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Carotid Artery Stenosis : Current and Emerging Treatments - Seemant Chaturvedi

Carotid Artery Stenosis

Current and Emerging Treatments

By: Seemant Chaturvedi (Editor), Peter M. Rothwell (Editor)

Hardcover Published: 28th July 2005
ISBN: 9780824754174
Number Of Pages: 359

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Providing a thorough overview of rapid developments in medical therapy, surgery, and angioplasty, this reference provides a complete review of carotid artery stenosis treatment, as well as a clear overview of carotid surgery and stenting. Offering chapters by seasoned authorities on epidemiology, imaging with ultrasound and angiography, cholesterol lowering, blood pressure management, homocysteine treatment, and diet modification, this guide is a stand-alone source for current information and understanding of this burgeoning science.

"I enjoyed this book, and because of its relatively small size, it is an easy read with excellent and updated coverage of the topic of carotid artery stenosis. This book will fill an unmet need for a concise overview of the topic written from a multidisciplinary perspective. This is definitely a worthwhile goal because of the rapid changes in carotid disease, and the authors have done a credible job of meeting that objective." -Doody's Reivews

Prefacep. v
Contributorsp. xv
Introductionp. 1
Pathophysiologyp. 1
Early Carotid Surgeryp. 3
Carotid Endarterectomyp. 3
Carotid Angioplastyp. 4
Intervention for Asymptomatic Carotid Stenosisp. 5
Conclusionsp. 5
Referencesp. 6
Epidemiology of Carotid Artery Stenosisp. 11
Introductionp. 11
Risk Factorsp. 12
Asymptomatic Carotid Artery Stenosisp. 14
Symptomatic Carotid Artery Stenosisp. 16
Conclusionsp. 21
Referencesp. 21
Pathophysiologyp. 31
Atherosclerosisp. 32
Carotid Localization of Atheosclerosisp. 40
Importance of Embolism in Carotid Stroke: Evidence from Clinical Studiesp. 42
Hemodynamic Factors in Carotid Stenosis Strokep. 45
The Active "Carotid Plaque" in Humans: Clinical Studiesp. 47
Referencesp. 50
Carotid Imaging-Is Angiography Still Needed?p. 55
Introductionp. 55
Digital Subtraction Angiographyp. 55
Referencesp. 73
Carotid Imaging: Use of Ultrasoundp. 77
Introductionp. 77
Ultrasound Technologyp. 78
Normal Findingsp. 81
Neck Arteriesp. 82
Intima-Media Thickness-The Initial Stagep. 87
Plaque Development-The Intermediate Stagep. 88
Plaque Development-The Terminal Stagep. 96
Perspectivesp. 99
Referencesp. 100
Antithrombotic Therapy for Carotid Artery Stenosisp. 111
Extracranial Symptomatic Carotid Stenosisp. 111
Oral Anticoagulantsp. 118
Ongoing Studiesp. 119
Conclusionsp. 120
Referencesp. 120
Stroke Prevention, Blood Cholesterol, and Statinsp. 123
Are Blood Lipids a Recognized Risk Factor for Stroke?p. 124
Use of Statins in Stroke Preventionp. 125
Safetyp. 130
The Use of Fibric Acid Agents and Stroke Preventionp. 134
Use of Lipid-Lowering Agents in Stroke Prevention, Important Subgroupsp. 136
The Use of Lipid-Lowering Agents in Stroke Prevention, Pending Questionsp. 137
Current Guidelinesp. 142
Conclusionsp. 143
Referencesp. 143
Management of Hypertension in Carotid Stenosisp. 151
Does the Type of Medication Matter?p. 153
Treating the Underlying Cause of Hypertensionp. 153
Is it Safe to Treat Hypertension in Patients with Severe Stenosis?p. 154
Conclusionsp. 155
Referencesp. 157
Hyperhomocyst(e)inemia and Carotid Atherosclerosisp. 159
Introductionp. 159
Metabolism of Homocyst(e)inep. 160
Homocyst(e)ine and the Pathogenesis of Atherothrombosisp. 162
Hyperhomocyst(e)inemia and the Risk of Carotid Atherosclerosisp. 163
Recommendations for Therapeutic Management or Refinement of Diagnosisp. 163
Referencesp. 168
Diet in the Management of Patients with Carotid Stenosisp. 175
Referencesp. 179
Angiogenesis and Angiogenic Growth Factors as Future Therapies for Cerebrovascular Diseasep. 181
Introductionp. 181
Vasculogenesis and Angiogenesisp. 182
Angiogenic Growth Factors and the Corresponding Receptorsp. 183
Examples of Signal Transduction Pathways Used During Angiogenesisp. 185
Balancing Pro-Angiogenesis and Anti-Angiogenesisp. 186
Therapeutic Angiogenesisp. 186
Basic Fibroblast Growth Factor and Therapeutic Angiogenesisp. 187
Clinical Trials Testing the Safety and Efficacy of FGF-2p. 188
Basic Fibroblast Growth Factor in Studies of Cerebrovascular Diseasep. 190
Potential Toxicity of FGF-2 as an Example of an Angiogenic Growth Factorp. 191
Future Steps with FGF-2 and Other Angiogenic Growth Factorsp. 191
Summaryp. 191
Referencesp. 192
What Are the Current Operative Risks of Carotid Endarterectomy?p. 197
What is the Risk of CEA for Symptomatic Stenosis?p. 197
What is the Risk of CEA for Asymptomatic Stenosis?p. 199
Does the Type of Presenting Symptom Matter?p. 200
Is Operative Risk Related to Sex?p. 200
Does Age Matter?p. 201
Does Timing Matter?p. 202
Summaryp. 203
Referencesp. 203
Benefits of Endarterectomy for Recently Symptomatic Carotid Stenosisp. 207
Which Range of Stenosis?p. 207
What About Near-Occlusions?p. 210
Which Subgroups Benefit Most?p. 211
How Soon Should Surgery be Performed?p. 217
Which Individuals Benefit Most?p. 218
Summaryp. 223
Referencesp. 225
Management of Carotid Artery Disease: Carotid Endarterectomy for Asymptomatic Carotid Stenosisp. 229
Detecting and Quantifying Carotid Artery Stenosisp. 229
Prevalence of Neurologically Asymptomatic Carotid Stenosisp. 230
Prognosis of Asymptomatic Carotid Stenosisp. 230
Prognostic Factorsp. 231
Surgical Risks of Carotid Endarterectomy for Asymptomatic Carotid Stenosisp. 232
Balance of Benefits and Risks (Effectiveness) of Carotid Endarterectomy for Neurologically Asymptomatic Carotid Stenosis-Evidence from Unconfounded Randomized Controlled Trialsp. 234
Asymptomatic Carotid Surgery Trialp. 236
How Should Neurologically Asymptomatic Carotid Stenosis be Managed?p. 239
Summaryp. 240
Referencesp. 240
Surgical Controversiesp. 245
Generalizability of Trial Resultsp. 245
Volume of Surgery and Outcomep. 248
Optimal Perioperative Antiplatelet Therapyp. 251
Choice of Anesthesiap. 253
Sinus Nerve Blockadep. 256
Shunt Deploymentp. 257
Eversion or Traditional Endarterectomy?p. 260
Patch or Primary Closure?p. 262
Should Heparin be Reversed with Protamine?p. 264
Is There a Role for Perioperative Monitoring?p. 265
Surveillance and Management of Restenosisp. 268
Summaryp. 270
Referencesp. 270
Symptomatic Carotid Artery Occlusion: Extracranial Intracranial Bypass and Other Treatment Optionsp. 277
How to Identify Patients at High Risk of Recurrent Ischemic Stroke?p. 278
Treatment Optionsp. 280
Concluding Remarksp. 282
Referencesp. 283
Stenting for Symptomatic Stenosisp. 287
Introductionp. 287
Risks Associated with Carotid Endarterectomyp. 288
The Benefits of Endovascular Treatmentp. 288
Problems with Endovascular Treatmentp. 288
Case Seriesp. 289
Randomized Trialsp. 291
Meta-Analysis of the Randomized Trialsp. 295
The Role of Cerebral Protection Devicesp. 297
The Future of Carotid Stentingp. 298
Ongoing Trialsp. 298
Ensuring Safety-The International Carotid Stenting Study Protocolp. 298
Conclusionp. 300
Referencesp. 300
Stenting for Asymptomatic Stenosisp. 305
Introductionp. 305
Historical Backgroundp. 305
Comparative Clinical Trialsp. 308
Technical and Economic Considerationsp. 311
Future Expectationsp. 312
Referencesp. 314
Angioplasty and Stenting for Non-atherosclerotic Diseases of the Carotid Arteryp. 317
Introductionp. 317
Angioplasty and Stenting for Carotid Artery Dissectionp. 318
Angioplasty for Radiation-Induced Carotid Stenosisp. 319
Angioplasty for Fibromuscular Dysplasia of the Carotid Arteryp. 319
Takayasu's Diseasep. 320
Intracranial Vasculitisp. 321
Conclusionsp. 321
Referencesp. 322
Controversies in Endovascular Therapy for Carotid Artery Stenosisp. 325
Introductionp. 325
Which are the Patients that Should Undergo Carotid Angioplasty and Stenting?p. 325
What Type of Antithrombotic Therapy Should be used During Carotid Angioplasty and Stenting?p. 327
Should Carotid Angioplasty and Stenting be Performed with Cerebral Embolic Protection?p. 334
Summaryp. 335
Referencesp. 335
Table of Contents provided by Ingram. All Rights Reserved.

ISBN: 9780824754174
ISBN-10: 0824754174
Series: Neurological Disease and Therapy
Audience: Professional
Format: Hardcover
Language: English
Number Of Pages: 359
Published: 28th July 2005
Country of Publication: US
Dimensions (cm): 23.83 x 15.49  x 2.26
Weight (kg): 0.58
Edition Number: 1