Screening For Asymptomatic Carotid Artery Stenosis PDF Download

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Languages : en
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Author: U. S. Department Human Services
Publisher:
ISBN: 9781490902173
Category :
Languages : en
Pages : 44

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Cerebrovascular disease is the third leading cause of death in the U.S. Approximately 500,000 Americans each year suffer a first stroke. The mortality rate for cerebrovascular disease has declined by nearly 70% since 1950. Much of the decrease is likely due to reduced cigarette smoking and improved control of hypertension. In addition to controlling such risk factors as tobacco use and hypertension, carotid endarterectomy (CEA) has been proposed as a strategy for reducing the burden of suffering due to stroke. Randomized controlled trials (RCTs) have shown that CEA effectively reduces stroke among people who have severe carotid artery stenosis (CAS) and have had a transient ischemic attack (TIA) or "minor stroke." It is not clear, however, whether screening asymptomatic people (i.e., those who have never had a TIA) to detect CAS and treatment with CEA is effective in reducing stroke. In 1996, the USPSTF concluded that there was insufficient evidence to recommend for or against screening of asymptomatic persons for CAS using physical exam or carotid ultrasound. This recommendation was based on new evidence at the time, including the Asymptomatic Carotid Artery Study (ACAS), a RCT involving 1662 subjects with asymptomatic stenosis greater than 60%. Results of ACAS suggested that the overall benefit of treatment with CEA depends greatly on the perioperative complications. At that time, there was limited information about CEA complications in the general population. After a trend of declining usage of CEA, the publication of ACAS led to a reversal and the number of carotid endarterectomies performed in the U.S. increased significantly. Data then began to emerge about complication rates from CEA performed in community and academic settings. Since the previous Task Force review, the largest RCT of CEA versus medical treatment of asymptomatic CAS, the Asymptomatic Carotid Surgery Trial (ACST), has been published. This review updates the 1996 Task Force review of screening for CAS, focusing on duplex ultrasound as the screening test (with various confirmation tests) and CEA as the treatment for clinically important CAS. It draws upon the 1996 recommendation, updates the evidence on the natural history of CAS, the accuracy of screening tests, and the benefits of treatment for CAS with CEA, and includes a systematic review of the evidence since 1994 on the harms of carotid endarterectomy. Medical interventions were not reviewed in this report. The USPSTF has reviewed screening for several identified CAS and stroke factors, including hyperlipidemia, hypertension, aspirin prophylaxis, and smoking. The key questions were: Key Question 1. Is there direct evidence that screening adults with ultrasound for asymptomatic CAS reduces fatal and/or nonfatal stroke? Key Question 2. What is the accuracy and reliability of ultrasound to detect clinically important CAS? Key Question 3. For people with asymptomatic CAS 60%-99%, does intervention with CEA reduce CAS-related morbidity or mortality? Key Question 4. Does treatment for asymptomatic CAS 60%-99% with CEA result in harm?

Author: Agency for Healthcare Research and Quality
Publisher: CreateSpace
ISBN: 9781508439509
Category : Medical
Languages : en
Pages : 166

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Carotid artery stenosis refers to atherosclerotic narrowing of the extracranial carotid arteries. It typically refers to the internal carotid arteries or the common and internal carotid arteries. A “clinically important” degree of stenosis is defined as the percentage of stenosis that corresponds to a substantially increased risk for stroke. However, because stroke risk depends on more than just the degree of stenosis, it is difficult to set a lower limit on the range that defines potential clinical importance. Asymptomatic patients have no significant neurologic symptoms referable to the carotid artery and have not experienced a cerebrovascular event (i.e., a stroke or transient ischemic attack). The main purpose of this report is to systematically evaluate the current evidence on whether screening asymptomatic adults for CAS reduces the risk for fatal or nonfatal ipsilateral stroke and the evidence on harms associated with screening and interventions for CAS. The scope and methods of this report differ from earlier USPSTF reviews on this topic by 1) using systematic methods for all key question, 2) addressing new key questions about the availability of valid, reliable risk stratification tools to distinguish a person's likelihood for asymptomatic CAS and to distinguish risk for ipsilateral stroke caused by CAS or for harms from surgery or intervention in persons with asymptomatic CAS (recommendations of some groups state that screening might be considered for persons with multiple risk factors), 3) adding carotid angioplasty and stenting (CAAS) to the included interventions, 4) adding a question about the incremental benefit of medical therapy for asymptomatic CAS, and 5) conducting quantitative synthesis for many outcomes.

Author: Issam D. Moussa
Publisher: CRC Press
ISBN: 0203089855
Category : Medical
Languages : en
Pages : 244

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This well-illustrated text reviews the current state of knowledge with regard to the various anatomic and physiologic methods available to identify asymptomatic patients who are at high risk to develop a future stroke. Asymptomatic Carotid Artery Stenosis is particularly targeted towards physicians involved in clinical decision making regarding rev

Author: Ali F. AbuRahma
Publisher: Springer
ISBN: 3319547607
Category : Medical
Languages : en
Pages : 863

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This large format book is the definitive text on vascular surgery written by expert editors and contributors. It is well supported by exceptional illustrative material. The book is invaluable to all those who work in vascular laboratories as wel.l as internists, cardiologists, vascular laboratory directors and staff, general surgeons involved in vascular surgery and the vascular surgery community in general Noninvasive Vascular Diagnosis comprehensively covers all aspects of noninvasive evaluation of the circulatory system in the extremities. The increasing popularity of noninvasive techniques is not reflected in the number of comprehensive works on the topic and it is clear from the success of the first edition that the demand for an updated volume is increasing.

Author: Peter Schneider
Publisher: CRC Press
ISBN: 1000611388
Category : Medical
Languages : en
Pages : 346

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From patient selection and monitoring to follow-up care, Carotid Interventions is the first source to offer a practical how-to approach to carotid angioplasty and stenting-providing maneuvers and strategies for difficult situations, as well as step-by-step guidance on specific surgical procedures, equipment selection and instrumentation, protection

Author: Jong S. Kim
Publisher: John Wiley & Sons
ISBN: 1444300687
Category : Medical
Languages : en
Pages : 272

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Intracranial atherosclerosis is the dominant cause of stroke inover 70% of the world’s population. Globalization is leadingto an increasingly heterogeneous society everywhere. Advances inimaging techinology allow this previously inaccessible pathology tobe clinically studied. Edited by internationally renowned clinicians, IntracranialAtherosclerosis is the first book to examine intracranialcauses of stroke. Clinical practice is allied with basic science toguide all those with an interest in stroke on the diagnosis andmanagement of intracranial atherosclerosis.

Author: Morteza Naghavi
Publisher: Springer Science & Business Media
ISBN: 1603271791
Category : Medical
Languages : en
Pages : 712

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Despite recent advances in the diagnosis and treatment of symptomatic atherosclerosis, available traditional screening methods for early detection and treatment of asymptomatic coronary artery disease are grossly insufficient and fail to identify the majority of victims prior to the onset of a life-threatening event. In Asymptomatic Atherosclerosis: Pathophysiology, Detection and Treatment, Dr. Morteza Naghavi and leading authorities from the Society for Heart Attack Prevention and Eradication (SHAPE) present a new paradigm for the screening and primary prevention of asymptomatic atherosclerosis. The text focuses on accurate, yet underutilized, measures of subclinical atherosclerosis, notably coronary artery calcium scanning and carotid intima-media thickness measurement. The authors introduce a comprehensive approach to identifying the vulnerable patients (asymptomatic individuals at risk of a near future adverse event). Additional chapters discuss future directions towards containing the epidemic of atherosclerotic cardiovascular disease using innovative solutions such as preemptive interventional therapies (bioabsorbable stents) for stabilization of vulnerable atherosclerotic plaques, mass unconditional Polypill therapy for population-based risk reduction, and ultimately vaccination strategies to prevent the development of atherosclerosis. Up-to-date and authoritative, Asymptomatic Atherosclerosis: Pathophysiology, Detection, and Treatment is a must-have for any cardiologist or primary care physician who wishes to practice modern preventive cardiology and manage the increasing number of asymptomatic atherosclerotic patients. Outlines more accurate measures of risk (coronary artery calcium and carotid intima-media thickness) than traditional risk factors (total cholesterol, LDL cholesterol, HDL cholesterol) Presents new multipronged strategies to aid in the early detection and treatment of high risk asymptomatic patients

Author: László Csiba
Publisher: Cambridge University Press
ISBN: 1107659159
Category : Medical
Languages : en
Pages : 333

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Neurosonology is non-invasive, portable, and has excellent temporal resolution, making it a valuable and increasingly popular tool for the diagnosis and monitoring of neurological conditions when compared to other imaging techniques. This guide looks beyond the use of neurovascular ultrasound in stroke to encompass a wide range of other neurological diseases and emergencies. It offers a practical approach to the examination of patients, interpretation of ultrasound studies, and the application of neurosonology to the development of management and treatment strategies. Each chapter incorporates a thorough and clear procedural methodology alongside scanning tips for trainees; this step-by-step approach is further enhanced by example images and focused diagnostic questions. Authored and edited by international experts, this practical manual of neurosonology is an invaluable resource for neurologists, neurosurgeons, intensivists, radiologists, and ultrasonographers.

Author: Keith D. Calligaro
Publisher: Lippincott Williams & Wilkins
ISBN:
Category : Medical
Languages : en
Pages : 252

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