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15 results on '"MESH: Carotid Stenosis"'

1. Safety and Outcome of Carotid Dissection Stenting During the Treatment of Tandem Occlusions: A Pooled Analysis of TITAN and ETIS

Author

Marnat, Gaultier, Lapergue, Bertrand, Sibon, Igor, Gariel, Florent, Bourcier, Romain, Kyheng, Maeva, Labreuche, Julien, Dargazanli, Cyril, Consoli, Arturo, Blanc, Raphael, Piotin, Michel, Mazighi, Mikael, Richard, Sebastien, Gory, Benjamin, Redjem, Hocine, Escalard, Simon, Desilles, Jean-Philippe, Ciccio, Gabriele, Smajda, Stanislas, Fahed, Robert, Obadia, Mikael, Sabben, Candice, Corabianu, Ovide, De Broucker, Thomas, Smadja, Didier, Alamowitch, Sonia, Ille, Olivier, Manchon, Eric, Garcia, Pierre-Yves, Taylor, Guillaume, Ben Maacha, Malek, Bourdain, Frédéric, Decroix, Jean-Pierre, Wang, Adrien, Evrard, Serge, Tchikviladze, Maya, Coskun, Oguzhan, Di Maria, Federico, Rodesh, Georges, Leguen, Morgan, Tisserand, Marie, Pico, Fernando, Rakotoharinandrasana, Haja, Tassan, Philippe, Poll, Roxanna, Nighoghossian, Norbert, Riva, Roberto, Eker, Omer, Turjman, Francis, Derex, Laurent, Cho, Tae-Hee, Mechtouff, Laura, Claire Lukaszewicz, Anne, Philippeau, Frédéric, Cakmak, Serkan, Blanc-Lasserre, Karine, Vallet, Anne-Evelyne, Barreau, Xavier, Berge, Jérôme, Menegon, Patrice, Lucas, Ludovic, Olindo, Stéphane, Renou, Pauline, Sagnier, Sharmila, Poli, Mathilde, Debruxelles, Sabrina, Rouanet, François, Tourdias, Thomas, Liegey, Jean-Sebastien, Detraz, Lili, Daumas-Duport, Benjamin, Alexandre, Pierre-Louis, Roy, Monica, Lenoble, Cédric, L’Allinec, Vincent, Girot, Jean-Baptiste, Desal, Hubert, Bracard, Serge, Anxionnat, René, Braun, Marc, Derelle, Anne-Laure, Tonnelet, Romain, Liao, Liang, Zhu, François, Schmitt, Emmanuelle, Planel, Sophie, Humbertjean, Lisa, Mione, Gioia, Lacour, Jean-Christophe, Bonnerot, Mathieu, Riou-Comte, Nolwenn, Costalat, Vincent, Gascou, Grégory, Lefèvre, Pierre-Henri, Derraz, Imad, Riquelme, Carlos, Arquizan, Caroline, Gaillard, Nicolas, Mourand, Isabelle, Corti, Lucas, Cagnazzo, Federico, Anadani, Mohammad, Spiotta, Alejandro, Alawieh, Ali, Haussen, Diogo, Nogueira, Raul, Papanagiotou, Panagiotis, Siddiqui, Adnan, Dorn, Franziska, Cognard, Christophe, Ribo, Marc, Psychogios, Marios, Labeyrie, Marc Antoine, Biondi, Alessandra, Andrew Grossberg, Jonathan, Guenego, Adrien, Darcourt, Julien, Vukasinovic, Isabelle, Pomero, Elisa, Davies, Jason, Renieri, Leonardo, Hecker, Corentin, Muchada Muchada, Maria, Houdart, Emmanuel, Turner, Raymond, Turk, Aquilla, Chaudry, Imran, Lockau, Johanna, Kastrup, Andreas, Behme, Daniel, Shallwani, Hussain, Christopher, Maurer, Département de Neuro-Radiologie [Bordeaux] (DNR - Bordeaux), CHU Bordeaux [Bordeaux], Hôpital Foch [Suresnes], Service de neurologie [Bordeaux], CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Centre hospitalier universitaire de Nantes (CHU Nantes), Fondation Ophtalmologique Adolphe de Rothschild [Paris], Santé Publique : épidémiologie et qualité des soins (EA 2694), Université Lille 2 - Faculté de Médecine -Centre d'Etudes et de Recherche en Informatique Médicale [Lille] (CERIM), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Département de Neuroradiologie[Montpellier], Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [Montpellier]-Université de Montpellier (UM), Imagerie Adaptative Diagnostique et Interventionnelle (IADI), Université de Lorraine (UL)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de neurologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), and Université de Montpellier (UM)

Subjects
Male, MESH: Cerebral Hemorrhage, MESH: Cerebral Angiography, carotid dissection, Carotid Artery, Internal, Dissection, 030204 cardiovascular system & hematology, 0302 clinical medicine, MESH: Carotid Stenosis, MESH: Emergencies, Occlusion, Odds Ratio, Carotid Stenosis, Acute ischemic stroke, MESH: Treatment Outcome, MESH: Middle Aged, Cerebral infarction, Endovascular Procedures, MESH: Postoperative Hemorrhage, Middle Aged, cerebral infarction, 3. Good health, reperfusion, Dissection, Treatment Outcome, Pooled analysis, dissection, Female, Stents, Radiology, Internal carotid artery, Carotid dissection, Cardiology and Cardiovascular Medicine, Carotid Artery, Internal, MESH: Ischemic Stroke, Adult, medicine.medical_specialty, MESH: Carotid Artery, Internal, MESH: Endovascular Procedures, internal carotid artery, Postoperative Hemorrhage, MESH: Carotid Artery, Internal, Dissection, 03 medical and health sciences, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, medicine.artery, medicine, Humans, In patient, cardiovascular diseases, Mortality, Ischemic Stroke, Retrospective Studies, Advanced and Specialized Nursing, cerebral hemorrhage, MESH: Humans, MESH: Mortality, business.industry, MESH: Adult, MESH: Retrospective Studies, medicine.disease, MESH: Male, MESH: Odds Ratio, Cerebral Angiography, MESH: Stents, Neurology (clinical), Emergencies, business, MESH: Female, 030217 neurology & neurosurgery
Abstract

Background and Purpose: The efficacy of endovascular therapy in patients with acute ischemic stroke due to tandem occlusion is comparable to that for isolated intracranial occlusion in the anterior circulation. However, the optimal management of acute cervical internal carotid artery lesions is unknown, especially in the setting of carotid dissection, but emergency carotid artery stenting (CAS) is frequently considered. We investigated the safety and efficacy of emergency CAS for carotid dissection in patients with acute stroke with tandem occlusion in current clinical practice. Methods: We retrospectively analyzed a prospectively maintained database composed of 2 merged multicenter international observational real-world registries (Endovascular Treatment in Ischemic Stroke and Thrombectomy in Tandem Lesion). Data from endovascular therapy performed in the treatment of tandem occlusions related to acute cervical carotid dissection between January 2012 and January 2019 at 24 comprehensive stroke centers were analyzed. Results: The study assessed 136 patients with tandem occlusion due to dissection, including 65 (47.8%) treated with emergency CAS and 71 (52.2%) without. The overall rates of favorable outcome (90-day modified Rankin Scale score, 0–2) and successful reperfusion (modified Thrombolysis in Cerebral Infarction, 2b–3) were 58.0% (n=76 [95% CI, 49.6%–66.5%]) and 77.9% (n=106 [95% CI, 71.0%–85.0%]), respectively. In subgroup analyses, the rate of successful reperfusion (89.2% versus 67.6%; adjusted odds ratio, 2.24 [95% CI, 1.33–3.77]) was higher after CAS, whereas the 90-day favorable outcome (54.3% versus 61.4%; adjusted odds ratio, 0.84 [95% CI, 0.58–1.22]), symptomatic intracerebral hemorrhage (sICH; 10.8% versus 5.6%; adjusted odds ratio, 1.59 [95% CI, 0.79–3.17]), and 90-day mortality (8.0% versus 5.8%; adjusted odds ratio, 1.00 [95% CI, 0.48–2.09]) did not differ. In sensitivity analyses of patients with successful intracranial reperfusion, CAS was not associated with an improved clinical outcome. Conclusions: Emergency stenting of the dissected cervical carotid artery during endovascular therapy for tandem occlusions seems safe, whatever the quality of the intracranial reperfusion.

Published
2020
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2. Chronic occlusion of the internal carotid artery: Endovascular revascularization technique of long occlusive lesions

Author

Carlos Riquelme, Alain Bonafe, Federico Cagnazzo, Cyril Dargazanli, Imad Derraz, Vincent Costalat, Pierre-Henri Lefevre, Gregory Gascou, Département de Neuroradiologie[Montpellier], and Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [Montpellier]-Université de Montpellier (UM)

Subjects
Carotid Artery Diseases, Male, medicine.medical_specialty, Endovascular revascularization, MESH: Endovascular Procedures, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, MESH: Carotid Stenosis, medicine.artery, MESH: Cerebral Revascularization, medicine, [INFO.INFO-IM]Computer Science [cs]/Medical Imaging, Humans, Carotid Stenosis, Radiology, Nuclear Medicine and imaging, cardiovascular diseases, Aged, MESH: Treatment Outcome, MESH: Aged, Chronic occlusion, MESH: Humans, MESH: Middle Aged, Cerebral Revascularization, Radiological and Ultrasound Technology, business.industry, MESH: Carotid Artery Diseases, Endovascular Procedures, Endovascular recanalization, Middle Aged, MESH: Male, 3. Good health, Hypoperfusion, Treatment Outcome, Chronically occluded internal carotid artery, cardiovascular system, Female, Neurology (clinical), Radiology, Internal carotid artery, business, Perfusion, MESH: Female, 030217 neurology & neurosurgery, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Carotid stents
Abstract

Background Despite series of endovascular recanalization of chronically occluded ICA (COICA) have been already reported, technical aspects of this strategy were not described. We discussed technical details and feasibility of this strategy. Clinical presentation Five COICA (C1-cavernous ICA) patients presenting symptomatic hypoperfusion were recanalized with multiple coronary and carotid stents. All patients experienced long-term reperfusion with resolution of the clinical symptoms. Conclusion Endovascular revascularization of COICA appears feasible and associated with improvement of the hypoperfusion.

Published
2020
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3. Localized hypertrophic neuropathy of the sciatic nerve in children: MRI findings

Author

Franck Marin, Bertrand Bruneau, Philippe Violas, Laurent Riffaud, Yves Gandon, Anne Michel, Jean-Yves Gauvrit, Adrien Roux, Catherine Tréguier, Service de radiologie et imagerie médicale [Rennes] = Radiology [Rennes], CHU Pontchaillou [Rennes], Service de neurochirurgie [Rennes] = Neurosurgery [Rennes], Service de chirurgie pédiatrique [Rennes] = Paediatric / Pediatric surgery [Rennes], Service d'explorations fonctionnelles neurologiques [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-CHU Pontchaillou [Rennes], Vision, Action et Gestion d'informations en Santé (VisAGeS), Institut National de la Santé et de la Recherche Médicale (INSERM)-Inria Rennes – Bretagne Atlantique, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-SIGNAUX ET IMAGES NUMÉRIQUES, ROBOTIQUE (IRISA-D5), Institut de Recherche en Informatique et Systèmes Aléatoires (IRISA), CentraleSupélec-Télécom Bretagne-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de Recherche en Informatique et en Automatique (Inria)-École normale supérieure - Rennes (ENS Rennes)-Université de Bretagne Sud (UBS)-Centre National de la Recherche Scientifique (CNRS)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Université de Rennes (UNIV-RENNES)-Institut National des Sciences Appliquées (INSA)-CentraleSupélec-Télécom Bretagne-Université de Rennes 1 (UR1), Institut National des Sciences Appliquées (INSA)-Université de Rennes (UNIV-RENNES)-Institut National des Sciences Appliquées (INSA)-Institut de Recherche en Informatique et Systèmes Aléatoires (IRISA), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École normale supérieure - Rennes (ENS Rennes)-Université de Bretagne Sud (UBS)-Centre National de la Recherche Scientifique (CNRS)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Université de Rennes (UNIV-RENNES)-Institut National des Sciences Appliquées (INSA), Université de Rennes (UR)-CHU Pontchaillou [Rennes], Université de Rennes (UR)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université de Bretagne Sud (UBS)-École normale supérieure - Rennes (ENS Rennes)-Institut National de Recherche en Informatique et en Automatique (Inria)-Télécom Bretagne-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS)-Université de Rennes (UR)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université de Bretagne Sud (UBS)-École normale supérieure - Rennes (ENS Rennes)-Institut National de Recherche en Informatique et en Automatique (Inria)-Télécom Bretagne-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche en Informatique et Systèmes Aléatoires (IRISA), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université de Bretagne Sud (UBS)-École normale supérieure - Rennes (ENS Rennes)-Télécom Bretagne-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS), and Gauvrit, Jean-Yves

Subjects
Pathology, intraneural perineuromia, Contrast Media, sciatic nerve, MESH: Magnetic Resonance Imaging, 030218 nuclear medicine & medical imaging, MESH: Aged, 80 and over, 0302 clinical medicine, MESH: Risk Factors, MESH: Carotid Stenosis, Hypertrophic neuropathy, MESH: Child, Medicine, Neuroradiology, Localized hypertrophic neuropathy, MESH: Aged, child, MESH: Middle Aged, MESH: Hypertrophy, Peripheral Nervous System Diseases, Magnetic Resonance Imaging, MESH: Infant, MESH: Predictive Value of Tests, Intraneural perineurioma, MESH: Leg, 3. Good health, MESH: Sciatic Nerve, Child, Preschool, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], MESH: Peripheral Nervous System Diseases, Sciatic nerve, MESH: Hemorrhage, Mri findings, medicine.medical_specialty, MESH: Imaging, Three-Dimensional, MESH: Stroke, MESH: Multivariate Analysis, MESH: Electromyography, 03 medical and health sciences, Imaging, Three-Dimensional, MESH: Contrast Media, Humans, Radiology, Nuclear Medicine and imaging, [SDV.NEU] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Retrospective Studies, Neurological deficit, Leg, MESH: Humans, Electromyography, business.industry, MESH: Child, Preschool, Infant, MESH: Retrospective Studies, Hypertrophy, MESH: Prospective Studies, MESH: Male, eye diseases, nervous system, Pediatrics, Perinatology and Child Health, business, MESH: Female, 030217 neurology & neurosurgery
Abstract

International audience; BACKGROUND: Localized hypertrophic neuropathy (LHN) of the sciatic nerve in children is a rare condition characterized by a painless neurological deficit in the sciatic nerve territory. OBJECTIVE: To demonstrate the role of MRI using a specific protocol and describe the primary findings in LHN. MATERIALS AND METHODS: Imaging in four children (age 2 years to 12 years) is presented. All children presented with lower limb asymmetry. Three had a steppage gait. LHN was confirmed by electrophysiological studies and by MRI of the whole sciatic nerve with a dedicated protocol covering the lumbar spine and the lower limb. RESULTS: There were four direct MRI findings: (1) linear and focal hypertrophy with progressive enlargement of a peripheral nerve or plexus diameter, (2) abnormal hyperintensity of the nerve on T2-weighted images, (3) preserved fascicular configuration, and (4) variable enhancement after intravenous gadolinium administration. In addition there were atrophy and fatty infiltration of innervated muscles. MRI was helpful for determining the extent of lesions and in excluding peripheral nerve compression or tumour. CONCLUSION: MRI of the whole sciatic nerve is the method of choice for diagnosing LHN of the sciatic nerve.

Published
2012
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4. Concordance Rate Differences of 3 Noninvasive Imaging Techniques to Measure Carotid Stenosis in Clinical Routine Practice

Author

Philippe Douek, Bernard Langella, Michel Lamure, Bruno Guias, Carmen Rotaru, Pierre Gouny, Norbert Nighoghossian, Valérie Buthion, Pierre Chirossel, Jean François Heautot, Jean Michel Serfaty, Michel Nonent, Chahin Pachai, Laurent Derex, Jean-Yves Gauvrit, Charles Veyret, Isabelle Jars, François Rouhart, Département de radiologie [Brest] (DR - Brest), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO), Hémostase, bio-ingénierie et remodelage cardiovasculaires (LBPC), Université Paris Diderot - Paris 7 (UPD7)-Université Paris 13 (UP13)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Galilée, Cerebrovascular Unit [Lyon], Hôpital neurologique et neurochirurgical Pierre Wertheimer [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Service de Neurologie [Brest], Service de Neurologie [Lyon], CHU Lyon, Service de Radiologie [Hôpital de la Croix-Rousse - HCL], Hôpital de la Croix-Rousse [CHU - HCL], Département de Médecine Interne et Pneumologie [Brest] (DMIP - Brest), Service de radiologie et imagerie médicale [Rennes] = Radiology [Rennes], CHU Pontchaillou [Rennes], Service de chirurgie thoracique et cardio vasculaire [Brest] (CCTV - Brest), COACTIS (COACTIS), Université Jean Monnet [Saint-Étienne] (UJM)-Université Lumière - Lyon 2 (UL2), Laboratoire d'analyse des systèmes de santé (LASS), Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Université Jean Moulin - Lyon 3 (UJML), Université de Lyon, Theralys [Lyon], Theralys, Service de radiologie [Saint-Etienne], CHU Saint-Etienne-Université Jean Monnet [Saint-Étienne] (UJM), Vision, Action et Gestion d'informations en Santé (VisAGeS), Institut National de la Santé et de la Recherche Médicale (INSERM)-Inria Rennes – Bretagne Atlantique, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-SIGNAUX ET IMAGES NUMÉRIQUES, ROBOTIQUE (IRISA-D5), Institut de Recherche en Informatique et Systèmes Aléatoires (IRISA), CentraleSupélec-Télécom Bretagne-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de Recherche en Informatique et en Automatique (Inria)-École normale supérieure - Rennes (ENS Rennes)-Université de Bretagne Sud (UBS)-Centre National de la Recherche Scientifique (CNRS)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Université de Rennes (UNIV-RENNES)-Institut National des Sciences Appliquées (INSA)-CentraleSupélec-Télécom Bretagne-Université de Rennes 1 (UR1), Institut National des Sciences Appliquées (INSA)-Université de Rennes (UNIV-RENNES)-Institut National des Sciences Appliquées (INSA)-Institut de Recherche en Informatique et Systèmes Aléatoires (IRISA), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École normale supérieure - Rennes (ENS Rennes)-Université de Bretagne Sud (UBS)-Centre National de la Recherche Scientifique (CNRS)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Université de Rennes (UNIV-RENNES)-Institut National des Sciences Appliquées (INSA), Plateforme neurinfo [Rennes], Centre de Recherche et d'Application en Traitement de l'Image et du Signal (CREATIS), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-École Supérieure Chimie Physique Électronique de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Brestois Santé Agro Matière (IBSAM), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Institut Galilée-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), COnception de l'ACTIon en Situation (COACTIS), Université Lumière - Lyon 2 (UL2)-Université Jean Monnet - Saint-Étienne (UJM), Université Jean Moulin - Lyon 3 (UJML), Université de Lyon-Université de Lyon-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Centre National de la Recherche Scientifique (CNRS), Service de Radiologie [CHU Saint-Etienne], Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E)-Université Jean Monnet - Saint-Étienne (UJM), Université de Rennes (UR)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université de Bretagne Sud (UBS)-École normale supérieure - Rennes (ENS Rennes)-Institut National de Recherche en Informatique et en Automatique (Inria)-Télécom Bretagne-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS)-Université de Rennes (UR)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université de Bretagne Sud (UBS)-École normale supérieure - Rennes (ENS Rennes)-Institut National de Recherche en Informatique et en Automatique (Inria)-Télécom Bretagne-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche en Informatique et Systèmes Aléatoires (IRISA), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université de Bretagne Sud (UBS)-École normale supérieure - Rennes (ENS Rennes)-Télécom Bretagne-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS), Université de Lyon-Université de Lyon-École Supérieure de Chimie Physique Électronique de Lyon (CPE)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Male, medicine.medical_treatment, MESH: Magnetic Resonance Angiography, MESH: Ultrasonics, Carotid endarterectomy, Magnetic resonance angiography, 030218 nuclear medicine & medical imaging, MESH: Aged, 80 and over, 0302 clinical medicine, MESH: Carotid Stenosis, Carotid Stenosis, Ultrasonics, Prospective Studies, Stroke, Ultrasonography, Aged, 80 and over, MESH: Aged, MESH: Middle Aged, medicine.diagnostic_test, Middle Aged, MESH: Predictive Value of Tests, MESH: Reproducibility of Results, Predictive value of tests, Female, Radiology, MESH: Image Enhancement, MESH: Tomography, X-Ray Computed, Cardiology and Cardiovascular Medicine, psychological phenomena and processes, medicine.medical_specialty, Concordance, 03 medical and health sciences, Predictive Value of Tests, medicine, Humans, cardiovascular diseases, Aged, Advanced and Specialized Nursing, MESH: Humans, business.industry, Reproducibility of Results, Digital subtraction angiography, Image Enhancement, medicine.disease, MESH: Prospective Studies, MESH: Male, Stenosis, Angiography, Neurology (clinical), Tomography, X-Ray Computed, business, MESH: Female, Magnetic Resonance Angiography, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, 030217 neurology & neurosurgery
Abstract

Background and Purpose— To replace digital subtraction angiography (DSA) in carotid stenosis evaluation, noninvasive imaging techniques have to reach a high concordance rate. Our purpose is to compare the concordance rates of contrast-enhanced MR angiography (CEMRA) and CT angiography (CTA) with Doppler ultrasound (DUS) in clinical routine practice. Methods— We evaluated prospectively with DUS, CEMRA, and CTA 150 patients suspected of carotid stenosis. The overall concordance rates of the 3 techniques were calculated for symptomatic stenosis ≥50% and ≥70%, for asymptomatic stenosis ≥60%, and for occlusion. For the carotid arteries treated by surgery (n=97), the results of each method and combined techniques were recorded, and misclassification rates were evaluated from surgical reports. Results— The overall concordance rates of DUS-CEMRA, DUS-CTA, and CEMRA-CTA were not statistically different. However, the concordance rate of DUS-CEMRA (92.53%) was significantly higher than that for DUS-CTA (79.10%) in the surgical asymptomatic stenosis group ( P =0.0258). CTA considered alone would misclassify the stenosis in a significant number of cases (11 of 64) in the surgical asymptomatic group compared with CEMRA (3 of 67) and DUS (1 of 66) ( P =0.0186 versus MRA, P =0.0020 versus DUS). Conclusions— With the techniques as utilized in our study, the overall concordance rates of combined noninvasive methods are similar for measuring carotid stenosis in clinical routine practice, but in asymptomatic carotid stenosis, the decision making for surgery is significantly altered if DUS and CTA are considered in place of DUS and CEMRA.

Published
2004
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5. Overestimation of moderate carotid stenosis assessed by both Doppler US and contrast enhanced 3D-MR angiography in the CARMEDAS study

Author

A. Pasco-Papon, Jean-Yves Gauvrit, Jean Michel Serfaty, Philippe Douek, Michel Nonent, J.-O. Fortrat, X. Papon, Valérie Buthion, C. Pachai, Y. Le Bras, A Badra, Luc Bressollette, D. Ben Salem, J.-P. Cottier, C. Rotaru, Jérôme Berge, Pierre Gouny, Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO), Département de radiologie [Brest] (DR - Brest), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Département de Radiologie [Bichat] (DR- Bichat), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Health System Analysis Laboratory (GATE), Université de Lyon, Département de Neuro-Radiologie [Angers] (DNR - Angers), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé (CREATIS), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Département de Médecine Interne et Pneumologie [Brest] (DMIP - Brest), Département de Chirurgie Vasculaire [Angers] (DCV - Angers), Bioclinica SAS (B SAS), Bioclinica SAS, Département d'Angiologie [Angers] (DA - Angers), Service de chirurgie thoracique et cardio vasculaire [Brest] (CCTV - Brest), Département de Neuro-Radiologie [Bordeaux] (DNR - Bordeaux), CHU Bordeaux [Bordeaux], Département de Radiologie [Niort] (DR - Niort), CH Niort, Vision, Action et Gestion d'informations en Santé (VisAGeS), Institut National de la Santé et de la Recherche Médicale (INSERM)-Inria Rennes – Bretagne Atlantique, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-SIGNAUX ET IMAGES NUMÉRIQUES, ROBOTIQUE (IRISA-D5), Institut de Recherche en Informatique et Systèmes Aléatoires (IRISA), Université de Rennes (UR)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université de Bretagne Sud (UBS)-École normale supérieure - Rennes (ENS Rennes)-Institut National de Recherche en Informatique et en Automatique (Inria)-Télécom Bretagne-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS)-Université de Rennes (UR)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université de Bretagne Sud (UBS)-École normale supérieure - Rennes (ENS Rennes)-Institut National de Recherche en Informatique et en Automatique (Inria)-Télécom Bretagne-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche en Informatique et Systèmes Aléatoires (IRISA), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université de Bretagne Sud (UBS)-École normale supérieure - Rennes (ENS Rennes)-Télécom Bretagne-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS), Service de radiologie et imagerie médicale [Rennes] = Radiology [Rennes], CHU Pontchaillou [Rennes], Imagerie et modélisation Vasculaires, Thoraciques et Cérébrales (MOTIVATE), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Jean Monnet [Saint-Étienne] (UJM)-Hospices Civils de Lyon (HCL)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), CentraleSupélec-Télécom Bretagne-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de Recherche en Informatique et en Automatique (Inria)-École normale supérieure - Rennes (ENS Rennes)-Université de Bretagne Sud (UBS)-Centre National de la Recherche Scientifique (CNRS)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Université de Rennes (UNIV-RENNES)-Institut National des Sciences Appliquées (INSA)-CentraleSupélec-Télécom Bretagne-Université de Rennes 1 (UR1), Institut National des Sciences Appliquées (INSA)-Université de Rennes (UNIV-RENNES)-Institut National des Sciences Appliquées (INSA)-Institut de Recherche en Informatique et Systèmes Aléatoires (IRISA), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École normale supérieure - Rennes (ENS Rennes)-Université de Bretagne Sud (UBS)-Centre National de la Recherche Scientifique (CNRS)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Université de Rennes (UNIV-RENNES)-Institut National des Sciences Appliquées (INSA), and Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Jean Monnet [Saint-Étienne] (UJM)-Hospices Civils de Lyon (HCL)-Institut National des Sciences Appliquées de Lyon (INSA Lyon)

Subjects
Male, Contrast Media, MESH: Magnetic Resonance Angiography, Magnetic resonance angiography, 030218 nuclear medicine & medical imaging, 0302 clinical medicine, MESH: Aged, 80 and over, MESH: Carotid Stenosis, Contrast (vision), Carotid Stenosis, media_common, Aged, 80 and over, MESH: Aged, MESH: Middle Aged, Radiological and Ultrasound Technology, medicine.diagnostic_test, Middle Aged, MESH: Predictive Value of Tests, Predictive value of tests, cardiovascular system, Female, Radiology, medicine.medical_specialty, media_common.quotation_subject, MESH: Imaging, Three-Dimensional, Sensitivity and Specificity, 03 medical and health sciences, Imaging, Three-Dimensional, Predictive Value of Tests, MESH: Contrast Media, Image Interpretation, Computer-Assisted, medicine, Humans, Radiology, Nuclear Medicine and imaging, cardiovascular diseases, Aged, MESH: Humans, business.industry, Mr angiography, Ultrasonography, Doppler, Digital subtraction angiography, medicine.disease, MESH: Sensitivity and Specificity, MESH: Male, Stenosis, Angiography, MESH: Ultrasonography, Doppler, Neurology (clinical), Doppler ultrasound, business, MESH: Female, MESH: Image Interpretation, Computer-Assisted, Magnetic Resonance Angiography, 030217 neurology & neurosurgery, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

International audience; PURPOSE: To evaluate the agreement and diagnostic accuracy of Contrast enhanced magnetic resonance angiography (CE-MRA), Doppler ultrasound (DUS) and Digital subtraction angiography (DSA) in the assessment of carotid stenosis. METHODS: DUS, CE-MRA and DSA were performed in 56 patients included in the Carotide-angiographie par résonance magnétique-échographie-doppler-angioscanner (CARMEDAS) multicenter study with a carotid stenosis ≥ 50%. Three readers evaluated stenoses on CE-MRA and DSA (NASCET criteria). Velocities criteria were used for stenosis estimation on DUS. RESULTS: CE-MRA had a sensitivity and specificity of 96-98% and 66-83% respectively for carotid stenoses ≥ 50% and a sensitivity and specificity of 94% and 76-84% respectively for carotid stenoses ≥ 70%. The interobserver agreement of CE-MRA was excellent, except for moderate stenoses (50-69%). DUS had a sensitivity and specificity of 88 and 75% respectively for carotid stenoses ≥ 50% and a sensitivity and specificity of 83 and 86% respectively for carotid stenoses ≥ 70%. Combined concordant CE-MRA and DUS had a sensitivity and specificity of 100 and 85-90% respectively for carotid stenoses ≥ 50% and a sensitivity and specificity of 96-100% and 80-87% respectively for carotid stenoses ≥ 70%. The positive predictive value of the association CE-MRA and DUS for carotid stenoses ≥ 70% is calculated between 77 and 82% while the negative predictive value is calculated between 97 and 100%. CE-MRA and DUS have concordant findings in 63-72%, and the overestimations cases were recorded only for carotid stenosis ≤ 69%. CONCLUSION: Combined DUS-CE-MRA is excellent for evaluation of severe stenosis but remains debatable in moderate stenosis (50-69%) due to the risk of overestimations.

Published
2011
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6. Indications for carotid screening in patients with coronary artery disease

Author

Philippe Lacroix, Victor Aboyans, Neuroépidémiologie Tropicale et Comparée ( NETEC ), Université de Limoges ( UNILIM ) -Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Génomique, Environnement, Immunité, Santé, Thérapeutique ( GEIST FR CNRS 3503 ), Service de Chirurgie Thoracique et Vasculaire - Médecine vasculaire [CHU Limoges], CHU Limoges, Neuroépidémiologie Tropicale et Comparée (NETEC), and Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST FR CNRS 3503)-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Université de Limoges (UNILIM)

Subjects
Duplex ultrasonography, MESH : Stroke, MESH : Prevalence, medicine.medical_treatment, MESH : Magnetic Resonance Angiography, MESH: Magnetic Resonance Angiography, Coronary Artery Disease, 030204 cardiovascular system & hematology, MESH: Risk Assessment, Severity of Illness Index, Magnetic resonance angiography, MESH: Endarterectomy, Carotid, Coronary artery disease, 0302 clinical medicine, MESH: Practice Guidelines as Topic, MESH: Carotid Stenosis, Prevalence, Mass Screening, Carotid Stenosis, MESH: Coronary Artery Disease, Coronary Artery Bypass, MESH : Risk Assessment, MESH : Peripheral Vascular Diseases, Stroke, Endarterectomy, MESH: Treatment Outcome, Peripheral Vascular Diseases, Endarterectomy, Carotid, Ultrasonography, Doppler, Duplex, MESH : Prognosis, medicine.diagnostic_test, MESH : Endarterectomy, Carotid, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, General Medicine, Prognosis, 3. Good health, Causality, MESH: Reproducibility of Results, MESH : Practice Guidelines as Topic, Treatment Outcome, medicine.anatomical_structure, Practice Guidelines as Topic, Cardiology, MESH : Ultrasonography, Doppler, Duplex, MESH : Severity of Illness Index, Radiology, medicine.symptom, MESH : Sensitivity and Specificity, MESH : Causality, Artery, medicine.medical_specialty, MESH: Ultrasonography, Doppler, Duplex, MESH: Causality, MESH : Treatment Outcome, Risk Assessment, Sensitivity and Specificity, Asymptomatic, MESH: Prognosis, MESH: Stroke, 03 medical and health sciences, Internal medicine, MESH: Severity of Illness Index, medicine, Humans, MESH: Patient Selection, MESH: Mass Screening, cardiovascular diseases, MESH : Coronary Artery Disease, MESH: Prevalence, MESH : Carotid Stenosis, MESH : Mass Screening, MESH: Humans, business.industry, Patient Selection, MESH: Coronary Artery Bypass, MESH : Reproducibility of Results, MESH : Humans, MESH: Peripheral Vascular Diseases, Reproducibility of Results, MESH : Patient Selection, medicine.disease, MESH: Sensitivity and Specificity, MESH : Coronary Artery Bypass, Stenosis, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, Magnetic Resonance Angiography, 030217 neurology & neurosurgery
Abstract

International audience; We reviewed the literature about the usefulness of screening for carotid artery lesions in patients with coronary artery disease (CAD). The use of duplex ultrasonography to detect carotid lesions has a two-fold interest in this situation. First, it enables the detection of severe carotid artery stenosis (CS), a potentially reversible cause of stroke. Stroke is frequent in patients with CAD, accounting for at least in one-fourth of all cardiovascular events during follow-up. The mean prevalence of CS > 60% in patients with CAD is 9%, too low to justify routine carotid screening. However, older age, history of a cerebrovascular event, and peripheral arterial disease are useful factors for focusing screening on a high-risk subset of patients with CAD. Trials assessing the interest of prophylactic carotid surgery in asymptomatic CS of 60% or more found similar benefits in the subset of patients with CAD. Screening for CS in patients undergoing coronary artery bypass grafting is also important because CS is a marker, and sometimes the source, of perioperative stroke. Unfortunately, randomized studies to determine the best strategy in this situation are lacking. Second, while measurement of the carotid intima-media thickness does not provide substantial prognostic information for patients with CAD, the presence of plaque, especially hypoechogenic or echolucent (lipid-rich) plaque, is associated with an unstable or high-risk cardiovascular status. In this situation, specific studies are warranted to compare carotid imaging with biomarkers such as C-reactive protein and stratify the cardiovascular risk.

Published
2009
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7. Carotid bruit: good for silent cardiovascular disease?

Author

Philippe Lacroix, Victor Aboyans, Neuroépidémiologie Tropicale et Comparée (NETEC), Université de Limoges (UNILIM)-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST FR CNRS 3503), Service de Chirurgie Thoracique et Vasculaire - Médecine vasculaire [CHU Limoges], and CHU Limoges

Subjects
medicine.medical_specialty, MEDLINE, Disease, 030204 cardiovascular system & hematology, MESH: Prognosis, 03 medical and health sciences, 0302 clinical medicine, Meta-Analysis as Topic, MESH: Carotid Stenosis, Internal medicine, medicine, Humans, Carotid Stenosis, MESH: Meta-Analysis as Topic, 030212 general & internal medicine, ComputingMilieux_MISCELLANEOUS, MESH: Humans, business.industry, MESH: Cardiovascular Diseases, General Medicine, Prognosis, Carotid bruit, Cardiovascular Diseases, Cardiology, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, medicine.symptom, business
Abstract

International audience

Published
2008
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8. Safety of endovascular treatment of carotid artery stenosis compared with surgical treatment: a meta-analysis

Author

Jean-Pierre Favre, Werner Hacke, Jean-Michel Bartoli, Jean-Louis Mas, Hans H. Eckstein, Peter A. Ringleb, Gilles Chatellier, Laboratoire de Santé Publique et Informatique Médicale (SPIM), Institut National de la Santé et de la Recherche Médicale (INSERM), Institut de médecine moléculaire de Rangueil (I2MR), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-IFR150-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire de Chimie et de Biochimie Pharmacologiques et Toxicologiques (LCBPT - UMR 8601), Université Paris Descartes - Paris 5 (UPD5)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS), Service de Pédiatrie, Centre Hospitalier Universitaire de Nice (CHU Nice)-Hôpital l'Archet, Laboratoire de Santé Publique et Informatique Médicale ( SPIM ), Institut National de la Santé et de la Recherche Médicale ( INSERM ), Institut de médecine moléculaire de Rangueil ( I2MR ), Université Toulouse III - Paul Sabatier ( UPS ), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-IFR150-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Laboratoire de Chimie et de Biochimie Pharmacologiques et Toxicologiques ( LCBPT - UMR 8601 ), Université Paris Descartes - Paris 5 ( UPD5 ) -Centre National de la Recherche Scientifique ( CNRS ), CHU Nice-Hôpital l'Archet, and Université Paris Descartes - Paris 5 (UPD5)-Centre National de la Recherche Scientifique (CNRS)

Subjects
medicine.medical_specialty, MESH : Stroke, medicine.medical_treatment, Carotid endarterectomy, MESH : Treatment Outcome, 030204 cardiovascular system & hematology, MESH: Risk Assessment, MESH: Stroke, law.invention, MESH: Endarterectomy, Carotid, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, MESH: Carotid Stenosis, Angioplasty, medicine, MESH: Patient Selection, MESH : Angioplasty, MESH : Risk Assessment, Stroke, MESH : Stents, Endarterectomy, MESH : Carotid Stenosis, MESH: Treatment Outcome, MESH: Angioplasty, MESH: Humans, business.industry, MESH : Humans, MESH: Time Factors, MESH : Endarterectomy, Carotid, [ SDV.SP.PHARMA ] Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, Odds ratio, MESH : Patient Selection, medicine.disease, MESH: Odds Ratio, 3. Good health, Surgery, Clinical trial, Stenosis, MESH: Stents, [SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, MESH : Odds Ratio, Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery, MESH : Time Factors
Abstract

International audience; BACKGROUND AND PURPOSE: Since publication of previous meta-analyses comparing endovascular and surgical treatment of patients with carotid artery stenosis, two further large-scale trials have been conducted, almost doubling the number of patients available for analysis. Therefore, it is justified to update these meta-analyses. METHODS: Relevant trials were identified by a search of the literature using an electronic database. Trials with a nonrandomized patient allocation were not included. We focused on events within 30 days after intervention and made two sets of analysis: one with all trials and one with large trials exclusively including symptomatic patients. RESULTS: Only Endartérectomie Versus Angioplastie chez les patients ayant une Sténose carotide Symptomatique Serrée (EVA3S) and Stent-Supported Percutaneous Angioplasty of the Carotid Artery versus Endarterectomy (SPACE) were identified to be included in the updated meta-analysis. In total, 2985 patients were included in eight trials of which 89% were symptomatic. In contrast to previous analyses, this meta-analysis found a significant difference between the odds ratios of any stroke or death within 30 days after treatment with a disadvantage of endovascular treatment when analysing all trials (odds ratio [OR], 1.38; 95% confidence interval [CI] 1.04-1.83; P = .024). Significant heterogeneity was found for this analysis (P = .03). The increase of the odds of suffering from disabling stroke or death in the endovascular compared with the surgical group was not significant in the analysis of all trials (OR, 1.37; 95% CI, 0.92-2.04; P = .12); no heterogeneity was found for this analysis (P = .27). In the analysis of the large trials with symptomatic patients, the OR for the endpoint any stroke or death was 1.29 (95% CI 0.94-1.76; P = .11); with a hint for heterogeneity (P = .10). For the endpoint disabling stroke or death, the OR was 1.33 (95% CI 0.89-1.93; P =.17) without any heterogeneity (P = .58). CONCLUSION: The expressiveness of this meta-analysis is limited by the heterogeneity of some tests. The main result is that surgical treatment still remains the gold standard for treatment of patients with symptomatic carotid artery stenosis, who do not have an increased surgical risk. Carotid artery stenting is neither safer than nor as safe as carotid endarterectomy in large clinical trials when short-term stroke and death rates are taken into account. Further recruitment into ongoing randomized trials is strongly recommended.

Published
2008
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9. Carotid angioplasty stenting revisited: clinical and radiological (MRI) outcome

Author

Thierry Adoukounou, Rene Chapot, Laurent Magy, Francisco Macian, Karima Ghorab, Jean-Michel Vallat, Service de Neurologie [CHU Limoges], CHU Limoges, Neuroépidémiologie Tropicale et Comparée (NETEC), Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST FR CNRS 3503)-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Université de Limoges (UNILIM), and Université de Parakou (UP)

Subjects
Male, medicine.medical_treatment, Treatment outcome, 030204 cardiovascular system & hematology, Outcome (game theory), MESH: Endarterectomy, Carotid, Cohort Studies, 0302 clinical medicine, MESH: Aged, 80 and over, Risk Factors, MESH: Risk Factors, MESH: Carotid Stenosis, Stroke outcome, Carotid Stenosis, MESH: Cohort Studies, MESH: Treatment Outcome, Aged, 80 and over, MESH: Aged, Endarterectomy, Carotid, MESH: Middle Aged, Middle Aged, 3. Good health, Treatment Outcome, Neurology, Radiological weapon, cardiovascular system, Female, Stents, Radiology, Cardiology and Cardiovascular Medicine, Cohort study, medicine.medical_specialty, MESH: Diffusion Magnetic Resonance Imaging, 03 medical and health sciences, Carotid angioplasty, Angioplasty, medicine, Humans, cardiovascular diseases, Aged, MESH: Angioplasty, MESH: Humans, business.industry, Contraindications, medicine.disease, MESH: Male, Stenosis, MESH: Stents, Diffusion Magnetic Resonance Imaging, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Neurology (clinical), business, MESH: Female, 030217 neurology & neurosurgery
Abstract

Background: Although carotid angioplasty and stenting (CAS) is widely used to treat carotid stenosis, recent studies point to the inferiority of the procedure compared with carotid endarterectomy. Methods: We present 50 consecutive cases of CAS treated in our unit. Endarterectomy was contraindicated in these patients due to high operative risk. All the patients underwent a diffusion-weighted MRI (DWI) before and after the procedure and had a neurological assessment in a stroke unit. Results: No deaths were recorded until 30 days after the procedure. Six patients [12%, confidence interval at 95% (CI95) = 3.7–20.2] had a positive DWI MRI after the procedure but only 2 (4%, CI95 = 0–9.43) had a worse neurological status. Conclusion: This study shows that CAS is feasible with a low morbid-mortality rate in patients with a high surgical risk. DWI is highly sensitive to detect neurological complications after the procedure.

Published
2008
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10. Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis

Author

Philippe Piquet, Jean-François Albucher, Pascal Favrole, Jean-François Bonneville, Abstr Act, Thierry Moulin, Michel Lievre, Didier Leys, Jacques Watelet, Jean-Pierre Pruvo, Xavier Ducrocq, Maurice Giroud, Alain Viguier, Fausto Viader, Gilles Chatellier, Bernard Beyssen, Vincent Larrue, Jean-Philippe Neau, Hassan Hosseini, Jean-Christophe Pillet, Alain Branchereau, S Investigators, Jean-Louis Mas, Emmanuel Touzé, Pierre Garnier, Jean-Pierre Becquemin, Service de Pédiatrie, Centre Hospitalier Universitaire de Nice (CHU Nice)-Hôpital l'Archet, Laboratoire de Santé Publique et Informatique Médicale (SPIM), Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Chirurgie Vasculaire, Hôpital de la Timone [CHU - APHM] (TIMONE), Laboratoire d'Astrophysique de Grenoble (LAOG), Université Joseph Fourier - Grenoble 1 (UJF)-Institut national des sciences de l'Univers (INSU - CNRS)-Centre National de la Recherche Scientifique (CNRS), Thérapeutiques substitutives du coeur et des vaisseaux (TSCV), Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Centre National de la Recherche Scientifique (CNRS), Neurologie Vasculaire [Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Evaluation et modélisation des effets thérapeutiques, Département biostatistiques et modélisation pour la santé et l'environnement [LBBE], Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), Science et Ingénierie des Matériaux et Procédés (SIMaP), Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Institut National Polytechnique de Grenoble (INPG)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS), Service de neuroradiologie [Lille], Hôpital Roger Salengro [Lille]-Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Hôpital Sainte-Marguerite [CHU - APHM] (Hôpitaux Sud ), Swedish Institute of Space Physics [Uppsala] (IRF), Neuropsychologie cognitive et neuroanatomie fonctionnelles de la mémoire humaine, Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-École Pratique des Hautes Études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de neurologie, Hôpital Sainte-Anne, Migrations Internationales, Territorialités, Identités (MITI), Université de Poitiers-Université Bordeaux Montaigne (UBM)-Centre National de la Recherche Scientifique (CNRS), Service de neurologie [Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), CHU Nice-Hôpital l'Archet, Laboratoire de Santé Publique et Informatique Médicale ( SPIM ), Institut National de la Santé et de la Recherche Médicale ( INSERM ), Hôpital de la Timone [CHU - APHM] ( TIMONE ), Laboratoire d'Astrophysique de Grenoble ( LAOG ), Université Joseph Fourier - Grenoble 1 ( UJF ) -Institut national des sciences de l'Univers ( INSU - CNRS ) -Centre National de la Recherche Scientifique ( CNRS ), Thérapeutiques substitutives du coeur et des vaisseaux ( TSCV ), Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ) -Centre National de la Recherche Scientifique ( CNRS ), Université Toulouse III - Paul Sabatier ( UPS ), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], Laboratoire de Biométrie et Biologie Evolutive ( LBBE ), Université Claude Bernard Lyon 1 ( UCBL ), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique ( Inria ) -Centre National de la Recherche Scientifique ( CNRS ), Science et Ingénierie des Matériaux et Procédés ( SIMaP ), Université Joseph Fourier - Grenoble 1 ( UJF ) -Institut polytechnique de Grenoble - Grenoble Institute of Technology ( Grenoble INP ) -Institut National Polytechnique de Grenoble ( INPG ) -Centre National de la Recherche Scientifique ( CNRS ) -Université Grenoble Alpes ( UGA ), Hôpital Roger Salengro-Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] ( CHRU Lille ), Hôpital Sainte-Marguerite [CHU - APHM] ( Hôpitaux Sud ), Swedish Institute of Space Physics [Uppsala] ( IRF ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -École pratique des hautes études ( EPHE ) -Université de Caen Normandie ( UNICAEN ), Normandie Université ( NU ) -Normandie Université ( NU ), Migrations Internationales, Territorialités, Identités ( MITI ), Université Bordeaux Montaigne-Université de Poitiers-Centre National de la Recherche Scientifique ( CNRS ), Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ), Normandie Université (NU)-Normandie Université (NU)-École pratique des hautes études (EPHE), Université de Poitiers-Université Bordeaux Montaigne-Centre National de la Recherche Scientifique (CNRS), Université Toulouse III - Paul Sabatier (UT3), Université Bordeaux Montaigne-Université de Poitiers-Centre National de la Recherche Scientifique (CNRS), Institut de médecine moléculaire de Rangueil ( I2MR ), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-IFR150-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Université Fédérale Toulouse Midi-Pyrénées, Service de chirurgie cadiovasculaire et thoracique [Rouen], CHU Rouen-Hôpital Charles Nicolle [Rouen]-Université de Rouen Normandie ( UNIROUEN ), Centre de Recherches sur la Cognition et l'Apprentissage ( CeRCA ), and Université de Poitiers-Université de Tours-Centre National de la Recherche Scientifique ( CNRS )

Subjects
Male, MESH : Stroke, medicine.medical_treatment, MESH : Risk, MESH : Aged, Myocardial Infarction, 030204 cardiovascular system & hematology, MESH: Endarterectomy, Carotid, 0302 clinical medicine, MESH: Carotid Stenosis, MESH : Female, Carotid Stenosis, MESH: Incidence, Stroke, MESH : Stents, Endarterectomy, MESH: Treatment Outcome, MESH: Aged, Endarterectomy, Carotid, MESH: Risk, Incidence, MESH : Endarterectomy, Carotid, General Medicine, MESH: Follow-Up Studies, MESH : Incidence, 3. Good health, MESH: Myocardial Infarction, Treatment Outcome, Female, Stents, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Risk, medicine.medical_specialty, MESH : Male, MESH : Treatment Outcome, MESH: Stroke, 03 medical and health sciences, Angioplasty, medicine, Humans, MESH : Angioplasty, cardiovascular diseases, MESH : Carotid Stenosis, Aged, MESH: Angioplasty, MESH: Humans, Vascular disease, business.industry, MESH : Humans, Stent, [ SDV.SP.PHARMA ] Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, MESH : Follow-Up Studies, medicine.disease, MESH: Male, Surgery, Stenosis, MESH: Stents, Relative risk, [ SDV.NEU ] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], [SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, Carotid stenting, MESH : Myocardial Infarction, business, MESH: Female, 030217 neurology & neurosurgery, Follow-Up Studies
Abstract

International audience; BACKGROUND: Carotid stenting is less invasive than endarterectomy, but it is unclear whether it is as safe in patients with symptomatic carotid-artery stenosis. METHODS: We conducted a multicenter, randomized, noninferiority trial to compare stenting with endarterectomy in patients with a symptomatic carotid stenosis of at least 60%. The primary end point was the incidence of any stroke or death within 30 days after treatment. RESULTS: The trial was stopped prematurely after the inclusion of 527 patients for reasons of both safety and futility. The 30-day incidence of any stroke or death was 3.9% after endarterectomy (95% confidence interval [CI], 2.0 to 7.2) and 9.6% after stenting (95% CI, 6.4 to 14.0); the relative risk of any stroke or death after stenting as compared with endarterectomy was 2.5 (95% CI, 1.2 to 5.1). The 30-day incidence of disabling stroke or death was 1.5% after endarterectomy (95% CI, 0.5 to 4.2) and 3.4% after stenting (95% CI, 1.7 to 6.7); the relative risk was 2.2 (95% CI, 0.7 to 7.2). At 6 months, the incidence of any stroke or death was 6.1% after endarterectomy and 11.7% after stenting (P=0.02). There were more major local complications after stenting and more systemic complications (mainly pulmonary) after endarterectomy, but the differences were not significant. Cranial-nerve injury was more common after endarterectomy than after stenting. CONCLUSIONS: In this study of patients with symptomatic carotid stenosis of 60% or more, the rates of death and stroke at 1 and 6 months were lower with endarterectomy than with stenting. (ClinicalTrials.gov number, NCT00190398 [ClinicalTrials.gov].).

Published
2006
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11. Asymptomatic carotid occlusion in a young HIV-infected patient receiving HAART

Author

Vandhuick, Olivier, De Saint Martin, Luc, Pasquier, Elisabeth, Bressollette, Luc, Calvez, Ghislaine, Département de Médecine Interne et Pneumologie [Brest] (DMIP - Brest), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), and Université de Brest (UBO)-Université de Brest (UBO)

Subjects
Adult, Male, MESH: Humans, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, MESH: CD4 Lymphocyte Count, virus diseases, MESH: Adult, HIV Infections, MESH: HIV Infections, MESH: Tunica Intima, MESH: Antiretroviral Therapy, Highly Active, MESH: Male, CD4 Lymphocyte Count, MESH: Carotid Stenosis, MESH: Tunica Media, Antiretroviral Therapy, Highly Active, cardiovascular system, Humans, Carotid Stenosis, cardiovascular diseases, Tunica Intima, Tunica Media, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Ultrasonography
Abstract

International audience; The discovery of an asymptomatic and spontaneous internal carotid occlusion in a young HIV-infected patient, without atherosclerosis, asks the question of cardio-vascular disease's mechanism. A pro-atherogenic profile HAART-associated does not fully explain the high cardio-vascular disease's incidence among the HIV infected population. Carotid stenosis and/or thrombophilic conditions are emergent problems among HIV-infected persons.

Published
2006

12. Plaque density on CT, a potential marker of ischemic stroke

Author

Serfaty, Jean-Michel, Nonent, Michel, Nighoghossian, Norbert, Rouhart, François, Derex, L., Rotaru, C., Chirossel, P., Thabut, G., Guias, Bruno, Heautot, J.-F., Gouny, Pierre, de La Vega, A., Pachai, C., Ecochard, R., Villard, J., Douek, Philippe-Charles, Renseigné, Non, Département de Radiologie (LYON - Radio), CHU Lyon, Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO), Service d'Imagerie (CHRU - CB), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Service de Neurologie (NN), Hôpital neurologique et neurochirurgical Pierre Wertheimer [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Service de Neurologie [Brest], Département de Médecine Interne et Pneumologie [Brest] (DMIP - Brest), Service de chirurgie thoracique et cardio vasculaire [Brest] (CCTV - Brest), Biostatistiques santé, Département biostatistiques et modélisation pour la santé et l'environnement [LBBE], Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), Service de Radiologie, Hôpital Louis Pradel [CHU - HCL], Laboratoire Creatis, Compte Général, Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), Centre de Recherche et d'Application en Traitement de l'Image et du Signal (CREATIS), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), and Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-École Supérieure Chimie Physique Électronique de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Male, Pathology, [SDV.IB.IMA]Life Sciences [q-bio]/Bioengineering/Imaging, [INFO.INFO-IM] Computer Science [cs]/Medical Imaging, Contrast Media, 030218 nuclear medicine & medical imaging, Brain Ischemia, 0302 clinical medicine, MESH: Aged, 80 and over, [INFO.INFO-TS]Computer Science [cs]/Signal and Image Processing, MESH: Carotid Stenosis, Carotid Stenosis, Stroke, ComputingMilieux_MISCELLANEOUS, Randomized Controlled Trials as Topic, Aged, 80 and over, MESH: Aged, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, MESH: Middle Aged, Cerebral infarction, MESH: Brain Ischemia, Middle Aged, Prognosis, MESH: Predictive Value of Tests, [PHYS.MECA.ACOU]Physics [physics]/Mechanics [physics]/Acoustics [physics.class-ph], [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, [INFO.INFO-TI] Computer Science [cs]/Image Processing [eess.IV], Ischemic Attack, Transient, [INFO.INFO-TI]Computer Science [cs]/Image Processing [eess.IV], [PHYS.PHYS.PHYS-MED-PH]Physics [physics]/Physics [physics]/Medical Physics [physics.med-ph], Cardiology, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Female, medicine.symptom, [PHYS.MECA.ACOU] Physics [physics]/Mechanics [physics]/Acoustics [physics.class-ph], MESH: Tomography, X-Ray Computed, [SPI.SIGNAL]Engineering Sciences [physics]/Signal and Image processing, Carotid Artery, Internal, medicine.medical_specialty, MESH: Carotid Artery, Internal, [INFO.INFO-TS] Computer Science [cs]/Signal and Image Processing, [SDV.IB.MN]Life Sciences [q-bio]/Bioengineering/Nuclear medicine, Asymptomatic, MESH: Prognosis, MESH: Stroke, [SDV.IB.MN] Life Sciences [q-bio]/Bioengineering/Nuclear medicine, Central nervous system disease, 03 medical and health sciences, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Predictive Value of Tests, Internal medicine, MESH: Contrast Media, [INFO.INFO-IM]Computer Science [cs]/Medical Imaging, medicine, Humans, Aged, Retrospective Studies, [SPI.SIGNAL] Engineering Sciences [physics]/Signal and Image processing, [SPI.ACOU]Engineering Sciences [physics]/Acoustics [physics.class-ph], [SDV.IB] Life Sciences [q-bio]/Bioengineering, [SPI.ACOU] Engineering Sciences [physics]/Acoustics [physics.class-ph], [PHYS.PHYS.PHYS-MED-PH] Physics [physics]/Physics [physics]/Medical Physics [physics.med-ph], MESH: Humans, Vascular disease, business.industry, MESH: Biological Markers, Retrospective cohort study, MESH: Retrospective Studies, Odds ratio, medicine.disease, MESH: Male, Stenosis, [SDV.IB.IMA] Life Sciences [q-bio]/Bioengineering/Imaging, MESH: Randomized Controlled Trials as Topic, Neurology (clinical), business, Tomography, X-Ray Computed, MESH: Ischemic Attack, Transient, MESH: Female, 030217 neurology & neurosurgery, Biomarkers, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

International audience; The authors sought to determine in a retrospective analysis whether carotid plaque soft TD on CT is associated with recent ischemic neurologic events. Among 141 patients (99 asymptomatic), 106 plaques with more than 50% stenosis were selected for density measurements. They found an odds ratio for neurologic events associated with a 10-point decrease in density of 1.54 (p = 0.002), showing an association between plaque density and neurologic events.

Published
2006
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13. Common carotid artery intima-media thickness, carotid plaques, and walking speed

Author

Jérôme Gariepy, Christophe Tzourio, Béatrice Tavernier, Alexis Elbaz, Annick Alpérovitch, Mahmoud Zureik, Benoît Février, Mahaut Ripert, Neuroépidémiologie, Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), 3C Study Center, 3C study Center Dijon, Epidémiologie des maladies chroniques: impact des intéractions gène environnement sur la santé des populations, Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre de Médecine Préventive Cardiovasculaire, Hôpital Broussais, 3C Study Center - Etude des 3 Cités (3C), and Tzourio, Christophe

Subjects
Carotid Artery Diseases, Male, Walking, 030204 cardiovascular system & hematology, 0302 clinical medicine, MESH: Aged, 80 and over, Risk Factors, MESH: Risk Factors, MESH: Carotid Stenosis, Odds Ratio, Carotid Stenosis, Common carotid artery, Stroke, Aged, 80 and over, MESH: Aged, ultrasonography, MESH: Motor Activity, Carotid Arteries, medicine.anatomical_structure, Quartile, Cardiology, cardiovascular system, Female, epidemiology, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Tunica Media, Cardiology and Cardiovascular Medicine, Tunica media, medicine.medical_specialty, gait, 03 medical and health sciences, medicine.artery, Internal medicine, medicine, Humans, MESH: Walking, [SDV.NEU] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], cardiovascular diseases, intima-media thickness, Aged, Advanced and Specialized Nursing, MESH: Carotid Arteries, MESH: Humans, business.industry, motor activity, MESH: Carotid Artery Diseases, Tinetti test, MESH: Gait, MESH: Tunica Intima, medicine.disease, Gait, MESH: Odds Ratio, MESH: Male, Preferred walking speed, Intima-media thickness, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Tunica Media, Physical therapy, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Neurology (clinical), Tunica Intima, business, MESH: Female, 030217 neurology & neurosurgery
Abstract

Background and Purpose— Gait dysfunction is an important cause of disability among the elderly and may be, in part, of vascular origin. We studied the association between carotid ultrasound parameters and measures of gait and balance in subjects 65 to 85 years of age who participated in the baseline phase of the Three-City Study in the Dijon center. Methods— The study population comprised 2572 noninstitutionalized individuals. Carotid plaques and common carotid artery intima-media thickness (CCA-IMT) were measured using ultrasonography. Gait and balance measures included walking speed and a modified version of the Tinetti scale. Results— Mean maximum walking speed (MWS) decreased with increasing CCA-IMT and number of plaques ( P −4 ). Compared with subjects in the lowest CCA-IMT quintile, the odds ratio (95% CI) for being in the lowest MWS quartile was 1.1 (0.8 to 1.6) in the second, 1.3 (0.9 to 1.8) in the third, 1.7 (1.2 to 2.4) in the fourth, and 2.2 (1.6 to 3.1) in the higher CCA-IMT quintile ( P −4 ). Mean (SD) CCA-IMT was 0.716 (0.118) mm in subjects with a modified Tinetti score P =0.006). The proportion of subjects in the lowest MWS quartile ( P =0.006) or with a modified Tinetti score P =0.05) increased with the number of plaques. These relations were attenuated after adjustment for vascular risk factors. Conclusions— Carotid plaques and higher CCA-IMT values are associated with worse performances on gait and balance tests. Our results suggest that vascular factors may play an important and under-recognized role in motor function.

Published
2005
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14. Endovascular treatment for carotid artery stenosis after neck irradiation

Author

Favre, Jean-Pierre, Nourissat, Alice, Duprey, Ambroise, Nourissat, Ghislain, Albertini, Jean Noël, Becquemin, Jean-Pierre, Renseigné, Non, Institut de médecine moléculaire de Rangueil (I2MR), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-IFR150-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Reims Champagne-Ardenne (URCA), Thérapeutiques substitutives du coeur et des vaisseaux (TSCV), Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Centre National de la Recherche Scientifique (CNRS), and Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées- Institut Fédératif de Recherche Bio-médicale Institution (IFR150)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Male, Time Factors, MESH: Radiotherapy, medicine.medical_treatment, 030204 cardiovascular system & hematology, Postoperative Complications, MESH: Aged, 80 and over, 0302 clinical medicine, Restenosis, MESH: Carotid Stenosis, MESH: Postoperative Complications, Carotid Stenosis, Aged, 80 and over, MESH: Aged, MESH: Middle Aged, medicine.diagnostic_test, Interventional radiology, Middle Aged, Thrombosis, 3. Good health, Female, Stents, Radiology, MESH: Neck, Cardiology and Cardiovascular Medicine, Adult, medicine.medical_specialty, MESH: Radiation Injuries, 03 medical and health sciences, Angioplasty, medicine, Humans, Radiation Injuries, Aged, Retrospective Studies, MESH: Angioplasty, MESH: Humans, Radiotherapy, Vascular disease, business.industry, MESH: Time Factors, MESH: Adult, MESH: Retrospective Studies, Retrospective cohort study, Vascular surgery, medicine.disease, MESH: Male, Surgery, MESH: Stents, Stenosis, [SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, business, MESH: Female, Neck, 030217 neurology & neurosurgery
Abstract

International audience; BACKGROUND: To lower the risk of complications, carotid angioplasty and stenting (CAS) has been proposed as an alternative to open surgery for carotid artery stenosis after neck irradiation. However, there are little postoperative data to support the benefits of this strategy. This study evaluated the outcome of CAS in patients who had undergone neck irradiation. METHODS: This retrospective study was conducted at 15 vascular surgery or interventional radiology centers in France between January 1998 and July 2006. A total of 135 patients (115 men) with a mean age of 67 +/- 8 years (range, 43-88) underwent CAS for 149 irradiation-induced lesions. The interval between irradiation and discovery of the lesions was 12 +/- 8 years. Mean diameter reduction was 81% (range, 50%-95%), and stenosis was symptomatic in 34%. Contralateral carotid lesions were observed in 48% of patients, including thrombosis in 18 and stenosis >50% in 53. RESULTS: Technical failure occurred during CAS in three cases. The overall technical success rate was 98%. A cerebral protection device was used in 59%. No death, one transient ischemic attack, and two strokes occurred during the first postoperative month. Mean follow-up was 30 months. Six patients were lost to follow-up. Survival rates were 93.9% at 1 year and 75.3% at 3 years. Complications after the first postoperative month included neurologic events in six, carotid thrombosis in nine, and restenosis in 18. The rates of freedom from neurologic and anatomic events were, respectively, 96.2% and 93.2% at 1 year and 93.1% and 85.9% at 3 years. CONCLUSION: The immediate outcome of CAS for irradiation-induced carotid artery stenosis was satisfactory. Medium-term neurologic outcome was acceptable, but the incidence of anatomic events such as thrombosis and restenosis was high. A randomized study is needed to confirm that the outcome of the endovascular and surgical therapy is comparable in this indication.

Published
2008
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15. Assessment of carotid artery stenosis before coronary artery bypass surgery. Is it always necessary?

Author

Luc Bressollette, Florent Le Ven, Eric Bezon, Jacques Boschat, Jacques Mansourati, Jean-Christophe Cornily, David Le Saux, Grégoire Le Gal, Ulric Vinsonneau, Martine Gilard, Jean-Jacques Blanc, Département de Cardiologie (CHRU - Cardio), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Optimisation des régulations physiologiques (ORPHY (EA 4324)), Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO)-Université de Brest (UBO)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Service de Cardiologie (BREST - Cardio), Département de Cardiologie (HIA - Cardio), Hôpital d'Instruction des armées, Département de Médecine Interne et Pneumologie [Brest] (DMIP - Brest), Centre d'Investigation Clinique (CIC - Brest), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM), Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO), Service d'Hémodynamique, and Centre Hospitalier Régional Universitaire de Brest (CHRU Brest)-Hôpital de la Cavale Blanche - CHRU Brest (CHU - BREST )

Subjects
Male, MESH: Chi-Square Distribution, medicine.medical_treatment, Coronary artery bypass, 030204 cardiovascular system & hematology, MESH: Risk Assessment, Severity of Illness Index, Coronary artery disease, MESH: Endarterectomy, Carotid, Coronary artery bypass surgery, 0302 clinical medicine, Risk Factors, MESH: Risk Factors, MESH: Carotid Stenosis, Carotid artery disease, Prevalence, Carotid Stenosis, MESH: Coronary Artery Disease, Stroke, Endarterectomy, MESH: Aged, Endarterectomy, Carotid, Ultrasonography, Doppler, Duplex, AVC, General Medicine, MESH: Predictive Value of Tests, 3. Good health, Coronaropathie, Cardiology, cardiovascular system, Female, France, medicine.symptom, Cardiology and Cardiovascular Medicine, Algorithms, MESH: Preoperative Care, medicine.medical_specialty, MESH: Ultrasonography, Doppler, Duplex, MESH: Algorithms, Risk Assessment, MESH: Stroke, 03 medical and health sciences, Predictive Value of Tests, Internal medicine, MESH: Severity of Illness Index, Preoperative Care, medicine, Humans, MESH: Patient Selection, cardiovascular diseases, MESH: Prevalence, Aged, Retrospective Studies, Chi-Square Distribution, MESH: Humans, business.industry, Patient Selection, MESH: Coronary Artery Bypass, MESH: Retrospective Studies, Pontage coronaire, Perioperative, medicine.disease, MESH: Male, Surgery, MESH: France, Stenosis, Carotid bruit, business, Athérosclérose carotidienne, MESH: Female, 030217 neurology & neurosurgery, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

International audience; BACKGROUND: Extracranial internal carotid artery stenosis is a risk factor for perioperative stroke in patients undergoing coronary artery bypass surgery (CAB). Although selective and non-selective methods of preoperative carotid screening have been advocated, it remains unclear if this screening is clinically relevant. AIM: To test whether selective carotid screening is as effective as non-selective screening in detecting significant carotid disease. METHODS: The case records of patients consecutively undergoing CAB were reviewed. Patients were stratified retrospectively into high- or low-risk groups according to risk factors for significant carotid stenosis and perioperative stroke: peripheral vascular disease (PVD), carotid bruit, diabetes mellitus, age >70 years and/or history of cerebrovascular disease. Prevalence of carotid stenosis detected by ultrasonography, surgical management and perioperative stroke rates were determined in each group. RESULTS: Overall, 205 consecutive patients underwent preoperative carotid screening. The prevalence of significant carotid stenosis was 5.8%. Univariate analysis confirmed that PVD (P=0.005), carotid bruit (P=0.003) and diabetes mellitus (P=0.05) were significant risk factors for stenosis. Carotid stenosis was a risk factor for stroke (P=0.03). Prevalence of carotid stenosis was higher in the high-risk group (9.1%) than the low-risk group (1.2%) (P70 years, with carotid bruit, a history of cerebrovascular disease, diabetes mellitus or PVD would have reduced the screening load by 40%, with trivial impact on surgical management or neurological outcomes.

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