Objective: The risk of stroke in patients with recently symptomatic carotid stenosis is considerably higher than in patients with asymptomatic stenosis. In the present study it was hypothesised that excessive platelet...Objective: The risk of stroke in patients with recently symptomatic carotid stenosis is considerably higher than in patients with asymptomatic stenosis. In the present study it was hypothesised that excessive platelet activation might partly contribute to this difference. Methods: A full blood count was done and whole blood flow cytometry used to measure platelet surface expression of CD62P, CD63, and PAC1 binding and the percentage of leucocyte-platelet complexes in patients with acute (0-21 days, n = 19) and convalescent (79-365 days) symptomatic (n = 16) and asymptomatic (n = 16) severe (≥70%) carotid stenosis. Most patients were treated with aspirin (37.5-300 mg daily) although alternative antithrombotic regimens were more commonly used in the symptomatic group. Results: The mean platelet count was higher in patients with acute and convalescent symptomatic compared with asymptomatic carotid stenosis. There were no significant differences in the median percentage expression of CD62P and CD63, or PAC1 binding between the acute or convalescent symptomatic and asymptomatic patients. The median percentages of neutrophil-platelet (p = 0.004), monocyte-platelet (p = 0.046), and lymphocyte-platelet complexes (p = 0.02) were higher in acute symptomatic than in asymptomatic patients. In patients on aspirin monotherapy, the percentages of neutrophil-platelet and monocyte-platelet complexes (p=0.03) were higher in acute symptomatic (n=11) than asymptomatic patients (n = 14). In the convalescent phase, the median percentages of all leucocyte-platelet complexes in the symptomatic group dropped to levels similar to those found in the asymptomatic group. Conclusion: Increased platelet count and leucocyte-platelet complex formation may contribute to the early excess risk of stroke in patients with recently symptomatic carotid stenosis.展开更多
Background and Purpose:Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS) patients with carotid stenosis were randomized between endovascu lar treatment and endarterectomy. The rates of residual sev...Background and Purpose:Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS) patients with carotid stenosis were randomized between endovascu lar treatment and endarterectomy. The rates of residual severe stenosis and rest enosis and their contribution to recurrent symptoms was unclear.Methods:Endovas cular patients:were treated by balloon angioplasty alone (88%) or stenting (22 %). Patches were used in 63%of endarterectomy patients. Carotid stenosis was c ategorizedas mild (0%to 49%), moderate (50%to 69%), severe (70%to 99%), or occluded, using standardized Doppler ultrasound criteria at the examination clo sest to 1 month (n=283) and 1 year (n=347) after treatment. Recurrent cerebrovas cular symptoms during follow-up were analyzed. Results:More patients had ≥70 %stenosis of the ipsilateral carotid artery 1 year after endovascular treatment than after endarterectomy (18.5%versus 5.2%, P=0.0001). Residual severe steno sis was present in 6.5%of patients at 1 month after endovascular treatment.Betw een 1 month and 1 year, restenosis to ≥70%stenosis occurred in 10.5%of the en dovascular group. After endarterectomy,1.7%had residual severe stenosis at 1 mo nth, and 2.5%developed severe restenosis. The results were significantly better after stenting compared with angioplasty alone at 1 month(P< 0.001) but not at 1 year. Recurrent ipsilateral symptoms were more common in endovascular patients with severe stenosis(5/32 [15.6%]) compared with lesser degrees of stenosis at 1 year (11/141 [7.8%], P=0.02), but most were transient ischemic attacks and n one were disabling or fatal strokes. There were no recurrent symptoms in the 9 e ndarterectomy patients with≥70%stenosis at 1 year. Conclusions:Carotid stenos is 1 year after endovascular treatment is partly explained by poor initial anato mical results and partly by restenosis. The majority of patients were treated by angioplasty without stenting. Further randomized studies are required to determ ine whether newer carotid stenting techniques are associated with a lower risk o f restenosis. The low rate of recurrent stroke in both endovascular and endarter ectomy patients suggests that treatment of rest enosis should be limited to pati ents with recurrent symptoms, but long term follow up data are required.展开更多
文摘Objective: The risk of stroke in patients with recently symptomatic carotid stenosis is considerably higher than in patients with asymptomatic stenosis. In the present study it was hypothesised that excessive platelet activation might partly contribute to this difference. Methods: A full blood count was done and whole blood flow cytometry used to measure platelet surface expression of CD62P, CD63, and PAC1 binding and the percentage of leucocyte-platelet complexes in patients with acute (0-21 days, n = 19) and convalescent (79-365 days) symptomatic (n = 16) and asymptomatic (n = 16) severe (≥70%) carotid stenosis. Most patients were treated with aspirin (37.5-300 mg daily) although alternative antithrombotic regimens were more commonly used in the symptomatic group. Results: The mean platelet count was higher in patients with acute and convalescent symptomatic compared with asymptomatic carotid stenosis. There were no significant differences in the median percentage expression of CD62P and CD63, or PAC1 binding between the acute or convalescent symptomatic and asymptomatic patients. The median percentages of neutrophil-platelet (p = 0.004), monocyte-platelet (p = 0.046), and lymphocyte-platelet complexes (p = 0.02) were higher in acute symptomatic than in asymptomatic patients. In patients on aspirin monotherapy, the percentages of neutrophil-platelet and monocyte-platelet complexes (p=0.03) were higher in acute symptomatic (n=11) than asymptomatic patients (n = 14). In the convalescent phase, the median percentages of all leucocyte-platelet complexes in the symptomatic group dropped to levels similar to those found in the asymptomatic group. Conclusion: Increased platelet count and leucocyte-platelet complex formation may contribute to the early excess risk of stroke in patients with recently symptomatic carotid stenosis.
文摘Background and Purpose:Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS) patients with carotid stenosis were randomized between endovascu lar treatment and endarterectomy. The rates of residual severe stenosis and rest enosis and their contribution to recurrent symptoms was unclear.Methods:Endovas cular patients:were treated by balloon angioplasty alone (88%) or stenting (22 %). Patches were used in 63%of endarterectomy patients. Carotid stenosis was c ategorizedas mild (0%to 49%), moderate (50%to 69%), severe (70%to 99%), or occluded, using standardized Doppler ultrasound criteria at the examination clo sest to 1 month (n=283) and 1 year (n=347) after treatment. Recurrent cerebrovas cular symptoms during follow-up were analyzed. Results:More patients had ≥70 %stenosis of the ipsilateral carotid artery 1 year after endovascular treatment than after endarterectomy (18.5%versus 5.2%, P=0.0001). Residual severe steno sis was present in 6.5%of patients at 1 month after endovascular treatment.Betw een 1 month and 1 year, restenosis to ≥70%stenosis occurred in 10.5%of the en dovascular group. After endarterectomy,1.7%had residual severe stenosis at 1 mo nth, and 2.5%developed severe restenosis. The results were significantly better after stenting compared with angioplasty alone at 1 month(P< 0.001) but not at 1 year. Recurrent ipsilateral symptoms were more common in endovascular patients with severe stenosis(5/32 [15.6%]) compared with lesser degrees of stenosis at 1 year (11/141 [7.8%], P=0.02), but most were transient ischemic attacks and n one were disabling or fatal strokes. There were no recurrent symptoms in the 9 e ndarterectomy patients with≥70%stenosis at 1 year. Conclusions:Carotid stenos is 1 year after endovascular treatment is partly explained by poor initial anato mical results and partly by restenosis. The majority of patients were treated by angioplasty without stenting. Further randomized studies are required to determ ine whether newer carotid stenting techniques are associated with a lower risk o f restenosis. The low rate of recurrent stroke in both endovascular and endarter ectomy patients suggests that treatment of rest enosis should be limited to pati ents with recurrent symptoms, but long term follow up data are required.
