International Angiology最新文献

{"title":"Mid-term outcomes of endovascular treatment for internal carotid artery dissection.","authors":"Salvatore Bruno, Domenico Mirabella, Ettore Dinoto, Felice Pecoraro","doi":"10.23736/S0392-9590.25.05426-4","DOIUrl":"https://doi.org/10.23736/S0392-9590.25.05426-4","url":null,"abstract":"<p><strong>Background: </strong>This study aims to assess the feasibility and safety of endovascular treatment of spontaneous internal carotid artery dissections (ICAD) using a proximal embolic protection device (EPD).</p><p><strong>Methods: </strong>From January 2012 to December 2023 all consecutive patients admitted for ICAD who underwent carotid artery stenting using MoMa Ultra (Medtronic, Minneapolis, MN, USA) proximal EPD were included in this single-center study and were retrospectively analyzed. The presence of neurological symptoms was the only indication for treatment. Early outcomes included technical success, perioperative mortality, and major cardiovascular and cerebral complications. Late outcomes were recurrent neurological symptoms, patency, and reinterventions.</p><p><strong>Results: </strong>A total of 9 patients were included in the study, all presenting with neurological symptoms. Among them, 8 were diagnosed with a transitory ischemic attack (TIA), while 1 had amaurosis fugax and transitory aphasia. Significant haemodinamic ICAD were 7. Complete anatomic resolution was achieved in all patients with no further lesions of the carotid axis. At a median follow-up of 63.9 months (IQR 27.1- 63.3), a single patient died due to worsening of pre-existent chronic heart failure; no intrastent restenosis were registered and all stents were patent.</p><p><strong>Conclusions: </strong>The use of a proximal EPD for endovascular treatment of ICAD under flow arrest seems to be feasible and safe, minimizing the risk of intraoperative stroke. Larger series are required to confirm these results and validate the treatment strategy.</p>","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":"44 4","pages":"323-329"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144953079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of carotid plaque analysis in therapeutic decision-making for carotid disease.","authors":"Ivan B Casella, Helio B Neto, Eduardo C Teixeira, José A Tavares Monteiro, Bruno D Constantin, Peter C Françolin, Thiago N Villari, Calógero Presti","doi":"10.23736/S0392-9590.25.05443-4","DOIUrl":"10.23736/S0392-9590.25.05443-4","url":null,"abstract":"<p><p>Carotid atherosclerosis is an important yet declining etiology of embolic stroke and cerebrovascular or retinal ischemic events with an embolic source. The severity of stenosis is the most important anatomic factor for deciding whether to use optimized medical therapy alone or interventional therapy. Recently, specific features of the atherosclerotic plaque have attracted increasing attention; for example, total plaque area, juxtaluminal black area, intraplaque hemorrhage, and mainly echolucent plaques are associated with high risk of late stroke, and these features now influence the therapeutic choices. This review describes the current state of carotid plaque analysis using different image modalities and its effect on current guidelines and clinical practice.</p>","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":" ","pages":"283-290"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Female sex and outcomes of symptomatic carotid stenosis revascularization.","authors":"Giulio Accarino, Gaetano Lanza, Umberto M Bracale, Jessica Lanza, Giulia Colonna, Maurizio Taurino, Pasqualino Sirignano","doi":"10.23736/S0392-9590.25.05428-8","DOIUrl":"10.23736/S0392-9590.25.05428-8","url":null,"abstract":"<p><p>Since stroke continues to be a major worldwide cause of death and disability, its prevention and treatment have become increasingly significant to public health. Up to 20% of all strokes are caused by carotid artery disease (CAD). Carotid revascularization techniques such as carotid endarterectomy (CEA) and carotid artery stenting (CAS) are established procedures aimed at reducing stroke risk. Recent studies, while confirming their effectiveness, suggest that women may experience different and sometimes less favorable post-operative outcomes compared to men. These differences stem from factors including anatomy, physiology, hormones, and socioeconomics. Current clinical guidelines rarely include gender-specific recommendations, as women have historically been underrepresented in clinical trials. However, the limited literature on risk assessment for women with CAD highlights significant differences. In this narrative review, we explore the impact of sex-related differences in CAD, outcomes of revascularization, and patterns of diagnosis and referral. We also highlight the gaps hindering personalized medical approaches. We examine the influence of anatomical and physiological variations on procedural risks, analyze hormonal effects on vascular wall physiology, and address metabolic differences between genders. Additionally, we discuss specific perioperative considerations for women and review current guidelines, identifying controversial issues arising from the lack of gender-based evidence. A key objective of this review is to emphasize the importance of research into personalized therapeutic strategies, aiming to improve the understanding of gender-specific influences and ultimately enhance outcomes for women undergoing carotid revascularization.</p>","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":" ","pages":"255-262"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144010474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Explainable artificial intelligence in the prediction of high-risk asymptomatic carotid plaques based on ultrasonic image features.","authors":"Nicoletta Prentzas, Chara S Skouteli, Efthyvoulos Kyriacou, Maura Griffin, Andrew Nicolaides, Christos P Loizou, Antonis Kakas, Constantinos S Pattichis","doi":"10.23736/S0392-9590.25.05449-5","DOIUrl":"https://doi.org/10.23736/S0392-9590.25.05449-5","url":null,"abstract":"<p><strong>Background: </strong>The addition of ultrasonic plaque texture features to clinical features in patients with asymptomatic internal carotid artery stenosis (ACS) improved the ability of a Support Vector Machine (SVM) model to identify plaques that are likely to produce stroke. However, SVM like many Artificial Intelligence (AI) black-box models lack transparency, limiting their adoption in critical settings. Explainable AI (XAI) techniques offer potential solutions by making model decision more interpretable. This study investigates whether incorporating XAI techniques can improve interpretability without significantly compromising predictive accuracy in stroke risk assessment.</p><p><strong>Methods: </strong>We developed an Argumentation-based Explainable Machine Learning (ArgEML) methodology and framework for explainable machine learning predictions via argumentation. We used this framework to learn explainable argumentation theories from a real-life dataset of patients with asymptomatic carotid stenosis. We assessed the performance of these theories using standard machine learning (ML) metrics, while interpretability was evaluated through model transparency and quality of explanations.</p><p><strong>Results: </strong>Results indicate that the ArgEML models maintain high predictive accuracy while significantly improving the interpretability of the predictions. Moreover, undecided predictions are addressed as dilemmas which still offer valuable information through the explanations of the different prediction capabilities.</p><p><strong>Conclusions: </strong>Our findings suggest that ArgEML enhances the interpretability of stroke prediction from real life medical data without sacrificing predictive performance. Moreover, explanations offer valuable insights into misclassified cases and cases where a definite prediction cannot be derived. This transparency can help refine a model, guiding clinical decisions and improving AI adoption in healthcare.</p>","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":"44 4","pages":"291-300"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of transcarotid artery revascularization in symptomatic carotid stenosis.","authors":"Christos D Liapis, Georgios Tzavellas","doi":"10.23736/S0392-9590.25.05450-1","DOIUrl":"https://doi.org/10.23736/S0392-9590.25.05450-1","url":null,"abstract":"<p><strong>Introduction: </strong>Carotid artery stenosis is a significant risk factor for ischemic stroke, particularly in symptomatic patients. While carotid endarterectomy (CEA) has traditionally been the gold standard for management, transcarotid artery revascularization (TCAR) has emerged as a minimally invasive alternative. TCAR combines direct carotid access with flow reversal technology to reduce embolic risk mainly from the aortic arch. This review examines the current evidence regarding the safety, efficacy, and long-term outcomes of TCAR in symptomatic carotid stenosis, comparing it with CEA and transfemoral carotid artery stenting (TFCAS).</p><p><strong>Evidence acquisition: </strong>PubMed/Medline was searched for studies evaluating the efficacy of TCAR in patients with symptomatic carotid stenosis. Search terms used included 'transcarotid artery revascularization', 'TCAR', 'symptomatic carotid stenosis' and 'stroke' in various combinations.</p><p><strong>Evidence synthesis: </strong>A total of 187 articles were considered for inclusion in this narrative review. An overview of the TCAR technique, as well as its main advantages and limitations is presented. The clinical evidence from TCAR studies, systematic reviews and meta-analyses is discussed. The indications of TCAR for symptomatic patients are reported based on the recommendations of the 2022 Society for Vascular Surgery guidelines. Finally, patient selection criteria, procedural considerations, and future directions for TCAR in the management of symptomatic carotid disease are analyzed and discussed.</p><p><strong>Conclusions: </strong>TCAR has demonstrated promising results for the management of both symptomatic and asymptomatic carotid stenosis. The main disadvantage of TCAR is its high cost compared with CEA. Hopefully, the cost-effectiveness of TCAR will improve in the future, thus further increasing its use and applications for the invasive management of patients with symptomatic carotid stenosis.</p>","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":"44 4","pages":"316-322"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144953017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemodynamics in carotid artery stenosis.","authors":"Bryan B Ho, Cayetana Lazcano-Etchebarne, Andrew Schwartz, Hualong Bai, Yuichi Ohashi, Alan Dardik","doi":"10.23736/S0392-9590.25.05441-0","DOIUrl":"10.23736/S0392-9590.25.05441-0","url":null,"abstract":"<p><p>Atherosclerotic plaque in the carotid artery is an important risk factor for cerebrovascular events. The unique geometry of the carotid bifurcation, including a secondary helical curvature and non-planarity of the daughter vessels, influences local hemodynamics and contributes to plaque formation. Multiple imaging modalities, including inter-arterial angiography, Duplex ultrasound, computed tomographic angiography, and magnetic resonance imaging, are used to diagnose and stratify the severity of carotid stenosis. Experimental and computational models of carotid bifurcation have shown the presence of disturbed flow, decreased wall shear stress, and an increased oscillatory shear index, along the outer wall of the carotid bulb and the internal carotid artery that correlates with areas of plaque deposition. Carotid endarterectomy and carotid stent placement both change the local hemodynamics at the bifurcation by altering the geometry of the carotid sinus and internal carotid artery, impacting long-term outcomes. Machine learning approaches have been increasingly applied to reduce the computational costs of numerical simulations and prognosticate the effects of carotid artery stenosis.</p>","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":"44 4","pages":"271-282"},"PeriodicalIF":1.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12955722/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144953076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The future in the management of patients with asymptomatic carotid artery stenosis.","authors":"Kosmas I Paraskevas, Sherif A Sultan, Ali F Aburahma, Wesley S Moore, Matthew Blecha, Piotr Myrcha, Clark J Zeebregts, Ales Blinc, Alun H Davies, Mario D'Oria, Mauro Gargiulo, Pavel Poredos, Alexei Svetlikov, Bruce A Perler, Seemant Chaturvedi, Gemmi Sufali, Luca Saba, Jens Eldrup-Jorgensen, Sean P Lyden, Carlo Setacci, Vincenzo DI Lazzaro, Tilman Reiff, Agnieszka Sawicka, Christos D Liapis, Gaetano Lanza, Gaia Spinetti, Antonino Bruno, Andrew N Nicolaides, Ankur Thapar, Maarten Uyttenboogaart, Arkadiusz Jawien, Dimitri P Mikhailidis, Francesco Spinelli, Francesco Stilo, Piotr Musialek, Victor Gurevich, Mauro Silvestrini, Young M Erben, Peter A Schneider, Gregory Y Lip, Christopher J White, Alan Dardik, James F Meschia, Mahmoud B Malas, Peter Gloviczki, Marc L Schermerhorn, Armando Mansilha","doi":"10.23736/S0392-9590.25.05401-X","DOIUrl":"10.23736/S0392-9590.25.05401-X","url":null,"abstract":"<p><strong>Introduction: </strong>The optimal management of patients with asymptomatic (AsxCS) and symptomatic carotid stenosis (SxCS) is still debatable. The present article will discuss emerging technological advances for the diagnosis and management of patients with AsxCS.</p><p><strong>Evidence acquisition: </strong>PubMed/MedLine was searched until December 31, 2024 for studies in English discussing emerging technological advances in the diagnosis and management of patients with AsxCS.</p><p><strong>Evidence synthesis: </strong>Several technological advances have recently been reported, among others, nanoplastics and microplastics, artificial intelligence and machine learning in predictive analytics for stroke prevention, digital twins for personalized monitoring, electronic tattoos for continuous non-invasive monitoring, stroke risk prediction through plaque morphology and late-phase contrast-enhanced ultrasound. A brief overview of each technological advance is presented and discussed.</p><p><strong>Conclusions: </strong>The technological advances discussed in the present article will aid the early diagnosis of AsxCS as well as the individualized optimal management of patients with AsxCS.</p>","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":" ","pages":"175-182"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The rising utilization and associated outcomes of transcarotid arterial revascularization.","authors":"Paul Crisostomo, Paula Pinto Rodriguez, Nabeeha Khan, Amy Liu, Sydney Flanagan, Karen Yuan, Lauren Carmon, Matthew Blecha","doi":"10.23736/S0392-9590.25.05421-5","DOIUrl":"https://doi.org/10.23736/S0392-9590.25.05421-5","url":null,"abstract":"<p><p>The purpose of this review is to provide a summary of indications, techniques and tips, outcomes and utilization of transcarotid artery revascularization (TCAR) stenting with flow reversal system. Subsections of procedural description; technical tips, technical complications and morbidities, outcomes and future applications are included. Following the PROOF feasibility trial in 2009, the Safety and Efficacy Study for Reverse Flow Used During Carotid Artery Stenting Procedure (ROADSTER) trial in 2012 was the initial prospective, multicenter clinical trial conducted to evaluate the safety and efficacy of TCAR (ENROUTE transcarotid neuroprotection system along with a variety of carotid artery stents). The ROADSTER trial involved 141 patients enrolled between November 2012 and July 2014, including symptomatic patients with ≥50% stenosis and asymptomatic patients with ≥70% stenosis. The results showed that within 30 days, the all-stroke rate was 1.4%, the combined rate of stroke and death was 2.8%, and the composite rate of stroke, death, and MI was 3.5%. At that time, the all-stroke rate of 1.4% was the lowest reported stroke rate for any prospective, multicenter clinical trial CAS. TCAR represents a significant advancement in the management of carotid artery disease, providing a unique combination of procedural safety, versatility, and innovation. Its flow reversal technology, which minimizes embolic risks in high-risk anatomical scenarios, sets it apart from other revascularization techniques. As ongoing studies and clinical trials clarify its long-term durability and outcomes, TCAR is positioned to play an increasingly crucial role in carotid revascularization. By delivering better outcomes and expanding access to minimally invasive care, TCAR is paving the way for a new standard in treating carotid artery disease across diverse patient populations.</p>","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":"44 3","pages":"212-223"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144953049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potential impact of artificial intelligence in predicting cerebrovascular events in patients with carotid artery stenosis.","authors":"Andreia Coelho, João Peixoto, Armando Mansilha","doi":"10.23736/S0392-9590.25.05424-0","DOIUrl":"https://doi.org/10.23736/S0392-9590.25.05424-0","url":null,"abstract":"<p><strong>Introduction: </strong>The purpose of this review was to critically evaluate the current literature on AI applicability to developing prediction models for cerebrovascular events in patients with carotid artery stenosis using standardized tools.</p><p><strong>Evidence acquisition: </strong>A systematic review was performed in accordance with the Preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. Critical appraisal was conducted using PROBAST risk-of-bias and the TRIPOD-AI reporting adherence tools.</p><p><strong>Evidence synthesis: </strong>A total of eight studies were included. Most studies were retrospective and single-center with unclear/high risk of bias and poor adherence to reporting standards. Discrimination area under the receiver operating characteristic curve (AUROC) ranged from 0.71-0.99 while software accuracy ranged from 0.725-0.95. Globally, AI prediction tools outperformed traditional regression model and were consistent in concluding that associating clinical and imageologic data reached the best accuracy and discrimination. Some studies identified risk factors inconsistent with our current understanding, such as high calcium burden in the carotid plaque. However, external validation and calibration data were scarce.</p><p><strong>Conclusions: </strong>Novel tools to predict individual prognosis and outcomes of patients with carotid artery stenosis would help improve patient care from a personalized medicine point of view. Up to date, studies on AI-based predictive models have identified potential risk factors we were previously unaware of. Although AI-based predictive models hold great promise, translation to real world practice remains limited.</p>","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":"44 3","pages":"189-194"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144953054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to reach optimal cardiovascular risk profile in carotid artery stenosis.","authors":"Jan Pitha","doi":"10.23736/S0392-9590.25.05442-2","DOIUrl":"https://doi.org/10.23736/S0392-9590.25.05442-2","url":null,"abstract":"<p><p>Carotid artery stenosis carries not only risk for ischemic strokes but also for other fatal cardiovascular events. Therefore, the control of modifiable cardiovascular risk factors as smoking, dyslipidemia, hypertension and diabetes mellitus is of primary importance in patients with carotid stenosis irrespectively of symptoms. This strategy is based on combination of lifestyle measures with pharmacotherapy. The basic lifestyle rule is expressed by the numbers 0-5-30; which mean 0 cigarettes, 5 portions of vegetables and fruits per day and 30 minutes of exercise per day. Very low concentrations of atherogenic LDL cholesterol (in patients at the highest risk less than 1.4 mmol/L) are to be reached; it is recently achievable by wide spectrum of potent hypolipemic drugs. In hypertension, the optimal levels of systolic blood pressure are 130-140 mmHg; in severe bilateral carotid stenoses slower lowering of blood pressure is recommended. Similarly, in diabetic individuals, hypoglycemia should be avoided caused by too intensive anti-diabetic treatment. Nevertheless, recently available antidiabetic drugs are less dangerous in this respect. Other risk factors recently under scrutiny are lipoprotein(a) and subclinical inflammation. Finally, very frequent but often critical and neglected risk factor is nonadherence of patients to cardiovascular risk management.</p>","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":"44 3","pages":"235-244"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144953009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}