Carotid Artery Stenosis: Current and Emerging Treatments

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ISBN: 9780824754174 | 0824754174
Cover: Hardcover
Copyright: 7/28/2005

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Wayne State Univ., Detroit, MI. Provides a summary of carotid artery stenosis treatment and an overview of stenting. Includes new studies on catheter design and distal protection devices. Offers information on surgery with carotid endarterectomy for symptomatic stenosis. For practitioners.

Preface

Contributors

1. Introduction

(10)

Peter M. Rothwell and Seemant Chaturvedi

1. Pathophysiology

(2)

2. Early Carotid Surgery

(1)

3. Carotid Endarterectomy

(1)

4. Carotid Angioplasty

(1)

5. Intervention for Asymptomatic Carotid Stenosis

(1)

6. Conclusions

(1)

References

(5)

2. Epidemiology of Carotid Artery Stenosis

(20)

Robert Cote and Jeffrey Minuk

1. Introduction

(1)

2. Risk Factors

(2)

3. Asymptomatic Carotid Artery Stenosis

(2)

4. Symptomatic Carotid Artery Stenosis

(5)

5. Conclusions

(1)

References

(10)

3. Pathophysiology

(24)

Hugh Markus

1. Atherosclerosis

(8)

2. Carotid Localization of Atherosclerosis

(2)

3. Importance of Embolism in Carotid Stroke: Evidence from Clinical Studies

(3)

4. Hemodynamic Factors in Carotid Stenosis Stroke

(2)

5. The Active "Carotid Plaque" in Humans: Clinical Studies

(3)

References

(5)

4. Carotid Imaging-Is Angiography Still Needed?

(22)

David Pelz

1. Introduction

(1)

2. Digital Subtraction Angiography

(18)

References

(4)

5. Carotid Imaging: Use of Ultrasound

(34)

Michael G. Hennerici and Michael Daffertshofer

1. Introduction

(1)

2. Ultrasound Technology

(3)

3. Normal Findings

(1)

4. Neck Arteries

(5)

5. Intima-Media Thickness-The Initial Stage

(1)

6. Plaque Development-The Intermediate Stage

(8)

7. Plaque Development-The Terminal Stage

(3)

8. Perspectives

(1)

References

100

(11)

6. Antithrombotic Therapy for Carotid Artery Stenosis

111

(12)

Seemant Chaturvedi

1. Extracranial Symptomatic Carotid Stenosis

111

(7)

2. Oral Anticoagulants

118

(1)

3. Ongoing Studies

119

(1)

4. Conclusions

120

(1)

References

120

(3)

7. Stroke Prevention, Blood Cholesterol, and Statins

123

(28)

Pierre Amarenco, Philippa Lavallee, and Pierre-Jean Touboul

1. Are Blood Lipids a Recognized Risk Factor for Stroke?

124

(1)

2. Use of Statins in Stroke Prevention

125

(5)

3. Safety

130

(4)

4. The Use of Fibric Acid Agents and Stroke Prevention

134

(2)

5. Use of Lipid-Lowering Agents in Stroke Prevention, Important Subgroups

136

(1)

6. The Use of Lipid-Lowering Agents in Stroke Prevention, Pending Questions

137

(5)

7. Current Guidelines

142

(1)

8. Conclusions

143

(1)

References

143

(8)

8. Management of Hypertension in Carotid Stenosis

151

(8)

J. David Spence

1. Does the Type of Medication Matter?

153

(1)

2. Treating the Underlying Cause of Hypertension

153

(1)

3. Is it Safe to Treat Hypertension in Patients with Severe Stenosis?

154

(1)

4. Conclusions

155

(2)

References

157

(2)

9. Hyperhomocyst(e)inemia and Carotid Atherosclerosis

159

(16)

Houta S. Sabet and L. Creed Pettigrew

1. Introduction

159

(1)

2. Metabolism of Homocyst(e)ine

160

(2)

3. Homocyst(e)ine and the Pathogenesis of Atherothrombosis

162

(1)

4. Hyperhomocyst(e)inemia and the Risk of Carotid Atherosclerosis

163

(1)

5. Recommendations for Therapeutic Management or Refinement of Diagnosis

163

(5)

References

168

(7)

10. Diet in the Management of Patients with Carotid Stenosis

175

(6)

J. David Spence

References

179

(2)

11. Angiogenesis and Angiogenic Growth Factors as Future Therapies for Cerebrovascular Disease

181

(16)

Brian H. Annex and Christopher D. Kontos

1. Introduction

181

(1)

2. Vasculogenesis and Angiogenesis

182

(1)

3. Angiogenic Growth Factors and the Corresponding Receptors

183

(2)

4. Examples of Signal Transduction Pathways Used During Angiogenesis

185

(1)

5. Balancing Pro-Angiogenesis and Anti-Angiogenesis

186

(1)

6. Therapeutic Angiogenesis

186

(1)

7. Basic Fibroblast Growth Factor and Therapeutic Angiogenesis

187

(1)

8. Clinical Trials Testing the Safety and Efficacy of FGF-2

188

(2)

9. Basic Fibroblast Growth Factor in Studies of Cerebrovascular Disease

190

(1)

10. Potential Toxicity of FGF-2 as an Example of an Angiogenic Growth Factor

191

(1)

11. Future Steps with FGF-2 and Other Angiogenic Growth Factors

191

(1)

12. Summary

191

(1)

References

192

(5)

12. What Are the Current Operative Risks of Carotid Endarterectomy?

197

(10)

Peter M. Rothwell

1. What is the Risk of CEA for Symptomatic Stenosis?

197

(2)

2. What is the Risk of CEA for Asymptomatic Stenosis?

199

(1)

3. Does the Type of Presenting Symptom Matter?

200

(1)

4. Is Operative Risk Related to Sex?

200

(1)

5. Does Age Matter?

201

(1)

6. Does Timing Matter?

202

(1)

7. Summary

203

(1)

References

203

(4)

13. Benefits of Endarterectomy for Recently Symptomatic Carotid Stenosis

207

(22)

Peter M. Rothwell

1. Which Range of Stenosis?

207

(3)

2. What About Near-Occlusions?

210

(1)

3. Which Subgroups Benefit Most?

211

(6)

4. How Soon Should Surgery be Performed?

217

(1)

5. Which Individuals Benefit Most?

218

(5)

6. Summary

223

(2)

References

225

(4)

14. Management of Carotid Artery Disease: Carotid Endarterectomy for Asymptomatic Carotid Stenosis

229

(16)

Graeme J. Hankey

1. Detecting and Quantifying Carotid Artery Stenosis

229

(1)

2. Prevalence of Neurologically Asymptomatic Carotid Stenosis

230

(1)

3. Prognosis of Asymptomatic Carotid Stenosis

230

(1)

4. Prognostic Factors

231

(1)

5. Surgical Risks of Carotid Endarterectomy for Asymptomatic Carotid Stenosis

232

(2)

6. Balance of Benefits and Risks (Effectiveness) of Carotid Endarterectomy for Neurologically Asymptomatic Carotid Stenosis-Evidence from Unconfounded Randomized Controlled Trials

234

(2)

7. Asymptomatic Carotid Surgery Trial

236

(3)

8. How Should Neurologically Asymptomatic Carotid Stenosis be Managed?

239

(1)

9. Summary

240

(1)

References

240

(5)

15. Surgical Controversies

245

(32)

A. Ross Naylor

1. Generalizability of Trial Results

245

(3)

2. Volume of Surgery and Outcome

248

(3)

3. Optimal Perioperative Antiplatelet Therapy

251

(2)

4. Choice of Anesthesia

253

(3)

5. Sinus Nerve Blockade

256

(1)

6. Shunt Deployment

257

(3)

7. Eversion or Traditional Endarterectomy?

260

(2)

8. Patch or Primary Closure?

262

(2)

9. Should Heparin be Reversed with Protamine?

264

(1)

10. Is There a Role for Perioperative Monitoring?

265

(3)

11. Surveillance and Management of Restenosis

268

(2)

12. Summary

270

(1)

References

270

(7)

16. Symptomatic Carotid Artery Occlusion: Extracranial Intracranial Bypass and Other Treatment Options

277

(10)

Catharina J.M. Klijn and L. Jaap Kappelle

1. How to Identify Patients at High Risk of Recurrent Ischemic Stroke?

278

(2)

2. Treatment Options

280

(2)

3. Concluding Remarks

282

(1)

References

283

(4)

17. Stenting for Symptomatic Stenosis

287

(18)

Lucy Coward and Martin M. Brown

1. Introduction

287

(1)

2. Risks Associated with Carotid Endarterectomy

288

(1)

3. The Benefits of Endovascular Treatment

288

(1)

4. Problems with Endovascular Treatment

288

(1)

5. Case Series

289

(2)

6. Randomized Trials

291

(4)

7. Meta-Analysis of the Randomized Trials

295

(2)

8. The Role of Cerebral Protection Devices

297

(1)

9. The Future of Carotid Stenting

298

(1)

10. Ongoing Trials

298

(1)

11. Ensuring Safety The International Carotid Stenting Study Protocol

298

(2)

12. Conclusion

300

(1)

References

300

(5)

18. Stenting for Asymptomatic Stenosis

305

(12)

Mark K. Borsody and Seemant Chaturvedi

1. Introduction

305

(1)

2. Historical Background

305

(3)

3. Comparative Clinical Trials

308

(3)

4. Technical and Economic Considerations

311

(1)

5. Future Expectations

312

(2)

References

314

(3)

19. Angioplasty and Stenting for Non-atherosclerotic Diseases of the Carotid Artery

317

(8)

Kumar Rajamani and Seemant Chaturvedi

1. Introduction

317

(1)

2. Angioplasty and Stenting for Carotid Artery Dissection

318

(1)

3. Angioplasty for Radiation-Induced Carotid Stenosis

319

(1)

4. Angioplasty for Fibromuscular Dysplasia of the Carotid Artery

319

(1)

5. Takayasu's Disease

320

(1)

6. Intracranial Vasculitis

321

(1)

7. Conclusions

321

(1)

References

322

(3)

20. Controversies in Endovascular Therapy for Carotid Artery Stenosis

325

(20)

Andrew R. Xavier, Catalina C. Ionita, Jawad E. Kirmani, and and Adnan I. Qureshi

1. Introduction

325

(1)

2. Which are the Patients that Should Undergo Carotid Angioplasty and Stenting?

325

(2)

3. What Type of Antithrombotic Therapy Should be used During Carotid Angioplasty and Stenting?

327

(7)

4. Should Carotid Angioplasty and Stenting be Performed with Cerebral Embolic Protection?

334

(1)

5. Summary

335

(1)

References

335

(10)

Index

345

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Carotid Artery Stenosis: Current and Emerging Treatments

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