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Surgical and Radiologic Intervention for Prevention of Ischemic Stroke

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Controversies in Vascular Neurosurgery

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Abstract

Stroke is now the fourth leading cause of death in the United States, down from its previously third ranking place [1]. Approximately 88 % of all strokes are ischemic, 9 % are intracerebral hemorrhages, and 3 % are subarachnoid hemorrhages [2]. The etiology of ischemic strokes can be broadly categorized into several subtypes as cardioembolic, extracranial atherosclerotic, intracranial atherosclerotic, lacunar, traumatic (e.g., dissections), inflammatory (e.g., moyamoya, vasculitis), and cryptogenic. A population-based study of incidence (per 100,000 population) for ischemic stroke subtype identified 40 cardioembolic, 27 intracranial and extracranial atherosclerosis, 25 lacunar, 4 other or uncommon cause (i.e., traumatic, inflammatory), and 52 cryptogenic [3]. This chapter focuses on thromboembolic strokes that develop from extracranial carotid atherosclerosis, identifies the preferred tools useful in the process of diagnosis and surgical or endovascular planning, and discusses particular indications for each treatment.

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References

  1. Towfighi A, Saver JL. Stroke declines from third to fourth leading cause of death in the United States: historical perspective and challenges ahead. Stroke. 2011;42(8):2351–5.

    Article  PubMed  Google Scholar 

  2. Thom T, Haase N, Rosamond W, Howard VJ, Rumsfeld J, Manolio T, et al. Heart disease and stroke statistics – 2006 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2006;113(6):e85–151.

    Article  PubMed  Google Scholar 

  3. Petty GW, Brown Jr RD, Whisnant JP, Sicks JD, O’Fallon WM, Wiebers DO. Ischemic stroke subtypes: a population-based study of incidence and risk factors. Stroke. 1999;12:2513–6.

    Article  Google Scholar 

  4. Brott TG, Hobson 2nd RW, Howard G, Roubin GS, Clark WM, Brooks W, et al. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med. 2010;363(1):11–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Bots ML, Breslau PJ, Briët E, de Bruyn AM, van Vliet HH, van den Ouweland FA, et al. Cardiovascular determinants of carotid artery disease. The Rotterdam Elderly Study. Hypertension. 1992;6(2):717–20.

    Article  Google Scholar 

  6. European Stroke Organisation, Tendera M, Aboyans V, Bartelink ML, Baumgartner I, Clément D, Collet JP, et al. ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2011;32(22):2851–906.

    Article  Google Scholar 

  7. Mathiesen EB, Joakimsen O, Bønaa KH. Prevalence of and risk factors associated with carotid artery stenosis: the Tromsø Study. Cerebrovasc Dis. 2001;12(1):44–51.

    Article  CAS  PubMed  Google Scholar 

  8. Bos D, van der Rijk MJ, Geeraedts TE, Hofman A, Krestin GP, Witteman JC, et al. Intracranial carotid artery atherosclerosis: prevalence and risk factors in the general population. Stroke. 2012;43(7):1878–84.

    Article  PubMed  Google Scholar 

  9. Saha SP, Whayne Jr TF, Mukherjee D. Evidence-based management of carotid artery disease. Int J Angiol. 2010;19(1):e21–4.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Lanzino G, Rabinstein AA, Brown Jr RD. Treatment of carotid artery stenosis: medical therapy, surgery, or stenting? Mayo Clin Proc. 2009;84(4):362–87.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med. 1991;325(7):445–53.

    Article  Google Scholar 

  12. European Carotid Surgery Trialists’ Collaborative Group. Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet 1998;351(9113):1379–87.

    Google Scholar 

  13. Johansson EP, Arnerlöv C, Wester P. Risk of recurrent stroke before carotid endarterectomy: the ANSYSCAP study. Int J Stroke. 2013;8(4):220–7.

    Article  CAS  PubMed  Google Scholar 

  14. Ois A, Cuadrado-Godia E, Rodríguez-Campello A, Jimenez-Conde J, Roquer J. High risk of early neurological recurrence in symptomatic carotid stenosis. Stroke. 2009;40(8):2727–31.

    Article  PubMed  Google Scholar 

  15. Ebrahim S, Papacosta O, Whincup P, Wannamethee G, Walker M, Nicolaides AN, et al. Carotid plaque, intima media thickness, cardiovascular risk factors, and prevalent cardiovascular disease in men and women: the British Regional Heart Study. Stroke. 1999;30(4):841–50.

    Article  CAS  PubMed  Google Scholar 

  16. Mineva PP, Manchev IC, Hadjiev DI. Prevalence and outcome of asymptomatic carotid stenosis: a population-based ultrasonographic study. Eur J Neurol. 2002;9(4):383–8.

    Article  CAS  PubMed  Google Scholar 

  17. O’Leary DH, Polak JF, Kronmal RA, et al. Distribution and correlates of sonographically detected carotid artery disease in the Cardiovascular Health Study. The CHS Collaborative Research Group. Stroke. 1992;3(12):1752–60.

    Article  Google Scholar 

  18. Powers WJ. Management of patients with atherosclerotic carotid occlusion. Curr Treat Options Neurol. 2011;13(6):608–15.

    Article  PubMed  Google Scholar 

  19. Grubb Jr RL, Derdeyn CP, Fritsch SM, Carpenter DA, Yundt KD, Videen TO, et al. Importance of hemodynamic factors in the prognosis of symptomatic carotid occlusion. JAMA. 1998;280(12):1055–60.

    Article  PubMed  Google Scholar 

  20. Powers WJ, Derdeyn CP, Fritsch SM, et al. Benign prognosis in never-symptomatic carotid occlusion. Neurology. 2000;54(4):878–82.

    Article  CAS  PubMed  Google Scholar 

  21. Byrnes KR, Ross CB. The current role of carotid duplex ultrasonography in the management of carotid atherosclerosis: foundations and advances. Int J Vasc Med. 2012;2012:187872. doi:10.1155/2012/187872.

    PubMed  PubMed Central  Google Scholar 

  22. Chappell FM, Wardlaw JM, Young GR, et al. Carotid artery stenosis: accuracy of noninvasive tests – individual patient data meta-analysis. Radiology. 2009;1(2):493–502.

    Article  Google Scholar 

  23. Thanvi B, Robinson T. Complete occlusion of extracranial internal carotid artery: clinical features, pathophysiology, diagnosis and management. Postgrad Med J. 2007;83(976):95–9.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Ogasawara K, Ogawa A, Terasaki K, Shimizu H, Tominaga T, Yoshimoto T. Use of cerebrovascular reactivity in patients with symptomatic major cerebral artery occlusion to predict 5-year outcome: comparison of xenon-133 and iodine-123-IMP single-photon emission computed tomography. J Cereb Blood Flow Metab. 2002;22(9):1142–8.

    Article  CAS  PubMed  Google Scholar 

  25. Meschia JF, Brott TG, Hobson 2nd RW. Diagnosis and invasive management of carotid atherosclerotic stenosis. Mayo Clin Proc. 2007;82(7):851–8.

    Article  PubMed  Google Scholar 

  26. Hobson 2nd RW, Weiss DG, Fields WS, Goldstone J, Moore WS, Towne JB, et al. Efficacy of carotid endarterectomy for asymptomatic carotid stenosis. The Veterans Affairs Cooperative Study Group. N Engl J Med. 1993;328(4):221–7.

    Article  PubMed  Google Scholar 

  27. Chatzikonstantinou A, Wolf ME, Schaefer A, Hennerici MG. Asymptomatic and symptomatic carotid stenosis: an obsolete classification? Stroke Res Treat. 2012;12:340798. doi:10.1155/2012/340798. Epub 2012 Jan 23.

    Google Scholar 

  28. Amarenco P, Bogousslavsky J, Callahan 3rd A, Goldstein LB, Hennerici M, Rudolph AE, et al. High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med. 2006;355(6):549–59.

    Article  CAS  PubMed  Google Scholar 

  29. Ballantyne CM. Cholesterol, lipids, and statins. Tex Heart Inst J. 2005;32(3):378–9.

    PubMed  PubMed Central  Google Scholar 

  30. Patel A, MacMahon S, Chalmers J, Neal B, Billot L, Woodward M, ADVANCE Collaborative Group. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358(24):2560–72.

    Article  CAS  PubMed  Google Scholar 

  31. Gerstein HC, Miller ME, Byington RP, Goff Jr DC, Bigger JT, Buse JB, Action to Control Cardiovascular Risk in Diabetes Study Group, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358(24):2545–59.

    Article  CAS  PubMed  Google Scholar 

  32. Boussageon R, Bejan-Angoulvant T, Saadatian-Elahi M, Lafont S, Bergeonneau C, Kassaï B, et al. Effect of intensive glucose lowering treatment on all cause mortality, cardiovascular death, and microvascular events in type 2 diabetes: meta-analysis of randomised controlled trials. BMJ. 2011;343:d4169. doi:10.1136/bmj.d4169.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Chimowitz MI, Lynn MJ, Derdeyn CP, Turan TN, Fiorella D, Lane BF, et al. Stenting versus aggressive medical therapy for intracranial stenosis. N Engl J Med. 2011;365(11):993–1003.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Endarterectomy for asymptomatic carotid artery stenosis. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. JAMA. 1995;273(18):1421–8.

    Google Scholar 

  35. Johnston SC, Rothwell PM, Nguyen-Huynh MN, Giles MF, Elkins JS, Bernstein AL, et al. Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet. 2007;369(9558):283–92.

    Article  PubMed  Google Scholar 

  36. Rothwell PM, Eliasziw M, Gutnikov SA, Warlow CP, Barnett HJ, Carotid Endarterectomy Trialists Collaboration. Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery. Lancet. 2004;363(9413):915–24.

    Article  CAS  PubMed  Google Scholar 

  37. Reichmann BL, van Lammeren GW, Moll FL, de Borst GJ. Is age of 80 years a threshold for carotid revascularization? Curr Cardiol Rev. 2011;7(1):15–21.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Powers WJ, Clarke WR, Grubb Jr RL, Videen TO, Adams Jr HP, Derdeyn CP, COSS Investigators. Extracranial-intracranial bypass surgery for stroke prevention in hemodynamic cerebral ischemia: the Carotid Occlusion Surgery Study randomized trial. JAMA. 2011;306(18):1983–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Awad IA, Spetzler R. Extracranial-intracranial bypass surgery: a critical analysis in light of the International Cooperative Study. Neurosurgery. 1986;19(4):655–64.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, University of Cincinnati (UC) College of Medicine, ML 0515, Cincinnati, OH, 45267-0515, USA

    Andrew J. Ringer MD

  2. Comprehensive Stroke Center, UC Neuroscience Institute, Cincinnati, OH, USA

    Andrew J. Ringer MD

  3. Mayfield Clinic, Cincinnati, OH, USA

    Andrew J. Ringer MD

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  1. Andrew J. Ringer MD
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Correspondence to Andrew J. Ringer MD .

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Editors and Affiliations

  1. Neuroscience Inst. Dept. of Neurosurgery, Drexel Univ. College of Medicine, Drexel, Philadelphia, Pennsylvania, USA

    Erol Veznedaroglu

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Ringer, A.J. (2016). Surgical and Radiologic Intervention for Prevention of Ischemic Stroke. In: Veznedaroglu, E. (eds) Controversies in Vascular Neurosurgery. Springer, Cham. https://doi.org/10.1007/978-3-319-27315-0_10

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  • DOI: https://doi.org/10.1007/978-3-319-27315-0_10

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-27313-6

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