International Angiology最新文献

{"title":"High-risk carotid plaque features may be more accurate predictors of ipsilateral ischemic stroke risk than the degree of carotid artery stenosis.","authors":"Kosmas I Paraskevas, Luca Saba, Bruce A Perler, Ali Aburahma, Sherif Sultan, James F Meschia, Brajesh K Lal, Sean P Lyden, Mahmoud B Malas, Young M Erben, Armando Mansilha, Mauro Gargiuilo, Gianluca Faggioli, Rodolfo Pini, Christopher J White, Christopher J Abularrage, Francesco Spinelli, Matthew Blecha, Alan Dardik, Piotr Myrcha, Gaetano Lanza, Gaia Spinetti, Gabor Menyhei, Antonino Bruno, Peter Arthur Ringleb, Tilman Reiff, Francesco Stilo, Dimitri P Mikhailidis, William A Gray, Arkadiusz Jawien, Mario D'Oria, Alexei Svetlikov, Mauro Silvestrini, Pavel Poredos, Jose Fernandes E Fernandes, Vincenzo DI Lazzaro, Jens Eldrup-Jorgensen, Victor Gurevich, Christos D Liapis, David H Stone, Peter A Schneider, Enrico Gallitto, Meghan Dermody, Andrea Vacirca, Agnieszka Sawicka, Gemmi Sufali, Arturas Mackevicius, Tomas Baltrunas, Vikram S Kashyap, Clark J Zeebregts, Piotr Musialek, Carlo Setacci, Marc L Schermerhorn, Gregory Y Lip, Andrew N Nicolaides, Seemant Chaturvedi","doi":"10.23736/S0392-9590.25.05431-8","DOIUrl":"https://doi.org/10.23736/S0392-9590.25.05431-8","url":null,"abstract":"<p><strong>Introduction: </strong>The optimal management of patients with asymptomatic carotid stenosis (AsxCS) is enduringly controversial. The current stratification of AsxCS patients based on the degree of stenosis alone does not always reflect ipsilateral ischemic stroke risk. We hypothesized that the presence of ≥1 \"high-risk\" carotid plaque feature may more accurately identify AsxCS patients at high risk for a future ipsilateral ischemic cerebrovascular event.</p><p><strong>Evidence acquisition: </strong>We reviewed the literature for evidence supporting an association between high-risk carotid plaque features with ipsilateral ischemic stroke risk.</p><p><strong>Evidence synthesis: </strong>Certain carotid plaque features, such as intraplaque hemorrhage, lipid-rich necrotic core, thinning/rupture of the fibrous cap, ulceration, or neovascularization, may more accurately stratify patients at low vs. high future stroke risk. The presence of ≥1 \"high-risk\" carotid plaque characteristics can inform decisions on the conservative vs. invasive management of AsxCS patients and target carotid revascularization procedures to those AsxCS patient subgroups at high stroke risk who are more likely to benefit from them.</p><p><strong>Conclusions: </strong>The present article presents the rationale supporting stratification of AsxCS patients not based on the degree of stenosis, but on the presence of one or more specific high-risk plaque features that increase the risk of a future ipsilateral ischemic cerebrovascular event.</p>","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":"44 3","pages":"224-234"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144953022","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":"Outcomes of carotid revascularization procedures in symptomatic patients according to preoperative symptoms, timing from symptoms, and modified Rankin Scale Score.","authors":"Jemin Park, Marc L Schermerhorn","doi":"10.23736/S0392-9590.25.05439-2","DOIUrl":"https://doi.org/10.23736/S0392-9590.25.05439-2","url":null,"abstract":"<p><strong>Introduction: </strong>Stroke remains a common cause of death globally, and ischemic strokes make up 87% of all strokes. Carotid disease is implicated in 10-15% of ischemic strokes, and the treatment of choice has historically been a carotid endarterectomy (CEA), first described in the 1950s. However, recent advanced techniques such as transfemoral carotid artery stenting (tfCAS), introduced in the 1990s, and transcarotid artery revascularization (TCAR), introduced in the 2010s, have altered this landscape. In this article, we explore the history of the different modalities and focus on outcomes in symptomatic patients based on their preoperative symptoms, timing from symptoms, and stroke severity using the modified Rankin Scale (mRS) Score.</p><p><strong>Evidence acquisition: </strong>We conducted a focused overview of articles that reported outcomes of the three modalities based on preoperative symptom status, timing of symptoms, and mRS Score.</p><p><strong>Evidence synthesis: </strong>When patients were stratified on pre-procedural symptoms (stroke, hemispheric TIA, ocular TIA, or formerly symptomatic) and timing (recent defined as <180 days from event), patients with a recent stroke had the highest 30-day stroke/death rates irrespective of modality. Further, higher preoperative mRS scores were significantly associated with in-hospital stroke/death rates. The highest rates of in-hospital stroke/death occurred in patients undergoing revascularization within the first two days, consistent with SVS guidelines that recommend delaying revascularization until days two to fourteen post-event.</p><p><strong>Conclusions: </strong>There is no consensus on the ideal carotid revascularization procedure; however, it is prudent to consider the patient's presenting symptoms, timing of symptoms, and potential disability from stroke in deciding between the different modalities.</p>","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":"44 3","pages":"245-253"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144953014","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":"Screening for asymptomatic carotid stenosis: routine or selective?","authors":"Bruce A Perler","doi":"10.23736/S0392-9590.25.05372-6","DOIUrl":"10.23736/S0392-9590.25.05372-6","url":null,"abstract":"<p><p>Stroke is one of the most serious health care conditions in the western world. In the USA nearly 800,000 strokes occur annually and in the EU more than 1.1 million strokes occur each year. It has been estimated that in the United States, 66,000 of 600,000 first-time strokes, and in the UK 16,500 of 150,000 new strokes annually, occur secondary to thromboembolism from extracranial carotid disease, and many of these strokes occur in individuals who were completely asymptomatic until that stroke occurred. A simple diagnostic test, Duplex ultrasound, can identify significant internal carotid stenoses in patients with asymptomatic disease. However, routine screening of individuals is controversial. This commentary will discuss the pros and cons of routine screening for asymptomatic carotid disease.</p>","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":" ","pages":"169-174"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772265","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 vasa vasorum in carotid stenosis.","authors":"Alexei V Svetlikov, Aleksandr S Shapovalov, Pyotr V Pigarevsky, Svetlana V Maltseva, Sergei V Lukin, Viktor S Gurevich","doi":"10.23736/S0392-9590.25.05445-8","DOIUrl":"10.23736/S0392-9590.25.05445-8","url":null,"abstract":"<p><p>Carotid stenosis is a significant health concern, characterized by the narrowing of the internal carotid artery due to atherosclerotic plaque formation. It represents a major risk factor for ischemic stroke, which is remaining a leading cause of disability and mortality worldwide. The development and progression of atherosclerosis within the vascular wall involve the intricate interplay of several factors, including, in particular, the role of \"vessels of the vessels\" or \"vasa vasorum.\" Vasa vasorum are small blood vessels that play a crucial role in nourishing the walls of larger blood vessels, including the carotid arteries. Over the years, emerging evidence has suggested that vasa vasorum's involvement in atherosclerosis goes beyond a mere nutritional function. Dysfunctional vasa vasorum have been associated with intraplaque hemorrhage, local inflammation and atherosclerotic plaque destabilization, ultimately leading to stroke. The relationships between vasa vasorum functionality and carotid stenosis is becoming an active area of research in the field of clinical complications of atherosclerosis. This review aims to explore the current state of knowledge regarding the role of vasa vasorum in carotid stenosis and the potential implications for its risk stratification, diagnosis, and treatment.</p>","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":" ","pages":"203-211"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608264","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":"An algorithmic approach to patient-specific treatment: medical management, carotid endarterectomy, carotid artery stenting and transcarotid artery revascularization.","authors":"Ali F Aburahma","doi":"10.23736/S0392-9590.25.05418-5","DOIUrl":"https://doi.org/10.23736/S0392-9590.25.05418-5","url":null,"abstract":"<p><p>The treatment of asymptomatic carotid artery stenosis (AsxCS) has been controversial over the past three decades. In this article an algorithmic approach to patient-specific treatment is described whether medical management or a carotid intervention is considered, including carotid endarterectomy (CEA), transfemoral carotid artery stenting (TFCAS), and/or transcarotid artery revascularization (TCAR). This article will summarize the commonly-quoted randomized controlled trials for both TFCAS and CEA which were published over the past two decades for both symptomatic (SxCS) and AsxCS, and create an algorithmic approach to patient-specific treatment according to risk stratification. Patients should be classified according to symptomatic status, followed by risk stratification. Patients with <70% AsxCS or <50% SxCS should be treated with best medical therapy alone. However, patients with ≥70% AsxCS and ≥50% SxCS should undergo CEA or TFCAS or TCAR with best medical therapy according to individual risk stratification. These three modalities can be complementary and very helpful in selecting proper therapy according to their risk.</p>","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":"44 3","pages":"195-202"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144953046","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":"Introducing the special issues on consensus in Carotid Disease. Part 1 and Part 2.","authors":"Kosmas I Paraskevas, Dimitri P Mikhailidis, Matthew Blecha, Brajesh K Lal, Luca Saba, Bruce A Perler, Clark J Zeebregts, Mario D'Oria, Carlo Setacci, Jessica Lanza, Domenica Crupi, Francesco Stilo, Francesco Spinelli, Pavel Poredos, Ales Blinc, Arturas Mackevicius, Gaetano Lanza, Christopher J White, Piotr Musialek, Agnieszka Sawicka, Gabor Menyhei, Ivan B Casella, Alan Dardik, Arkadiusz Migdalski, Antonino Bruno, Arkadiusz Jawien, Vincenzo DI Lazzaro, Sherif Sultan, Michael C Stoner, Ankur Thapar, Christopher J Abularrage, Seemant Chaturvedi, Meghan Dermody, Gianluca Faggioli, Andreia Coelho, Alexei Svetlikov, Victor Gurevich, Christos D Liapis, Francesco Setacci, Csaba Csobay-Novak, Mark K Eskandari, Gaia Spinetti, Rodolfo Pini, Gabriel A Wallace, Piotr Myrcha, Salvatore Bruno, Felice Pecoraro, Alun H Davies, Eric A Secemsky, Vikram S Kashyap, Ian M Loftus, Jan Pitha, Maarten Uyttenboogaart, Jose Fernandes E Fernandes, Jens Eldrup-Jorgensen, David H Stone, Young M Erben, Mauro Silvestrini, Tilman Reiff, Gregory Y Lip, Peter A Schneider, Mahmoud B Malas, Sean P Lyden, Marc L Schermerhorn, Ali F Aburahma, Peter Gloviczki, Andrew N Nicolaides, Armando Mansilha","doi":"10.23736/S0392-9590.25.05483-5","DOIUrl":"https://doi.org/10.23736/S0392-9590.25.05483-5","url":null,"abstract":"","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":"44 3","pages":"165-168"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952994","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":"Systematic review of contemporary outcomes for medical management of symptomatic patients with moderate to severe carotid stenosis.","authors":"Agilandiswari A Jothi, Nishita Gadi, Alun H Davies, Ankur Thapar","doi":"10.23736/S0392-9590.25.05423-9","DOIUrl":"https://doi.org/10.23736/S0392-9590.25.05423-9","url":null,"abstract":"<p><strong>Introduction: </strong>Medical therapy for secondary prevention of stroke has evolved markedly since the landmark North American Symptomatic Carotid Endarterectomy Trial (NASCET) and European Carotid Surgery Trial 1 (ECST-1) carotid surgery trials. The aim of this study was to perform a systematic review of stroke outcomes in adults with recent stroke or transient ischemic attack (TIA) with 50-99% carotid stenosis, treated with modern medical therapy over the last decade.</p><p><strong>Evidence acquisition: </strong>A systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, using a predefined search strategy on MEDLINE, EMBASE, Google Scholar, The Cochrane Database and clinicaltrials.gov. Inclusion criteria were studies of symptomatic patients with 50-99% carotid atherosclerotic stenosis published since 2015.</p><p><strong>Evidence synthesis: </strong>Six completed studies gave original data on stroke and TIA outcomes. In general, the risk of bias was moderate to high. One-month stroke outcomes were reported as 1%, at 3 months 2%, at 1 year 10% and at 2 years 13%.</p><p><strong>Conclusions: </strong>Modern medical therapy, along with improvements in hyperacute stroke care, may have reduced the early risks associated with carotid plaque rupture. This in turn has implications for the role of carotid endarterectomy.</p>","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":"44 3","pages":"183-188"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144953066","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":"Screening for asymptomatic carotid stenosis: routine or selective?","authors":"Bruce A Perler","doi":"10.23736/S0392-9590.25.05400-8","DOIUrl":"https://doi.org/10.23736/S0392-9590.25.05400-8","url":null,"abstract":"<p><p>The current review discusses the advantages and disadvantages of routine vs. selective screening for asymptomatic carotid artery stenosis. The cost-effectiveness of screening programs is discussed. Furthermore, the rationale of offering selective screening, as well as the current recommendations regarding screening for asymptomatic carotid stenosis are presented. A selective screening strategy would identify individuals at high cardiovascular disease (CVD) risk early and would allow the timely initiation of conservative lifestyle measures and best medical therapy to prevent both stroke and CVD morbidity and mortality.</p>","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015026","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":"Medium-term results of stenting with Hunter's canal fasciotomy for long femoropopliteal occlusions.","authors":"Alexey V Cheban, Olesya S Osipova, Pavel V Ignatenko, Alexandr A Gostev, Shoraan B Saaya, Andrey A Karpenko","doi":"10.23736/S0392-9590.25.05272-1","DOIUrl":"10.23736/S0392-9590.25.05272-1","url":null,"abstract":"<p><strong>Background: </strong>The present study investigates the hypothesis that fasciotomy of the Hunter's canal increases the mobility of the superficial femoral artery and reduces the risk of stent fracture. The objective of this study was to compare the long-term success of drug-eluting nitinol stents with and without a fasciotomy for patients with total femoropopliteal occlusion. The hypothesis is that fasciotomy of Hunter's canal can increase the mobility of the superficial femoral artery and reduce the incidence of stent breakage. The objective of this study was to compare the long-term patency of drug-eluting nitinol stents with and without fasciotomy in patients with total femoropopliteal occlusions.</p><p><strong>Methods: </strong>A randomized clinical trial was conducted in patients with femoral-popliteal stenococclusive lesions longer than 200 mm. Patients in group 1 (Zilver) underwent recanalization of the femoropopliteal artery occlusion with stenting. In the second group (ZilverFas), recanalization of the femoropopliteal occlusion with stenting and fasciotomy of Hunter's canal was performed. The follow-up evaluation of patency was conducted at 24 months.</p><p><strong>Results: </strong>The present study involved a total of 60 subjects. The primary patency at 24 months was 33% and 60% in the Zilver and ZilverFas groups, respectively (P=0.03). The freedom from target revascularization (TLR) in the Zilver and ZilverFas groups was 40% and 64%, respectively (P=0.1). The primary assisted patency at 24 months was 46.7% in the Zilver group versus 66.5% in the ZilverFas group (log-rank P=0.14) versus 46.7% in the Zilver group (log-rank P=0.14), while the 2-year secondary patency was 53.3% in the Zilver group compared to 69% in the ZilverFas group (log-rank P=0.24) compared to 53.3% in the Zilver group (log-rank P=0.24). In the Zilver and ZilverFas groups, the number of patients with stent failures was 14 and 7, respectively (P=0.05). In the Zilver and ZilverFas groups, the number of stents that fractured was 14 and 7, respectively (P=0.05). Multivariable Cox regression analysis revealed that fasciotomy significantly reduced the risk of reocclusion and restenosis by 2.1 times.</p><p><strong>Conclusions: </strong>The present study has demonstrated that decompression of the stented segment of the superficial femoral artery (SFA) with fasciotomy leads to a significant improvement in patency of the femoropopliteal segment and a substantial reduction in the number and severity of stent fractures.</p>","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":"44 2","pages":"150-158"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127553","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":"Portal vein dilation in Klippel-Trenaunay and CLOVES syndromes.","authors":"Asma Maqsood, Jaime Alonso Sanchez, Gary Peiser, Aisling Carroll-Downey, Maria F Dien Equivel, Joao Amaral, Laura Willis, Manuel Carcao, Alessandro Gasparetto","doi":"10.23736/S0392-9590.25.05416-1","DOIUrl":"https://doi.org/10.23736/S0392-9590.25.05416-1","url":null,"abstract":"<p><strong>Background: </strong>Klippel-Trenaunay Syndrome (KTS) and congenital lipomatous overgrowth, vascular anomalies, epidermal nevi and skeletal abnormalities (CLOVES) syndrome are rare conditions associated with overgrowth and vascular anomalies more frequently involving the lower extremities. Although uncommon, these syndromes can be associated with portal vein (PV) abnormalities, including PV thrombosis, and PV hypertension. In this study, we describe additional findings of PV dilation in five patients with KTS or CLOVES.</p><p><strong>Methods: </strong>A single institution 20 year retrospective review was performed to evaluate PV findings in patients with vascular anomalies and overgrowth of the lower extremities. Two radiologists reviewed the imaging examinations (US, CT and MRI) and recorded type and location of vascular alterations.</p><p><strong>Results: </strong>Of 35 patients (25 females, 24 KTS, 7 CLOVES and 4 other, median age: 8.5 years) with available abdominal imaging, 5 patients had PV dilation and one PV thrombosis. All patients presented additional abdominal vascular anomalies in association.</p><p><strong>Conclusions: </strong>Systematic evaluation of the abdominopelvic region in patients with KTS and CLOVES can identify vascular anomalies, including PV dilation, which may indicate a prethrombotic state. Early detection and monitoring of these findings could have clinical implications for preventing complications such as portal hypertension and thrombosis.</p>","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":"44 2","pages":"159-163"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127577","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}