Health-Related Quality of Life among Patients with Severe Carotid Artery Stenosis

Publisher Copyright: © 2015 by Elina Pucite.Information about changes of health-related quality of life (HRQoL) after revascularisation as well how revascularisation procedure influences daily activities, cognitive functioning and general health is controversial. The objectives of our study were to evaluate and describe the HRQoL among patients with severe carotid artery disease; to evaluate the difference of HRQoL between symptomatic and asymptomatic carotid artery disease; and to explore the possible associations between some demographic and clinical characteristics of patients with carotid artery disease and HRQoL. The cross-sectional study included 33 patients who were referred for carotid artery endarterectomy. Data assessment was done one to three days before surgery. The HRQoL was assessed using the Medical Outcome Survey Form 36 (SF-36v2). Patients with symptomatic carotid artery disease had the lowest mean SF-36v2 scores for physical functioning, role-physical, general health and mental health. There was moderate correlation (rs= 0.441) between mean SF-36v2 scores of mental health and Montreal Cognitive Assessment Scale (MoCA) scores. There is also indirect indication for probable correlation between MoCA test scores and mean SF-36v2 scores of social functioning, which might become statistically significant if more patients would be included. Patients with severe carotid artery disease in our study had lower mean SF-36v2 scores for role-physical, for bodily pain and for perception about their health status (general health). HRQoL in patients with severe carotid artery, stenosis was poorer in patients with symptomatic carotid artery disease and was not affected by gender and other clinical characteristics.publishersversionPeer reviewe

Carotid artery disease in patients undergoing elective coronary artery bypass surgery

OBJECTIVE: To determine frequency of carotid artery disease in patients undergoing elective coronary artery bypass grafting (CABG) using Doppler sonography.STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Radiology Department, The Aga Khan University Hospital, Karachi, from January 2005 to September 2008. METHODOLOGY: Patients with known cardiovascular disease waiting for CABG surgery were enrolled for carotid artery Doppler sonography. A predefined data entry form was used for data collection. Coronary angiography findings, carotid artery findings and other associated factors were noted from medical and radiological records. Frequency and pattern of carotid artery disease along with associated risk factors were evaluated. Data was entered and analyzed in SPSS version 15. Pearson chi-square for categorical and independent t test was applied for continuous variables at 95% confidence level. P-value of less than 0.05 were considered significant. RESULTS: A total of 176 patients (85% male, mean age=65 years) undergoing elective coronary artery bypass grafting were evaluated preoperatively for carotid artery disease by neck color Doppler sonography. Twenty percent of patients were found to have advanced carotid artery disease (\u3e 50% stenosis), 6% had critical stenosis (\u3e 75% stenosis) and 3% had complete stenosis. Frequency of atherosclerotic plaques was 50%, more common on right side and more prevalent in common carotid artery. Family background of carotid or coronary artery disease and history of smoking were significantly associated with presence of carotid artery disease (p \u3c 0.05). CONCLUSION: A sizeable proportion of patients undergoing elective coronary artery bypass grafting surgery for coronary artery disease were found to have coexistant carotid artery disease

A Prospective Study of Prevalence of Carotid Artery Disease in Patients with Coronary Artery Disease and its Correlation with Traditional Atherosclerotic Risk Factors in Central India

Introduction: Early atherosclerosis mainly involves carotid artery, which leads to increased carotid artery intima media thickness (CIMT).The potential value of CIMT improving the predictive capacity of traditional risk factors of CAD is an understudied and underutilized issue. Because of increasing availability of highly sensitive ultrasonography probes and for a noninvasive procedures, we can predict coronary artery disease (CAD) more precisely in patients having multiple traditional risk factors so it may reduce morbidity and mortality due to CAD and elevated CIMT can be used as surrogate marker of underlying CAD.Methods: This study enrolled 250 admitted patients as a case of CAD. The patients were assessed by detailed history taking, thorough clinical examination, measurement of CIMT, blood sugar and lipid level.Results: Carotid artery disease was present in 88 (35%) of 250 CAD patients. All modifiable cardiovascular risk factors were statistically significantly high in patients of CAD with carotid artery disease. In obese, diabetic, hypertensive, dyslipidemia and smoker patients, carotid artery disease was present in 55% (P = 0.00), 41% (P = 0.00), 43% (P = 0.007), 47% (P = 0.002) and 43% (P = 0.003) respectively. CAD patients who had 1 risk factor, 29% were associated with carotid artery disease. Comparison of single risk factor with patients who had no risk factor, there was non-significant correlation for carotid artery disease. CAD patients who had 2, 3, 4 and 5 risk factors, carotid artery disease was present 24 (32%) (p = 0.02), 15 (55%) (P = 0.0003), 17 (61%) (P = 0.00006) and 6 (67%) (P = 0.0008).Conclusion: elevated CIMT can be used as one of the important risk factor for early diagnosis of CAD and to reduce morbidity and mortality due to CAD

Comparison of extra cranial with intra cranial carotid artery disease in ischemic stroke

INTRODUCTION: Stroke is defined as developing symptoms or and signs of global or focal, loss of cerebral function with symptoms lasting for more than 24 hours or leading to death with no apparent cause other than vascular origin. Globally, the rate of occurrence of stroke is estimated as 400 - 800 per lakh of population. Around 57 lakh deaths occur due to stroke in a year. Approximately, 1.6 crore new acute strokes are reported yearly. Worldwide, stroke mortality is high in Eastern Europe and Asia. In India, the rate of occurrence of stroke is estimated as 90 - 222 per lakh of population. Approximately, 14 – 16 lakhs new acute strokes are reported yearly. 12% of them occur in the age group of less than 40 years. In fact, it is estimated that the incidence of stroke will reach one million annually by the year 2050. Stroke is a leading cause of long term disability in our society. As the longevity of the population increase, the incidence is on the rise. Adoption of western diet may further increase the prevalence and incidence of cardiovascular disease and stroke. Of the hundreds and thousands of stroke survivors each year, approximately 30% need support for day- to-day activities 20% need assistance with ambulation and 16% require institutional care. Hence the need for identifying stroke risk factors to the reduce morbidity and mortality due to stroke. AIM OF THE STUDY: To assess the following in patients with anterior circulation ischemic stroke: 1. Risk factors involved in carotid artery stroke. 2. Clinical profile, pattern of vascular involvement in carotid artery stroke. 3. Extra cranial internal carotid artery disease by carotid doppler. 4. Intracranial carotid artery disease by transcranial doppler in patients who showed extracranial internal carotid artery disease. 5. Comparing the concordance and discordance of carotid artery disease in extracranial and intracranial part of internal carotid artery. MATERIALS AND METHODS: This cross sectional study was conducted during Jan 2011 to Oct 2012 at Madras Institute of Neurology, Rajiv Gandhi Government General Hospital, and Chennai. Patients with clinical features suggestive of stroke were enrolled in this study; all were subjected to CT Brain, MRI Brain and Carotid Doppler. Inclusion Criteria: 1. All the patients with clinical feature suggestive of stroke, 2. Imaging showing ischemic infarct in the anterior circulation, 3. Carotid Doppler showing atherosclerotic carotid artery disease, 4. Patients with anterior circulation TIA. Exclusion Criteria: 1. All hemorrhagic strokes, 2. Posterior circulation stroke, 3. Patients without carotid artery disease on carotid doppler, 4. Patients with cardiac disease. RESULTS: Among the total 485 patients, 150 patients (30.9%) with posterior circulation stroke or venous infarcts, intra cerebral hemorrhage were excluded from the study. Remaining 335 patients were subjected to cardiac evaluation, of them 23 patients (6.8%) who showed cardiac abnormalities were excluded from the study. Out of the 312 patients only 70 patients who showed carotid artery disease in carotid doppler were enrolled in this study and subjected to transcranial doppler to study the intra cranial part of internal carotid artery involvement. CONCLUSION: 1. The common risk factors for carotid artery disease in our study are dyslipidemia, systemic hypertension, diabetes mellitus, smoking and alcohol consumption, in the order of occurrence. 2. Incidence of transient ischemic attack was high in patients with intracranial carotid artery disease indicating the need for intensive management of these patients to prevent morbidity and mortality 3. The most common radiological presentation is the territorial infarct involving the middle cerebral artery territory followed by watershed infarcts. 4. Most of the patients with extracranial internal carotid artery disease also had co-existing intracranial internal carotid artery disease which in turn may further lead to stroke. This emphasizes the need to search for intracranial disease in patients with extra cranial carotid artery disease. 5. Transcranial doppler can be used as a noninvasive initial screening tool for detecting intracranial internal carotid artery stenosis before considering any invasive investigation

Carotid artery disease screening : assessment of criteria

The Department of Radiology at St. Luke’s Hospital has provided a screening service for stroke related disease since April 1991. This consisted of Duplex Ultrasound screening (DUS) for Extracranial Carotid Artery Disease (ECAD) followed by angiography or intra-arterial digital subtraction angiography (lADSA) or digital intravenous angiography (DIVA) if ultrasound screening was positive for significant disease. The aim of this study was to evaluate in the local context, the various criteria for assessment already established overseas and to devise the best combination of these criteria to improve the detection of disease, thus improving the quality of the•local screening service. 504 patients have been screened for stroke related disease. Twelve patients (6M : 6F) with significant disease, who were considered for surgery, were referred for angiography, IADSA or DIVA. Comparison of these two modalities, DUS and vascular study, were made on 22 sides for the Multicentre Criteria (MCC), the Modified Seattle Criteria (MSC) and the Modified Washington Criteria (MWC). The accuracy, sensitivity, specificity, positive predictive value and negative predictive value were calculated for the MCC, the MSC and the MWC for peak systolic velocity. For the MCC the end diastolic velocity, the systolic velocity ratio and the diastolic velocity ratio were also compiled. The highest precision for extra cranial carotid artery disease screening can be achieved by a combination of the MCC or MSC for peak systolic velocity and with the systolic velocity ratio for the MCC.peer-reviewe

Carotid Artery Disease

This book will bring out the state of art of carotid stenosis in the basic and clinical approaches for better understanding of the mechanisms and useful therapies for these disease. We hope that would be a new current trend understanding new aspects regarding this scientific problematic involving not only anatomical, functional but also clinical questions

Transcarotid Artery Revascularization Versus Carotid Endarterectomy Based on Safety and Efficacy

For patients with carotid artery disease who are at risk for traditional open surgery, a less-invasive, clinically proven alternative called transcarotid artery revascularization (TCAR) is available. This paper assesses whether similar patients undergoing either TCAR or carotid carotid endarterectomy (CEA) have equivalent rates of postoperative stroke (CVA), death, cranial nerve injury, and myocardial infarction (MI). This data is beneficial to surgeons in order to evaluate the most effective therapeutic intervention in patients presenting with carotid artery disease

Extracranial Carotid Artery Disease

Magnetic Resonance Angiography (MRA) is a noninvasive means for studying the integrity of the vascular system. This unit presents a basic protocol describing an MRA technique for imaging the carotid arteries, time‐of‐flight MRA, and an for contrast‐enhanced MRA. A second basic protocol based on high‐resolution spin‐echo scanning is also described. This protocol can be used to study the vessel wall in more detail. The parameters given here are derived from experience at 1.5 T and may need to be altered slightly depending on the field strength and the equipment manufacturer. In particular, optimal TE may vary with different field strength.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/145358/1/cpmia0103.pd

Improving Patient Decision-Making in Health Care

Outlines regional variations within Minnesota in rates of patients with similar conditions receiving elective surgery, the concept of shared decision making, treatment choices for eight conditions, and steps for ensuring patients make informed decisions

Carotid artery Disease Assessed by Color Doppler Flow Imaging: Comparison Between Diabetic and Non-Diabetic Patients

Background: Carotid artery disease is most often seen in hypertensive patients and in patients with diabetes mellitus. More than 50% stenosis of extra cranial internal carotid arteries is linked with about 8–15% of ischemic strokes. The incidence of carotid artery stenosis (CAS) among diabetic patients is rising as compared to non-diabetic patients.  Methods: A cross-sectional study was performed on 120 patients, out of whom 60 were diabetic and 60 non-diabetics with clinically suspected carotid artery disease.  The study was conducted at the university ultrasound clinic in Green Town by Doppler ultrasonography using the Toshiba XARIO XG, which features a linear probe of 5-7.5 MHz frequency. The data was analyzed with the help of SPSS version 25.0. Variables like age, gender, diabetes, and Intima-media thickness (IMT) were reported and the mean ± standard deviation of Pulsatility Index, Resistive Index, Peak Systolic Velocity, and End Diastolic Velocity were calculated with a significant p-value, which is less than 0.05. An independent t-test was applied to compare Doppler indices in diabetic and non-diabetic subjects.Results: Data was collected from 120 patients. IMT of right and left carotid artery, PI and RI of right carotid were observed to be statistically significant in diabetic and non-diabetic.Conclusions: This study concluded that there is a significant correlation found between carotid artery disease and diabetes. Through ultrasonography, the presence of plaque and stenosis was found in more diabetic patients than in non-diabetic patients.Keywords: Ultrasonography; Carotid artery disease; Carotid artery stenosis; Carotid plaque; Vascular ultrasound; Diabetes