Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-25T17:38:43.638Z Has data issue: false hasContentIssue false
  • English
  • Français

Diagnosis and Prevention of Atherosclerotic Cerebral Infarction

Published online by Cambridge University Press:  07 November 2014

Jesse Weinberger
Get access Rights & Permissions [Opens in a new window]

Abstract

Atherosclerotic disease accounts for ~25% of ischemic strokes. Atherosclerotic stroke is caused mainly by embolic events from the carotid artery bifurcation or the aortic arch, although intracranial thrombosis can occur, more often in African Americans, Asians, and diabetes patients. Primary prevention of stroke is critical for patients with risk factors for atherosclerosis, including hypertension, diabetes, smoking and hypercholesterolemia. Stroke can be prevented in patients with established atherosclerotic disease by identification and management of patients with carotid artery stenosis by non-invasive testing. Particular attention must be paid to patients with transient symptoms of brain ischemia.

Type
Review Articles
Information
CNS Spectrums , Volume 10 , Issue 7 , July 2005 , pp. 553 - 566
Copyright
Copyright © Cambridge University Press 2005

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Genazzani, AR, Petraglia, F, Purdy, RH, eds. The Brain: Source and Target for Sex Steroid 1. American Heart Association. Heart Disease and Stroke Statistics–2003 Update. Dallas, Tex: American Heart Association; 2002.Google Scholar
2.Bogousslavsky, J, Van Melle, G, Regli, F. The Lausanne Stroke Registry: analysis of 1,000 consecutive patients with first stroke. Stroke. 1988;19:1083–1092.Google Scholar
3.Ezekowitz, MD, Bridgers, SL, James, KE, et al.Warfarin in the prevention of stroke associated with nonrheumatic atrial fibrillation. Veterans Affairs Stroke Prevention in Nonrheumatic Atrial Fibrillation Investigators. N Engl J Med. 1992;327:1406–1412.Google Scholar
4.Fisher, CM. Lacunes: small, deep cerebral infarcts. Neurology. 1965;15:774–778.Google Scholar
5.Fisher, CM, Gore, I, Okabe, N, White, PD. Atherosclerosis of the carotid and vertebral arteries. Extracranial and intracranial. J Neuropath Exp Neurol. 1965;24:455–476.CrossRefGoogle Scholar
6.Sacco, RL, Kargman, DE, Gu, Q, Zamanillo, MC. Race-ethnicity and determinants of intracranial atherosclerotic cerebral infarction. Stroke. 1995;26:14–20.CrossRefGoogle ScholarPubMed
7.Elmore, EM, Mosquera, A, Weinberger, J. The prevalence of asymptomatic intracranial large-vessel occlusive disease: the role of diabetes. J Neuroimaging, 2003;13:224–22.Google Scholar
8.Tunick, PA, Culliford, AT, Lamparello, PJ, Kronzon, I. Atheromatosis of the aortic arch as an occult source of multiple systemic emboli. Ann Intern Med. 1991;114:391–392.CrossRefGoogle ScholarPubMed
9.Fuster, V. Coronary artery disease: a clinical-pathological correlation. In: Fuster, V, ed. Syndromes of Atherosclerosis: Correlations of Clinical Imaging and Pathology. Armonk, NY: Futura Publishing Co.; 1996:1–15.Google Scholar
10.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;53:502–514.Google Scholar
11.O'Brien, ER, Schwartz, SM. A new view of restenosis. In: Fuster, V, ed. Syndromes of Atherosclerosis: Chelations of Clinked imaging and Pathology. Armonk, NY: Futura Publishing Co.; 1996:485–505.Google Scholar
12.Bond, MG, Barnes, RW, Riley, WA, et al.High-resolution B-mode ultrasound scanning methods in the Atherosclerosis Risk in Communities (ARIC) cohort. J Neuroimaging. 1991;1:168–172.CrossRefGoogle Scholar
13.Falk, E. Plaque rupture with severe pre-existing coronary stenosis precipitating coronary thrombosis. Characteristics of coronary atherosclerotic plaques underlying fatal occlusion thrombi. Br Heart J. 1983;50:127–134.CrossRefGoogle ScholarPubMed
14.Imparato, AM, Riles, TS, Gorstein, F. The carotid bifurcation plaque: pathologic findings associated with cerebral ischemia. Stroke. 1979;10:238–245.Google Scholar
15.Imparato, AM, Riles, TS, Mintzer, R, Baumann, FG. The importance of hemorrhage in the relationship between gross morphologic characteristics and cerebral symptoms in 376 carotid artery plaques. Ann Surg. 1983;1979:195–203.CrossRefGoogle Scholar
16.Lusby, RJ, Ferrell, LD, Ehrenfeld, WK, Stoney, RJ, Wylie, EJ. Carotid plaque hemorrhage. Its role in production of cerebral ischemia. Arch Surg. 1982;117:1479–1488.CrossRefGoogle ScholarPubMed
17.Reilly, LM, Lusby, RJ, Hughes, L, Ferrell, LD, Stoney, RJ, Ehrenfeld, WK. Carotid plaque histology using real-time ultrasonography. Clinical and therapeutic implications. Am J Surg. 1983;146:188–193.Google Scholar
18.Steffen, CM, Gray-Weale, AC, Byrne, KE, Lusby, RJ. Carotid artery atheroma. Ultrasound appearance in symptomatic and asymptomatic vessels. Aust NZ J Surg. 1989;59:529–534.Google Scholar
19.Weinberger, J, Marks, SJ, Gaul, JJ, et al. Atherosclerotic plaque at the carotid artery bifurcation. Correlation of ultrasonographic imaging with morphology. J Ultrasound Med. 1987;6:363–366.CrossRefGoogle ScholarPubMed
20.Langsfeld, M, Gray-Weale, AC, Lusby, RJ. The role of plaque morphology and diameter reduction in the development of new symptoms in asymptomatic carotid arteries. J Vasc Surg. 1989;9:548–557.CrossRefGoogle ScholarPubMed
21.Johnson, JM, Kennelly, MM, Decesare, D, Morgan, S, Sparrow, A. Natural history of asymptomatic carotid plaque. Arch Surg. 1985;120:1010–1012.CrossRefGoogle ScholarPubMed
22.Weinberger, J, Ramos, L, Ambrose, JA, Fuster, V. Morphologic and dynamic changes of atherosclerotic plaque at the carotid artery bifurcation: Sequential imaging by real time imaging by real time B-mode ultrasonography. J Am Coll Cardiol. 1988;12:1515–1521.CrossRefGoogle ScholarPubMed
23.Moore, WS, Hall, AD. Importance of emboli from carotid bifurcation in pathogenesis of cerebral ischemic attacks. Arch Surg. 1970;101:708–711.CrossRefGoogle ScholarPubMed
24.Mitusch, R, Doherty, C, Wucherpfenning, H, et al.Vascular events during follow-up in patients with aortic arch atherosclerosis. Stroke. 1997;28:36–39.Google Scholar
25.Weinberger, J, Papamitsakis, N, Newfield, A, Godbold, J, Goldman, M. Plaque morphology correlates with cerebrovascular symptoms in patients with complex aortic arch plaque. Arch Neurol. 2000;57:81–84.CrossRefGoogle ScholarPubMed
26.Jorge, RE, Robinson, RG, Arndt, S, Starkstein, S. Mortality and poststroke depression: a placebo controlled trial of antidepressants. Am J Psychiatry. 2003;160:1823–1829.CrossRefGoogle ScholarPubMed
27.The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Arch intern Med. 1997;157:2413–2444.Google Scholar
28.Gueyffier, F, Boutitie, F, Boisel, JP, et al.Effect of antihypertensive drug treatment on cardiovascular outcomes in women and men. A meta-analysis of individual patient data from randomized, controlled trials. The INDANA Investigators. Ann intern Med. 1997;126:761–767.CrossRefGoogle Scholar
29.Insua, JT, Sacks, HS, Lau, TS, et al.Drug treatment of hypertension in the elderly: a meta-analysis. Ann Intern Med. 1994;121:355–362.Google Scholar
30.Perry, HM, Davis, BR, Price, TR, et al.Effect of treating isolated systolic hypertension on the risk of developing various types and subtypes of stroke: the Systolic Hypertension, in the Elderly Program (SHEP). JAMA. 2000;284:465–471.Google Scholar
31.Gueyffier, F, Bulpitt, C, Boissel, JP, et al.Antihypertensive drugs in very old people: a subgroup meta-analysis of randomised controlled trials. INDANA Group. Lancet. 1999;353:793–796.Google Scholar
32.Voko, Z, Bots, ML, Hofman, A, Koudstaal, PJ, Witteman, JC, Breteler, MM. J-shaped relation between blood pressure and stroke in treated hypertensives. Hypertension. 1999;34:1181–1185.Google Scholar
33.Alex, M, Baron, EK, Goldenberg, S, Blumenthal, HT. An autopsy study of cerebrovascular accident in diabetes melilitus. Circulation. 1962;25:663–667.Google Scholar
34.Merimee, TJ. Diabetic retinopathy. A synthesis of perspectives. N Engl J Med. 1990;322:978–983.Google Scholar
35.Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. UK Prospective Diabetes Study Group. BMJ. 1998;317:703–713.Google Scholar
36.Woo, J, Lam, CW, Kay, R, Wong, AH, Teoh, R, Nicholls, MG. The influence of hyperglycemia and diabetes mellitus on immediate and 3-month morbidity and mortality after acute stroke. Arch Neurol. 1990;47:1174–1177.Google Scholar
37.Yusuf, S, Sleight, P, Pogue, J, Bosch, J, Davtes, R, Dagenais, G. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med. 2000;342:145–153.Google Scholar
38.Ibsen, H, Lindholm, LH, Pedersen, OL, Dahlof, B, Kjeldsen, S. The effect of losartan versus atenolol on cardiovascular morbidity and mortality in patients with diabetes mellitus in the LIFE-study [Danish]. Ugeskr Laeger. 2003;165:459–462.Google Scholar
39.Dahlof, B, Devereux, RB, Kjeldsen, SE, et al.Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet. 2002;359:995–1003.Google Scholar
40.Kjeldsen, SE, Dahlof, B, Devereux, RB, et al.Effects of Iosartan on cardiovascular morbidity and mortality in patients with isolated systolic hypertension and left ventricular hypertrophy: a Losartan Intervention for Endpoint Reduction (LIFE) substudy. JAMA. 2002;288:1491–1498.Google Scholar
41.Kannel, WB, Wolf, PA. Epidemiology of cerebrovascular disease. In Ross-Russell, RW, ed. Vascular Disease of the Central Nervous System. New York, NY: Churchill Livingstone; 1983:1–24.Google Scholar
42.Arenillas, JF, Molina, CA, Chacon, P, et al.High lipoprotein (a), diabetes and the extent of symptomatic intracranial atherosclerosis. Neurology. 2004;63:27–32.Google Scholar
43.Welch, GN, Loscalzo, J. Homocysteine and atherothtombosis. N Engl J Med. 1998;338:1042–1050.Google Scholar
44.Ridker, PM, Rifai, N, Pfeffer, MA, Sacks, F, Braunwald, E. Long-term effects of pravastatin on plasma concentration of C-reactive protein. The Cholesterol and Recurrent Events (CARE) Investigators. Circulation. 1999;100:230–235.Google Scholar
45.Brown, BG, Zhao, X-Q, Poulin, D, Albers, JJ. Coronary angiographic changes, lipid-lowering therapy and their relationship to clinical cardiac events, In: Fuster, V, ed. Syndromes of Atherosclerosis: Correlations of Clinical Imaging and Pathobgy. Armonk, NY: Futura Publishing Co.; 1996:471–482.Google Scholar
46.Randomised trial of cholesterol lowering in 4444 patients with coronary, heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet. 1994;344:1383–1389.Google Scholar
47.Effect of simvastatin on coronary atheroma: the Multicentre Anti-Atheroma Study (MAAS). Lancet. 1994;344:633–638.Google Scholar
48.Shepherd, J, Cobbe, SM, Ford, I, et al.Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. West of Scotland Coronary Prevention Study Group. N Engl J Med. 1995;333:1301–1307.Google Scholar
49.Schwartz, GG, Olsson, AG, Ezekowitz, MD, et al.Effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes: the MIRACL study: a randomized controlled trial. JAMA. 2001;285:1711–1718Google Scholar
50.Jukema, JWBruschke, AVG, van Boven, AJ, et al.Effects of lipid lowering by pravastatin on progression and regression of coronary artery disease in symptomatic men with normal to moderately elevated serum cholesterol levels. The Regression Growth Evaluation Statin Study (REGRESS). Circulation. 1995;91:2528–2540.Google Scholar
51.Furberg, CD, Adams, HP Jr, Applegate, WB, et al.Effect of lovastatin on early carotid atherosclerosis and cardiovascular events. Asymptomatic Carotid Artery Progression Study (ACAPS) Research Group. Gradation. 1994;90:1679–1687.Google Scholar
52.Crouse, JR 3rd, Byington, RP, Bond, MG, et al.Pravastatin, lipids, and atherosclerosis in the carotid arteries (PLAC-II) Am J Cardiol. 1995;75:455–459.CrossRefGoogle ScholarPubMed
53.Collins, R, Armitage, J, Parish, S, Sleight, P, Peto, R; Heart Protection Study Collaborative Group. Effects of cholesterol-lowering with simvastatin on stroke and other major vascular events in 20536 people with cerebrovascular disease or other high-risk conditions. Lancet. 2004;363:757–766.Google Scholar
54.Corti, R, Fuster, V, Fayad, ZA, et al.Lipid lowering by simvastatin induces regression of human atherosclerotic lesions: two years' follow-up by high-resolution noninvasive magnetic resonance imaging. Circulation. 2002;106:2884–2887.Google Scholar
55.Kushi, LH, Folsom, AR, Prineas, RJ, Mink, PJ, Wu, Y, Bostick, RM. Dietary antioxidant vitamins and death from coronary heart disease in postmenopausal women. N Engl J Med. 1996;334:1156–1162.Google Scholar
56.Stephens, NG, Parsons, A, Schofield, PM, Kelly, F; Cheeseman, K, Mitchinson, MJ. Randomised controlled trial of vitamin E in patients with coronary disease: Cambridge Heart Antioxidant Study (CHAOS). Lancet. 1996;347:781–786.CrossRefGoogle ScholarPubMed
57.Salonen, JT, Salonen, R. Ultrasound B-mode imaging in observational studies of atherosclerotic progression. Circulation. 1993;87(3 suppl):I156–I165.Google Scholar
58.Tell, GS, Howard, G, McKinney, WM, Toole, JF. Cigarette smoking cessation and extracranial carotid atherosclerosis. JAMA. 1989;261:1178–1180.Google Scholar
59.ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. Major outcomes in high-risk hypertensive patients randomized to angiotensin-convert-ing enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Loweting Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA. 2002;288:2981–2997.CrossRefGoogle Scholar
60.PROGRESS Collaborative Group. Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack. Lancet. 2001;358:1033–1041.Google Scholar
61.Papademetriou, V, Farsang, C, Elmfeldt, D, et al.Stroke prevention with the angiotensin II type 1-receptor blocker candesartan in elderly patients with isolated systolic hypertension: the Study on Cognition and Prognosis in the Elderly (SCOPE). J Am Coll Cardiol. 2004;44:1175–1180.Google Scholar
62.Fernandez-Ortiz, A, Badimon, JJ, Falk, E, et al.Characterization of the relative thrombo-genicity of atherosclerotic plaque components: implications for consequences of plaque rupture. J Am Coll Cardiol. 1994;23:1562–1569.Google Scholar
63.Badimon, L, Badimon, JJ. Mechanisms of arterial thrombosis in nonparallel streamlines: platelet thrombi grow on the apex of stenotic severely injured vessel wall. Experimental study in the pig model. J Clin Invest. 1989;84:1134–1144.Google Scholar
64.Ruggeri, ZM. Mechanisms of shear-induced platelet adhesion and aggregation. Thromb Haemost. 1993;70:119–123.Google Scholar
65.Sinzinger, H, Rodrigues, M, Kritz, H. Radioisotopic imaging of atheroma. In: Fuster, V, ed. Syndromes of Atherosclerosis: Correlations of Clinical Imagingand Pathology. Armonk, NY: Futura Publishing Co.; 1996:369–383.Google Scholar
66.Roth, GJ, Majerus, PW. The mechanism of the effect of aspirin on human platelet. I. Acetylation of a particular fraction protein. J Clin Invest. 1975;56:624–632.Google Scholar
67.Antithrombotic Trialists' Collaboration. Collaborative meta-analysis of randomized trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ. 2002;324:71–86.CrossRefGoogle Scholar
68.Johnson, M, Walton, PL, Cotton, RC, Strachan, CJL. Pharmacological evaluation of ticlopidine, a novel inhibitor of platelet function. Thromb Haemost. 1977;38:64–69.Google Scholar
69.Hass, WK, Easton, JD, Adams, HP Jr, et al.A randomized trial comparing ticlopidine hydrochloride with aspirin for the prevention of stroke in high-risk patients. Ticlopidine Aspirin Stroke Study Group. N Engl J Med. 1988;321:501–507Google Scholar
70.Grotta, JC, Norris, JW, Kamm, B. Prevention of stroke with ticlopidine: who benefits most? TASS Baseline and Angiographic Data Subgroup. Neurology. 1992;42:1111–1115.CrossRefGoogle ScholarPubMed
71.Gorelick, P, Richardson, De J, Kelly, M, et al.Aspirin and ticlopidine for prevention of recurrent stroke in black patients: a randomized clinical trial. JAMA. 2003;289:2947–2957.Google Scholar
72.Bennett, CL, Weinberg, PD, Rozenberg-Ben-Dror, K, Yarnold, PR, Kwaan, HC, Green, D. Thrombotic thrombocytopenic purpura associated with ticlopidine. A review of 60 cases. Ann Intern Med. 1998;128:541–544.Google Scholar
73.A randomised, blinded, trial of Clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee. Lancet. 1996;348:1329–1339.Google Scholar
74.Yusuf, S, Zhao, F, Mehta, SR, et al.Effects of Clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med. 2001;345:494–502.Google Scholar
75.Dienet, HC, Bogousslavsky, J, Brass, LM, et al.Aspirin and Clopidogrel compared with Clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet. 2004;364:331–337.Google Scholar
76.Fitzgerald, GA. Dipyridamole. N Engl J Med. 1987;316:1247–1257.Google Scholar
77.Acheson, J, Danta, G, Hutchinson, EC. Controlled trial of dipyridamole in cerebral vascular disease. Br Med J. 1969;1:614–615Google Scholar
78.Persantine Aspirin Trial in cerebral ischemia. Part II: Endpoint results. The American-Canadian Co-Operative Study group. Stroke. 1985;16:406–415.Google Scholar
79.European Stroke Prevention Study. ESPS Group. Stroke. 1990;21:1122–1130.CrossRefGoogle Scholar
80.Diener, HC, Cunha, L, Forbes, C, et al.European Stroke Prevention Study 2. Dipyridamole and acetylsalicylic acid in the secondary prevention of stroke. J Neurol Sci. 1996;143:1–13.Google Scholar
81.Mohr, JP, Thompson, JL, Lazar, RM, et al.A comparison of warfarin and aspirin for the ptevention of recurrent ischemic stroke. N Engl J Med. 2001;345:1444–1451.Google Scholar
82.Hankey, GJ. Ongoing and planned trials of antiplatelet therapy in the acute and long-term management of patients with ischaemic brain syndromes: setting a new standard of care. Cerebrovasc Dis. 2004;17:11–16.Google Scholar
83.Weinberger, J, Biscarra, V, Weitzner, I Jr, Sacher, M. Noninvasive carotid artery testing: role in the management of patients with transient ischemic attacks. N Y State J Med. 1981;81:1463–1468.Google Scholar
84.Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med. 1991;325;445–453.Google Scholar
85.Barnett, HJM, Taylor, DW, Eliasziw, M, et al.Benefit of carotid endarterectomy in patients with symptomatic moderate to severe stenosis. N Engl J Med. 1998;339:1415–1425.Google Scholar
86.Polak, JF, Bajakian, RL, O'Leary, DH, Anderson, MR, Donaldson, MC, Jolesz, FA. Detection of internal carotid artery stenosis: comparison of MR angiography, color Doppler sonography and arteriography. Radiology. 1992;182:35–40.Google Scholar
87.Wennberg, DE, Lucas, FL, Birkmeyer, JD, et al.Variation in carotid endarterectomy mortality in the Medicare population. Trial hospitals, volume and patient characteristics. JAMA 1998;270:1278–1281Google Scholar
88.Cebul, RD, Snow, RJ, Pine, R, Hertzer, NR, Norris, DG. Indications, outcomes and provider volumes for carotid endarterectomy. JAMA. 1998;279:1282–1287.Google Scholar
89.Endarterectomy for asymptomatic carotid artery stenosis. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. JAMA. 1995;273:1421–1428.CrossRefGoogle Scholar
90.Halliday, A, Mansfield, A, Marro, J, et al.Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial. Lancet. 2004;363:1491–1502.Google Scholar
91.Norris, JW, Zhu, CZ, Bornstein, NM, Chambers, BR. Vascular risks of asymptomatic carotid stenosis. Stroke. 1991;22:1485–1490.Google Scholar
92.Diethrich, EB, Ndiaye, M, Reid, DB. Stenting in the carotid artery: initial experience in 110 patients. J Endovasc Surg. 1996;3:42–62.Google Scholar
93.Wholey, MH, Wholey, MH, Jarmolowski, CR, Eles, G, Levy, D, Buecthel, J. Endovascular stents fot carotid artery occlusive disease. J Endovasc Surg. 1997;4:326–328.Google Scholar
94.Qureshi, AI, Luft, AR, Janardhan, V, et al.Identification of patients at risk for peripro-cedural neurological deficits associated with carotid angioplasty and stenting. Stroke. 2000;31:376–382.Google Scholar
95.Alazzaz, A, Thornton, J, Aletich, VA, Debrun, GM, Ausman, JI, Charbel, F. intracranial percutaneous transluminal angioplasty fot arteriosclerotic stenosis. Arch Neurol. 2000;57:1625–1630.Google Scholar
96.Malek, AM, Higashida, RT, Phatouros, CC, et al.Stent angioplasty for cervical carotid artery stenosis in high-risk symptomatic NASCET-ineligible patients. Stroke. 2000;31:3029–3033Google Scholar
97.Cremonesi, A, Manetti, R, Setacci, F, Setacci, C, Castriota, F. Protected carotid stenting. Clinical advantages and complications of embolic protection devices in 442 consecutive patients. Stroke. 2003;34:1936–1943.CrossRefGoogle ScholarPubMed
98.Yadav, J, Wholey, MH, Kuntz, RE, et al.Protected carotid-artery stenting versus endarterectomy in high risk patients. N Engl J Med. 2004;351:493–501.Google Scholar
99.Hilton, TC, Menke, DBlackshear, JL. Variable effect of anticoagulation in the treatment of severe protruding atherosclerotic debris. Am Heart J. 1994;127:1645–1647.Google Scholar
100.Dressler, FA, Craig, WR, Castello, R, Labovitz, AJ. Mobile aortic atheroma and systemic emboli: efficacy of anticoagulation and influence of plaque morphology on recurrent stroke. J Am Coll Cardiol. 1998;31:134–138.Google Scholar
101.Fredberg, RS, Tunick, PA, Culliform, AT, et al.Disappearance of a large intraaortic mass in a patient with prior systemic embolization. Am Heart J. 1993:25(5 pt 1):1445–1447.Google Scholar
102.Tunick, PA, Nayar, AC, Goodkin, GM, et al.Effect of treatment on the incidence of stroke and other emboli in 519 patients with severe thoracic aortic plaque. Am J Cardiol. 2002;90:1320–1325.Google Scholar
103.Tunick, PA, Culliford, AT, Lamparello, PJ, Kronzon, I. Atheromatosis of the aortic arch as an occult source of multiple systemic emboli. Ann Intern Med. 1991;114:391–392.Google Scholar
104.Geraci, A, Weinberger, J. Natural history of aortic arch plaque. Neurology. 2000;54:749–751.Google Scholar
105.Chimowitz, MI, Kokkinos, J, Strong, J, et al.The wararin-aspirin symptomatic intracranial disease study. Neurology. 1995;45:1488–1493.Google Scholar
106.Caplan, LR. Advances in stroke research: basic science, treatment, and clinical trial outcomes. Highlights of the 29th International Stroke Conference. Rev Neurol Dis. 2004;1:91–94.Google Scholar
107.Bhatt, DL, Marso, SP, Hirsch, AT, Ringleb, PA, Hacke, W, Topol, EJ. Amplified benefit of clopidogrel versus aspirin in patients with diabetes mellitus. Am J Cardiol. 2002;90:625–628.Google Scholar
108.Gupta, R, Shumacher, HC, Magla, S, et al.Urgent endovascular revascularization for symptomatic intracranial atherosclerotic stenosis. Neurology. 2003;61:1729–1735.Google Scholar
109.Chaturvedi, S, Caplan, LP. Angioplasty for intracranial atherosclerosis: is the treatment worse than the disease? Neurobgy. 2003;61:1647–1658.Google Scholar
110.Weinberger, J, Rothlauf, E, Materese, E, Halperin, J. Noninvasive evaluation of the extracranial carotid arteries in patients with cerebrovascular events and atrial fibrillations. Arch Int Med. 1990;150:458–460.Google Scholar
111.Kanter, MC, Tegeler, CH, Pearce, LA, Weinberger, J, et al.Carotid stenosis in patients with atrial fibrillation. Prevalence, risk factors, and relationship to stroke in the Stroke Prevention in Atrial Fibrillation Study. Arch Int Med. 1994;154:1372–1377.Google Scholar
112.Horowitz, DR, Tuhrim, S, Weinberger, JM, Rudolph, SH. Mechanisms in lacunar infarction. Stroke. 1992;23:325–327.Google Scholar