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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
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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
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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
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4. The Asymptomatic Carotid Stenosis and Risk of Stroke (ACSRS) study. Aims and results of quality control

Author

Nicolaides, A, Sabetai, M, Kakkos, SK, Dhanjil, S, Tegos, T, Stevens, JM, Thomas, DJ, Francis, S, Griffin, M, Geroulakos, G, Ioannidou, E, Kyriacou, E, ACSRS Study Group: Adovasio, R, Ziani, B, Alò, FP, Cicilioni, CG, Ambrosio, G, Andreev, A, Andreozzi, GM, Verlato, F, Camporese, G, Arosio, E, Barkauskas, E, Barros, D'Sa AA, Batchvarova, V, Dramov, A, Belardi, P, Novelli, GP, Simoni, G, Bell, P, Bornstein, NM, Bouchier Hayes, D, Fitzgerald, P, Cairols, MA, Cao, PG, DeRango, P, Carboni, GP, Geoffredo, C, Catalano, M, Chambers, B, Goetzmann, M, Dickinson, A, Clement, D, Bobelyn, M, Coccheri, S, Conti, E, Dimakakos, PB, Kotsis, T, Eikelboom, B, Entz, L, Ferrari Bardile, A, Aloi, T, Salerno, M, Fernandes e. Farnandes, J, Pedro, L, Fitzgerald, DE, O'Shaunnersy, A, Dooley, C, McMahon, N, Fletcher, J, Forconi, S, Cappeli, R, Bicchi, M, Arrigucci, S, Gallai, V, Cardaiolli, G, Kakkos, S, Gomez Isaza, LF, Gorgoyannis, G, Liasis, N, Graf, M, Guarini, P, Hardy, S, Harris, P, Aston, S, Iosa, G, Katsamouris, A, Giannoukas, A, Krazanowski, M, Ladurner, G, Leal Monedero, J, Lee, BB, 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, MS, Rosfors, S, Carlström, C, Rudofsky, G, Schroeder, T, Gronholdt, ML, Finocchi, C, Rodriguez, G, Spartera, C, Ventura, M, Scarpelli, P, Sprynger, M, Sadzot, B, Hottermans, C, Moonen, G, Taylor, PR, Tovar Pardo, A, Negreira, J, Vayssairat, M, Valaikiené, J, Walker, MG, Wilkinson, AR, Barnett, HJ, Bernstein, EF, Moore, W, Standness, LE, Tsapogas, M, van Gijn, J., BIASI, GIORGIO MARIA, MINGAZZINI, PAOLO, Nicolaides, A, Sabetai, M, Kakkos, S, Dhanjil, S, Tegos, T, Stevens, J, Thomas, D, Francis, S, Griffin, M, Geroulakos, G, Ioannidou, E, Kyriacou, E, ACSRS 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, D, 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, Dimakakos, P, Kotsis, T, Eikelboom, B, Entz, L, Ferrari Bardile, A, Aloi, T, Salerno, M, Fernandes e. Farnandes, J, Pedro, L, Fitzgerald, D, O'Shaunnersy, A, Dooley, C, Mcmahon, N, 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, Krazanowski, 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, Carlström, C, Rudofsky, G, Schroeder, T, Gronholdt, M, Finocchi, C, Rodriguez, G, Spartera, C, Ventura, M, Scarpelli, P, Sprynger, M, Sadzot, B, Hottermans, C, Moonen, G, Taylor, P, Tovar Pardo, A, Negreira, J, Vayssairat, M, Valaikiené, J, Walker, M, Wilkinson, A, Barnett, H, Bernstein, E, Moore, W, Standness, L, Tsapogas, M, and van Gijn, J

Subjects
MED/22 - CHIRURGIA VASCOLARE, Carotid artery stenosis, Carotid Endarterectomy, Echo Doppler, Risk of stroke
Abstract

AIM: The results of the Asymptomatic Carotid Atherosclerosis Study (ACAS) study have provided the first scientific evidence that in patients with asymptomatic carotid stenosis greater than 60% carotid endarterectomy reduces the risk of stroke from 2% to 1% per year. The implications are that approximately 20 operations need to be performed in order to prevent 1 stroke in 5 years. The aims of the Asymptomatic Carotid Stenosis and Risk of Stroke (ACSRS) study are to identify a subgroup or subgroups at a risk for stroke higher than 4% and a group at a risk for stroke less than 1% per year using systemic and local risk factors (plaque characterization) in addition to the degree of stenosis. The aim of this paper is to present the protocol and the results of the quality control. METHODS: The ACSRS is a multicentre natural history study of patients with asymptomatic internal carotid diameter stenosis greater than 50% in relation to the bulb. The degree of stenosis is graded using multiple established ultrasonic duplex criteria. In addition, ultrasonic plaque characterization is performed and clinical risk factors and medications are recorded. Training is provided centrally. All carotid ultrasound examinations are recorded on video-tape which together with CT-brain scans and ECG are analysed at the coordinating centre with feedback information to partner centres. RESULTS: The video recordings and analysis of data centrally with feed back information have provided quality control with a significant improvement not only in the completion of data forms but also in the grading of internal carotid stenosis and plaque recordings using ultrasound. CONCLUSION: The high level of quality of data collected will add credibility to the results of the ACSRS study and may eventually promote the development of international standards of plaque imaging and characterization

Published
2003

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

Author

Kakkos, Sk, Sabetai, M, Tegos, T, Stevens, J, Thomas, D, Griffin, M, Geroulakos, G, Nicolaides AN Adovasio, B, Ziani, B, Alò, Fp, Cicilioni, Cg, Ambrosio, G, Andreev, A, Andreozzi, Gm, Verlato, F, Camporese, G, Arosio, E, Barkauskas, E, Barros D'Sa AA, Brannigan, P, Batchvarova, V, Dramov, A, Belardi, P, Novelli, Gp, Simoni, G, Bell, P, Biasi, Gm, Mingazzini, P, Bornstein, Nm, Bouchier Hayes, D, Fitzgerald, P, Cairols, Ma, Cao, Pg, Derango, P, Catalano, M, Chambers, B, Goetzmann, M, Dickinson, A, Clement, D, Bobelyn, M, Coccheri, S, Conti, E, Diamantopoulos, E, Andreadis, Ea, Dimakakos, Pb, Kotsis, T, Eikelboom, B, Entz, L, Aloi Ferrari Bardile, T, Salerno, M, Fernandes J, Fernandes e., Pedro, L, Fitzgerald, De, O'Shaunnersy, A, Fletcher, J, Forconi, S, Cappeli, R, Bicchi, M, Arrigucci, S, Gallai, V, Cardaiolli, G, Kakkos, S, Gomez Isaza LF, 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, Bb, 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, Pujia, A, Raso, A, Rispoli, Pietro, Conforti, M, Robinson, T, Dennis, Ms, Rosfors, S, Rudofsky, G, Schroeder, T, Gronholdt, Ml, Finocchi, C, Rodriguez, G, Spartera, C, Ventura, M, Scarpelli, P, Sprynger, M, Sadzot, B, Hottermans, C, Taylor, Pr, Tovar Pardo, A, Negreira, J, Vayssairat, M, Faintuch, Jm, Valaikiené, J, Walker, Mg, Wilkinson, Ar, Barnett, Hj, Bernstein, Ef, Jones, Am, Moore, W, Myers, K, Strandness, De, Toole, J, Tsapogas, M, and van Gijn, J.

Published
2009

7. Results of carotid endarterectomy in diabetic patients

Author

Gaigalaite, Barkauskas E, and Aukse Meskauskiene

Subjects
Intracerebral hemorrhage, medicine.medical_specialty, business.industry, medicine.medical_treatment, General Medicine, Perioperative, Odds ratio, Carotid endarterectomy, Diabetic angiopathy, medicine.disease, Internal medicine, Diabetes mellitus, diabetes mellitus, Cardiology, Medicine, risk factors, Myocardial infarction, business, carotid endarterectomy, operative complications, Stroke
Abstract

Patients with diabetes mellitus have been shown to have an increased incidence of complications after major vascular surgery. The objective of this study was to evaluate the results of carotid endarterectomy in diabetic patients, to determine if results differ from nondiabetic patients, and to examine the risk factors for poor outcome among diabetic patients. Material and methods. We reviewed all carotid endarterectomies performed in Emergency Hospital of Vilnius University. From 1995 to 2005, 707 carotid endarterectomies were performed. Of these, 100 operations were performed in diabetic patients (14%) and the remaining 607 in nondiabetic patients. Results. Diabetic patients were younger (P&lt, 0.05) and were obese more often (P&lt, 0.001), they smoked less often (P&lt, 0.001) than nondiabetic patients. Diabetics were more likely to have severe bilateral carotid stenosis than nondiabetic patients (P&lt, 0.01). Postoperative complications (stroke) were more common in diabetic patients than in nondiabetic patients (12.0% vs. 3.4%, P&lt, 0.001) as well as intracerebral hemorrhages (3.0% vs. 0.3%, P&lt, 0.001), no perioperative myocardial infarction was found in diabetic patients. Risk factors for complications were age ≥75 (odds ratio (OR) 2.2, 95% confidence interval (CI)=1.0–4.9), smoking (OR 2.7, 95% CI=1.8– 4.2), obesity (OR 6.1, 95% CI=3.9–9.5), and bilateral carotid stenosis (OR 2.1, 95% CI=1.3–3.6). Conclusion. Diabetes mellitus significantly increased the risk of mortality and intracerebral hemorrhage but not myocardial infarction. It should be taken into consideration in making decisions about the performance and perioperative management of carotid endarterectomy.

Published
2007
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8. Severity of asymptomatic carotid stenosis and risk of ipsilateral hemispheric ischaemic events: results from the ACSRS study

Author

Adovasio, R, Ziani, B, Alò, Fp, Cicilioni, Cg, Ambrosio, G, Andreev, A, Andreozzi, Gm, Verlato, F, Camporese, G, Arosio, E, Barkauskas, E, Barros D'Sa AA, Brannigan, P, Batchvarova, V, Dramov, A, Belardi, P, Novelli, Gp, Simoni, G, Bell, P, Biasi, Gm, Mingazzini, P, Bornstein, Nm, Bouchier Hayes, D, Fitzgerald, P, Cairols, Ma, Cao, Pg, Derango, P, Carboni, Gp, Geoffredo, C, Catalono, M, Chambers, B, Goetzmann, M, Dickinson, A, Clement, D, Bobelyn, M, Coccheri, S, Conti, E, Diamantopoulos, E, Andreadis, Ea, Middleton, L, Pantziaris, M, Tyllis, T, Minar, E, Willfort, A, Moggi, L, Nenci, G, Radicchia, S, Nicolaides, A, Kakkos, S, 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, Ms, Rosfos, S, Rudofsky, G, Schroeder, T, Gronholdt, Ml, Finocchi, C, Rodriguez, G, Dimakakos, Pb, Kotsis, T, Eikelboom, B, Entz, L, Ferrari, Bardile, Aloi, T, Salerno, M, Fernandes J, Fernandes e., Pedro, L, Fitzgerald, De, O'Shaunnersy, A, Fletcher, F, Forconi, S, Cappeli, R, Bicchi, M, Arrigucci, S, Gallai, V, Cardaiolli, G, Geroulakos, G, Gomez Isaza LF, 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, Bb, Liapis, C, Galanis, P, Liboni, W, Pavanelli, E, Mannarino, E, Vaudo, G, Mccollum, P, Levison, R, Micieli, G, Bosone, D, Barnett, Hj, Bernstein, Ef, Jones, Am, Moore, W, Myers, K, Strandness, De, Toole, J, Tsapogas, M, van Gijn, J, Spartera, C, Ventura, M, Scarpelli, P, Sprynger, M, Sadzot, B, Hottermans, C, Moonen, Taylor, Pr, Tovar Pardo, A, Negreira, J, Vayssairat, M, Faintuch, Jm, Valaikiené, J, Walker, Mg, and Wilkinson, A. R.

Published
2005

9. Asymptomatic internal carotid artery stenosis and cerebrovascular risk stratification

Author

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, BIASI, GIORGIO MARIA, MINGAZZINI, PAOLO, DeRango, P, Ferrari Bardileah, n, McCollum, P, Moonenbp, n, Wilkinson, A., 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, BIASI, GIORGIO MARIA, MINGAZZINI, PAOLO, DeRango, P, Ferrari Bardileah, n, McCollum, P, Moonenbp, n, and Wilkinson, A.

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 <70% stenos

Published
2010

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

Author

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, Pantziaris, M, DeRango, P, Ferrari Bardilead, n, McCollum, P, Pantziaris, M., BIASI, GIORGIO MARIA, MINGAZZINI, PAOLO, 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, Pantziaris, M, DeRango, P, Ferrari Bardilead, n, McCollum, P, Pantziaris, M., BIASI, GIORGIO MARIA, and MINGAZZINI, PAOLO

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 (P<0.0001 compared to the high risk group). There was not any significant difference in the cumulative ipsilateral stroke rate, which was 12% in the low and 13% in the high cardiovascular risk group (Log Rank P>0.05). 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.

Published
2005

11. Effect of image normalization on carotid plaque classification and the risk of ipsilateral hemispheric ischemic events: Results from the Asymptomatic Carotid Stenosis and Risk of Stroke study

Author

Nicolaides, A, Kakkos, S, Griffin, M, Sabetai, M, Dhanjil, S, Thomas, D, Geroulakos, G, Georgiou, N, Francis, S, Ioannidou, E, Doré, C, Asymptomatic Carotid, S, 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, D, 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, B, Aloi, T, Salerno, M, Fernandes e. 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, Moonen, Taylor, P, Tovar Pardo, A, Negreira, J, Vayssairat, M, Faintuch, J, Valaikiené, J, Walker, M, Wilkinson, A, Nicolaides, AN, Kakkos, SK, Thomas, DJ, Doré, CJ, Asymptomatic Carotid Stenosis, Alò, FP, Cicilioni, CG, Andreozzi, GM, Barros, D'Sa AA, Novelli, GP, Bornstein, NM, Cairols, MA, Cao, PG, DeRango, P, Carboni, GP, Andreadis, EA, Dimakakos, PB, Ferrari Bardile, Fitzgerald, DE, Gomez Isaza, LF, Lee, BB, McCollum, P, Dennis, MS, Gronholdt, ML, Taylor, PR, Faintuch, JM, Walker, MG, Wilkinson, AR, BIASI, GIORGIO MARIA, MINGAZZINI, PAOLO, Nicolaides, A, Kakkos, S, Griffin, M, Sabetai, M, Dhanjil, S, Thomas, D, Geroulakos, G, Georgiou, N, Francis, S, Ioannidou, E, Doré, C, Asymptomatic Carotid, S, 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, D, 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, B, Aloi, T, Salerno, M, Fernandes e. 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, Moonen, Taylor, P, Tovar Pardo, A, Negreira, J, Vayssairat, M, Faintuch, J, Valaikiené, J, Walker, M, Wilkinson, A, Nicolaides, AN, Kakkos, SK, Thomas, DJ, Doré, CJ, Asymptomatic Carotid Stenosis, Alò, FP, Cicilioni, CG, Andreozzi, GM, Barros, D'Sa AA, Novelli, GP, Bornstein, NM, Cairols, MA, Cao, PG, DeRango, P, Carboni, GP, Andreadis, EA, Dimakakos, PB, Ferrari Bardile, Fitzgerald, DE, Gomez Isaza, LF, Lee, BB, McCollum, P, Dennis, MS, Gronholdt, ML, Taylor, PR, Faintuch, JM, Walker, MG, Wilkinson, AR, BIASI, GIORGIO MARIA, and MINGAZZINI, PAOLO

Abstract

The aim of this study was to determine the effect of image normalization on plaque classification and the risk of ipsilateral ischemic neurologic events in patients with asymptomatic carotid stenosis. The first 1,115 patients recruited to the Asymptomatic Carotid Stenosis and Risk of Stroke (ACSRS) study with a follow-up of 6 to 84 months (mean 37.1 months) were included in this study. Duplex ultrasonography was used for grading the degree of internal carotid artery stenosis and for plaque characterization (types 1-5), which was performed before and after image normalization. One hundred sixteen ipsilateral ischemic hemispheric events occurred. Image normalization resulted in 60% of plaques being reclassified. Before image normalization, a high event rate was associated with all types of plaque. After image normalization, 109 (94%) of the events occurred in patients with plaque types 1 to 3. For patients with European Carotid Stenosis Trial (ECST) 70 to 99% diameter stenosis (equivalent to North American Symptomatic Carotid Endarterectomy Trial [NASCET] 50-99%) with plaque types 1 to 3, the cumulative stroke rate was 14% at 7 years (2% per year), and for patients with plaque types 4 and 5, the cumulative stroke rate was 0.9% at 7 years (0.14% per year). The results suggest that asymptomatic patients with plaque types 4 and 5 classified as such after image normalization are at low risk irrespective of the degree of stenosis.

Published
2005

12. Pakartotinių išeminių įvykių simptominės vidinės miego arterijos baseine įtaka priešoperacinei pacientų būklei ir atokiosioms neurologinėms baigtims po operacijos.

Author

Slautaitė, I., Barkauskas, E. V., Mackevičius, A., and Laurikėnas, K.

Subjects
*CAROTID artery, *ENDARTERECTOMY, *STENOSIS, *STROKE, *CEREBRAL ischemia, *TREATMENT effectiveness
Abstract

Patients with recently diagnosed symptomatic ICA stenosis have a high risk of early recurrent ischemic stroke. Endarterectomy is the main choice of treatment of these patients; however, some of them suffer repeated cerebral ischemic events before surgery. The risk of recurrent is chemic symptomatic events are well emphasized, however the influence of them on pre operative patients state and late post operative neurological out comes is not studied well. Seventy five patients with first ever ipsilateral cerebral event were prospectively followed until carotid endarterectomy. After the first ischemic event 52% of patients suffered recurrent or progressive ischemia symptoms. It was found that repeated ischemic events pro longed recovery, worsened pre operative patients state and outcomes after 3 months and 1 year. The functional outcomes in patients who had suffered from repeated ischemia after 3 months as well as 1 year after the operation were poorer in comparison with outcomes of the patients who had experienced only one ischemic event, there were less patients who have very good outcomes (mRS<2). The comparison of the groups in accordance with the number of disabled (mRS≥3) patients during long-term period showed no statistically significant difference. [ABSTRACT FROM AUTHOR]

Published
2012

13. Pakartotinės smegenų išemijos rizika ir ją nuspėjantys veiksniai iki operacinio simptominės vidinės miego arterijos gydymo.

Author

Slautaitė, I., Barkauskas, E., Mackevičius, A., Laurikėnas, K., and Sabaliauskienė, Z.

Subjects
*CAROTID artery surgery, *DISEASE relapse, *CEREBRAL ischemia, *ENDARTERECTOMY, *MEDICAL protocols, *REGRESSION analysis, *MEDICAL statistics, *THERAPEUTICS, *DISEASE risk factors, CAROTID artery stenosis
Abstract

Extracranial internal carotid artery (ICA) stenosis accounts for 10-20% of all strokes. Patients with recently symptomatic ICA stenosis have a high risk of early recurrent ischemic stroke. Endarterectomy is the main choice of treatment of these patients; however, some of them suffer repeated cerebral ischemic events before surgery. It is therefore important to identify high-risk patients, so that these can be treated in more timely fashion. Seventy one patients with first ever ipsilateral cerebral event (38 after TIA and 33 after stroke) were prospectively followed until carotid endarterectomy. Thirty six patients (50.7 %) had suffered repeated ischemic events (6 new TIA and 30 cerebral infarctions). The patients with repeated ischemia more frequently had peripheral arterial disease (p-0.045), high-grade stenosis (p-0.021) and low echogenicity of arterial plaque (p-0.017), the first event reported more frequently with arm paresis (p-0.012), these patients had a higher ABCD2 prognostic scale scores (p-0.001). Multivariable regression analysis revealed that higher estimates of the ABCD2 scores, low echogenicity of arterial plaque, increased common carotid IM thickness, and presence of collateral blood flow through anterior commtmicating artery were independent predictors of further cerebral ischemic events. [ABSTRACT FROM AUTHOR]

Published
2011

14. 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.

16. Hipoperfuziniai praeinantieji smegenų išemijos priepuoliai: drebančios galūnės sindromas.

Author

Slautaitė, I., Mackevičius, A., Barkauskas, E., Vilimas, A., and Rakauskienė, I.

Subjects
*TRANSIENT ischemic attack, *CEREBROVASCULAR disease, *ASTHENIA, *DISEASES of the anatomical extremities, *HYPERKINESIA, *SEIZURES (Medicine)
Abstract

Transient ischemic attacks (TIAs) are considered to be warning signs of impending stroke. Classical TIAs are transient neurological deficits that may include difficulties with language, weakness, numbness, or visual loss. A much less common form is low-flow TIA or Limbshaking syndrome (LLS), first described by Miller-Fisherin 1962. The clinical features of LSS comprise a group of rhythmic or arrhythmic involuntary hyperkinesias affecting the limbs. These involuntary movements may be initially mistaken for focal motor seizures and are highly associated with severe extracranial or intracranial ICA occlusive disease. In this case report we present two patients with an unusual form of carotid transient ischemic attack-limbshaking, aiming to warn physicians about this potentially harming and uncommon condition. [ABSTRACT FROM AUTHOR]

Published
2010

17. Asimptominė vidinės miego arterijos stenozė: natūrali eiga, klinikinė reikšmė ir gydymas.

Author

Slautaitė, I., Mackevičius, A., and Barkauskas, E.

Subjects
*DISEASE management, *PHYSICIAN practice patterns, *CLINICAL trials, *MEDICAL history taking, *ENDARTERECTOMY, *SURGERY, *CEREBROVASCULAR disease patients, CAROTID artery stenosis
Abstract

Asymptomatic atherosclerotic internal carotid artery stenosis is common finding in general population. The prevalence of this lesion rises with age and stenosis greater than 50% is present in about 10% of population over age 65 years. Clinicians from different disciplines interfere with asymptomatic internal carotid artery stenosis. To give patients balanced advice about optimal management for asymptomatic severe carotid stenosis, the risk of stroke from the lesion it self and the influence of best medical practice intervention must be understood and weighted up against the likely risk of potential benefit or endo vascular intervention. Natural history studies and clinical trials have reported on annual risk of ipsilateral stroke of approximately 1-3%. However some patients have a higher risk of stroke. In addition the average annual rates of other cardiovascular events and nonstroke death are higher than those of ipsilateral stroke, reaching 8.7%. When symptomatic, internal carotid artery stenosisis responsible for approximately 30% of ischemic anterior circulation strokes and optimal prophylactictreatment can reduce the potential risk of stroke. De spite the publication of several randomized controlled trials of carotid endarterectomy in asymptomatic patients the role of invasive treatment in this patients population remains controversial. In this review we out line the prevalence, natural history, and the evidence for carotid endarterectomy in patients with asymptomatic carotid stenosis. [ABSTRACT FROM AUTHOR]

Published
2009

18. [Risk of stroke and death after carotid endarterectomy].

Author

Meškauskienė A, Barkauskas E, Gaigalaitė V, Laurikėnas K, Bičkuvienė I, and Mackevičius A

Subjects
Adult, Aged, Aged, 80 and over, Diabetes Mellitus epidemiology, Female, Humans, Incidence, Lithuania epidemiology, Male, Middle Aged, Prognosis, Risk, Stroke mortality, Endarterectomy, Carotid statistics & numerical data, Stroke epidemiology
Abstract

Objective: The benefit of carotid endarterectomy is highly dependent on surgical risk. The aim of this study was to evaluate the incidence of stroke and death after carotid endarterectomy, risk factors for poor outcomes, and importance of surgeon's competence., Material and Methods: A total of 790 carotid endarterectomies performed in the Vilnius University Emergency Hospital between 1995 and 2006 were analyzed. Risk factors, neurological symptoms, comorbidities, radiologic and angiographic findings, morbidity and mortality, experience and volume of a vascular surgeon were prospectively recorded in a database. Univariate and multivariable logistic regression and receiver operating characteristic curves were used to analyze the data., Results: Among the 790 cases studied, in-hospital mortality was 2.2%, and stroke morbidity was 2.4%. Postoperative complications were more common in patients with diabetes mellitus than without (12% vs. 3.4%, P<0.001) and in patients with any stroke than in patients with nonspecific symptoms (10.7% vs. 1.4%, P<0.02). The postoperative stroke rate was 10% for a surgeon who performed <6 carotid endarterectomies per year and 4.6% for a surgeon who performed ≥6 carotid endarterectomies (P=0.02). In the multivariate logistic regression, combined mortality and stroke was independently predicted by diabetes mellitus (OR, 3.51; 95% CI, 1.60-7.66; P=0.002), any stroke (OR, 4.14; 95% CI, 1.57-10.91; P=0.004), and low-volume surgeon (OR, 0.32; 95% CI, 0.13-0.78; P=0.013). The receiver operating characteristic curve analysis showed an overall predicting value of 0.72., Conclusions: Diabetes mellitus, any stroke, and low-volume vascular surgeon were significant predictors for poor outcome after carotid endarterectomy.

Published
2011

19. [Impact of diabetes mellitus on other cardiovascular risk factors in patients with stenosis of the internal carotid artery].

Author

Meshkauskiene AI, Barkauskas EM, and Gaigalaite VB

Subjects
Adult, Age Distribution, Angiography, Carotid Stenosis diagnosis, Carotid Stenosis surgery, Endarterectomy, Carotid methods, Estonia epidemiology, Female, Follow-Up Studies, Humans, Intermittent Claudication epidemiology, Male, Middle Aged, Morbidity trends, Myocardial Ischemia epidemiology, Prospective Studies, Risk Factors, Stroke epidemiology, Survival Rate trends, Ultrasonography, Doppler, Duplex, Carotid Stenosis complications, Diabetes Mellitus, Type 2 complications, Intermittent Claudication etiology, Myocardial Ischemia etiology, Stroke etiology
Abstract

Aim: To examine cardiovascular risk factors, clinical features and their impact on the results of carotid endarterectomy in diabetic patients with stenosis of the internal carotid artery., Material and Methods: We analysed data on 100 diabetic and 607 nondiabetic patients who underwent carotid endarterectomy in Vilnius University Emergency hospital from 1995 through 2005., Results: Diabetic patients with carotid artery stenosis were younger (p < 0.05), they smoked less often (p < 0.001) and were more often obese (p < 0.001) than nondiabetic patients. 93% of diabetic patients had arterial hypertension or hypercholesterolemia or even more cardiovascular risk factors. Diabetic were more likely to have nonspecific symptoms and severe bilateral carotid stenosis (p < 0.01). Perioperative stroke and mortality rate was 12% for diabetic and 3.4% for nondiabetic patients (p < 0.001), but no perioperative myocardial infarction was identified in diabetic patients. Four clinical factors increased the odds of complications: age 75 > (odds ratio--OR 2.2; 95% confidence interval--CI 1-4.9), smoking (OR 2.7, 95% CI 1.8-4.2), obesity (OR 6.1; 95% CI 3.9-9.5) and severe bilateral carotid stenosis (OR 2.1; 95% CI 1.3-3.6)., Conclusion: Diabetes mellitus in patients with severe carotid artery stenosis changes conventional risk factors, clinical picture of the disease and increases the risk of carotid endarterectomy.

Published
2008

20. [Results of carotid endarterectomy in diabetic patients].

Author

Meskauskiene A, Barkauskas E, and Gaigalaite V

Subjects
Age Factors, Aged, Body Mass Index, Cerebral Hemorrhage etiology, Confidence Intervals, Data Interpretation, Statistical, Female, Humans, Male, Middle Aged, Myocardial Infarction etiology, Obesity complications, Odds Ratio, Postoperative Complications, Risk Factors, Smoking adverse effects, Stroke etiology, Treatment Outcome, Carotid Stenosis surgery, Diabetic Angiopathies surgery, Endarterectomy, Carotid mortality
Abstract

Unlabelled: Patients with diabetes mellitus have been shown to have an increased incidence of complications after major vascular surgery. The objective of this study was to evaluate the results of carotid endarterectomy in diabetic patients, to determine if results differ from nondiabetic patients, and to examine the risk factors for poor outcome among diabetic patients., Material and Methods: We reviewed all carotid endarterectomies performed in Emergency Hospital of Vilnius University. From 1995 to 2005, 707 carotid endarterectomies were performed. Of these, 100 operations were performed in diabetic patients (14%) and the remaining 607 in nondiabetic patients., Results: Diabetic patients were younger (P<0.05) and were obese more often (P<0.001), they smoked less often (P<0.001) than nondiabetic patients. Diabetics were more likely to have severe bilateral carotid stenosis than nondiabetic patients (P<0.01). Postoperative complications (stroke) were more common in diabetic patients than in nondiabetic patients (12.0% vs. 3.4%, P<0.001) as well as intracerebral hemorrhages (3.0% vs. 0.3%, P<0.001); no perioperative myocardial infarction was found in diabetic patients. Risk factors for complications were age >/=75 (odds ratio (OR) 2.2; 95% confidence interval (CI)=1.0-4.9), smoking (OR 2.7; 95% CI=1.8-4.2), obesity (OR 6.1; 95% CI=3.9-9.5), and bilateral carotid stenosis (OR 2.1; 95% CI=1.3-3.6)., Conclusion: Diabetes mellitus significantly increased the risk of mortality and intracerebral hemorrhage but not myocardial infarction. It should be taken into consideration in making decisions about the performance and perioperative management of carotid endarterectomy.

Published
2007

21. [Carotid artery atherosclerotic stenosis, plaque structure and stroke].

Author

Meskauskiene A, Barkauskas E, and Gaigalaite V

Subjects
Aged, Carotid Stenosis diagnosis, Carotid Stenosis mortality, Carotid Stenosis surgery, Data Interpretation, Statistical, Diabetes Complications, Female, Humans, Hypertension complications, Male, Middle Aged, Obesity complications, Patient Selection, Risk Factors, Smoking adverse effects, Stroke mortality, Carotid Artery, Internal pathology, Carotid Stenosis complications, Carotid Stenosis pathology, Endarterectomy, Carotid, Stroke etiology
Abstract

Objectives: The main indication for carotid endarterectomy is severity of stenosis carotid artery. Several studies have shown the relationship between carotid plaque morphology and cerebrovascular disorders. The purpose of this study was to evaluate the structure of carotid plaque and correlate carotid plague morphology with neurological symptoms, stroke risk factors, severity of carotid stenosis and operative stroke., Methods: Operative specimens of 262 carotid plaques were examined macroscopically. Plague morphology was characterized as either heterogeneous or homogeneous. Stroke risk factors, cerebrovascular symptoms, severity of carotid stenosis and risk for mortality and operative stroke were compared between symptomatic and asymptomatic patients with heterogeneous and homogeneous plague., Results: Heterogeneous plaques were present in 198 (75%) of 262 arteries. Heterogeneous plaques were found in 121 symptomatic and 77 asymptomatic patients (p<0.001). Homogeneous plagues did not differ in symptomatic and asymptomatic patients. The structure of plaque did not correlate with any severity of stenosis. There were no significant differences in age, sex, smoking and arterial hypertension between heterogeneous and homogeneous groups. Higher level of fibrinogen but not hypercholesterolemia was associated with heterogeneity of plaque. Postoperative stroke was mainly present in the patients with heterogeneous plaques, but the difference was not statistically significant., Conclusions: Heterogeneous plaques were present in 75 % of patients with carotid artery stenosis. Heterogeneous plagues were associated with cerebrovascular symptoms more often than homogeneous ones. Plague structure did not correlate with severity of carotid artery stenosis and operative stroke was not associated with plaque heterogeneity. These findings suggest that plague heterogeneity should be considered in selecting patients for carotid endarterectomy.

Published
2005

22. Risk of carotid endarterectomy in patients with cerebral infarction.

Author

Barkauskas E, Meskauskiene A, and Laurikenas K

Subjects
Adult, Aged, Aged, 80 and over, Carotid Stenosis epidemiology, Cerebral Infarction epidemiology, Cerebral Infarction physiopathology, Cerebrovascular Circulation physiology, Diabetes Mellitus epidemiology, Female, Humans, Hypertension epidemiology, Male, Middle Aged, Myocardial Infarction epidemiology, Peripheral Vascular Diseases epidemiology, Prevalence, Risk Assessment, Risk Factors, Brain blood supply, Brain surgery, Cerebral Infarction surgery, Endarterectomy, Carotid methods
Abstract

Stroke is a clinical diagnosis, but there is uncertainty as to the relative risks of surgery in patients with a visible infarction on brain CT. It is not clear whether visible infarction is associated with higher operative risk and poor outcome or is simply an indicator of a more "severe" stroke. Some studies have indicated that CT evidence of stroke carries an increased risk, other studies have found that patients with a low density and without significant shift on CT, with a stable neurological deficit and a normal level of consciousness can safely undergo carotid endarterectomy. Our aim was to answer a the specific question whether visible brain infarction on CT increases the operative risk of carotid endarterectomy, with special attention to the neurological complications. This analysis involved 105 patients with a visible brain infarct on CT scan who underwent carotid endarterectomy in Vilnius University Emergency Hospital. Carotid endarterectomy was performed in 86 men and in 19 women with mean carotid stenosis 87%, ranging from 42% to 99% by angiography. Clinical symptoms of stroke were present in 95 patients (86 carotid and 9 vertebrobasilar). Carotid endarterectomy underwent 76 patients with symptomatic carotid stenosis, 16 patients with symptoms of contralateral carotid artery, 9 patients with vertebrobasilar symptoms and 4 patients with nonspecific symptoms. Among symptomatic patients there were 46 patients with unilateral carotid stenosis and 30 patients with bilateral stenosis. Angiography of asymptomatic patients (n=29) revealed unilateral carotid lesions in 9 cases, bilateral stenosis in 8 patients and concomitant bilateral carotid and vertebral stenosis in 12 patients. The postoperative mortality rate was 2.9%, a new stroke occurred in 1.9%. The total rate of complications--4.8%. Patients with visible brain infarction on CT scan can safely undergo carotid endarterectomy with a standard operative risk, but risks modelling will be required if we are to target surgery most effectively at individuals.

Published
2005

23. Carotid artery atherosclerotic plaque: clinical and morphological-immunohistochemical correlation.

Author

Lastas A, Graziene V, Barkauskas E, Salkus G, and Rimkevicius A

Subjects
Aged, Arteriosclerosis microbiology, Arteriosclerosis pathology, Carotid Arteries microbiology, Carotid Arteries pathology, Carotid Artery Diseases microbiology, Carotid Artery Diseases pathology, Chlamydophila Infections microbiology, Chlamydophila Infections pathology, Chlamydophila pneumoniae isolation & purification, Female, Humans, Macrophages microbiology, Male, Carotid Artery Diseases diagnosis, Chlamydophila Infections diagnosis
Abstract

Background: The purpose of the study was to: 1) investigate carotid atherosclerotic plaque morphology and immunohistochemistry (IHC) with respect to the localization sites of Chlamydia pneumoniae, 2) find correlations between plaque morphology and clinical sonographical characteristics, and 3) determine the correlation between abundance of C. pneumoniae and complexity of the plaque., Material/methods: 200 patients with asymptomatic (A=59) and symptomatic (S=141) courses of carotid stenosis admitted to the Neurology and Neurosurgery Clinic for TIA or acute ischemic stroke were studied. For IHC the atherosclerotic plaques were incubated with primarily monoclonal anti-Chlamydia pneumoniae antibody clone RP402, code no. M6600, diluted 1:50 (DAKO). Statistical evaluation was performed., Results: 34 (17%) homogeneous (HO), or stable, and 166 (83%) heterogeneous (HE), or unstable, plaques were divided into 3 HO and 5 HE subtypes according to the number of histopathological signs and prevalence of inflammatory cell types, having different sonographical characteristics and plaque thickness. Complex plaques of both A and S patients have activation signs for chronic inflammation, phagocytosis, and atheromatosis: all three of these in HE plaque subtypes, and only for atheromatosis in HO plaques., Conclusions: 1) C. pneumoniae IHC signals were found in every kind of phagocyte (histiocytes, macrophages, foreign body macrophages, foam cells, PMNs) located in the fibrous cap, atheroma (necrotic core), and especially at the boundary of fibrous cap/atheroma; 2) complexities were found, so plaque instability signs strongly correlate with abundance of C. pneumoniae (p<0.001); 3) sufficient correlation between plaque thickness and disease symptomaticity (p<0.01) was found.

Published
2004

24. [Complications of carotid endarterectomy].

Author

Meskauskiene A, Barkauskas E, Laurikenas K, Gaigalaite V, and Palaikis M

Subjects
Adult, Age Factors, Aged, Aged, 80 and over, Carotid Stenosis surgery, Chi-Square Distribution, Endarterectomy, Carotid mortality, Female, Humans, Logistic Models, Male, Middle Aged, Prognosis, Risk Factors, Endarterectomy, Carotid adverse effects, Postoperative Complications
Abstract

Background and Purpose: Carotid endarterectomy has been shown to be beneficial in patients with high-grade carotid stenosis. This benefit will be realized only if the operation is performed safely. We determined the ratio of operative complications and sought to identify the risk factors for operative stroke and death from carotid endarterectomy., Methods: Two hundred fifty seven patients underwent carotid endarterectomy during 1995-1999 years in Vilnius emergency hospital. Nineteen potential risk factors for operative complications were examined., Results: Mortality of endarterectomy was 2.7%, the overall risk of stroke and/or death was 4.3%. In multivariate logistic-regression models a symptom status (recent history of stroke) and angiographic features (contralateral stenosis 70% and more) were as independent risk factors for operative stroke and death., Conclusions: The risk of stroke and death from carotid endarterectomy is related to clinical and angiographic characteristics. These observations may help clinicians to estimate operative risks for individual patients.

Published
2002

25. [Surgeries on the carotid arteries].

Author

Pauliukas PA and Barkauskas EM

Subjects
Carotid Artery, Internal surgery, Constriction, Pathologic surgery, Endarterectomy adverse effects, Humans, Recurrence, Veins transplantation, Arteriosclerosis surgery, Arteriovenous Shunt, Surgical methods, Carotid Artery Diseases surgery, Endarterectomy methods
Abstract

The article lays emphasis on the main causes of restenosis after endarterectomy from the bifurcation of the carotid artery and shows the methods of its prevention. A new method for endarterectomy of the bifurcation of the carotid artery is suggested, which consists in reimplantation of the internal carotid artery. The authors claim this method to be optimal in combined affection: atherosclerotic constriction of carotid artery bifurcation and pathological tortuosity of the internal carotid artery. The authors possess an experience in 351 operations on the carotid arteries, 177 of them were conducted for loops and kinks of the carotid arteries; 152, for endarterectomy in atherosclerotic affection of the carotid arteries; and 22 for other, less frequently encountered affections of the carotid arteries.

Published
1990

26. [10-year experience of surgical treatment of occlusive diseases of the aorta and main arteries].

Author

Martsinkiavichius A, Triponis V, and Barkauskas E

Subjects
Aorta, Abdominal surgery, Brachiocephalic Trunk abnormalities, Humans, Leg blood supply, Vascular Surgical Procedures methods, Aortic Diseases surgery, Arterial Occlusive Diseases surgery, Brachiocephalic Trunk surgery, Iliac Artery surgery
Abstract

The authors report the results of 1268 reconstructive operations in cases of various ischaemic syndromes. Surgical technique and indications for surgery are discussed. The clinical material consists of 115 reconstructive operations on the supraaortic branches, 462 operations in the aortoiliac segment, 57 reconstructions of the abdominal aorta and its visceral branches, as well as 652 reconstructive procedures on the arteries below the inguinal ligament. The latter operations include 70 femorotibial venous bypasses in patients with rest pain and gangrene.

Published
1976

30. [Clinical aspects of circulatory disorders in the vertebral arteries and the possibilities for their surgical treatment].

Author

Martsinkiavichius AM, Barkauskas EM, and Triponis VIu

Subjects
Adult, Aged, Blood Circulation, Blood Pressure, Cerebrovascular Circulation, Female, Heart Rate, Humans, Male, Middle Aged, Neurologic Manifestations, Vertebral Artery abnormalities, Arterial Occlusive Diseases surgery, Arteriosclerosis surgery, Vertebral Artery surgery
Abstract

Experience in the follow-up of 84 patients who underwent operation for transient cerebral vascular insufficiency in the vertebro-basilar bed is summarized. It was found that most patients with abnormally tortuous or anomalously branching vertebral arteries had transient disorders of the carciac rhythm or increased arterial pressure. Operative treatment of such patients contributes to correction of the neurologic symptoms and leads to normalization of the cardiac rhythm and arterial pressure.

Published
1978

32. [Restoration of blood flow in the external carotid artery].

Author

Barkauskas EM, Pauliukas PA, Zhiburkus II, Sudikas AG, and Zubkiavichene AI

Subjects
Adult, Aged, Blood Vessel Prosthesis, Carotid Artery Diseases physiopathology, Carotid Artery, External physiopathology, Carotid Artery, External surgery, Endarterectomy, Female, Humans, Male, Middle Aged, Regional Blood Flow, Arteriosclerosis surgery, Carotid Artery Diseases surgery
Abstract

The external carotid artery revascularization procedures were performed in 19 cases. Fourteen patients had ischemic stroke history. Ten patients had occluded the ipsilateral internal carotid artery to the stenosed external carotid artery. Six patients had occluded the common as well as internal carotid artery on the same side. Positive neurologic changes were obtained in 73.7% of the operated patients. The external carotid artery revascularization procedures are recommended in cases when the ipsilateral internal carotid artery is occluded.

Published
1987

34. [Technics of the surgical approach to the vertebral arteries].

Author

Pauliukas PA and Barkauskas EM

Subjects
Cervical Vertebrae blood supply, Cervical Vertebrae surgery, Humans, Spinal Canal surgery, Vascular Surgical Procedures methods, Vertebral Artery abnormalities, Arteriosclerosis Obliterans surgery, Vertebral Artery surgery
Published
1989

36. [Surgical technic of straightening kinks of the internal carotid arteries].

Author

Pauliukas PA and Barkauskas EM

Subjects
Adolescent, Adult, Age Factors, Anastomosis, Surgical, Carotid Artery Diseases surgery, Child, Humans, Methods, Carotid Artery, Internal surgery
Abstract

The article describes surgical techniques used in 11 cases for correcting loops and pathological tortuosity of the internal carotid arteries. Resection of the proximal segment of the artery with its reimplantation into the bifurcation of the carotid artery is the technically simplest method. In marked degeneration of the arterial wall in the region of the loop, the latter must be resected and arterial end-to-end anastomosis established. The authors describe a method which they developed for resecting a high loop of the internal carotid artery.

Published
1989

37. [Changes in the internal carotid artery in its loop-shaped kinking and their clinical significance].

Author

Pauliukas PA, Matskevichus ZK, and Barkauskas EM

Subjects
Adult, Carotid Artery Diseases pathology, Carotid Artery Diseases surgery, Carotid Artery, Internal surgery, Child, Humans, Prognosis, Carotid Artery, Internal pathology
Abstract

Loops and kinks of the internal carotid, common carotid, and vertebral arteries which were resected in operations on 45 patients were examined histologically and histochemically. Gross pathological changes were found in the arterial wall in the region of the loops and kinks: destruction of the smooth muscles and elastic fibrils and fragmentation of the internal elastic membrane. Fibrous tissue prevailed in all layers of the arterial wall, forming its soft framework and in this way preventing the straightening out of the kinked artery or its loop. The changes were most marked in the loops of the internal carotid artery, microaneurysms with parietal thrombosis were even encountered. The findings of microscopic and histochemical study compel the surgeon to resort to excision of the loop or kink and subsequent establishment of an end-to-end anastomosis or replacement of the whole pathologically changed arterial segment by a graft of autologous vein, as the most radical method of surgical treatment of this pathological condition. In children and in some adults, however, favourable results can be produced by total mobilization of the loop, its downward transposition, resection of its proximal segment, and reimplantation into the bifurcation of the carotid artery.

Published
1989

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