A comparative analysis of the clinical and anamnestic status of patients with chronic occlusion of the carotid arteries based on the data of observational registries

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OBJECTIVE

To study the clinical and anamnestic status of patients with chronic carotid artery occlusion (CCAO) based on the analysis of risk factors, demographic and clinical and anatomical characteristics, the dynamics of the disease; to evaluate ongoing drug therapy, the incidence of strokes (MI) and deaths (according to the local registry compared with the results of other observational studies).

MATERIAL AND METHODS

PubMed and eLibrary searches for a systematic review were performed from October 24 to December 10, 2021 independently by two investigators. Out of 870 articles, based on inclusion/exclusion criteria, 8 studies were selected and included in the systematic review.

RESULTS

A comparative analysis of the clinical and anamnestic status of patients with CCAO according to the present review showed the following data on the prevalence of the main risk factors/diseases: hypertension — 79.1%; male gender — 83.7%; smoking — 46%; diabetes mellitus — 30.5%. Of the entire of own Duplex registry group (n=2548), 7 patients were identified with CCAO (0.27%). All patients were male (mean age 71.3±9.4 years). Endpoints were recorded in 5 of 7 participants during the follow-up period (8.9 years): 5 deaths, 2 fatal MI, 1 non-fatal MI, 1 myocardial infarction. A significant impact of the fact of MI on the survival of patients was confirmed using the standard log-rank test (p=0.02 and the Cox—Mendel test (p=0.04). The incidence of MI during the prospective follow-up according to the analyzed studies ranged from 4.3% (within a month of follow-up) to 42.8% (with a follow-up of 8.9 years), and averaged 12%.

CONCLUSIONS

A comparative analysis of the clinical and anamnestic status of patients with CCAO based on data from observational registers showed that the probability of detecting this pathology is associated with age and male gender. Data obtained from prospective observation of patients with CCAO in our own study show that the development of MI is one of the main factors affecting the survival of this category of patients.

Keywords:

clinical and anamnestic status

chronic carotid artery occlusion

cerebral stroke

death

observational studies

Authors:

Gaisenok O.V.

United Hospital with Outpatient Department of the Administrative Department of the President of the Russian Federation

Rezvaya A.A.

Central State Medical Academy of the Administrative Department of the President of the Russian Federation

Received:

02.05.2022

Accepted:

15.08.2022

List of references:

Nakamura A, Wakugawa Y, Yasaka M, et al. Antegrade internal carotid artery collateral flow and cerebral blood flow in patients with common carotid artery occlusion. J Ultrasound Med. 2012;31(10):1561-1566. https://doi.org/10.7863/jum.2012.31.10.1561
Sedykh DY, Kazantsev AN, Tarasov RS, et al. Predictors of Progressive Course of Multifocal Atherosclerosis in Patients With Myocardial Infarction. Kardiologiia. 2019;59(5):36-44. (In Russ.). https://doi.org/10.18087/cardio.2019.5.10257
Takagi T, Yoshimura S, Yamada K, et al. Angioplasty and stenting of totally occluded common carotid artery at the chronic stage. Neurol Med Chir (Tokyo). 2010;50(11):998-1000. https://doi.org/10.2176/nmc.50.998
Brott TG, Halperin JL, Abbara S, et al. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery. Developed in collaboration with the American Academy of Neurology and Society of Cardiovascular Computed Tomography. Catheter Cardiovasc Interv. 2013;81(1):76-123. https://doi.org/10.1002/ccd.22983
Aboyans V, Ricco JB, Bartelink MEL, et al. ESC Scientific Document Group. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteriesEndorsed by: the European Stroke Organization (ESO)The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J. 2018;39(9):763-816. https://doi.org/10.1093/eurheartj/ehx095
Chen YH, Leong WS, Lin MS, et al. Predictors for Successful Endovascular Intervention in Chronic Carotid Artery Total Occlusion. JACC Cardiovasc Interv. 2016;9(17):1825-1832. https://doi.org/10.1016/j.jcin.2016.06.015
Xu B, Li C, Guo Y, et al. Current understanding of chronic total occlusion of the internal carotid artery. Biomed Rep. 2018;8(2):117-125. https://doi.org/10.3892/br.2017.1033
Gaba K, Bulbulia R. Identifying asymptomatic patients at high-risk for stroke. J Cardiovasc Surg (Torino). 2019;60(3):332-344.
Lamanna A, Maingard J, Barras CD, et al. Carotid artery stenting: Current state of evidence and future directions. Acta Neurol Scand. 2019;139(4):318-333. https://doi.org/10.1111/ane.13062
Ong CT, Wong YS, Sung SF, et al. Progression of Mild to Moderate Stenosis in the Internal Carotid Arteries of Patients With Ischemic Stroke. Front Neurol. 2018;9:1043. https://doi.org/10.3389/fneur.2018.01043
Li Y, Zhu G, Ding V, et al. Assessing the Relationship between Atherosclerotic Cardiovascular Disease Risk Score and Carotid Artery Imaging Findings. J Neuroimaging. 2019;29(1):119-125. https://doi.org/10.1111/jon.12573
Usachev DYu, Lukshin VA, Yakovlev SB, et al. Clinical guidelines for the surgical treatment of stenotic lesions of the main cerebral arteries in a neurosurgical hospital. Clinical guidelines (approved at the XXXVIII Plenum of the Board of the Association neurosurgeons of Russia, St. Petersburg 17.04.2014). (In Russ.). Accessed Febrary 20, 2022. https://ruans.org/Text/Guidelines/stenosis.pdf
Gaisenok OV, Kurnosov PA, Leonov AS, Zateyshchikov DA. Screening of familial hypercholesterolemia among patients in age under 40 years old exposed by duplex scanning of carotid arteries, by the local registry data. Terapevticheskii Arkhiv. 2018;90(9):37-41. (In Russ.). https://doi.org/10.26442/terarkh201890937-41
Gaisenok O, Drapkina O. Gender differences in the detection of carotid atherosclerosis: DUPLEX registry cross-sectional study results. Monaldi Arch Chest Dis. 2022 Feb 7. Epub ahead of print. https://doi.org/10.4081/monaldi.2022.2128
Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet. 1998;351(9113):1379-1387.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. https://doi.org/10.1136/bmj.n71
Riles TS, Imparato AM, Posner MP, Eikelboom BC. Common carotid occlusion. Assessment of the distal vessels. Ann Surg. 1984;199(3):363-366. https://doi.org/10.1097/00000658-198403000-00019
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-383. https://doi.org/10.1016/0021-9681(87)90171-8
Charlson Comorbidity Index (CCI) — MDCalc. Accessed Febrary 20, 2022. https://www.mdcalc.com/charlson-comorbidity-index-cci
den Hartog AG, Achterberg S, Moll FL, et al.; SMART Study Group. Asymptomatic carotid artery stenosis and the risk of ischemic stroke according to subtype in patients with clinical manifest arterial disease. Stroke. 2013;44(4):1002-1007. https://doi.org/10.1161/STROKEAHA.111.669267
Belczak S, Mulatti GC, Abrão SR, et al. Common Carotid Artery Occlusion: A Single-Center Experience in 40 Cases. Int J Angiol. 2016;25(1):39-43. https://doi.org/10.1055/s-0035-1547340
Viticchi G, Falsetti L, Buratti L, et al. Carotid occlusion: Impact of cerebral hemodynamic impairment on cognitive performances. Int J Geriatr Psychiatry. 2021;36(1):197-206. https://doi.org/10.1002/gps.5414
Fokin AA, Mudriakova MV. Comparative results of surgical and medical treatment in patients with internal carotid artery occlusion of the contralateral. Herald of the Northwestern State Medical University named after I.I. Mechnikov. 2016;8(3):24-29. (In Russ.). Accessed March 31, 2022. https://vestnik.szgmu.ru/files/vestnik3.pdf
Högberg D, Kragsterman B, Björck M, et al. Carotid artery atherosclerosis among 65-year-old Swedish men — a population-based screening study. Eur J Vasc Endovasc Surg. 2014;48(1):5-10. https://doi.org/10.1016/j.ejvs.2014.02.004
Yuan HW, Ji RJ, Wang AG, et al. Age and composite end-point events in medium follow-up of patients with carotid artery total occlusion using drug therapy. Atherosclerosis. 2017;265:184-189. https://doi.org/10.1016/j.atherosclerosis.2017.09.006
Klonaris C, Kouvelos GN, Kafeza M, et al. Common carotid artery occlusion treatment: revealing a gap in the current guidelines. Eur J Vasc Endovasc Surg. 2013;46(3):291-298. https://doi.org/10.1016/j.ejvs.2013.06.006
Timmis A, Townsend N, Gale CP, et al; European Society of Cardiology. European Society of Cardiology: Cardiovascular Disease Statistics 2019. Eur Heart J. 2020;41(1):12-85. https://doi.org/10.1093/eurheartj/ehz859
Navis A, Garcia-Santibanez R, Skliut M. Epidemiology and Outcomes of Ischemic Stroke and Transient Ischemic Attack in the Adult and Geriatric Population. J Stroke Cerebrovasc Dis. 2019;28(1):84-89. https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.09.013
Cheung CM, Tsoi TH, Hon SF, et al. Outcomes after first-ever stroke. Hong Kong Med J. 2007;13(2):95-99.
Goldstein LB, Samsa GP, Matchar DB, Horner RD. Charlson Index comorbidity adjustment for ischemic stroke outcome studies. Stroke. 2004;35(8):1941-1945. https://doi.org/10.1161/01.STR.0000135225.80898.1c
Brusselaers N, Lagergren J. The Charlson Comorbidity Index in Registry-based Research. Methods Inf Med. 2017;56(5):401-406. https://doi.org/10.3414/ME17-01-0051
Möller S, Bliddal M, Rubin KH. Methodical considerations on adjusting for Charlson Comorbidity Index in epidemiological studies. Eur J Epidemiol. 2021;36(11):1123-1128. https://doi.org/10.1007/s10654-021-00802-z
Novella A, Elli C, Tettamanti M, et al; REPOSI* Investigators. Comparison between drug therapy-based comorbidity indices and the Charlson Comorbidity Index for the detection of severe multimorbidity in older subjects. Aging Clin Exp Res. 2021;33(7):1929-1935. https://doi.org/10.1007/s40520-020-01706-w
Hall RE, Porter J, Quan H, Reeves MJ. Developing an adapted Charlson comorbidity index for ischemic stroke outcome studies. BMC Health Serv Res. 2019;19(1):930. https://doi.org/10.1186/s12913-019-4720-y
Tikhonoff V, Zhang H, Richart T, Staessen JA. Blood pressure as a prognostic factor after acute stroke. Lancet Neurol. 2009;8(10):938-948. https://doi.org/10.1016/S1474-4422(09)70184-X
Appelros P, Matérne M, Jarl G, Arvidsson-Lindvall M. Comorbidity in Stroke-Survivors: Prevalence and Associations with Functional Outcomes and Health. J Stroke Cerebrovasc Dis. 2021;30(10):106000. https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.106000
Gaisenok OV, Berns SA, Boshkov VB, Medvedev PI. Subclavian steal syndrome: description of a clinical case, pathogenesis of disease and approaches to treatment. REJR. 2019;9(4):177-184. (In Russ.). https://doi.org/10.21569/2222-7415-2019-9-4-177-184
Kim J, Lee HS, Nam CM, Heo JH. Effects of Statin Intensity and Adherence on the Long-Term Prognosis After Acute Ischemic Stroke. Stroke. 2017;48(10):2723-2730. https://doi.org/10.1161/STROKEAHA.117.018140
Staubach S, Soekeland K, Ledwoch J, et al. Stroke rates after carotid artery stenting depend on study-specific definitions. EuroIntervention. 2016;12(4):526-530. https://doi.org/10.4244/EIJV12I4A88
Stroes ES, Thompson PD, Corsini A, et al; European Atherosclerosis Society Consensus Panel. Statin-associated muscle symptoms: impact on statin therapy-European Atherosclerosis Society Consensus Panel Statement on Assessment, Aetiology and Management. Eur Heart J. 2015;36(17):1012-1022. https://doi.org/10.1093/eurheartj/ehv043
Budimkic MS, Pekmezovic T, Beslac-Bumbasirevic L, et al. Long-term medication persistence in stroke patients treated with intravenous thrombolysis. Clin Neurol Neurosurg. 2016;141:19-22. https://doi.org/10.1016/j.clineuro.2015.12.003
Bushnell CD, Olson DM, Zhao X, et al; AVAIL Investigators. Secondary preventive medication persistence and adherence 1 year after stroke. Neurology. 2011;77(12):1182-1190. https://doi.org/10.1212/WNL.0b013e31822f0423
Vitturi BK, Gagliardi RJ. The influence of statin withdrawal and adherence on stroke outcomes. Neurol Sci. 2021;42(6):2317-2323. https://doi.org/10.1007/s10072-020-04790-y
Qin H, Chen Y, Liu G, et al. Management characteristics and prognosis after stroke in China: findings from a large nationwide stroke registry. Stroke Vasc Neurol. 2021;6(1):1-9. https://doi.org/10.1136/svn-2020-000340
Jacobowitz GR, Rockman CB, Gagne PJ, et al. A model for predicting occult carotid artery stenosis: screening is justified in a selected population. J Vasc Surg. 2003;38(4):705-709. https://doi.org/10.1016/s0741-5214(03)00730-4
North American Symptomatic Carotid Endarterectomy Trial Collaborators, Barnett HJM, Taylor DW, Haynes RB, et al. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med. 1991;325(7):445-453. https://doi.org/10.1056/NEJM199108153250701
Qureshi AI, Janardhan V, Bennett SE, et al. Who should be screened for asymptomatic carotid artery stenosis? Experience from the Western New York Stroke Screening Program. J Neuroimaging. 2001;11(2):105-111. https://doi.org/10.1111/j.1552-6569.2001.tb00019.x

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