BACKGROUND AND PURPOSE: DSA (digital subtraction angiography) is the gold standard for measuring carotid artery stenosis (CS). Yet, the correlation between DSA and stenosis is not well documented. MATERIAL AND METHODS: We compared CS as measured by DSA to carotid artery specimens obtained from carotid endarterectomy surgery. Patients were divided into three groups according to NASCET criteria (North American Symptomatic Carotid Endarterectomy Trial): stenosis of 30-49% (mild), stenosis of 50-69% (moderate), and stenosis of 70-99% (severe). RESULTS: This prospective cohort study involved 644 patients. The mean stenosis in the mild stenosis group (n = 128 patients) was 54% ECST (European Carotid Surgery Trial), 40% NASCET, and 72% ESs (endarterectomy specimens). The mean absolute difference between ECST and NASCET was 14%. The mean stenosis in the moderate stenosis group (n = 347 patients) was 66% ECST, 60% NASCET, and 77% ES. The mean absolute difference between ECST and NASCET was 6%. The mean stenosis in the severe group (n = 169 patients) was 80% ECST, 76% NASCET, and 79% ES. No significant correlation coefficients were found between DSA and ES methods. In the mild group, the CC was 0.16 (ESCT) and 0.13 (NASCET); in the moderate group, the CC was 0.05 (ESCT) and 0.01 (NASCET); and in the severe group, the CC was 0.23 (ESCT) and 0.10 (NASCET). For all groups combined, CC was 0.22 for the ECST and 0.20 for the NASCET method. CONCLUSION: The relationship between DSA and ES methods to measure CS is almost random. This lack of a relationship between the DSA and ES techniques questions the validity of current DSA-based guidelines.

• Klíčová slova
• Angiography, Atherosclerosis, Carotid artery, Digital subtraction, Endarterectomy, Stroke,
• MeSH
• arteria carotis interna chirurgie   MeSH
• digitální subtrakční angiografie MeSH
• karotická endarterektomie * MeSH
• lidé MeSH
• prospektivní studie MeSH
• stenóza arteria carotis * diagnostické zobrazování   chirurgie   MeSH
• stenóza MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH

This study constitutes a cross sectional analysis of the association between cognitive impairment defined by neuropsychological tests and carotid stenosis. The main objective was to compare the results of the Mini-Mental State Examination (MMSE) and Addenbrooke's Cognitive Examination-Revised (ACE-R) with regard to the degree of carotid stenosis. The sample comprised 744 patients who underwent a carotid duplex ultrasound and cognitive function testing (by ACE-R and MMSE). A multivariable analysis of potential confounding factors was completed. The significance of the different number of positive (MMSE ≤ 27, ACE-R ≤ 88) and negative (MMSE ≥ 28, ACE-R ≥ 89) results of the neuropsychological tests was analysed with regard to the degree of carotid stenosis (50-99%). Neuropsychological test results were also compared between carotid stenosis of 50-69%, 70-89%, and 90-99%. For both the MMSE and ACE-R, a difference was observed between positive and negative test results when higher degrees of stenosis were present. However, for the ACE-R only, more severe stenosis (80-89%, 90-99%) was predominantly associated with positive test results (p-value < 0.017). The same dependence for ACE-R (although not statistically significant) was observed in the group of patients without an ischemic stroke (confounding factor). In the case of the MMSE and more severe stenosis, negative results predominated, regardless of the confounding factor. There were no statistically significant differences in test results between carotid stenosis of 50-69%, 70-89%, and 90-99%. The results suggest that for assessing the early risk of cognitive impairment in patients with carotid atherosclerosis, the ACE-R appears more suitable than the MMSE.

• Klíčová slova
• Atherosclerosis, Carotid stenosis, Cognitive impairment, Neuropsychological test,
• MeSH
• demence * diagnóza   etiologie   psychologie   MeSH
• lidé MeSH
• neuropsychologické testy MeSH
• průřezové studie MeSH
• stenóza arteria carotis * diagnóza   diagnostické zobrazování   MeSH
• stenóza MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND: Carotid endarterectomy is beneficial in symptomatic patients with ≥70% stenosis at the bifurcation of the internal carotid artery. The fact that the duplex ultrasound is widely used, inexpensive and non-invasive for examination of the carotid arteries underlines the importance of high accuracy of this method for grading internal artery stenosis. PATIENTS AND METHODS: Duplex scans and arteriograms of carotid arteries of 142 patients were reviewed. Peak and end-diastolic velocities of the common and internal carotid arteries were recorded, and the percent stenosis of the internal carotid artery was determined by arteriogram. Receiver-operator characteristic curves of sensitivity, specificity, positive and negative predictive values and accuracy were determined. RESULTS: The recommended criteria for the detection of ≥70% stenosis of the internal carotid artery were: peak systolic velocity in the internal carotid artery ≥215 cm/s, end-diastolic velocity in the internal carotid artery ≥65 cm/s, ratio of peak systolic velocities in the internal and common carotid arteries ≥2.7 and ratio of the end-diastolic velocities of the internal and common carotid arteries ≥3.7. CONCLUSION: These criteria allow for reliable determination of internal carotid artery stenosis ≥70% by duplex ultrasound.

• Klíčová slova
• carotid stenosis, diagnosis, duplex ultrasound, extracranial occlusive disease,
• MeSH
• arteria carotis interna diagnostické zobrazování   MeSH
• dospělí MeSH
• duplexní dopplerovská ultrasonografie metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• prediktivní hodnota testů MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• senzitivita a specificita MeSH
• stenóza arteria carotis diagnóza   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVES: Sleep apnea is associated with advanced atherosclerosis. This study was focused on sleep breathing in patients with hemodynamically significant carotid stenosis, currently free from clinical symptoms. DESIGN AND SETTINGS: 17 patients with carotid artery stenosis of 70% and more in the absence of actual neurological symptoms indicated for non-acute endarterectomy, and 17 age- and sex-matched controls were examined using sleep polygraphy. 12 patients had a follow-up sleep polygraphy a month after the surgery. RESULTS: The criteria of obstructive sleep apnea (OSA) were met by 4 patients prior to operation, by 2 patients after the operation, and by 2 control subjects. The pre-surgery apnea/hypopnea index (AHI) was 14 (+/-SD=17.0), post-surgery 8.3 (+/-9.0) and in the controls 6.7(+/-6.7). The pre-surgery oxygen desaturation index was 20.1 (+/-17.7), post-surgery 15.0 (+/-12.0) and in the controls 11.6 (+/-6.1). A comparison between the pre-surgery results seen in the patients and in controls after adjustment for BMI revealed no significant difference. The only significant difference between the pre-surgery and post-surgery values was found in the AHI (P=0.045). CONCLUSION: According to this study there exists an association between carotid stenosis and OSA, however this association is explainable by a higher BMI. The study also found a tendency toward OSA alleviation in response to endarterectomy.

• MeSH
• arteriae carotides patologie   chirurgie   MeSH
• incidence MeSH
• index tělesné hmotnosti MeSH
• komorbidita MeSH
• krk anatomie a histologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• obstrukční spánková apnoe komplikace   epidemiologie   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• stenóza arteria carotis komplikace   epidemiologie   chirurgie   MeSH
• studie případů a kontrol MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND: In this article, we present our experience with such operations performed under local anaesthesia. METHODS: From January 1997 to November 2007, there were 387 patients operated on for asymptomatic carotid stenosis. Patient data were retrospectively evaluated. Thirty-day neurological morbidity and mortality from six different subgroups were analysed and compared. The numbers of perioperative transient ischaemic attacks, as well as surgical and other perioperative complications were also evaluated. RESULTS: Overall morbidity and mortality was 1.8% (seven patients). Stroke was noted in 1.3% (five patients). Transitory ischaemic attacks within the first 30 days were observed in 1.6% (six patients). Only those patients who had intraluminal shunt insertion were found to have significantly higher morbidity and mortality. (p = 0.000018). Myocardial infarction was observed in 0.5% (two patients), one fatal. CONCLUSION: We have achieved acceptable morbidity and mortality rates (1.8%) according to the parameters set by previous studies such as Asymptomatic Carotid Atherosclerosis Study and Asymptomatic Carotid Stenosis Trial as well as American Heart Association and European Stroke Organisation guidelines. All surgeries were done under local anaesthesia. Shunts were inserted in 22 cases (5.68%).

• MeSH
• cévní mozková příhoda etiologie   mortalita   prevence a kontrola   MeSH
• karotická endarterektomie metody   mortalita   MeSH
• lidé středního věku MeSH
• lidé MeSH
• lokální anestezie metody   mortalita   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• stenóza arteria carotis etiologie   mortalita   chirurgie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

BACKGROUND AND PURPOSE: Statins reduce stroke risk when initiated months after transient ischemic attack (TIA)/stroke and reduce early vascular events in acute coronary syndromes, possibly via pleiotropic plaque stabilization. Few data exist on acute statin use in TIA. We aimed to determine whether statin pretreatment at TIA onset modified early stroke risk in carotid stenosis. METHODS: We analyzed data from 2770 patients with TIA from 11 centers, 387 with ipsilateral carotid stenosis. ABCD2 score, abnormal diffusion weighted imaging, medication pretreatment, and early stroke were recorded. RESULTS: In patients with carotid stenosis, 7-day stroke risk was 8.3% (95% confidence interval [CI], 5.7-11.1) compared with 2.7% (CI, 2.0%-3.4%) without stenosis (P<0.0001; 90-day risks 17.8% and 5.7% [P<0.0001]). Among carotid stenosis patients, nonprocedural 7-day stroke risk was 3.8% (CI, 1.2%-9.7%) with statin treatment at TIA onset, compared with 13.2% (CI, 8.5%-19.8%) in those not statin pretreated (P=0.01; 90-day risks 8.9% versus 20.8% [P=0.01]). Statin pretreatment was associated with reduced stroke risk in patients with carotid stenosis (odds ratio for 90-day stroke, 0.37; CI, 0.17-0.82) but not nonstenosis patients (odds ratio, 1.3; CI, 0.8-2.24; P for interaction, 0.008). On multivariable logistic regression, the association remained after adjustment for ABCD2 score, smoking, antiplatelet treatment, recent TIA, and diffusion weighted imaging hyperintensity (adjusted P for interaction, 0.054). CONCLUSIONS: In acute symptomatic carotid stenosis, statin pretreatment was associated with reduced stroke risk, consistent with findings from randomized trials in acute coronary syndromes. These data support the hypothesis that statins started acutely after TIA symptom onset may also be beneficial to prevent early stroke. Randomized trials addressing this question are required.

• Klíčová slova
• carotid stenosis, ischemic attack, transient, statin,
• MeSH
• časové faktory MeSH
• cévní mozková příhoda diagnostické zobrazování   patofyziologie   prevence a kontrola   MeSH
• difuzní magnetická rezonance metody   MeSH
• ischemie mozku diagnostické zobrazování   farmakoterapie   patofyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• rentgendiagnostika MeSH
• rizikové faktory MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• statiny aplikace a dávkování   MeSH
• stenóza arteria carotis diagnostické zobrazování   farmakoterapie   patofyziologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• Research Support, N.I.H., Extramural MeSH
• Názvy látek
• statiny MeSH

BACKGROUND/AIM: This study aimed to identify the progression of carotid artery stenosis (CAS) in patients with head and neck cancer following radiation therapy (RT) by characterizing associated risk factors. PATIENTS AND METHODS: Panoramic radiographs (OPG), computed tomography (CT) scans, cone-beam CT (CBCT) scans, and ultrasonography (US) of 69 patients with head and neck tumors were selected and analyzed to identify the presence of CAS. Data on tumor location, smoking status, hypertension (HTN), hyperlipidemia (HLD), diabetes mellitus (DM), and treatment were collected from the patients' medical records. Patients who received chemotherapy or no treatment were excluded from the study. The differential diagnosis of other radiopacities and anatomical landmarks were excluded. Patients were divided into two groups: those with CAS (group1) and those without CAS (group 2) and their clinical information was compared. RESULTS: The overall prevalence of CAS on the panoramic radiographs was 16%. Of the 69 patients, 44 underwent radiography before and after radiotherapy, only seven had mild CAS on radiographs after radiotherapy, and no significant difference in CAS was identified before and after radiotherapy. There were also no differences between the groups regarding age, sex, smoking, hypertension, diabetes mellitus, hyperlipidemia, tumor location, and RT dose before and after radiation (p>0.05). CONCLUSION: Radiotherapy does not seem to affect the prevalence of CAS, although it has been identified in some patients after radiotherapy completion.

• Klíčová slova
• CT scans, Carotid artery stenosis, head and neck tumors, radiotherapy,
• MeSH
• diabetes mellitus * MeSH
• hyperlipidemie * komplikace   MeSH
• hypertenze * komplikace   epidemiologie   MeSH
• lidé MeSH
• nádory hlavy a krku * diagnostické zobrazování   radioterapie   komplikace   MeSH
• počítačová rentgenová tomografie škodlivé účinky   MeSH
• radioterapie škodlivé účinky   MeSH
• rentgendiagnostika panoramatická škodlivé účinky   MeSH
• rizikové faktory MeSH
• stenóza arteria carotis * diagnostické zobrazování   etiologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Carotid endarterectomy (CEA) is accepted as a primary modality to treat carotid stenosis. The accuracy of measuring carotid stenosis is important for indication of the CEA procedure. Different diagnostic tools have been developed and used in the past 2 decades for the diagnosis of carotid stenosis. Only a few studies, however, have focused on the comparison of different diagnostic tools to histological findings of carotid plaque. METHOD: Patients with internal carotid artery (ICA) stenosis were investigated primarily by computed tomography angiography (CTA). Digital subtraction angiography (DSA), Doppler ultrasonography (DUS) and magnetic resonance angiography (MRA) were performed as well. Atherosclerotic plaque specimens were transversally cut into smaller segments and histologically processed. The slides were scanned and specimens showing maximal stenosis were determined; the minimal diameter and the diameter of the whole plaque were measured. High quality histological specimen and histological measurement was considered to be the prerequisite for inclusion into the analysis. The preoperative findings were compared with histological measurement. CTA and histological measurements were obtained from 152 patients. DSA measurements were available in 138 of these cases, MRA in 107 and DUS in 88. A comparison between preoperative and histological findings was performed. In addition, correlation coefficients were computed and tested. RESULTS: A significant correlation was found for each of the diagnostic procedures. The strongest correlation coefficient and the best allocation of stenosis into clinical significant groups (<50 %, 50-69 %, ≥70 %) was observed for CTA. Mean differences in the whole cohort between preoperative and histological measurements were as follows: CTA underestimated histological measurement by 2.4 % (based on European Carotid Surgery Trial [ECST] methodology) and 11.9 % (based on North American Symptomatic Carotid Endarterectomy Trial [NASCET] methodology). DSA underestimated the histological measurement by 7 % (ECST) and 12.2 % (NASCET). MRA overestimated the histological measurement by 2.6 % (ECST) and underestimated by 0.6 % (NASCET). DUS overestimated the stenosis by 1.8 %. CONCLUSIONS: CTA yields the best accuracy in detection of carotid stenosis, provided that all axial slices of the stenosis are checked and carefully analysed. DSA underestimates moderate and mild ICA stenosis, whereas DUS overestimates high-grade ICA stenosis. For MRA, a relatively low correlation coefficient was observed with histological findings. We conclude that CTA-ecst technique is the most reliable technique for carotid stenosis measurement.

• Klíčová slova
• Atherosclerotic plaque, CT angiography, Carotid stenosis, Digital subtraction angiography, Doppler ultrasonography, Magnetic resonance angiography, Measurement accuracy,
• MeSH
• CT angiografie * MeSH
• karotická endarterektomie metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční angiografie * MeSH
• senioři MeSH
• stenóza arteria carotis diagnostické zobrazování   patologie   chirurgie   MeSH
• ultrasonografie dopplerovská * MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH

PURPOSE: Our objectives were to assess the abnormalities of subcortical nuclei by combining volume and shape analyses and potential association with cognitive impairment. PATIENTS AND METHODS: Twenty-nine patients with severe ACS of the unilateral internal carotid artery and 31 controls were enrolled between January 2017 to August 2018. All participants underwent a comprehensive neuropsychological evaluation, blood lipid biochemical measurements, and structural magnetic resonance imaging (MRI) to measure subcortical volumes and sub-regional shape deformations. Basic statistics, correction for multiple comparisons. Seventeen ACS patients underwent carotid endarterectomy (CEA) within one week after baseline measurements, cognitive assessments and MRI scans were repeated 6 months after CEA. RESULTS: The ACS patients had higher apolipoprotein B/apolipoprotein A1 (ApoB/ApoA1) ratio and worse performance in all cognitive domains than controls. Moreover, the ACS patients showed more profound thalamic atrophy assessed by shape and volume analysis, especially in the medial dorsal thalamus. No significant differences were found in other subcortical nuclei after multiple comparisons correction. At baseline, thalamic atrophy correlated with cognitive impairment and ApoB/ApoA1 ratio. Furthermore, mediation analysis at baseline showed that the association of carotid intima-media thickness with executive functioning was mediated by thalamic volume. After CEA, cognitive improvement and increase in the bilateral medial dorsal thalamic volume were observed. CONCLUSION: Our study identified the distinct atrophy of subcortical nuclei and their association with cognition in patients with ACS. Assessments of the thalamus by volumetric and shape analysis may provide an early marker for cerebral ischemia and reperfusion after CEA.

• Klíčová slova
• asymptomatic carotid stenosis, cognitive impairment, endarterectomy, magnetic resonance imaging, thalamus,
• MeSH
• asymptomatické nemoci MeSH
• atrofie MeSH
• intimomediální šíře tepenné stěny MeSH
• karotická endarterektomie metody   MeSH
• kognitivní dysfunkce * diagnóza   etiologie   MeSH
• lidé MeSH
• magnetická rezonanční tomografie metody   MeSH
• neuropsychologické testy MeSH
• prognóza MeSH
• senioři MeSH
• stenóza arteria carotis * komplikace   diagnóza   chirurgie   MeSH
• thalamus * diagnostické zobrazování   patologie   MeSH
• velikost orgánu MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND AND PURPOSE: Although the latest recommendations suggest that carotid endarterectomy (CEA) should be performed in symptomatic carotid artery stenosis (sCAS) patients within 2 weeks of the index event, only a minority of patients undergo surgery within the recommended time-frame. The aim of this international multicenter study was to prospectively evaluate the safety of early CEA in patients with sCAS in everyday clinical practice settings. METHODS: Consecutive patients with non-disabling acute ischaemic stroke (AIS) or transient ischaemic attack (TIA) due to sCAS (≥ 70%) underwent early (≤ 14 days) CEA at five tertiary-care stroke centers during a 2-year period. Primary outcome events included stroke, myocardial infarction (MI) or death occurring during the 30-day follow-up period and were defined according to the International Carotid Stenting Study criteria. RESULTS: A total of 165 patients with sCAS [mean age 69 ± 10 years; 69% men; 70% AIS; 6% crescendo TIA; 8% with contralateral internal carotid artery (ICA) occlusion] underwent early CEA (median elapsed time from symptom onset 8 days). Urgent CEA (≤ 2 days) was performed in 20 cases (12%). The primary outcomes of stroke and MI were 4.8% [95% confidence interval (CI) 1.5%-8.1%] and 0.6% (95% CI 0%-1.8%). The combined outcome event of non-fatal stroke, non-fatal MI or death was 5.5% (95% CI 2.0%-9.0%). Crescendo TIA, contralateral ICA occlusion and urgent CEA were not associated (P > 0.2) with a higher 30-day stroke rate. CONCLUSIONS: Our findings indicate that the risk of early CEA in consecutive unselected patients with non-disabling AIS or TIA due to sCAS is acceptable when the procedure is performed within 2 weeks (or even within 2 days) from symptom onset.

• Klíčová slova
• carotid artery, carotid endarterectomy, early, stroke,
• MeSH
• časové faktory MeSH
• cévní mozková příhoda chirurgie   MeSH
• karotická endarterektomie škodlivé účinky   normy   MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• stenóza arteria carotis chirurgie   MeSH
• tranzitorní ischemická ataka chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH