Management of significant atherosclerotic carotid artery disease: review of literature
DOI:
https://doi.org/10.18203/2349-2902.isj20214782Keywords:
Atherosclerosis, Carotid artery disease, Carotid endarterectomy, Carotid artery stenting, Randomised controlled trialsAbstract
Stroke is the third leading cause of death and disability in the world. Carotid artery stenosis due to atherosclerosis accounts for 20 to 30% of all strokes. The patients can be asymptomatic or present with a transient ischemic attack or stroke. Diagnosis is based primarily on imaging modalities like carotid Doppler, CT (Computed tomography) angiogram, MR (Magnetic resonance) angiogram or DSA (Digital subtraction angiogram). Treatment options include optimal medical therapy, carotid endarterectomy-touted as the gold standard for treating significant carotid stenosis; and carotid artery stenting, whose safety and efficacy have undergone significant improvements due to technological advances in the field. We presented a review of the literature outlining the various aspects of atherosclerotic carotid stenosis and the findings of several randomized controlled trials conducted to settle the debate between endarterectomy and stenting for carotid stenosis.
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References
Feigin VL, Lawes CM, Bennett DA, Anderson CS. Stroke epidemiology: a review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century. Lancet Neurol. 2003;2(1):43-53.
Rudd AG, Hoffman A, Irwin P, Pearson M, Lowe D, Intercollegiate Working Party for Stroke. Stroke units: research and reality. Results from the National Sentinel Audit of Stroke. Qual Saf Health Care. 2005;14(1):7-12.
Sacco RL. Clinical practice. Extracranial carotid stenosis. N Engl J Med. 2001;345(15):1113-8.
Risk of stroke in the distribution of an asymptomatic carotid artery. The European Carotid Surgery Trialists Collaborative Group. Lancet. 1995;345(8944):209-12.
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.
Goessens BM, Visseren FL, Algra A, Banga JD, Graaf Y, SMART Study Group. Screening for asymptomatic cardiovascular disease with noninvasive imaging in patients at high-risk and low-risk according to the European Guidelines on Cardiovascular Disease Prevention: the SMART study. J Vasc Surg. 2006;43(3):525-32.
Weerd M, Greving JP, Hedblad B, Lorenz MW, Mathiesen EB, Leary DH, et al. Prevalence of asymptomatic carotid artery stenosis in the general population: an individual participant data meta-analysis. Stroke. 2010;41(6):1294-7.
Rockman CB, Jacobowitz GR, Gagne PJ, Adelman MA, Lamparello PJ, Landis R, et al. Focused screening for occult carotid artery disease: patients with known heart disease are at high risk. J Vasc Surg. 2004;39(1):44-51.
Griffiths PD, Worthy S, Gholkar A. Incidental intracranial vascular pathology in patients investigated for carotid stenosis. Neuroradiology. 1996;38(1):25-30.
Kappelle LJ, Eliasziw M, Fox AJ, Sharpe BL, Barnett HJ. Importance of intracranial atherosclerotic disease in patients with symptomatic stenosis of the internal carotid artery. The North American Symptomatic Carotid Endarterectomy Trail. Stroke. 1999;30(2):282-6.
Klop RB, Eikelboom BC, Taks AC. Screening of the internal carotid arteries in patients with peripheral vascular disease by colour-flow duplex scanning. Eur J Vasc Surg. 1991;5(1):41-5.
Alexandrova NA, Gibson WC, Norris JW, Maggisano R. Carotid artery stenosis in peripheral vascular disease. J Vasc Surg. 1996;23(4):645-9.
Ahmed B, Khaffaf H. Prevalence of significant asymptomatic carotid artery disease in patients with peripheral vascular disease: a meta-analysis. Eur J Vasc Endovasc Surg. 2009;37(3):262-71.
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.
Tanimoto S, Ikari Y, Tanabe K, Yachi S, Nakajima H, Nakayama T, et al. Prevalence of carotid artery stenosis in patients with coronary artery disease in Japanese population. Stroke. 2005;36(10):2094-8.
Kallikazaros I, Tsioufis C, Sideris S, Stefanadis C, Toutouzas P. Carotid artery disease as a marker for the presence of severe coronary artery disease in patients evaluated for chest pain. Stroke. 1999;30(5):1002-7.
Steinvil A, Sadeh B, Arbel Y, Justo D, Belei A, Borenstein N, et al. Prevalence and predictors of concomitant carotid and coronary artery atherosclerotic disease. J Am Coll Cardiol. 2011;57(7):779-83.
Prasad K. Pathophysiology and Medical Treatment of Carotid Artery Stenosis. Int J Angiol. 2015;24(3):158-72.
Wahlgren CM, Zheng W, Shaalan W, Tang J, Bassiouny HS. Human carotid plaque calcification and vulnerability. Relationship between degree of plaque calcification, fibrous cap inflammatory gene expression and symptomatology. Cerebrovasc Dis. 2009;27(2):193-200.
Shaalan WE, Cheng H, Gewertz B, McKinsey JF, Schwartz LB, Katz D, et al. Degree of carotid plaque calcification in relation to symptomatic outcome and plaque inflammation. J Vasc Surg. 2004;40(2):262-9.
Yamazaki M, Uchiyama S. Pathophysiology of carotid stenosis. Brain Nerve. 2010;62:1269-75.
Naghavi M, Libby P, Falk E, Casscells SW, Litovsky S, Rumberger J, et al. From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: Part I. Circulation. 2003;108(14):1664-72.
Ku DN, Giddens DP, Zarins CK, Glagov S. Pulsatile flow and atherosclerosis in the human carotid bifurcation. Positive correlation between plaque location and low oscillating shear stress. Arteriosclerosis. 1985;5(3):293-302.
Zarins CK, Giddens DP, Bharadvaj BK, Sottiurai VS, Mabon RF, Glagov S. Carotid bifurcation atherosclerosis. Quantitative correlation of plaque localization with flow velocity profiles and wall shear stress. Circ Res. 1983;53(4):502-14.
Lind L, Andersson J, Larsson A, Sandhagen B. Shear stress in the common carotid artery is related to both intima-media thickness and echogenecity. The Prospective Investigation of the Vasculature in Uppsala Seniors study. Clin Hemorheol Microcirc. 2009;43(4):299-308.
Cushing SD, Berliner JA, Valente AJ, Territo MC, Navab M, Parhami F, et al. Minimally modified low density lipoprotein induces monocyte chemotactic protein 1 in human endothelial cells and smooth muscle cells. Proc Natl Acad Sci U S A. 1990;87(13):5134-8.
Steinberg D. Oxidized low density lipoprotein--an extreme example of lipoprotein heterogeneity. Isr J Med Sci. 1996;32(6):469-72.
Wang GP, Deng ZD, Ni J, Qu ZL. Oxidized low density lipoprotein and very low density lipoprotein enhance expression of monocyte chemoattractant protein-1 in rabbit peritoneal exudate macrophages. Atherosclerosis. 1997;133(1):31-6.
Navab M, Imes SS, Hama SY, Hough GP, Ross LA, Bork RW, et al. Monocyte transmigration induced by modification of low density lipoprotein in cocultures of human aortic wall cells is due to induction of monocyte chemotactic protein 1 synthesis and is abolished by high density lipoprotein. J Clin Invest. 1991;88(6):2039-46.
Hashimoto K, Kataoka N, Nakamura E, Tsujioka K, Kajiya F. Oxidized LDL specifically promotes the initiation of monocyte invasion during transendothelial migration with upregulated PECAM-1 and downregulated VE-cadherin on endothelial junctions. Atherosclerosis. 2007;194(2):9-17.
Nagy L, Tontonoz P, Alvarez JG, Chen H, Evans RM. Oxidized LDL regulates macrophage gene expression through ligand activation of PPARgamma. Cell. 1998;93(2):229-40.
Henriksen T, Mahoney EM, Steinberg D. Enhanced macrophage degradation of biologically modified low density lipoprotein. Arteriosclerosis. 1983;3(2):149-59.
Rajagopalan S, Meng XP, Ramasamy S, Harrison DG, Galis ZS. Reactive oxygen species produced by macrophage-derived foam cells regulate the activity of vascular matrix metalloproteinases in vitro. Implications for atherosclerotic plaque stability. J Clin Invest. 1996;98(11):2572-9.
Alpert JN. Extracranial carotid artery. Current concepts of diagnosis and management. Tex Heart Inst J. 1991;18(2):93-7.
Clark TG, Murphy MF, Rothwell PM. Long term risks of stroke, myocardial infarction, and vascular death in "low risk" patients with a non-recent transient ischaemic attack. J Neurol Neurosurg Psychiatry. 2003;74(5):577-80.
Ricotta JJ, Aburahma A, Ascher E. Updated Society for Vascular Surgery guidelines for management of extracranial carotid disease [published correction appears in. J Vasc Surg. 2012;894:1-31.
Rafailidis V, Charitanti A, Tegos T, Destanis E, Chryssogonidis I. Contrast-enhanced ultrasound of the carotid system: a review of the current literature. J Ultrasound. 2017;20(2):97-109.
Schindler A, Schinner R, Altaf N, Hosseini AA, Simpson RJ, Esposito BL, et al. Prediction of Stroke Risk by Detection of Hemorrhage in Carotid Plaques: Meta-Analysis of Individual Patient Data. JACC Cardiovasc Imaging. 2020;13(2):395-406.
Liao JK, Laufs U. Pleiotropic effects of statins. Annu Rev Pharmacol Toxicol. 2005;45:89-118.
Armstrong C, Joint National Committee. JNC8 guidelines for the management of hypertension in adults. Am Fam Physician. 2014;90(7):503-4.
Prasad K. Do statins have a role in reduction/prevention of post-PCI restenosis? Cardiovasc Ther. 2013;31(1):12-26.
Azen SP, Qian D, Mack WJ, Sevanian A, Selzer RH, Liu CR, et al. Effect of supplementary antioxidant vitamin intake on carotid arterial wall intima-media thickness in a controlled clinical trial of cholesterol lowering. Circulation. 1996;94(10):2369-72.
Kritchevsky SB, Shimakawa T, Tell GS, Dennis B, Carpenter M, Eckfeldt JH, et al. Dietary antioxidants and carotid artery wall thickness. The ARIC Study. Atherosclerosis Risk in Communities Study. Circulation. 1995;92(8):2142-50.
Devaraj S, Tang R, Huet B, Harris A, Seenivasan T, Lemos JA, et al. Effect of high-dose alpha-tocopherol supplementation on biomarkers of oxidative stress and inflammation and carotid atherosclerosis in patients with coronary artery disease. Am J Clin Nutr. 2007;86(5):1392-8.
Karppi J, Kurl S, Ronkainen K, Kauhanen J, Laukkanen JA. Serum carotenoids reduce progression of early atherosclerosis in the carotid artery wall among Eastern Finnish men. PLoS One. 2013;8(5):64107.
Gale CR, Ashurst HE, Powers HJ, Martyn CN. Antioxidant vitamin status and carotid atherosclerosis in the elderly. Am J Clin Nutr. 2001;74(3):402-8.
Tomeo AC, Geller M, Watkins TR, Gapor A, Bierenbaum ML. Antioxidant effects of tocotrienols in patients with hyperlipidemia and carotid stenosis. Lipids. 1995;30(12):1179-83.
Herder M, Arntzen KA, Johnsen SH, Eggen AE, Mathiesen EB. Long-term use of lipid-lowering drugs slows progression of carotid atherosclerosis: the Tromso study 1994 to 2008. Arterioscler Thromb Vasc Biol. 2013;33(4):858-62.
Burton GW, Ingold KU. Vitamin E: application of the principles of physical organic chemistry to the exploration of its structure and function. Acc Chem Res. 1986;19:194-201.
Bowry VW, Ingold KU, Stocker R. Vitamin E in human low-density lipoprotein. When and how this antioxidant becomes a pro-oxidant. Biochem J. 1992;288(2):341-4.
Doba T, Burton GW, Ingold KU. Antioxidant and co-antioxidant activity of vitamin C. The effect of vitamin C, either alone or in the presence of vitamin E or a water-soluble vitamin E analogue, upon the peroxidation of aqueous multilamellar phospholipid liposomes. Biochim Biophys Acta. 1985;835:298-303.
DaCosta M, Tadi P, Surowiec SM. Carotid Endarterectomy. StatPearls. 2021.
Mayor JM, Salemi JL, Dongarwar D, Salihu HM, Baker M, Mills JL, et al. Sex-Based Differences in Ten-Year Nationwide Outcomes of Carotid Revascularization. J Am Coll Surg. 2019;229(1):38-46.
Ahn SH, Prince EA, Dubel GJ. Carotid artery stenting: review of technique and update of recent literature. Semin Intervent Radiol. 2013;30(3):288-96.
Lownie SP, Pelz DM, Lee DH, Men S, Gulka I, Kalapos P. Efficacy of treatment of severe carotid bifurcation stenosis by using self-expanding stents without deliberate use of angioplasty balloons. AJNR Am J Neuroradiol. 2005;26(5):1241-8.
Maynar M, Baldi S, Rostagno R, Zander T, Rabellino M, Llorens R, et al. Carotid stenting without use of balloon angioplasty and distal protection devices: preliminary experience in 100 cases. AJNR Am J Neuroradiol. 2007;28(7):1378-83.
Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): a randomised trial. Lancet. 2001;357(9270):1729-37.
Bonati LH, Ederle J, McCabe DJ, Dobson J, Featherstone RL, Gaines PA, et al. Long-term risk of carotid restenosis in patients randomly assigned to endovascular treatment or endarterectomy in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): long-term follow-up of a randomised trial. Lancet Neurol. 2009;8(10):908-17.
Mas JL, Chatellier G, Beyssen B, Branchereau A, Moulin T, Becquemin JP, et al. Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis. N Engl J Med. 2006;355(16):1660-71.
Mas JL, Trinquart L, Leys D, Albucher JF, Rousseau H, Viguier A, et al. Endarterectomy Versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis (EVA-3S) trial: results up to 4 years from a randomised, multicentre trial. Lancet Neurol. 2008;7(10):885-92.
Yadav JS, Wholey MH, Kuntz RE, Fayad P, Katzen BT, Mishkel GJ, et al. Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med. 2004;351(15):1493-501.
SPACE Collaborative Group, Ringleb PA, Allenberg J, Brückmann H, Eckstein HH, Fraedrich G, et al. 30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised non-inferiority trial. Lancet. 2006;368(9543):1239-47.
Eckstein HH, Ringleb P, Allenberg JR, Berger J, Fraedrich G, Hacke W, et al. Results of the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) study to treat symptomatic stenoses at 2 years: a multinational, prospective, randomised trial. Lancet Neurol. 2008;7(10):893-902.
Brott TG, Hobson 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.
Bonati LH, Dobson J, Featherstone RL, Ederle J, Worp HB, Borst GJ, et al. Long-term outcomes after stenting versus endarterectomy for treatment of symptomatic carotid stenosis: the International Carotid Stenting Study (ICSS) randomised trial. Lancet. 2015;385(9967):529-38.
Rosenfield K, Matsumura JS, Chaturvedi S, Riles T, Ansel GM, Metzger DC, et al. Randomized Trial of Stent versus Surgery for Asymptomatic Carotid Stenosis. N Engl J Med. 2016;374(11):1011-20.
Halliday A, Bulbulia R, Bonati LH, Chester J, Bamford A, Peto R, et al. Second asymptomatic carotid surgery trial (ACST-2): a randomised comparison of carotid artery stenting versus carotid endarterectomy. Lancet. 2021;398(10305):1065-73.
Narins CR, Illig KA. Patient selection for carotid stenting versus endarterectomy: a systematic review. J Vasc Surg. 2006;44(3):661-72.
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