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Start Over Author "Dramov, A." Topic cardiology and cardiovascular medicine
5 results on '"Dramov, A."'

1. Severity of Asymptomatic Carotid Stenosis and Risk of Ipsilateral Hemispheric Ischaemic Events: Results from the ACSRS Study

Author

Nicolaides, A, Kakkos, S, Griffin, M, Sabetai, M, Dhanjil, S, Tegos, T, Thomas, D, Giannoukas, A, Geroulakos, G, Georgiou, N, Francis, S, Ioannidou, E, Doré, C, Adovasio, R, Ziani, B, Aló, E, 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, 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, Middleton, L, Pantziaris, M, Tyllis, T, Minar, E, Willfort, A, Moggi, L, Nenci, G, Radicchia, S, Norgren, L, Ribbie, 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, Schroeder, T, Gronholdt, M, Finocchi, C, Rodriguez, G, Dimakakos, P, Kotsis, T, Eikelboom, B, Entz, L, Ferrari Bardilleas, n, Aloi, T, Salerno, M, Fernandes, J., BIASI, GIORGIO MARIA, MINGAZZINI, PAOLO, Nicolaides, A, Kakkos, S, Griffin, M, Sabetai, M, Dhanjil, S, Tegos, T, Thomas, D, Giannoukas, A, Geroulakos, G, Georgiou, N, Francis, S, Ioannidou, E, Doré, C, Adovasio, R, Ziani, B, Aló, E, 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, Middleton, L, Pantziaris, M, Tyllis, T, Minar, E, Willfort, A, Moggi, L, Nenci, G, Radicchia, S, Norgren, L, Ribbie, 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, Schroeder, T, Gronholdt, M, Finocchi, C, Rodriguez, G, Dimakakos, P, Kotsis, T, Eikelboom, B, Entz, L, Ferrari Bardilleas, N, Aloi, T, Salerno, M, Fernandes, J, NICOLAIDES A N, KAKKOS S K, GRIFFIN M, SABETAI M, DHANJIL S, TEGOS T, THOMAS D J, GIANNOUKAS A, GEROULAKOS G, GEORGIOU N, FRANCIS S, IOANNIDOU E, and NOVO S

Subjects
Risk, medicine.medical_specialty, medicine.medical_treatment, Carotid Stenosi, Predictive Value of Test, Carotid endarterectomy, Severity of Illness Index, Asymptomatic, Brain Ischemia, chemistry.chemical_compound, Cerebrovascular Accident, medicine.artery, Internal medicine, Severity of illness, NASCET, MED/22 - CHIRURGIA VASCOLARE, medicine, Carotid, Stenosis, Medicine(all), Ultrasonography, Doppler, Duplex, Creatinine, business.industry, Risk Factor, Incidence (epidemiology), medicine.disease, major clinical study, Ultrasonography, Duplex, Doppler, chemistry, Predictive value of tests, Cardiology, Surgery, ECST, Radiology, Internal carotid artery, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Human
Abstract

Objectives. This study determines the risk of ipsilateral ischaemic neurological events in relation to the degree of asymptomatic carotid stenosis and other risk factors. Methods. Patients (n = 1115) with asymptomatic internal carotid artery (ICA) stenosis greater than 50% in relation to the bulb diameter were followed up for a period of 6-84 (mean 37.1) months. Stenosis was graded using duplex, and clinical and biochemical risk factors were recorded. Results. The relationship between ICA stenosis and event rate is linear when stenosis is expressed by the ECST method, but S-shaped if expressed by the NASCET method. In addition to the ECST grade of stenosis (RR 1.6; 95% CI 1.21-2.15), history of contralateral TIAs (RR 3.0; 95% CI 1.90-4.73) and creatinine in excess of 85 μmol/L (RR 2.1; 95% CI 1.23-3.65) were independent risk predictors. The combination of these three risk factors can identify a high-risk group (7.3% annual event rate and 4.3% annual stroke rate) and a low risk group (2.3% annual event rate and 0.7% annual stroke rate). Conclusions. Linearity between ECST percent stenosis and risk makes this method for grading stenosis more amenable to risk prediction without any transformation not only in clinical practice but also when multivariable analysis is to be used. Identification of additional risk factors provides a new approach to risk stratification and should help refine the indications for carotid endarterectomy. © 2005 Elsevier Ltd. All rights reserved.

Published
2005

2. Asymptomatic internal carotid artery stenosis and cerebrovascular risk stratification

Author

Nicolaides, Andrew N, Kakkos, Stavros K., Kyriacou, Efthyvoulos, Griffin, Maura, Sabetai, Michael, Thomas, Dafydd J., Tegos, Thomas, Geroulakos, George, Labropoulos, Nicos, Dor, Caroline J., Morris, Tim P., Naylor, Ross, Abbott, Anne L., Adovasio, Roberto, 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, Gp, 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., Diamantopoulos, E., Andreadis, E. A., Dimakakos, P. B., Kotsis, T., Eikelboom, B., Entz, L., Ferrari Bardile, Null, Aloi, T., Salerno, M., Fernandes e. Fernandes, J., Pedro, L., Fitzgerald, D. E., O'Shaunnersy, Anne, Fletcher, J., Forconi, S., Cappeli, R., Bicchi, M., Arrigucci, S., Gallai, V., Cardaiolli, G., Geroulakos, 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., Giannoukas, A., Krzanowski, M., Ladurner, G., Leal Monedero, J., Lee, B. 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., Nicolaides, A., Thomas, D, 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. S. J., Rosfors, S., Rudofsky, G., Schroeder, T., Gronholdt, M. L., Finocchi, C., Rodriguez, G., Spartera, C., Ventura, M., Scarpelli, P., Sprynger, M., Sadzot, B., Hottermans, C., Moonen, Null, Taylor, P. R., Tovar Pardo, A., Negreira, J., Vayssairat, M., Faintuch, J. M., Valaikiené, J., Walker, M. G., Wilkinson, A. R., Nicolaides, A, Kakkos, S, Kyriacou, E, Griffin, M, Sabetai, M, Thomas, D, Tegos, T, Geroulakos, G, Labropoulos, N, Dor, C, Morris, T, Naylor, R, Abbott, A, 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, Diamantopoulos, E, Andreadis, E, Dimakakos, P, Kotsis, T, Eikelboom, B, Entz, L, Ferrari Bardileah, N, Aloi, T, Salerno, M, Fernandes, J, Pedro, L, Fitzgerald, D, O'Shaunnersy, A, Fletcher, J, Forconi, S, Cappeli, 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, Schroeder, T, Gronholdt, M, Finocchi, C, Rodriguez, G, Spartera, C, Ventura, M, Scarpelli, P, Sprynger, M, Sadzot, B, Hottermans, C, Moonenbp, N, Taylor, P, Tovar Pardo, A, Negreira, J, Vayssairat, M, Faintuch, J, Valaikiené, J, Walker, M, Wilkinson, A, Nicolaides, Andrew N, Kakkos, Stavros K., Kyriacou, Efthyvoulo, Griffin, Maura, Sabetai, Michael, Thomas, Dafydd J., Tegos, Thoma, Geroulakos, George, Labropoulos, Nico, Dor, Caroline J., Morris, Tim P., Naylor, Ro, Abbott, Anne L., Adovasio, Roberto, 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, Gp, 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., Diamantopoulos, E., Andreadis, E. A., Dimakakos, P. B., Kotsis, T., Eikelboom, B., Entz, L., Ferrari Bardile, Null, Aloi, T., Salerno, M., Fernandes e. Fernandes, J., Pedro, L., Fitzgerald, D. E., O'Shaunnersy, Anne, Fletcher, J., Forconi, S., Cappeli, R., Bicchi, M., Arrigucci, S., Gallai, V., Cardaiolli, G., Geroulakos, 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., Giannoukas, A., Krzanowski, M., Ladurner, G., Leal Monedero, J., Lee, B. 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., Nicolaides, A., 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. S. J., Rosfors, S., Rudofsky, G., Schroeder, T., Gronholdt, M. L., Finocchi, C., Rodriguez, G., Spartera, C., Ventura, M., Scarpelli, P., Sprynger, M., Sadzot, B., Hottermans, C., Moonen, Null, Taylor, P. R., Tovar Pardo, A., Negreira, J., Vayssairat, M., Faintuch, J. M., Valaikiené, J., Walker, M. G., and Wilkinson, A. R.

Subjects
Male, Carotid Stenosi, carotid artery stenosis, Brain Ischemia, 80 and over, MED/22 - CHIRURGIA VASCOLARE, Carotid Stenosis, Cerebrovascular disease, cerebrovascular risk, Stroke, Ultrasonography, Aged, 80 and over, Middle Aged, cardiovascular system, Female, Radiology, Internal carotid artery, medicine.symptom, Cardiology and Cardiovascular Medicine, Carotid Artery, Internal, Adult, Aged, Amaurosis Fugax, Humans, ROC Curve, Risk Assessment, Surgery, Human, medicine.medical_specialty, Asymptomatic, Central nervous system disease, medicine.artery, medicine, Asymtomatic carotid stenosis, cardiovascular diseases, Risk factor, carotid surgery, Vascular disease, business.industry, Amaurosis fugax, medicine.disease, Internal, Stenosis, atherosclerosis, Carotid Artery, business
Abstract

Background: The purpose of this study was to determine the cerebrovascular risk stratification potential of baseline degree of stenosis, clinical features, and ultrasonic plaque characteristics in patients with asymptomatic internal carotid artery (ICA) stenosis. Methods: This was a prospective, multicenter, cohort study of patients undergoing medical intervention for vascular disease. Hazard ratios for ICA stenosis, clinical features, and plaque texture features associated with ipsilateral cerebrovascular or retinal ischemic (CORI) events were calculated using proportional hazards models. Results: A total of 1121 patients with 50% to 99% asymptomatic ICA stenosis in relation to the bulb (European Carotid Surgery Trial [ECST] method) were followed-up for 6 to 96 months (mean, 48). A total of 130 ipsilateral CORI events occurred. Severity of stenosis, age, systolic blood pressure, increased serum creatinine, smoking history of more than 10 pack-years, history of contralateral transient ischemic attacks (TIAs) or stroke, low grayscale median (GSM), increased plaque area, plaque types 1, 2, and 3, and the presence of discrete white areas (DWAs) without acoustic shadowing were associated with increased risk. Receiver operating characteristic (ROC) curves were constructed for predicted risk versus observed CORI events as a measure of model validity. The areas under the ROC curves for a model of stenosis alone, a model of stenosis combined with clinical features and a model of stenosis combined with clinical, and plaque features were 0.59 (95% confidence interval [CI] 0.54-0.64), 0.66 (0.62-0.72), and 0.82 (0.78-0.86), respectively. In the last model, stenosis, history of contralateral TIAs or stroke, GSM, plaque area, and DWAs were independent predictors of ipsilateral CORI events. Combinations of these could stratify patients into different levels of risk for ipsilateral CORI and stroke, with predicted risk close to observed risk. Of the 923 patients with

Published
2010

3. Predictors and clinical significance of progression or regression of asymptomatic carotid stenosis

Author

Kakkos, Sk, Nicolaides, An, Charalambous, I, Thomas, D, Giannopoulos, A, Naylor, Ar, Geroulakos, G, Abbott, Al, Asymptomatic Carotid Stenosis, Risk of Stroke Study Group Adovasio, R, Ziani, B, Alò, F, Cicilioni, C, Ambrosio, G, Andreev, A, Andreozzi, G, Verlato, F, Camporese, G, Arosio, E, Barkauskas, E, 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, E, Dimakakos, P, Kotsis, T, Eikelboom, B, Entz, L, Ferrari Bardile, A, Aloi, T, Salerno, M, Fernandes J, Fernandes e., Pedro, L, Fitzgerald, D, O'Shaughnessy, A, Fletcher, J, Forconi, S, Cappeli, R, Bicchi, M, Arrigucci, S, Gallai, V, Cardaiolli, G, Kakkos, S, 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, Nicolaides, A, 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, Pietro, Conforti, M, Robinson, T, Dennis, M, Rosfors, S, Rudofsky, G, Schroeder, T, Gronholdt, M, Finocchi, C, Rodriguez, G, Spartera, C, Ventura, M, Scarpelli, P, Sprynger, M, Sadzot, B, Hottermans, C, Moonen, M, Taylor, P, Tovar Pardo, A, Negreira, J, Vayssairat, M, Faintuch, J, Valaikiené, J, Walker, M, Wilkinson, A. R., Kakkos, Stavros K., Nicolaides, Andrew N., Charalambous, Ioanna, Thomas, Dafydd, Giannopoulos, Argyrio, Naylor, A. Ro, Geroulakos, George, Abbott, Anne L., Adovasio, Roberto, 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., Diamantopoulos, E., Andreadis, E. A., Dimakakos, P. B., Kotsis, T., Eikelboom, B., Entz, L., Ferrari Bardile, A., Aloi, T., Salerno, M., Fernandes E. Fernandes, J., Pedro, L., Fitzgerald, D. E., O'Shaughnessy, A. M., Fletcher, J., Forconi, S., Cappeli, R., Bicchi, M., Arrigucci, S., Gallai, V., Cardaiolli, G., Gomez Isaza, L. F., 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. 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. S. J., Rosfors, S., Rudofsky, G., Schroeder, T., Gronholdt, M. L., Finocchi, C., Rodriguez, G., Spartera, C., Ventura, M., Scarpelli, P., Sprynger, M., Sadzot, B., Hottermans, C., Moonen, M., Taylor, P. R., Tovar Pardo, A., Negreira, J., Vayssairat, M., Faintuch, J. M., Valaikiené, J., Walker, M. G., and Wilkinson, A. R.

Subjects
Male, Time Factors, Cost effectiveness, medicine.medical_treatment, Carotid Stenosi, Predictive Value of Test, Kaplan-Meier Estimate, Carotid endarterectomy, Retinal Disease, Risk Factors, 80 and over, Carotid Stenosis, Plaque, Atherosclerotic, Ultrasonography, Aged, 80 and over, Ultrasonography, Doppler, Duplex, Incidence, Remission Induction, Doppler, Middle Aged, Prognosis, Plaque, Atherosclerotic, Duplex, Europe, Stroke, Predictive value of tests, Disease Progression, Cardiology, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, Carotid Artery, Internal, Human, Adult, medicine.medical_specialty, Time Factor, Victoria, Prognosi, Asymptomatic, Retinal Diseases, Predictive Value of Tests, Internal medicine, medicine, Humans, Clinical significance, Aged, Asymptomatic Disease, business.industry, Risk Factor, medicine.disease, Internal, Confidence interval, Surgery, Stenosis, Asymptomatic Diseases, Relative risk, asymptomatic carotid artery stenosis, Carotid Artery, business
Abstract

OBJECTIVE: To determine baseline clinical and ultrasonographic plaque factors predictive of progression or regression of asymptomatic carotid stenosis and the predictive value of changes in stenosis severity on risk of first ipsilateral cerebral or retinal ischemic events (including stroke).METHODS: A total of 1121 patients with asymptomatic carotid stenosis of 50% to 99% in relation to the bulb diameter (European Carotid Surgery Trial [ECST] method) underwent six monthly clinical assessments and carotid duplexes for up to 8 years (mean follow-up, 4 years). Progression or regression was considered present if there was a change of at least one grade higher or lower, respectively, persisting for at least two consecutive examinations.RESULTS: Regression occurred in 43 (3.8%), no change in 856 (76.4%), and progression in 222 (19.8%) patients. Younger age, high grades of stenosis, absence of discrete white areas in the plaque, and taking lipid lowering therapy were independent baseline predictors of increased incidence of regression. High serum creatinine, male gender, not taking lipid lowering therapy, low grades of stenosis, and increased plaque area were independent baseline predictors of progression. One hundred and thirty first ipsilateral cerebral or retinal ischemic events, including 59 strokes, occurred. Forty (67.8%) of the strokes occurred in patients whose stenosis was unchanged, 19 (32.2%) in those with progression, and zero in those with regression. For the entire cohort, the 8-year cumulative ipsilateral cerebral ischemic stroke rate was zero in patients with regression, 9% if the stenosis was unchanged, and 16% if there was progression (average annual stroke rates of 0%, 1.1%, and 2.0%, respectively; log-rank, P = .05; relative risk in patients with progression, 1.92; 95% confidence interval, 1.14-3.25). For patients with baseline stenosis 70% to 99% in relation to the distal internal carotid (North American Symptomatic Carotid Endarterectomy Trial [NASCET] method), in the absence of progression (n = 349), the 8-year cumulative ipsilateral cerebral ischemic stroke rate was 12%. In the presence of progression (n = 77), it was 21% (average annual stroke rates of 1.5% and 2.6%, respectively; log-rank, P = .34). Only nine (30%) of the 30 strokes occurred in the progression group.CONCLUSIONS: Progressive asymptomatic carotid stenosis identified a subgroup with about twice the risk of ipsilateral stroke compared with those without progression. However, the clinical value of screening for progression simply for selecting patients for carotid procedures is limited because of the low frequency of progression and its relatively low associated stroke rate. The cost effectiveness of screening for change in stenosis severity to better direct current optimal medical treatment needs testing.

Published
2014

4. 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

5. The size of juxtaluminal hypoechoic area in ultrasound images of asymptomatic carotid plaques predicts the occurrence of stroke

Author

Kakkos, Sk, Griffin, Mb, Nicolaides, An, Kyriacou, E, Sabetai, Mm, Tegos, T, Makris, Gc, Thomas, Dj, Geroulakos, G, Asymptomatic Carotid Stenosis, Risk of Stroke Study Group, Adovasio, R, Ziani, B, Alò, F, Cicilioni, C, Ambrosio, G, Andreev, A, Andreozzi, G, Verlato, F, Camporese, G, Arosio, E, Barkauskas, E, Barros, 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, E, Dimakakos, P, Kotsis, T, Eikelboom, B, Entz, L, Ferrari Bardile, A, Aloi, T, Salerno, M, Fernandes, J, Pedro, L, Fitzgerald, D, O'Shaughnessy, A, Fletcher, J, Forconi, S, Cappeli, R, Bicchi, M, Arrigucci, S, Gallai, V, Cardaiolli, G, Kakkos, S, 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, Nicolaides, A, Thomas, D, 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, Pietro, Conforti, M, Robinson, T, Dennis, M, Rosfors, S, Rudofsky, G, Schroeder, T, Gronholdt, M, Finocchi, C, Rodriguez, G, Spartera, C, Ventura, M, Scarpelli, P, Sprynger, M, Sadzot, B, Hottermans, C, Moonen, M, Taylor, P, Tovar Pardo, A, Negreira, J, Vayssairat, M, Faintuch, J, Valaikiené, J, Walker, M, Wilkinson, R., Stavros K., Kakko, Maura B., Griffin, Andrew N., Nicolaide, Efthyvoulos, Kyriacou, Michael M., Sabetai, Thomas, Tego, Gregory C., Makri, Dafydd J., Thoma, George, Geroulako, Asymptomatic Carotid, Stenosi, Risk of Stroke Study, Group, Adovasio, Roberto, Kakkos, SK, Griffin, MB, Nicolaides, AN, Kyriacou, E, Sabetai, MM, Tegos, T, Makris, GC, Thomas, DJ, Geroulakos, G, and Novo, s

Subjects
Asymptomatic carotid plaque, Male, Time Factors, medicine.medical_treatment, Carotid endarterectomy, Kaplan-Meier Estimate, Severity of Illness Index, asymptomatic carotid artery stenosis, hypoecoic area, Stroke, Risk Factors, Carotid Stenosis, Ultrasonography, Doppler, Color, Prospective cohort study, Aged, 80 and over, Neovascularization, Pathologic, Middle Aged, Prognosis, Plaque, Atherosclerotic, Europe, Ischemic Attack, Transient, Predictive value of tests, Female, Radiology, medicine.symptom, juxtaluminal hypoechoic area, ultrasound images, asymptomatic carotid plaques, stroke, Cardiology and Cardiovascular Medicine, Carotid Artery, Internal, Adult, medicine.medical_specialty, Asymptomatic, Risk Assessment, Brain ischemia, Echography, Predictive Value of Tests, asymptomatic carotid artery stenosi, medicine, Humans, cardiovascular diseases, Aged, Proportional Hazards Models, business.industry, Proportional hazards model, medicine.disease, Acoustic shadow, Settore MED/11 - Malattie Dell'Apparato Cardiovascolare, Stenosis, ROC Curve, Asymptomatic Diseases, Linear Models, Surgery, business, Follow-Up Studies
Abstract

OBJECTIVE: To test the hypothesis that the size of a juxtaluminal black (hypoechoic) area (JBA) in ultrasound images of asymptomatic carotid artery plaques predicts future ipsilateral ischemic stroke. METHODS: A JBA was defined as an area of pixels with a grayscale value 10 mm(2) (P < .001). In a Cox model with ipsilateral ischemic events (amaurosis fugax, transient ischemic attack [TIA], or stroke) as the dependent variable, the JBA (8 mm(2)) was still significant after adjusting for other plaque features known to be associated with increased risk, including stenosis, grayscale median, presence of discrete white areas without acoustic shadowing indicating neovascularization, plaque area, and history of contralateral TIA or stroke. Plaque area and grayscale median were not significant. Using the significant variables (stenosis, discrete white areas without acoustic shadowing, JBA, and history of contralateral TIA or stroke), this model predicted the annual risk of stroke for each patient (range, 0.1%-10.0%). The average annual stroke risk was

Published
2013

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