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Stroke 1989;20: 844-849. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study (ACAS). Study II. 1. Major epidemiologists from the UK, USA and Europe contribute to the first ever, much needed comprehensive review of the epidemiology of peripheral vascular disease in the lower limbs. In the Framingham Study, the prevalence of significant (50%) carotid stenosis determined by duplex ultrasound in patients >65 years of age was 7% in women and 9% in men. asymptomatic carotid atherosclerosis. We hope this book serves as a reference for basic and advanced peripheral vascular care. Asymptomatic Carotid Atherosclerosis Study - How is Asymptomatic Carotid Atherosclerosis Study abbreviated? Carotid atherosclerosis (CAS) is a complex disease [ 1 ], which reflects cerebral atherosclerosis to a certain extent and can trigger ischemic stroke. While the NASCETtrial showed the benefit of CEA for patients symptomatic from carotid artery stenosis, the Asymptomatic Carotid Atherosclerosis Study (ACAS) trial sought to Following publication of ACAS, endarterectomy rates have dramatically increased in Florida [Stroke 1998; 29:1099-105] and in the Veterans Administration hospital system [Archives of Surgery 1997; 132:1134-9. Halliday A, Harrison M, Hayter E, Kong X, Mansfield A, Marro J, et al. c. Carotid revascularization endarterectomy versus stenting trial (NCT00004732). The primary endpoint was the composite of major adverse cardiac events (MACE) (cardiovascular death, myocardial infarction, and ischemic stroke). This test has good sensitivity and specificity.. Disorders that would seriously complicate surgery Found inside Page 159Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. Endarterectomy for asymptomatic carotid artery stenosis. Executive Committee for the With carotid plaques collected from participants of the North American Symptomatic Carotid Endarterectomy Trial (NASCET) and the Asymptomatic Carotid Atherosclerosis Study (ACAS) trials (71 symptomatic, 170 asymptomatic), Fisher et al. Two earlier randomised trials, Asymptomatic Carotid Atherosclerosis Study, from 1995, and the Veterans Affairs Cooperative Study, from 1993, had also reported a significant reduction in stroke risk by CEA and best medical therapy in comparison with best medical therapy alone. Knowing that a condition is asymptomatic is important because: It may develop symptoms later and only then require treatment. Recently, observational studies have assessed carotid atherosclerosis features in asymptomatic and symptomatic patients and their correlations with risk factors (RF) for The purpose of the study was to test whether treatment with febuxostat delays carotid intima-media thickness (IMT) progression in patients with asymptomatic hyperuricemia. Examination revealed prominent arcus lipoides (Figure 1A), crocodile shagreen (Figure 1B), mild cataract 5. American Journal of Cardiology, Vol.121, No.8, p949-955 Compatible history and findings on physical and neurological examinations Found inside Page 13Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. Endarterectomy for asymptomatic carotid artery stenosis. JAMA 1995; 273: 1421-8. Hypothesis. Our doctors define difficult medical language in easy-to-understand explanations of Found inside Page 1006women with either asymptomatic or moderate (50%69%) symptomatic carotid artery The Asymptomatic Carotid Atherosclerosis Study (ACAS) found that CEA Background and purpose: We sought to determine the incidence of recurrent carotid stenosis in patients in the Asymptomatic Carotid Atherosclerosis Study (ACAS) who had undergone carotid endarterectomy and were prospectively followed with Doppler ultrasound for up to 5 years. 1996 Dec. 27 (12):2216-24. . Comparisons were made according to the cIMT measurement (mean, maximum), carotid plaque evaluation (presence or area), and CAC scoring. Luca Scotti. Asymptomatic Carotid Atherosclerosis Study, Adolescent Medicine Trials Network for HIV/AIDS Interventions, Hispanic Community Health Study / Study of Latinos, Medical Optimization of Management of Type 2 Diabetes Complicating Pregnancy, Precision Interventions for Severe and/or Exacerbation-Prone Asthma Network (PrecISE), Periodontal treatment to Eliminate Minority Inequality and Rural disparities in Stroke, Predicting Responses to Standardized Pediatric Colitis Therapy, Subpopulations and Intermediate Outcome Measures in COPD Study. Found inside Page 415Executive Committee for the Asymptomatic Carotid Atherosclerosis Study (1995). Endarterectomy for asymptomatic carotid artery stenosis. JAMA 273, 14218. The BioImage Study (A Clinical Study of Burden of Atherosclerotic Disease in an At-Risk Population) sought to identify imaging biomarkers that predict near-term (3-year) atherothrombotic events. Circ Cardiovasc Imaging. 2015 Mar 24;65(11):1075-7. doi: 10.1016/j.jacc.2015.01.016. The ACAS and ACST trials randomized participants with 60% to 99% stenosis to CEA or aspirin. Relative Prognostic Value of Cardiac Troponin I and C-Reactive Protein in the General Population (from the Nord-Trndelag Health [HUNT] Study) Sigurdardottir et al. Found inside Page 179A ACA (anterior cerebral artery), 6 ACAS (Asymptomatic Carotid Atherosclerosis Study), 1, 19, 40, 47, 50, 80, 108, 112113 Acoustic shadowing, Found inside Page 28Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. Endarterectomy for asymptomatic carotid artery stenosis. JAMA 1995;273: 14211461. Again, best medical therapy at the time was aspirin. Europe PMC is an archive of life sciences journal literature. Patients Screened: 42,000Patients Enrolled: 1,662NYHA Class: Not givenMean Follow Up: 2.7 yearsMean Patient Age: 67Female: 36Mean Ejection Fraction: Not given. Found inside Page 185 Bornstein NM, Chambers BR: Vascular risks of asymptomatic carotid stenosis. clinical stroke: the Atherosclerosis Risk in Communities (ARIC) Study. This site needs JavaScript to work properly. It may resolve itself or become benign. Background:Atherosclerosis is a systemic inflammatory disease intertwined with neovascularisation. Dynamic contrast-enhanced magnetic resonance (DCE-MR) imaging enables assessment of plaque neovascularisation. Ultrasound detection of carotid plaque and carotid intimal-medial thickness (IMT) in asymptomatic patients is often related to advanced subclinical atherosclerosis, a risk of cardiovascular death and/or myocardial infarction (4,5). Accessibility Plaque areas from both carotid arteries were summed as the carotid plaque burden (cPB). Any stroke and perioperative death Atherosclerosis is by far the most frequent underlying cause of coronary artery disease, carotid artery disease, and peripheral arterial disease. One did not include stenosis exceeding 90% [CASSANOVA, Stroke 1991; 22:1229-1235], another was terminated early because of excess cardiac events [Mayo Clin Proc 1992; 67:513-8]. This well-illustrated text reviews the current state of knowledge with regard to the various anatomic and physiologic methods available to identify asymptomatic patients who are at high risk to develop a future stroke. Like the subsequent and larger Asymptomatic Carotid Atherosclerosis Study (ACAS, n = 1662, age 4079 years), patients were randomized to carotid endarterectomy (CEA) or medical management with aspirin ( Executive Committee for the Asymptomatic Carotid Atherosclerosis Study, 1995 ). We expect that asymptomatic patients with carotid atherosclerosis with characteristics of vulnerability of the plaque can develop atrophy of the total brain volume or/and grey matter volume along the timeframe of the study. Published on behalf of American Journal of Hypertension, Ltd., the American Journal of Hypertension (AJH) is a monthly, peer-reviewed journal that provides a forum for scientific inquiry of the highest standards in the field of The BioImage Study enrolled 5,808 asymptomatic U.S. adults (mean age: 69 years, 56.5% female) in a prospective cohort evaluating the role of vascular imaging on cardiovascular risk prediction. The unique haemodynamics at the carotid bifurcation predisposes this area to atherosclerosis. Found inside Page ivThe text focuses on accurate, yet underutilized, measures of subclinical atherosclerosis, notably coronary artery calcium scanning and carotid intima-media thickness measurement. The prediction of asymptomatic carotid atherosclerosis with electronic health records: a comparative study of six machine learning models Jiaxin Fan1, Mengying Chen1, Jian Luo2, Shusen Yang 3, Jinming Shi1, Qingling Yao 1, Xiaodong Zhang1, Shuang Du1, Huiyang Qu1, Yuxuan Cheng 1, Shuyin Ma1, Meijuan Zhang1, Xi Xu1, Qian Wang 4 and Shuqin Zhan1* 2018 Sep 1;19(9):1042-1050. doi: 10.1093/ehjci/jex239. JAMA. Like the first edition, this new edition of A History of Vascular Surgery paints engaging portraits of the surgeons and scientists whose ideas and practices underlie, and continue to influence, vascular surgery as we know it today. The Asymptomatic Carotid Atherosclerosis Study Group Asymptomatic Carotid Surgery Trial 845 ognized symptoms that might have occurred during sleep or periods of impaired alertness, when transi-tory neurologic deficits could be ignored or forgot-ten. The aim of this study is to compare plasma concentrations of these carotenoids in subjects with or without ultrasonic . b Asymptomatic carotid surgery trial. based observational study which examined the epidemiology of asymptomatic polyvascular abnormalities in Chinese adults [9,10]. Carotid Artery DiseasesAdvances in Research and Treatment: 2012 Edition is a ScholarlyBrief that delivers timely, authoritative, comprehensive, and specialized information about Carotid Artery Diseases in a concise format. Asymptomatic Carotid Stenosis and Risk of Stroke (ACSRS) Study Group. Stroke 1994; 25: 1122-1129 Baseline silent cerebral infarction Zhang Y, Guallar E, Qiao Y, Wasserman BA. This study aims to identify the diagnostic potential of microRNA-19a-3p (miR-19a-3p) for asymptomatic carotid artery stenosis (CAS) and clinical predictive potential for cerebral ischemia events (CIEs). We expect that asymptomatic patients with carotid atherosclerosis with characteristics of vulnerability of the plaque can develop atrophy of the total brain volume or/and grey matter volume along the timeframe of the study. The Asymptomatic Carotid Trial (ACT I), published in 2016, enrolled over 1400 asymptomatic patients who were not high risk and were randomized to stenting with embolic protection or carotid endarterectomy. Although recent studies suggest that measuring coronary artery calcification (CAC) may be superior to indirect atherosclerotic markers in predicting cardiac risk, there are limited data evaluating imaging-based biomarkers that directly quantify atherosclerosis in different vascular beds performed in a single cohort. Another study on asymptomatic patients with carotid stenosis is the Asymptomatic Carotid Atherosclerosis Study (ACAS). In addition, the Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST) trial enrolled both symptomatic and asymptomatic patients. Asymptomatic Carotid Atherosclerosis Study. A thorough procedural guide covering applications of neurosonology to diagnosis, monitoring of cerebrovascular and other neurological diseases. J Vasc Surg 1989; 9:548. Accessible handbook covering the investigation, diagnosis and management of transient ischemic attacks and minor strokes. Epub 2014 Apr 24. The Asymptomatic Carotid Atherosclerosis Study (ACAS) established that the long-term risk of ipsilateral stroke in neurologically asymptomatic patients with a $60% carotid stenosis was reduced by carotid endarterectomy. Asymptomatic atherosclerosis is a common entity even at young age. ASYMPTOMATIC CAROTID ARTERY STENOSIS. Carotid stenosis is a narrowing of the carotid arteries, the two major arteries that carry oxygen-rich blood from the heart to the brain. Accessibility and willingness to be followed for 5 years Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Pulmonary Hypertension and Venous Thromboembolism, CardioSource Plus for Institutions and Practices, Annual Scientific Session and Related Events, ACC Quality Improvement for Institutions Program, National Cardiovascular Data Registry (NCDR). Carotid endarterectomy (CEA) was compared with medical therapy in ACS patients in two large randomized trials a North American study published in 1995 (JW Gen Med May 16 1995) 1 and a European trial published in 2004 (JW Gen Med May 21 2004). a Asymptomatic carotid atherosclerosis study. The rate was much higher than 3.5% per annum rate in the Asymptomatic Carotid Atherosclerosis Study (ACAS), which recruited patients in 1995. 17. Lu Y, Dimitrov L, Chen SH, Bielak LF, Bis JC, Feitosa MF, Lu L, Kavousi M, Raffield LM, Smith AV, Wang L, Weiss S, Yao J, Zhu J, Gudmundsson EF, Gudmundsdottir V, Bos D, Ghanbari M, Ikram MA, Hwang SJ, Taylor KD, Budoff MJ, Gslason GK, O'Donnell CJ, An P, Franceschini N, Freedman BI, Fu YP, Guo X, Heiss G, Kardia SLR, Wilson JG, Langefeld CD, Schminke U, Uitterlinden AG, Lange LA, Peyser PA, Gudnason VG, Psaty BM, Rotter JI, Bowden DW, Ng MCY. Found inside Page 394The effect of hemodynamically significant carotid artery disease on the Executive Committee for the Asymptomatic Carotid Atherosclerosis Study . Results: Copyright 2015 American College of Cardiology Foundation. Keywords: Four other randomized prospective studies of carotid endarterectomy for asymptomatic carotid artery stenosis have been reported. BACKGROUND AND PURPOSE: The progression of atherosclerosis is related to various factors. Objectives: Circ Genom Precis Med. Curr Atheroscler Rep. 2021 Jun 19;23(8):44. doi: 10.1007/s11883-021-00943-2. Citation: Zhang L, Zhou Q, Shao LH, Wen J and Xia J (2021) Association of Carotid Atherosclerosis With White Matter Hyperintensity in an Asymptomatic Japanese Population: A Cross-Sectional Study. Endarterectomy Definition Endarterectomy is an operation to remove or bypass the fatty deposits, or blockage, in an artery narrowed by the buildup of fatty tissue (atherosclerosis). Carotid plaque thickness and carotid plaque burden predict future cardiovascular events in asymptomatic adult Americans. CAROTENOIDS AND ASYMPTOMATIC CAROTID ATHEROSCLEROSIS. d. Carotid revascularization and medical management for asymptomatic carotid stenosis (NCT02089217). Plaque echolucency and stroke risk in asymptomatic carotid stenosis: a systematic review and meta-analysis. Download PDF. Background and Purpose To determine the effect of a lipid-lowering agent and/or a low-dose antithrombotic agent on the progression of early-stage carotid atherosclerosis, noninvasive B-mode ultrasound was used to measure intimal-medial thickness in asymptomatic individuals with moderately elevated lipids as part of the ongoing multicenter Asymptomatic Carotid Artery Plaque Study. Found inside Page 279Recurrent carotid stenosis: results of the asymptomatic carotid atherosclerosis study. Stroke 1998; 29: 20182025. 30. Spagnoli LG, Mauriello A, It is principally a lipid-driven process initiated by the accumulation of low-density lipoprotein and remnant lipoprotein particles and an active inflammatory process in focal areas of arteries particularly at regions of ACAS - Asymptomatic Carotid Atherosclerosis Study. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomized controlled trial. Carotid endarterectomy for asymptomatic people was studied in the Asymptomatic Carotid Atherosclerosis Study (ACAS) and the Asymptomatic Carotid Surgery Trial (ACST). You now have a source you can cite with authority, confidence, and credibility. More information is available at http://www.ScholarlyEditions.com/. Atherosclerotic plaque in the cervical carotid artery is the most common cause. Current State and Future Directions. 2. Initially defined as TIA or infarction in the distribution of the study artery and any TIA, stroke, or death in the perioperative period. Asymptomatic Carotid Atherosclerosis Study. Found inside Page 60Asymptomatic carotid bruit and risk of stroke : the Framingham study . Atherosclerotic disease of the aortic arch and the risk of ischemic stroke . CONCLUSION: Patients with asymptomatic carotid artery stenosis of 60% or greater reduction in diameter and whose general health makes them good candidates for elective surgery will have a About the Journal. The prevalence of atherosclerotic plaques was high (25%), while the prevalence of >50% The study found that during five-year follow-up stenting was not inferior to surgery for post-procedure stroke or mortality. ACAS: Asymptomatic Carotid Atherosclerosis Study. ; It may be contagious, and the contribution of asymptomatic and pre-symptomatic infections to the transmission level of a disease helps set the required control measures to keep it from Second asymptomatic carotid surgery trial (ACST-2): a randomised comparison of carotid artery stenting versus carotid endarterectomy - The Lancet This paper. Stroke 1996; 27:1951-7 Doppler ultrasound as screening tool Abe Y, Rundek T, Sciacca RR, Jin Z, Sacco RL, Homma S, Di Tullio MR. 2021 Jun 18. doi: 10.1007/s00394-021-02611-2. Three treatment groups were formed. Langsfeld M, Gray-Weale AC, Lusby RJ. 35. Found insideThis book covers all aspects and the most vibrant topics of ischemic stroke research: from basic sciences to latest methods of clinical applications. PMC Circulation 2002; 106: 2422-7 18. We recruited patients with asymptomatic carotid atherosclerosis (US stenosis > 30%, ECST criteria), receiving medical treatments at a tertiary cardiac rehabilitation. For the primary endpoint of ipsilateral stroke and any perioperative stroke or death, the survival curves cross near 10 months and become significantly reduced in the surgical group by 3 years (p < 0.05). Giannoukas AD, Chabok M, Spanos K, Nicolaides A. Eur J Vasc Endovasc Surg. Arterioscler Thromb Vasc Biol. Invasive Cardiovascular Angiography and Intervention, Guest Editorial | ACC Chapters and Sections: Collaborating to Enhance Member Value, Cover Story | ACC: OutFront For Cardiovascular Clinicians Worldwide, Feature | The HeartBeet Clinic: A Plant-Forward Pilot Experience, Business of Medicine | MedAxiom Report: 2021 CV Provider Compensation, Production Survey, Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Pulmonary Hypertension and Venous Thromboembolism. 6. Offering routine carotid endarterectomy (CEA) or carotid artery stenting (CAS) to patients with asymptomatic carotid artery stenosis (ACS) is no longer considered as the optimal management of these patients. The reduction in 5-year ipsilateral stroke risk in the surgical group was 53% of the estimated 5-year risk in the medical group (95% CI, 22% to 72%), p = 0.004. Background: All had asymptomatic atherosclerosis of either the carotid artery or the femoral artery (which provides blood to the leg). Neurology 1997; 48:346-51 Validation of ACAS TIA/stroke algorithm General Exclusion Criteria. Found inside Page 340Executive Committee for the Asymptomatic Carotid Atherosclerosis Study Group. Endarterectomy for asymptomatic carotid artery stenosis. 2015 Mar 24;65(11):1065-74. doi: 10.1016/j.jacc.2015.01.017. Subgroup analysis by gender showed no statistically significant difference between genders, although the 5-year event rate reduction was greater for men (66%, 95% CI, 36% to 82%) than for women (17%, 95% CI, -96% to 65%). An analysis of perioperative surgical mortality and morbidity in the asymptomatic carotid atherosclerosis study. doi: 10.1161/CIRCIMAGING.114.002262. Importance. A possible association between body iron stores, measured as serum ferritin, and carotid arterial intimamedia thickening was investigated in the Atherosclerosis Risk in Communities Study during 1990-1992 using a matched case-control design. Looking for abbreviations of ACAS? The In cost-effectiveness analyses, surgical treatment improved quality-adjusted life expectancy from 7.82 to 8.12 QUALYs, at an incremental lifetime cost of $2041. Over a median follow-up of 2.7 years, MACE occurred in 216 patients (4.2%), of which 82 (1.5%) were primary events. Endarterectomy Versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis (EVA-3S) trial: results up to 4 years from a randomised, multicentre trial. Unilateral or bilateral surgically accessible stenosis of the common or internal carotid artery of at least 60% by arteriography; Doppler exam with velocity greater than instrument-specific cut point with 95% PPV; or Doppler exam with velocity greater than instrument-specific cut point with 90% PPV confirmed by ocular pneumoplethysmographic exam. In support of this contention are the recent findings that as many as 4% of patients with carotid Carotid artery sclerosis is usually seen in the elderly and more commonly in males. Found insideAsymptomatic Carotid Atherosclerosis Study Group. Study design for randomized prospective trialofcarotid endarterectomy for asymptomatic atherosclerosis. Found insideAtherosclerosis is a subject of enormous contention for cardiologists and in general for all medical doctors. With this publication we have given you a concise "state-of-the-art" look at the world of atheroma. J Am Coll Cardiol. Carotid artery stenosis is a narrowing of the lumen of the carotid artery. We therefore investigated whether treatment with febuxostat, a non-purine selective inhibitor of XO, delayed the progression of carotid atherosclerosis compared to non-pharmacological care for hyperuricemia in this patient population. The APAC has been described in detail recently [9,10]. This handbook supplements hands-on training in interventional cardiology with a specific focus on percutaneous intervention in patients with extracranial carotid artery stenosis. JAMA. JAMA 1995; 273:1421-8 Primary results Stroke 1989; 20: 844-849 Study design and organization 8% of the 27 808 participants aged >50 years [Rothwell P, personal communication]), in whom asymptomatic arteries, not truly asymptomatic carotid stenosis were evaluated. Detection of subclinical carotid or coronary atherosclerosis improves risk predictions and reclassification compared with conventional risk factors, with comparable results for either modality. Luca Scotti. de Virgilio C, Toosie K, Arnell T, Lewis RJ, Donayre CE, Baker JD, et al. Online ahead of print. No relevant medical or family history were reported and the visual acuities and intraocular pressures were within normal limits bilaterally. The European Asymptomatic Carotid Surgery Trial is ongoing [ Eur J Vasc Surg 1994; 8:703-10]. Study IV: We have meta-analyzed ten cohort prospective studies evaluating carotid plaque echogenicity for cerebrovascular symptoms prediction. The two randomized controlled studies mostly referenced on the subject of asymptomatic carotid stenosis are the Asymptomatic Carotid Atherosclerosis Study (ACAS) with 1662 and the Asymptomatic Carotid Surgery Trial (ACST) with 3120 patients [5, 6]. Eur J Nutr. CREST -2 is a study for people who have narrowing of their carotid artery, without stroke warning signs caused by that artery such as mini-strokes, temporary strokes called TIAs, temporary paralysis or numbness on one side of the body, temporary slurring of speech, or other temporary brain symptoms This is a cross-sectional interim analysis (August 2013September 2016) of a single center prospective study on carotid plaque vulnerability (MAGNETIC study). A broader secondary MACE endpoint also included all-cause death, unstable angina, and coronary revascularization. 9. Ultrasound is the primary modality used to screen for the presence of carotid stenosis. Serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of these two carotid artery procedures on fatal or disabling stroke are comparable. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Silent infarction among the ACAS patients is not uncommon, but rarely sizable, and of unknown clinical significance. This article summarizes the conclusions from available studies on the effects of carotid reperfusion procedures on cognitive function. The atherosclerotic process usually originates early in life and the condition remains asymptomatic for several decades. GILLINGS SCHOOL OF GLOBAL PUBLIC HEALTH | DEPARTMENT OF BIOSTATISTICS Found inside Page 17An analysis of perioperative surgical mortality and morbidity in the asymptomatic carotid atherosclerosis study . ACAS Investigators . Asymptomatic Carotid Also called carotid artery disease, carotid stenosis is caused by a buildup of plaque (atherosclerosis) inside the Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. Gupta A, Kesavabhotla K, Baradaran H, et al. MeSH 4 A total of 1,662 patients were randomized to CEA or medical therapy. Any ipsilateral TIA or stroke First, the 22% randomization rate was comparable to or better than other randomized trials, such as the North American Symptomatic Carotid Endarterectomy The aim of this study is to compare plasma concentrations of these carotenoids in subjects with or without ultrasonic . Materials and Methods: We prospectively recruited 1500 individuals who were older than 40 years and asymptomatic for Aim: To investigate the prevalence of ACAS in the Indian population, and to correlate ACAS with other vascular risk factors. Screening for Asymptomatic Carotid Plaques with Ultrasound. Carotid revascularization may lead to improved cognitive function beyond stroke prevention. CVD event rates, hazard ratios (HR), net reclassification index (NRI), and c-statistic of the markers were compared. Prevalence, impact, and predictive value of detecting subclinical coronary and carotid atherosclerosis in asymptomatic adults: the BioImage study J Am Coll Cardiol . Is There a Role of Coronary CTA in Primary Prevention? Background: Asymptomatic carotid artery stenosis (ACAS) is a marker for cerebrovascular disease, coronary atherosclerosis, and death. Carotid revascularization for primary prevention of stroke (CREST-2) is two independent multicenter, randomized controlled trials of carotid revascularization and intensive medical management versus medical management alone in patients with asymptomatic high-grade carotid stenosis. Found inside Page ivThis text is designed to be a comprehensive and state-of-the art approach in managing straight forward to complex arterial reconstructions. Sections will focus on carotid/vertebral anatomy, physiology, diagnostic modalities. A broader secondary MACE endpoint also included all-cause death, unstable angina, and c-statistic of the markers were.. Either asymptomatic or moderate ( 50 % 69 % ) symptomatic carotid endarterectomy for asymptomatic atherosclerosis anatomy. 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