1 / 37

Placca carotidea e ictus ischemico

Placca carotidea e ictus ischemico. Prevalence of Stroke. Rosamond W, Flegal K, Furie K, et al. Heart disease and stroke statistics--2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2008;117:e25-146.

sasha
Download Presentation

Placca carotidea e ictus ischemico

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Placca carotidea e ictus ischemico S.C. Angiologia Medica - Messina

  2. PrevalenceofStroke Rosamond W, Flegal K, Furie K, et al. Heart disease and stroke statistics--2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2008;117:e25-146. S.C. Angiologia Medica - Messina

  3. European Journal of Neurology 2006, 13: 581–598 S.C. Angiologia Medica - Messina

  4. J. Wepfer (1620–1695) T. Willis (1621–1675) M. E. DeBakey (1908-2008) S.C. Angiologia Medica - Messina

  5. 20 to 30% ofstrokesare causedbyatheroscleroticcarotidartery disease1 Carotidarterydiseaseincreases the riskforstroke: • Byplaque or clotbreaking off from the carotidarteries and blocking a smallerartery in the brain • Bynarrowingof the carotidarteries due toplaquebuild-up • By a bloodclotbecomingwedged in a carotidarterynarrowedbyplaque Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. Endarterectomy for Asymptomatic Carotid Artery Stenosis. JAMA 1995;273:1421 S.C. Angiologia Medica - Messina

  6. Stroke. 2010;41:1294-1297 S.C. Angiologia Medica - Messina

  7. Inzitari, D. et al. N Engl J Med 2000;342:1693-1700 S.C. Angiologia Medica - Messina

  8. S.C. Angiologia Medica - Messina

  9. S.C. Angiologia Medica - Messina

  10. La placca carotidea “importante”………….è quella che darà dei sintomi cerebrali ma anche MACEs(Major AdverseCardiovascularevents) • Come definirla ? • a rischio (embolico o emodinamico) • instabile • in progressione • vulnerabile S.C. Angiologia Medica - Messina

  11. Placca carotidea a “rischio” o “instabile”(fino al 1992) • Placca che determina una stenosi > 70 % (anche se di ecostruttura omogenea) • Placca che determina una stenosi > 50%, disomogenea o con superficie microulcerata. • Placca macro-ulcerata • Placca emorragica De Fabritiis, Scondottoet al, 1988 S.C. Angiologia Medica - Messina

  12. Placca carotidea a “rischio” o “instabile”(2000) Superficie fortemente irregolare Capuccio fibroso sottile Presenza dicoreanecogeno ampio La percentuale di stenosi non è più rilevante J.WilletCerebrovascDis. 10 suppl. 5, 2000 S.C. Angiologia Medica - Messina

  13. Stroke. 2006;37:2696-2701 S.C. Angiologia Medica - Messina

  14. S.C. Angiologia Medica - Messina

  15. S.C. Angiologia Medica - Messina

  16. S.C. Angiologia Medica - Messina

  17. Placca carotidea “instabile” (2006-2007) Flogosi (la placca recentemente sintomatica presenta i nfiltrazioni di macrofagi e linfociti T) Neovascolarizzazione (contiene microvasi immaturi) Fattori plasmatici dell’angiogenesi e della flogosi nei pazienti sintomatici Infezione (cellule correlate alla presenza di sostanze batteriche o virali) Connessione fra infezione e placca sintomatica S.C. Angiologia Medica - Messina

  18. Placca carotidea “vulnerabile” (2012) “Susceptibilityof a plaquetorupturethuscausing a clinicalcardiovascularevent.” % stenosi > 70% pressione parietale/shear stress basso e incostante infiammazione/neovascolarizzazione cappuccio fibroso sottile fissurazione cappuccio fibroso denudazione endoteliale ampia presenza di lipidi S.C. Angiologia Medica - Messina

  19. Radiology 2009 251:2 583-9 S.C. Angiologia Medica - Messina

  20. Carotid Endarterectomy SYMPTOMATIC PATIENTS p = .045 p < .001 p < .001 S.C. Angiologia Medica - Messina

  21. CEA vs MEDICAL AsymptomaticStenosis p <0.01 p <0.001 ns p <0.01 S.C. Angiologia Medica - Messina

  22. S.C. Angiologia Medica - Messina

  23. S.C. Angiologia Medica - Messina

  24. Stroke. 2000;31:774-781 S.C. Angiologia Medica - Messina

  25. CMAJ • AUG. 31, 2004; 171 (5) S.C. Angiologia Medica - Messina

  26. S.C. Angiologia Medica - Messina

  27. Stroke. 2010;41:e11-e17. S.C. Angiologia Medica - Messina

  28. “I pazienti con una stenosi carotidea in progressione sono ad alto rischio per eventi maggiori alle coronarie ed alla circolazione periferica e cerebrale (MACE :IMA, Stroke, Amputazione, Morte)” “L’infiammazione al centro della disfunsione endoteliale e della crescita della placca” “Ripetuti controlli ECD dovrebbero essere eseguiti nei pazienti con placche e stenosi moderate alla ricerca di una malattia progressiva” S.C. Angiologia Medica - Messina

  29. Stroke. 2007;38:1470-1475. S.C. Angiologia Medica - Messina

  30. From: Screening for Carotid Artery Stenosis: U.S.Preventive Services Task Force Recommendation Statement S.C. Angiologia Medica - Messina

  31. Comment: The perceived effectiveness and cost-effectiveness of carotid duplex ultrasound surveillance programs should be questioned. The studyraises a significantquestion: Do carotid duplex surveillanceprogramsprimarily benefit physicians, vascular laboratories, or patients? The fact that 40% of the patients had only two duplex ultrasound scans performed during the surveillance period is a serious study limitation. Follow-up was, however, comparable to other studies in the literature and therefore the results likely can be generally applied to other practices. The personal and economic impact of stroke is huge, but this report still calls into serious question the use of limited health care resources to fund carotid duplex surveillanceprograms. Conclusion: Carotid duplex ultrasound surveillanceprograms are costly and inefficient. S.C. Angiologia Medica - Messina

  32. Despite these advances in understanding the pathophysiology of atherosclerotic plaque, the utility of morphological, pathological, and biochemical features in predicting the occurrence of TIA, stroke, or other symptomatic manifestations of ECVD has not been established clearly by prospective studies. S.C. Angiologia Medica - Messina

  33. S.C. Angiologia Medica - Messina

  34. S.C. Angiologia Medica - Messina

  35. S.C. Angiologia Medica - Messina

  36. Conceptually, the presence of a vulnerable plaque is, by definition, a probabilistic entity. It does not denote the occurrence of an event at present but rather a higher riskfor such occurrence in the future relative to a non vulnerable or less vulnerable plaque. As such, before it is widely adopted by clinicians, plaque vulnerability (ifvalidated) should be able to provide incremental predictive value on top of currently available methods of risk stratification, which may be less expensive and less invasive than the methods proposed to detect vulnerable plaques. S.C. Angiologia Medica - Messina

  37. Moreover, the complex implications of such a probabilistic diagnosis are exemplified in the observation that not all plaques that rupture (the basis for the classic definition of the term) actually result in a clinical cardiovascular event. Some plaques would rupture and then become quiescent and heal without causing a myocardial infarction or stroke (so called silent plaque rupture). Conversely, not all acute cardiovascular events are the result of plaque rupture because non ruptured plaques have been implicated as culprit lesions nearly one third of the time in autopsy series. S.C. Angiologia Medica - Messina

More Related