Carotid stenosis as a risk factor for ischemic stroke
- Authors: Poverennova I.E.1, Tkachenko A.S.1, Zakharov A.1, Shirolapov I.V.2, Romanova T.V.1, Ananyeva S.A.2, Sergeeva M.S.2, Romanchuk N.P.2, Khan A.2
-
Affiliations:
- Samara State Medical University of the Ministry of Healthcare of Russia
- Samara State Medical University
- Section: Original Studies
- URL: https://innoscience.ru/2500-1388/article/view/627523
- DOI: https://doi.org/10.35693/SIM627523
- ID: 627523
Cite item
Full Text
Abstract
Aim – to analyze the effect of carotid stenosis of varying severity in combination with other factors on the risks of primary and recurrent ischemic stroke, using methods of mathematical regression analysis.
Material and methods. The study included 606 patients (examination by a neurologist, contrast-enhanced CT scan of the brain, ultrasound of the vessels of the head and neck, other tests and instrumental studies). The degree of carotid stenosis was assessed using the NASCET method (stenosis 0-49%, 50-69%, 70% or more). For the purpose of mathematical analysis, patients were divided into 3 comparison groups: those without a history of stroke, patients with a single stroke, and a group of patients with two or more ischemic strokes. In the presence of a history of stroke, the size of the ischemic lesion was assessed according to CT data, the severity of neurological deficit according to the NIHSS scale and the degree of its recovery, and the functional outcome of ischemic stroke (Rankine scale, Rivermead index). The study used logistic regression analysis to assess the relationship between the dependent variable (presence of primary or recurrent stroke) and a set of predictors, which were a set of clinical and instrumental indicators.
Results. The presence of carotid stenosis of 50%-69%, when combined with pathology of the cardiovascular system, acts as a factor that significantly increases the risk of developing primary ischemic stroke. Exceeding the size of the stenotic lesion by more than 70% has a high level of significance in the likelihood of recurrent ischemic stroke, this fact must be taken into account for secondary prevention of stroke.
Conclusion. Preliminary assessment and analysis of the degree of carotid stenosis and other comorbid factors, which together influence the risks of developing primary and recurrent ischemic stroke, has an undoubted potential for reducing the risk of recurrent vascular accidents and organizing a personalized approach to surgical treatment of patients.
Full Text
About the authors
Irina E. Poverennova
Samara State Medical University of the Ministry of Healthcare of Russia
Email: ipover555@mail.ru
ORCID iD: 0000-0002-2594-461X
MD, Professor, Head of the Department of Neurology and Neurosurgery
Russian Federation, SamaraAnastasia Sergeevna Tkachenko
Email: tka4enko.n777@yandex.ru
ORCID iD: 0000-0002-1081-7140
Alexander Zakharov
Email: zakharov1977@mail.ru
Igor V. Shirolapov
Samara State Medical University
Email: ishirolapov@mail.ru
ORCID iD: 0000-0002-7670-6566
SPIN-code: 3939-3590
MD, Cand. Sci. (Med.), Associate Professor
Russian Federation, SamaraTatyana V. Romanova
Samara State Medical University of the Ministry of Healthcare of Russia
Email: tvrom63@mail.ru
ORCID iD: 0000-0003-2851-8672
MD, Associate Professor, Professor of the Department of Neurology and Neurosurgery
Russian Federation, SamaraSvetlana A. Ananyeva
Samara State Medical University
Email: s.a.ananeva@samsmu.ru
ORCID iD: 0000-0002-2226-546X
PhD, Associate professor, Department of Neurology and neurosurgery
Russian Federation, SamaraMariya S. Sergeeva
Samara State Medical University
Email: m.s.sergeeva@samsmu.ru
ORCID iD: 0000-0002-0926-8551
SPIN-code: 3075-1082
Cand. Sci. (Biol.), Associate Professor
Russian Federation, SamaraNatalia P. Romanchuk
Samara State Medical University
Email: n.p.romanchuk@samsmu.ru
ORCID iD: 0000-0003-3522-6803
SPIN-code: 2469-9414
MD, Cand. Sci. (Med.), Associate Professor
Russian Federation, SamaraAzizuddin Khan
Author for correspondence.
Email: aziz199@gmail.com
ORCID iD: 0000-0001-5113-4760
Scopus Author ID: 24537732600
India
References
- Gusev EI, Skvortsova VI, Stakhovskaya LV. The problem of stroke in the Russian Federation: time for active joint actions. S.S. Korsakov Journal of Neurology and Psychiatry. 2007;107(8):4-10. (In Russ.) [Гусев Е.И., Скворцова В.И., Стаховская Л.В. Проблема инсульта в Российской Федерации: время активных совместных действий. Журнал неврологии и психиатрии имени С. С. Корсакова. 2007;107(8):4-10].
- Adams HP Jr, del Zoppo G, Alberts MJ, et al. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Circulation. 2007;115(20):e478-534. doi: 10.1161/CIRCULATIONAHA.107.181486
- Kopczak A, Schindler A, Sepp D, et al. Complicated Carotid Artery Plaques and Risk of Recurrent Ischemic Stroke or TIA. J Am Coll Cardiol. 2022;79(22):2189-2199. doi: 10.1016/j.jacc.2022.03.376
- Suslina ZA, Varakin YY. Clinical guidelines for early diagnosis, treatment and prevention of vascular diseases of the brain. M.: Medpress-inform, 2017, p. 440. (In Russ.) [Суслина З.А., Варакин Ю.Я. Клиническое руководство по ранней диагностике, лечению и профилактике сосудистых заболеваний головного мозга. М.: Медпресс-информ, 2017, стр. 440].
- Van Dam-Nolen DHK, Truijman MTB, van der Kolk AG, et al. Carotid Plaque Characteristics Predict Recurrent Ischemic Stroke and TIA: The PARISK (Plaque At RISK) Study. JACC Cardiovasc Imaging. 2022;15(10):1715-1726. doi: 10.1016/j.jcmg.2022.04.003
- Fassbender K, Lesmeister M, Merzou F. Prehospital stroke management and mobile stroke units. Curr Opin Neurol. 2023;36(2):140-146. doi: 10.1097/WCO.0000000000001150
- Kandyba DV. Stroke. Russian Family Doctor. 2016;20(3):5-15. (In Russ.) [Кандыба Д.В. Инсульт. Российский семейный врач. 2016;20(3):5-15]. doi: 10.17816/RFD201635-15
- Skvortsova VI, Shamalov NA. Modern approaches to the management of patients with stenosis of the carotid arteries. Consilium medicum. 2009;8:11-14. (In Russ.) [Скворцова В.И., Шамалов Н.А. Современные подходы к ведению больных со стенозами сонных артерий. Consilium medicum. 2009;8:11-14].
- Suslina ZA, Piradov MA, Domashenko MA. Stroke: the review of the problem (15 years after). S.S. Korsakov Journal of Neurology and Psychiatry. 2014;114(11):5 13. (In Russ.) [Суслина З.А., Пирадов М.А., Домашенко М.А. Инсульт: оценка проблемы (15 лет спустя). Журнал неврологии и психиатрии им. С.С. Корсакова. 2014;114(11):5 13].
- Repina LA, Romanova TV, Poverennova IE, Murtazina AK. A prognostic model for ischemic stroke outcome. Science and Innovations in Medicine. 2023;8(3):181-188. (In Russ.) [Репина Л.А., Романова Т.В., Повереннова И.Е., Муртазина А.Х. Прогностическая модель исхода ишемического инсульта. Наука и инновации в медицине. 2023;8(3):181-188]. doi: 10.35693/2500-1388-2023-8-3-181-188
- Barber PA. Magnetic resonance imaging of ischemia viability thresholds and the neurovascular unit. Sensors (Basel). 2013;13(6):6981-7003. doi: 10.3390/s130606981
- Markus HS. The global burden of stroke. Int J Stroke. 2023;18(6):632-633. doi: 10.1177/17474930231181677
- Levin OS, Bril EV. Primary and secondary prevention and counseling. Modern therapy in psychiatry and neurology. 2016;1:4-7. (In Russ.) [Левин О.С., Бриль Е.В. Первичная и вторичная профилактика и консультирование. Современная терапия в психиатрии и неврологии. 2016;1:4-7].
- Chang RW, Tucker LY, Rothenberg KA, et al. Incidence of Ischemic Stroke in Patients With Asymptomatic Severe Carotid Stenosis Without Surgical Intervention. JAMA. 2022;327(20):1974-1982. doi: 10.1001/jama.2022.4835
- Micheel A, Konietschke F, Hinterseher I, et al. Perioperative risk prediction using the POSSUM and V-POSSUM models in symptomatic carotid stenosis. Vasa. 2022;51(3):150-157. doi: 10.1024/0301-1526/a000997
- Lelyuk VG, Lelyuk SE. Ultrasound angiology. 3rd ed., add. and rev. M.: Real Time, 2007, p. 179-210. (In Russ.) [Лелюк В.Г., Лелюк С.Э. Ультразвуковая ангиология. 3-е изд., доп. и перер. М.:Реальное Время, 2007, cтр. 179-210].
- Medvedkova EY, Berdalin AB, Orlova EV, Lelyuk VG. Microembolic Signals in Arteries of the Base of the Brain after Ischemic Stroke. Bull Exp Biol Med. 2022;173(2):193-198. doi: 10.1007/s10517-022-05517-z
- Pokrovsky A. V., Beloyartsev D. F., Timina I. E., et al. Clinical manifestations and diagnosis of pathological deformation of the internal carotid artery. Angiology and vascular surgery. 2011;17(3):7-18. (In Russ.) [Покровский A.B., Белоярцев Д.Ф., Тимина И.Е., и др. Клинические проявления и диагностика патологической деформации внутренней сонной артерии. Ангиология и сосудистая хирургия. 2011;17(3):7-18].
- Yaghi S, Albin C, Chaturvedi S, Savitz SI. Roundtable of Academia and Industry for Stroke Prevention: Prevention and Treatment of Large-Vessel Disease. Stroke. 2024;55(1):226-235. doi: 10.1161/STROKEAHA.123.043910
- Lineback CM, Stamm B, Sorond F, Caprio FZ. Carotid disease, cognition, and aging: time to redefine asymptomatic disease? Geroscience. 2023;45(2):719-725. doi: 10.1007/s11357-022-00688-z
- Messas E, Goudot G, Halliday A, et al. Management of carotid stenosis for primary and secondary prevention of stroke: state-of-the-art 2020: a critical review. Eur Heart J Suppl. 2020;22(Suppl M):M35-M42. doi: 10.1093/eurheartj/suaa162
- Abbott AL. Extra-Cranial Carotid Artery Stenosis: An Objective Analysis of the Available Evidence. Front Neurol. 2022;13:739999. doi: 10.3389/fneur.2022.739999
- Warlow C, Sudlow C, Dennis M, Wardlaw J, Sandercock P. Stroke. Lancet. 2003;362(9391):1211-1224. doi: 10.1016/S0140-6736(03)14544-8
- Puig N, Solé A, Aguilera-Simon A, et al. Novel Therapeutic Approaches to Prevent Atherothrombotic Ischemic Stroke in Patients with Carotid Atherosclerosis. Int J Mol Sci. 2023;24(18):14325. doi: 10.3390/ijms241814325
- Pospelova ML, Zaitsev DE, Lepekhina AS, et al. Asymptomatic carotid stenosis. Problem status and prospective directions for ischemic stroke prediction. Medical News of North Caucasus. 2021;16(3):332-338. (In Russ.) [Поспелова М.Л., Зайцев Д.Е., Лепёхина А.С., и др. Асимптомные каротидные стенозы. Состояние проблемы и перспективные направления прогнозирования ишемического инсульта. Медицинский вестник Северного Кавказа. 2021;16(3):332-338]. doi: 10.14300/mnnc.2021.16080
- Pyatin VF, Shirolapov IV, Nikitim OL. Vibrational physical exercises as the rehabilitation in gerontology. Adv Gerontol. 2009; 22(2):337-342. (In Russ.) [Пятин В.Ф., Широлапов И.В., Никитин О.Л. Реабилитационные возможности вибрационной физической нагрузки в геронтологии. Успехи геронтологии. 2009; 22(2):337-342].
- Zakharov AV, Bulanov VA, Khivintseva EV, et al. Stroke Affected Lower Limbs Rehabilitation Combining Virtual Reality With Tactile Feedback. Front Robot AI. 2020;7:81. doi: 10.3389/frobt.2020.00081
- Alawieh A, Zhao J, Feng W. Factors affecting post-stroke motor recovery: Implications on neurotherapy after brain injury. Behav Brain Res. 2018;340:94-101. doi: 10.1016/j.bbr.2016.08.029
- Malik AN, Tariq H, Afridi A, Rathore FA. Technological advancements in stroke rehabilitation. J Pak Med Assoc. 2022;72(8):1672-1674. doi: 10.47391/JPMA.22-90
- Pyatin V.F., Kolsanov A.V., Shirolapov I.V. Recent Medical Techniques for Peripheral Nerve Repair: Clinico-Physiological Advantages of Artificial Nerve Guidance Conduits. Advances in Gerontology. 2017;7(2):148-154. doi: 10.1134/S2079057017020126
- Arasu R, Arasu A, Muller J. Carotid artery stenosis: An approach to its diagnosis and management. Aust J Gen Pract. 2021;50(11):821-825. doi: 10.31128/AJGP-10-20-5664
- Volkers EJ, Algra A, Kappelle LJ, et al. Prediction Models for Clinical Outcome After a Carotid Revascularization Procedure. Stroke. 2018;49(8):1880-1885. doi: 10.1161/STROKEAHA.117.020486
- Mohd AB, Alabdallat Y, Mohd OB, et al. Medical and Surgical Management of Symptomatic and Asymptomatic Carotid Artery Stenosis: A Comprehensive Literature Review. Cureus. 2023;15(8):e43263. doi: 10.7759/cureus.43263
- Rosário M, Fonseca AC. Update on Biomarkers Associated with Large-Artery Atherosclerosis Stroke. Biomolecules. 2023 Aug 16;13(8):1251. doi: 10.3390/biom13081251.
- Piegza M, Więckiewicz G, Wierzba D, Piegza J. Cognitive Functions in Patients after Carotid Artery Revascularization-A Narrative Review. Brain Sci. 2021;11(10):1307. doi: 10.3390/brainsci11101307
- Howard DPJ, Gaziano L, Rothwell PM. Risk of stroke in relation to degree of asymptomatic carotid stenosis: a population-based cohort study, systematic review, and meta-analysis. Lancet Neurol. 2021;20(3):193-202. doi: 10.1016/S1474-4422(20)30484-1
- Nies KPH, Smits LJM, Kassem M, et al. Emerging Role of Carotid MRI for Personalized Ischemic Stroke Risk Prediction in Patients With Carotid Artery Stenosis. Front Neurol. 2021;12:718438. doi: 10.3389/fneur.2021.718438
- Bir SC, Kelley RE. Carotid atherosclerotic disease: A systematic review of pathogenesis and management. Brain Circ. 2022;8(3):127-136. doi: 10.4103/bc.bc_36_22