Surrogate Outcome Markers and Cerebral Haemodynamics in Carotid Interventions

Abstract

In this thesis, various aspects of diagnostics and treatment for patients with carotid artery disease are described. We mainly focused on how individualized assessments of both procedural risks as well as potential advantages of surgical treatment of the carotid artery can assist in patient selection. Patients with a narrowing of the carotid artery have an increased risk of stroke. Treatment of the carotid artery by surgical intervention (atherosclerotic plaque removal) or endovascular stenting has proven to be effective in reduction of stroke risk. However, as a result of improvement in amongst others lifestyle counseling and medical therapy, risk of stroke as a result of cardiovascular disease has gradually decreased. Consequently, in a subset of patients, optimal treatment strategy is currently unclear and effectivity of changes in diagnostic and therapeutic strategy are difficult to assess. In this thesis we demonstrated that employment of so-called surrogate outcome markers based on imaging modalities (MR and/or CT) can be useful for determination of short- and long-term outcome of patient with carotid artery stenosis. We demonstrated that new imaging modalities can assists in identification of patients that can benefit more (or less) from an invasive procedure. An accurate consideration of risk factors as well as the potential benefits of such a procedure can contribute in planning individualized treatment strategies for patients with carotid artery stenosis.