American men (defined as Japanese men born and living in the U.S.) ages 40 to 49 years was conducted to assess intima-media thickness (IMT) of the carotid artery, coronary artery calcification (CAC), and serum fatty acids. RESULTS: Japanese men had the lowest levels of atherosclerosis, whereas whites and Japanese Americans had similar levels. Japanese had 2-fold higher levels of marine-derived n-3 fatty acids than whites and Japanese Americans in the U.S. Japanese had significant and nonsignificant inverse associations of marine-derived n-3 fatty acids with IMT and CAC prevalence, respectively. The significant inverse association with IMT remained after adjusting for traditional cardiovascular risk factors. Neither whites nor Japanese Americans had such associations. Significant differences between Japanese and whites in multivariable-adjusted IMT (mean difference 39 mum, 95% confidence interval [CI]: 21 to 57mum, p < 0.001) and CAC prevalence (mean difference 10.7%, 95% CI: 2.9% to 18.4%, p = 0.007) became nonsignificant after we adjusted further for marine-derived n-3 fatty acids (22 mum, 95% CI: -1 to 46 mum, p = 0.065 and 5.0%, 95% CI: -5.3% to 15.4%, p = 0.341, respectively). CONCLUSIONS: Very high levels of marine-derived n-3 fatty acids have antiatherogenic properties that are independent of traditional cardiovascular risk factors and may contribute to lower the burden of atherosclerosis in Japanese, a lower burden that is unlikely the result of genetic factors.


Assuntos
Povo Asiático/estatística & dados numéricos , Asiático/estatística & dados numéricos , Estenose das Carótidas/epidemiologia , Estenose Coronária/epidemiologia , Ácidos Graxos Ômega-3/sangue , População Branca/estatística & dados numéricos , Adulto , Estenose das Carótidas/sangue , Estenose Coronária/sangue , Estudos Transversais , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Prevalência , Fatores de Risco , Inquéritos e Questionários , Túnica Íntima/patologia , Túnica Média/patologia , Estados Unidos/epidemiologia
10.
Public Health Rev ; 28(1-4): 117-45, 2000.
Artigo em Inglês | MEDLINE | ID: mdl-11411265

RESUMO

Recent studies have demonstrated associations between occlusive vascular disease and hyperhomocysteinemia of both genetic and nutritional origin. In the present study we analyzed plasma samples from the 20th biannual examination of the Framingham Heart Study cohort to determine distribution of plasma homocysteine concentrations with emphasis on relationships to vitamins that serve as coenzymes in homocysteine metabolism and to prevalence of carotid artery stenosis. Results showed that homocysteine exhibited strong inverse association with plasma folate and weaker associations with plasma vitamin B12 and pyridoxal-5'-phosphate. We saw similar inverse associations between homocysteine and intakes of folate and vitamin B6, but not vitamin B12. Prevalence of high homocysteine (> 14 mumol/L) was 29.3% in this cohort, and was greatest among subjects with low folate status. Inadequate plasma concentrations of one or more B vitamins appear to contribute to 67% of the cases of high homocysteine. Prevalence of stenosis > or = 25% was 43% in men and 34% in women, with an odds ratio of 2.0 for individuals in the highest homocysteine quartile (> or = 14.4 mumol/L) compared with those in the lowest quartile (< or = 9.1 mumol/L), after adjustment for sex, age, HDL cholesterol, systolic blood pressure, and cigarette smoking (Ptrend < 0.001). Plasma concentrations of folate and pyridoxal-5'-phosphate and folate intake were inversely associated with extracranial carotid stenosis after adjustment for age, sex, and other risk factors. Studies using samples from the Framingham Study Offspring Cohort have shown that the US-mandated folic acid fortification of flour and cereal grain products resulted in an increase in the mean folate concentrations from 4.8 to 10.0 ng/mL (P < 0.001) and prevalence of low folate (< 3 ng/mL) decreased from 22.0 to 1.7% (P < 0.001) between the baseline and follow-up visits. Mean homocysteine concentration decreased from 10.1 to 9.4 microM (P < 0.001), and prevalence of high homocysteine (> 13 mumol/L) decreased from 18.7 to 9.8% (P < 0.001) between study visits. There were no statistically significant changes in the control group for folate or homocysteine between examinations. These data indicate a high prevalence of hyperhomocysteinemia in the Framingham Study population, the majority of which can be attributed to vitamin status and that this hyperhomocysteinemia is clinically relevant because of its association with increased risk of occlusive extracranial carotid stenosis. Insufficient levels of folate, and to a lesser extent vitamin B6, appear to predict part of this elevated risk through their role in homocysteine metabolism. These studies also indicate that the recently-implemented fortification of grain and cereal products with folic acid resulted in a substantial decline in plasma homocysteine. The impact of fortification on the US population is likely to be similar; however it awaits the next survey for further confirmation.


Assuntos
Ácido Fólico/uso terapêutico , Alimentos Fortificados , Homocisteína/sangue , Hiper-Homocisteinemia/epidemiologia , Complexo Vitamínico B/sangue , Idoso , Idoso de 80 Anos ou mais , Estenose das Carótidas/epidemiologia , Estudos de Coortes , Feminino , Ácido Fólico/sangue , Humanos , Hiper-Homocisteinemia/sangue , Hiper-Homocisteinemia/tratamento farmacológico , Masculino , Razão de Chances , Risco , Estados Unidos/epidemiologia
11.
Am Surg ; 58(8): 446-50, 1992 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-1642377

RESUMO

Carotid endarterectomy has recently become one of the more controversial operations. The tremendous increase in the number of endarterectomies performed, coupled with the apparent increase in morbidity and mortality associated with this operation in some studies, have brought into question the indications and results of the procedure. The potential for complications from the procedure itself, as well as increased morbidity and mortality from surgery on the elderly, make carotid endarterectomy a dangerous operation that must be done carefully and thoughtfully. The authors have performed carotid endarterectomies exclusively under local anesthesia to more closely evaluate the neurologic status of the patient. They believe that the operation performed in this manner obviates the use of a shunt and its inherent complications in greater than 80 per cent of the patients. This, coupled with the fact that many of the patients also have severe cardiac disease and the use of local anesthesia causes less hemodynamic changes and stress, should make carotid endarterectomy under local anesthesia the preferred approach.


Assuntos
Anestesia Local , Endarterectomia das Carótidas , Prática Privada , Fatores Etários , Anestesia Local/métodos , Anestesia Local/estatística & dados numéricos , Cegueira/epidemiologia , Cegueira/mortalidade , Cegueira/cirurgia , Estenose das Carótidas/epidemiologia , Estenose das Carótidas/mortalidade , Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas/métodos , Endarterectomia das Carótidas/mortalidade , Endarterectomia das Carótidas/estatística & dados numéricos , Humanos , Ataque Isquêmico Transitório/epidemiologia , Ataque Isquêmico Transitório/mortalidade , Ataque Isquêmico Transitório/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/mortalidade , Prática Privada/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Virginia/epidemiologia
12.
G Chir ; 12(4): 237-9, 1991 Apr.
Artigo em Italiano | MEDLINE | ID: mdl-1911070

RESUMO

The authors report their experience with regional anaesthesia in carotid surgery. They performed 80 carotid endarterectomies in 79 patients. Thirty-three patients were at high surgical risk because of contralateral internal carotid artery occlusion or bilateral stenosis (greater than 70%) or ischemic brain areas for past stroke. In this high risk group 4 strokes were registered in the postoperative period, while no strokes appeared in patients non at risk.


Assuntos
Anestesia por Condução , Anestesia Local , Endarterectomia das Carótidas , Isquemia Encefálica/epidemiologia , Isquemia Encefálica/cirurgia , Artéria Carótida Interna/cirurgia , Estenose das Carótidas/epidemiologia , Estenose das Carótidas/cirurgia , Transtornos Cerebrovasculares/epidemiologia , Endarterectomia das Carótidas/estatística & dados numéricos , Humanos , Complicações Pós-Operatórias/epidemiologia , Fatores de Risco
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA