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2. Silent embolic infarcts on computed tomography brain scans and risk of ipsilateral hemispheric events in patients with asymptomatic internal carotid artery stenosis

Author

Kakkos, S, Sabetai, M, Tegos, T, Stevens, J, Thomas, D, Griffin, M, Geroulakos, G, Nicolaides, A, Adovasio, R, Ziani, B, Alò, F, Cicilioni, C, Ambrosio, G, Andreev, A, Andreozzi, G, Verlato, F, Camporese, G, Arosio, E, Barkaukas, E, Barros D'Sa, A, Brannigan, P, Batchvarova, V, Dramov, A, Belardi, P, Novelli, G, Simoni, G, Bell, P, BIASI, GIORGIO MARIA, MINGAZZINI, PAOLO, Bornstein, N, Bouchier Hayes, D, Fitzgerald, P, Cairols, M, Cao, P, DeRango, P, Carboni, G, Geoffredo, C, Catalano, M, Chambers, B, Goetzmann, M, Dickinson, A, Clement, D, Bobelyn, M, Coccheri, S, Conti, E, Diamantopoulos, E, Andreadis, A, Dimakakos, P, Kotsis, T, Eikelboom, B, Entz, L, Ferrari Bardile, T, Salerno, M, Fernandes, J, Pedro, L, Fitzgerald, D, O'Shaunnersy, A, Fletcher, J, Forconi, S, Capelli, R, Bicchi, M, Arrigucci, S, Gallai, V, Cardaiolli, G, Gomez Isaza, L, Gorgoyannis, G, Liasis, N, Graf, M, Guarini, P, Hardy, S, Harris, P, Aston, S, Iosa, G, Katsamouris, A, Giannoukas, A, Krzanowski, M, Ladurner, G, Leal Monedero, J, Lee, B, Liapis, C, Galanis, P, Liboni, W, Pavanelli, E, Mannarino, E, Vaudo, G, McCollum, P, Levison, R, Micieli, G, Bosone, D, Middleton, L, Pantziaris, M, Tyllis, T, Minar, E, Willfort, A, Moggi, L, Nenci, G, Radicchia, S, Norgren, L, Ribbe, E, Novo, S, Tantillo, R, Olinic, D, Paaske, W, Pagnan, A, Pauletto, P, Pagliara, V, Pettina, G, Pratesi, C, Matticari, S, Polivka, J, Sevcik, P, Poredos, P, Blinc, A, Videcnik, V, Pujia, A, Raso, A, Rispoli, P, Conforti, M, Robinson, T, Dennis, M, Rosfors, S, Rudofsky, G, Finocchi, C, Rodriguez, G, Spartera, C, Ventura, M, Scarpelli, P, Sprynger, M, Sadzot, B, Hottermans, C, Moonenbj, n, Taylor, P, Tovar Pardo, A, Negreira, J, Vayssairat, M, Faintuch, J, Valaikiene, J, Walker, M, Wilkinson, A., Kakkos, S, Sabetai, M, Tegos, T, Stevens, J, Thomas, D, Griffin, M, Geroulakos, G, Nicolaides, A, Adovasio, R, Ziani, B, Alò, F, Cicilioni, C, Ambrosio, G, Andreev, A, Andreozzi, G, Verlato, F, Camporese, G, Arosio, E, Barkaukas, E, Barros D'Sa, A, Brannigan, P, Batchvarova, V, Dramov, A, Belardi, P, Novelli, G, Simoni, G, Bell, P, Biasi, G, Mingazzini, P, Bornstein, N, Bouchier Hayes, D, Fitzgerald, P, Cairols, M, Cao, P, Derango, P, Carboni, G, Geoffredo, C, Catalano, M, Chambers, B, Goetzmann, M, Dickinson, A, Clement, D, Bobelyn, M, Coccheri, S, Conti, E, Diamantopoulos, E, Andreadis, A, Dimakakos, P, Kotsis, T, Eikelboom, B, Entz, L, Ferrari Bardile, T, Salerno, M, Fernandes, J, Pedro, L, Fitzgerald, D, O'Shaunnersy, A, Fletcher, J, Forconi, S, Capelli, R, Bicchi, M, Arrigucci, S, Gallai, V, Cardaiolli, G, Gomez Isaza, L, Gorgoyannis, G, Liasis, N, Graf, M, Guarini, P, Hardy, S, Harris, P, Aston, S, Iosa, G, Katsamouris, A, Giannoukas, A, Krzanowski, M, Ladurner, G, Leal Monedero, J, Lee, B, Liapis, C, Galanis, P, Liboni, W, Pavanelli, E, Mannarino, E, Vaudo, G, Mccollum, P, Levison, R, Micieli, G, Bosone, D, Middleton, L, Pantziaris, M, Tyllis, T, Minar, E, Willfort, A, Moggi, L, Nenci, G, Radicchia, S, Norgren, L, Ribbe, E, Novo, S, Tantillo, R, Olinic, D, Paaske, W, Pagnan, A, Pauletto, P, Pagliara, V, Pettina, G, Pratesi, C, Matticari, S, Polivka, J, Sevcik, P, Poredos, P, Blinc, A, Videcnik, V, Pujia, A, Raso, A, Rispoli, P, Conforti, M, Robinson, T, Dennis, M, Rosfors, S, Rudofsky, G, Finocchi, C, Rodriguez, G, Spartera, C, Ventura, M, Scarpelli, P, Sprynger, M, Sadzot, B, Hottermans, C, Moonenbj, N, Taylor, P, Tovar Pardo, A, Negreira, J, Vayssairat, M, Faintuch, J, Valaikiene, J, Walker, M, and Wilkinson, A

Subjects
Male, medicine.medical_specialty, Time Factors, medicine.medical_treatment, internal carotid artery, Carotid endarterectomy, Kaplan-Meier Estimate, brain embolism, Asymptomatic, Risk Assessment, Central nervous system disease, Duplex scanning, Predictive Value of Tests, MED/22 - CHIRURGIA VASCOLARE, medicine, Humans, Carotid Stenosis, brain infarction, cardiovascular diseases, Prospective Studies, Stroke, Aged, Proportional Hazards Models, Ultrasonography, Doppler, Duplex, Cerebral infarction, business.industry, Amaurosis fugax, Cerebral Infarction, medicine.disease, major clinical study, neurologic disease, Stenosis, multicenter study, Intracranial Embolism, Ischemic Attack, Transient, transient ischemic attack, Disease Progression, carotid artery obstruction, Surgery, Female, Radiology, medicine.symptom, business, Cardiology and Cardiovascular Medicine, Tomography, X-Ray Computed, Carotid Artery, Internal, prospective study
Abstract

Udgivelsesdato: 2009-Apr OBJECTIVES: This study tested the hypothesis that silent embolic infarcts on computed tomography (CT) brain scans can predict ipsilateral neurologic hemispheric events and stroke in patients with asymptomatic internal carotid artery stenosis. METHODS: In a prospective multicenter natural history study, 821 patients with asymptomatic carotid stenosis graded with duplex scanning who had CT brain scans were monitored every 6 months for a maximum of 8 years. Duplex scans were reported centrally, and stenosis was expressed as a percentage in relation to the normal distal internal carotid criteria used by the North American Symptomatic Carotid Endarterectomy Trialists. CT brain scans were reported centrally by a neuroradiologist. In 146 patients (17.8%), 8 large cortical, 15 small cortical, 72 discrete subcortical, and 51 basal ganglia ipsilateral infarcts were present; these were considered likely to be embolic and were classified as such. Other infarct types, lacunes (n = 15), watershed (n = 9), and the presence of diffuse white matter changes (n = 95) were not considered to be embolic. RESULTS: During a mean follow-up of 44.6 months (range, 6 months-8 years), 102 ipsilateral hemispheric neurologic events (amaurosis fugax in 16, 38 transient ischemic attacks [TIAs], and 47 strokes) occurred, 138 patients died, and 24 were lost to follow-up. In 462 patients with 60% to 99% stenosis, the cumulative event-free rate at 8 years was 0.81 (2.4% annual event rate) when embolic infarcts were absent and 0.63 (4.6% annual event rate) when present (log-rank P = .032). In 359 patients with

Published
2008
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4. Factors associated with mortality in patients with asymptomatic carotid stenosis: Results from the ACSRS study

Author

Kakkos, S. K., Nicolaides, A. N., Griffin, M., Sabetai, M., Dhanjil, S., Thomas, D. J., Sonecha, T., Salmasi, A. M., Geroulakos, G., Georgiou, N., Francis, S., Ioannidou, E., Dore, C. J., Adovasio, R., Ziani, B., Alò, F. P., Cicilioni, C. G., Ambrosio, G., Andreev, A., Andreozzi, G. M., Verlato, F., Camporese, G., Arosio, E., Barkauskas, E., Barros D Sa, A. A. B., Brannigan, P., Batchvarova, V., Dramov, A., Belardi, P., Novelli, G. P., Simoni, G., Bell, P., Biasi, G. M., Mingazzini, P., Bornstein, N. M., Bouchier-Hayes, D., Fitzgerald, P., Cairols, M. A., Cao, P. G., Derango, P., Carboni, G. P., Geoffredo, C., Catalano, M., Chambers, B., Goetzmann, M., Dickinson, A., Clement, D., Bobelyn, M., Coccheri, S., Conti, E., Diamantopolous, E., Andreadis, E. A., Dimakakos, P. B., Kotsis, T., Eikelboom, B., Entz, L., Ferrari-Bardile, Aloi, T., Salerno, M., Fernandez E Fernandez, J., Pedro, L., Fitzgerald, D. E., O Shaunnersy, A., Fletcher, J., Forconi, S., Cappeli, R., Bicchi, M., Arigucci, S., Gallai, V., Cardaiolli, G., Kakkos, S., Gomez-Isaza, L. F., Gorgoyannis, G., Liasis, N., Graf, M., Guarini, P., Hardy, S., Harris, P., Aston, S., Iosa, G., Katsamouris, A., Glannoukas, A., Krzanowski, M., Ladurner, G., Leal-Monedero, J., Lee, B. B., Liapis, C., Galanis, P., Liboni, W., Pavanelli, E., elmo mannarino, Vaudo, G., Mccollum, P., Levison, R., Micieli, G., Bosone, D., Middleton, L., Pantziaris, M., Kakkos, S, Nicolaides, A, Griffin, M, Sabetai, M, Dhanjil, S, Thomas, D, Sonecha, T, Salmasi, A, Geroulakos, G, Georgiou, N, Francis, S, Ioannidou, E, Dore, C, Adovasio, R, Ziani, B, Alò, F, Cicilioni, C, Ambrosio, G, Andreev, A, Andreozzi, G, Verlato, F, Camporese, G, Arosio, E, Barkauskas, E, Barros D'Sa, A, Brannigan, P, Batchvarova, V, Dramov, A, Belardi, P, Novelli, G, Simoni, G, Bell, P, Biasi, G, Mingazzini, P, Bornstein, N, Bouchier Hayes, D, Fitzgerald, P, Cairols, M, Cao, P, Derango, P, Carboni, G, Geoffredo, C, Catalano, M, Chambers, B, Goetzmann, M, Dickinson, A, Clement, D, Bobelyn, M, Coccheri, S, Conti, E, Diamantopolous, E, Andreadis, E, Dimakakos, P, Kotsis, T, Eikelboom, B, Entz, L, Ferrari Bardilead, N, Aloi, T, Salerno, M, Fernandez, J, Pedro, L, Fitzgerald, D, O'Shaunnersy, A, Fletcher, J, Forconi, S, Cappeli, R, Bicchi, M, Arigucci, S, Gallai, V, Cardaiolli, G, Gomez Isaza, L, Gorgoyannis, G, Liasis, N, Graf, M, Guarini, P, Hardy, S, Harris, P, Aston, S, Iosa, G, Katsamouris, A, Glannoukas, A, Krzanowski, M, Ladurner, G, Leal Monedero, J, Lee, B, Liapis, C, Galanis, P, Liboni, W, Pavanelli, E, Mannarino, E, Vaudo, G, Mccollum, P, Levison, R, Micieli, G, Bosone, D, Middleton, L, and Pantziaris, M

Subjects
cause of death, Ultrasonography, Doppler, Duplex, MED/22 - CHIRURGIA VASCOLARE, cerebrovascular accident, carotid endarterectomy, major clinical study, Carotid Artery, Internal, Stenosi
Abstract

Aim. This study determines the factors associated with mortality in patients with asymptomatic carotid stenosis. Methods. Patients (n=1 101) with asymptomatic internal carotid artery stenosis greater than 50% in relation to the bulb diameter were followed up for a period of 6 to 84 (median 38) months. Stenosis was graded using duplex scanning and expressed as a percentage of the carotid bulb diameter. Clinical and biochemical risk factors were recorded. The end-points were ipsilateral ischemic stroke, cardiovascular death and all cause mortality. Results. In a Cox multivariate analysis 6 factors emerged as independent predictors of risk. Age, male gender, cardiac failure, left ventricular hypertrophy on electrocardiogram (ECG) and myocardial ischemia on ECG were associated with increased risk. Antiplatelet therapy was associated with decreased risk. Based on these risk factors a high-risk group consisting of one third of the population with a 40% cumulative cardiovascular death rate and a 66% all cause death rate at 7 years could be identified. The remaining 2/3 consisted of a low-risk group with a 10% cumulative cardiovascular death rate and a 21% all cause death rate at 7 years (P0.05). Conclusion. The methodology and findings from the ACSRS natural history study need to be applied to randomized controlled trials on the value of carotid endarterectomy or stenting in patients with asymptomatic carotid stenosis. They may help refine the indications for intervention in patients with carotid endarterectomy.

12. Quality of life measurement in patients with hypertension in cyprus

Author

Theodorou, M., Kaitelidou, D., Galanis, P., Middleton, N., Theodorou, P., Panagiotis Stafylas, Siskou, O., and Maniadakis, N.

Subjects
Euro-Qol and hypertension, Cyprus, Dyslipidaemia and QoL, Clinical Medicine, Medical and Health Sciences
Abstract

Cardiovascular diseases and hypertension may have a significant impact on the quality of life of those who suffer from these conditions. The aim of the present study was to measure health-related quality of life among Cypriot patients suffering from hypertension and/or dyslipidaemia, as well as to investigate any temporal changes in their quality of life at 3 and 6 months from the initial visit. Methods: A stratified random sampling method was used in this follow-up multi-centre study to select a representative sample of physicians who treat patients with hypertension in both public and private sector outpatient hospital clinics and physician offices. The participants were diagnosed by the physician according to the 2007 European guidelines for the management of arterial hypertension. The EQ-5D questionnaire was employed to measure self-assessed quality of life among these patients. Six hundred and fifty-four patients were recruited by physicians and agreed to participate, while 528 of them successfully completed EQ-5D at baseline and two subsequent phases (at 3 and 6 months), representing a response rate of 80.7%. Results: A total of 39.6% of the respondents reported problems in one or more of the EQ-5D dimensions. This was more apparent in the case of anxiety and depression. There appeared to be statistically significant improvements with regard to mobility, usual activities, pain/discomfort and anxiety/depression dimensions between the initial visit and on first follow up, as well as subsequently. Median (interquartile range) EQ-5D index scores were 0.97 (0.19), 0.97 (0.19) and 0.97 (0.17) at first visit, first follow-up and second follow-up respectively (p

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