Kosmas I Paraskevas

Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England, United Kingdom

Are you Kosmas I Paraskevas?

Claim your profile

Publications (208)864.35 Total impact

  • Kosmas I Paraskevas · Mike J Phillips · Clifford P Shearman
    Angiology 07/2015; DOI:10.1177/0003319715597090 · 2.37 Impact Factor
  • Angiology 07/2015; DOI:10.1177/0003319715594932 · 2.37 Impact Factor
  • Kosmas I Paraskevas · Andrew N Nicolaides · Frank J Veith
    [Show abstract] [Hide abstract]
    ABSTRACT: Several guidelines recommend carotid endarterectomy for patients with severe asymptomatic carotid stenosis to reduce the risk of a future cerebrovascular event, as long as the perioperative stroke/death rate is <3%. Based on improvements in best medical treatment, it was argued that currently best medical treatment alone should comprise the treatment-of-choice for asymptomatic carotid stenosis patients and that no intervention is warranted in these individuals. While it is true that best medical treatment should be used for the management of all asymptomatic carotid stenosis patients, emerging evidence suggests that best medical treatment alone may not prevent disease progression and the development of symptoms in some asymptomatic carotid stenosis patient subgroups. This article analyzes the results of two recent independent studies demonstrating that medical therapy alone may not be adequate for stroke prevention in some asymptomatic carotid stenosis patient subgroups. These results suggest that besides best medical treatment, additional carotid endarterectomy should be considered for specific asymptomatic carotid stenosis patients.
    Vascular 11/2014; 23(1). DOI:10.1177/1708538114560463 · 1.00 Impact Factor
  • Kosmas I Paraskevas · J David Spence · Frank J Veith · Andrew N Nicolaides
    Stroke 10/2014; 45(12). DOI:10.1161/STROKEAHA.114.006912 · 6.02 Impact Factor
  • Kosmas I Paraskevas · Frank J Veith
    [Show abstract] [Hide abstract]
    ABSTRACT: According to the 2011, as well as the 2014 updated American Heart Association/American Stroke Association Guidelines, carotid artery stenting (CAS) is indicated as an alternative to carotid endarterectomy (CEA) for the management of symptomatic carotid patients. According to these recommendations, CAS is preferred over CEA in symptomatic patients with specific technical, anatomic or physiologic characteristics that render these individuals at "high risk" for surgery (e.g. contralateral carotid occlusion, previous neck irradiation, recurrent carotid stenosis, etc.). This article will present emerging data suggesting that most of these criteria do not comprise contraindications for CEA. In fact, CEA is associated with similar (or even better) outcomes compared with CAS in many such "high-risk" patients. Based on these results, the indications of CAS in symptomatic patients may need to be reconsidered.
    Annals of Vascular Surgery 10/2014; 29(1). DOI:10.1016/j.avsg.2014.08.010 · 1.03 Impact Factor
  • Edward M Mulkern · Kosmas I Paraskevas · Philip Chan
    [Show abstract] [Hide abstract]
    ABSTRACT: Experimental models of recovery from limb ischemia are required for evaluating novel means of treating ischemia. We describe a mouse model to assess gait after inducing limb ischemia. Gait analysis was performed using a Plexiglass tube, the floor of which contained load cells. Gait was measured in 20 mice; 10 underwent ligation of the right hind limb artery and the other 10 underwent a sham operation. The gait of the animals was measured at 1, 2, and 4 weeks following the procedure. In sham-operated animals, the gait showed no measurable change. In the ligated animals, the ratio of the right fore-to-hind limb changed from 1.07 at baseline to 1.4 at day 0 (P = .001), 1.16 (P = .012 compared with control), and 1.04 (P = .37 compared with control) at weeks 2 and 4, respectively. Gait returned to normal within 4 weeks of induction of ischemia. This model may be helpful in testing potential novel therapies.
    Angiology 09/2014; DOI:10.1177/0003319714553006 · 2.97 Impact Factor
  • Source
    Kosmas I Paraskevas · Dimitri P Mikhailidis · Frank J Veith
    [Show abstract] [Hide abstract]
    ABSTRACT: The authors declare that there is no conflict of interests regarding the publication of this paper.
    BioMed Research International 09/2014; 2014:930738. DOI:10.1155/2014/930738 · 2.71 Impact Factor
  • Kosmas I Paraskevas · Frank J Veith
    Journal of Vascular Surgery 09/2014; 60(3):837. DOI:10.1016/j.jvs.2014.05.045 · 2.98 Impact Factor
  • Source
    Kosmas I Paraskevas · Frank J Veith
    Angiology 08/2014; 66(7). DOI:10.1177/0003319714549370 · 2.37 Impact Factor
  • Kosmas I Paraskevas · Jonathan D Beard · Frank J Veith
    [Show abstract] [Hide abstract]
    ABSTRACT: With increasing carotid artery stenting (CAS) expertise and improved CAS equipment, recent trials have demonstrated better results for CAS compared with earlier studies. As a result, it may be argued that CAS is currently non-inferior to carotid endarterectomy (CEA), at least in some patient subgroups. Consequently, there have been recent calls for extending CAS indications to include average surgical risk patients with symptomatic or asymptomatic carotid stenosis. However, CAS remains a less cost-effective option than CEA. Opening the floodgates to unrestricted CAS for both symptomatic and asymptomatic carotid patients would have considerable cost implications for any health system. Appropriate patient selection and keeping to the indications are crucial to optimize CAS outcomes.
    Expert Review of Cardiovascular Therapy 07/2014; 12(7):783-6. DOI:10.1586/14779072.2014.921118
  • Source
    A D Giannoukas · K I Paraskevas · R Bulbulia · A Halliday
    European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery 04/2014; 48(1). DOI:10.1016/j.ejvs.2014.03.009 · 3.07 Impact Factor
  • Kosmas I Paraskevas · Wesley S Moore · Frank J Veith
    Journal of Endovascular Therapy 04/2014; 21(2):303-5. DOI:10.1583/13-4549C.1 · 3.59 Impact Factor
  • International journal of cardiology 03/2014; 173(3). DOI:10.1016/j.ijcard.2014.03.074 · 6.18 Impact Factor
  • Kosmas I Paraskevas · Anne L Abbott · Frank J Veith
    [Show abstract] [Hide abstract]
    ABSTRACT: The optimal management of patients with symptomatic and asymptomatic carotid artery stenosis remains a subject of extensive debate. Several international societies and associations have published guidelines for the management of carotid patients. Although these recommendations are based on the same randomized trials, differences in interpretation of available knowledge have often led to different (or even conflicting) recommendations. This special report summarizes the current evidence-based optimal management of patients with symptomatic and asymptomatic carotid stenosis and compares key international guidelines. Finally, issues requiring further research are identified and discussed.
    Expert Review of Cardiovascular Therapy 03/2014; DOI:10.1586/14779072.2014.893826
  • Kosmas I Paraskevas · Frank J Veith
    JAMA The Journal of the American Medical Association 02/2014; 311(5):526-7. DOI:10.1001/jama.2013.285160 · 30.39 Impact Factor
  • Kosmas I Paraskevas · Stylianos Koutsias · Athanasios D Giannoukas
    The American journal of cardiology 02/2014; 113(3):570-1. DOI:10.1016/j.amjcard.2013.11.002 · 3.43 Impact Factor
  • K I Paraskevas · D P Mikhailidis · A D Giannoukas
    [Show abstract] [Hide abstract]
    ABSTRACT: Dear Editor, Luo et al. (2014) reported that the combination of atorvastatin plus ezetimibe de-creased carotid intima media thickness (cIMT) significantly more than atorvastatin mono-therapy. We would like to add a few comments. The ENHANCE trial (Kastelein et al., 2008) did not compare the effect of atorvastatin plus ezetimibe versus atorvastatin monotherapy on cIMT, as mentioned by Luo et al. (2014). The statin used was simvastatin. As Luo et al. (2014) state, the cIMT in ENHANCE was set too low and could not be reduced further. There are other deficiencies in the ENHANCE trial; these are discussed by us in Paraskevas et al. (2011). Briefly, the latter article also comments on other trials that show that ezetimibe, used together with a statin, decreases cIMT. Furthermore, this article also considers evidence that atorvas-tatin 80 mg/day did not reduce the cIMT when compared with placebo (CASHMERE study), probably because the cIMT was too low (virtually identical to that in ENHANCE). How-ever, ENHANCE produced useful information. The C-reactive protein (CRP) level dropped significantly more in the simvastatin plus ezetimibe group compared with the simvastatin monotherapy group (Kastelein et al., 2008). The same pattern was reported by Luo et al. (2014), in which the fall in high sensitivity CRP (hsCRP) level was significantly greater in the atorvastatin plus ezetimibe group compared with the atorvastatin monotherapy group. Indeed as Luo et al. (2014) state, doubling the dose of a statin only results in about 6% further fall in low density lipoprotein cholesterol (LDL-C) levels. A meta-analysis by our group showed that adding ezetimibe to a statin results in an average 23.6% fall in LDL-C levels compared with statin monotherapy (Mikhailidis et al., 2007). This meta-analysis also showed that the addition of ezetimibe to a statin increased the fall in CRP levels. Another meta-analysis showed that adding ezetimibe to a statin is more effective than doubling the dose of the statin (Mikhailidis et al., 2011). Ezetimibe has several potentially useful actions other than altering the lipid pro-file (Lioudaki et al., 2011). However, it is difficult to assess the contribution of these effects on vascular risk. Other researchers, as well as our group, have observed that high triglyceride levels fall to a greater extent than low levels when ezetimibe is added to a statin (Gazi et al., 2007; Fras and Mikhailidis, 2008; Migdalis et al., 2009; Shigematsu et al., 2012). Therefore, it would be useful to know if the fall in triglyceride levels was greater in the atorvastatin plus ezetimibe group compared with the atorvastatin monotherapy group if only triglyceride levels ≥1.7 or ≥2.0 mM are considered in the Luo et al. (2014) study. Also, it would be interesting to know if Luo et al. (2014) performed kidney function tests, since there is some evidence that adding ezetimibe to a statin will improve that variable (Gazi et al., 2007; Migdalis et al., 2009). The debate about the evidence supporting the use of ezetimibe to reduce the risk of vascular events continues (Gouni-Berthold et al., 2012). However, the findings of Luo et al. (2014) further support the conclusion that the cIMT results of the ENHANCE trial should not be included in this debate. Secondly, it is relevant that several guidelines mention that the use of ezetimibe is appropriate if LDL-C targets are not reached by statin monotherapy (Catapano et al., 2011; Perk et al., 2012; Teramoto et al., 2013; Anderson et al., 2013; Wanner and Tonelli, 2014; IAS Position Paper, 2014). The recent dyslipidemia guidelines issued by the American College of Cardiology/American Heart Association (Stone et al., 2013) focus on statins and only briefly mentions other lipid lowering options (Mikhailidis et al., 2014).
    Genetics and molecular research: GMR 01/2014; 13(3):4805-7. DOI:10.4238/2014.July.2.10 · 0.85 Impact Factor
  • Source
    A.D. Giannoukas · K.I. Paraskevas · R. Bulbulia · A. Halliday
  • Anne L Abbott · Kosmas I Paraskevas · J David Spence
    [Show abstract] [Hide abstract]
    ABSTRACT: To the Editor: We are less certain than Grotta (Sept. 19 issue)(1) that the female patient with recently symptomatic internal-carotid-artery stenosis described in the case vignette of his Clinical Practice article should be treated with carotid endarterectomy or stenting. On the basis of a published risk-prediction model(2) (available at www.stroke.ox.ac.uk), her 5-year risk of recurrent ipsilateral stroke could be as high as 25% but is probably considerably lower. This model is based on data from large, randomized trials that enrolled patients from 1981 through 1996. These trials showed the benefit of early carotid endarterectomy over medical treatment alone in cases . . .
    New England Journal of Medicine 12/2013; 369(24):2359-2361. DOI:10.1056/NEJMc1312990#SA2 · 54.42 Impact Factor
  • Kosmas I Paraskevas · Andrew N Nicolaides · Dimitri P Mikhailidis
    Angiology 10/2013; 64(7):489-91. DOI:10.1177/0003319712467493 · 2.37 Impact Factor

Publication Stats

1k Citations
864.35 Total Impact Points

Top co-authors View all


  • 2014
    • Sheffield Teaching Hospitals NHS Foundation Trust
      Sheffield, England, United Kingdom
  • 2013–2014
    • General University Hospital of Larissa
      Lárissa, Thessaly, Greece
  • 2008–2013
    • Red Cross Hospital, Athens
      Athínai, Attica, Greece
    • Royal Free Academy of PMC
      Londinium, England, United Kingdom
    • University College London
      • Division of Medicine
      London, ENG, United Kingdom
    • University of London
      Londinium, England, United Kingdom
  • 2007–2013
    • Royal Free London NHS Foundation Trust
      • Department of Clinical Biochemistry
      Londinium, England, United Kingdom
    • WWF United Kingdom
      Londinium, England, United Kingdom
  • 2006–2013
    • Κωνσταντοπούλειο νοσοκομείο Νέας Ιωνίας (Η Αγία Όλγα)
      Athínai, Attica, Greece
  • 2012
    • Central Manchester University Hospitals NHS Foundation Trust
      Manchester, England, United Kingdom
  • 2011
    • Hellenic Air Force
      Athínai, Attica, Greece
  • 2010
    • National and Kapodistrian University of Athens
      • Department of Medicine
      Athínai, Attica, Greece
  • 2008–2010
    • Harokopion University of Athens
      Athínai, Attica, Greece
  • 2009
    • Red Cross
      Washington, Washington, D.C., United States
  • 2003–2006
    • University of Pécs
      Fuenfkirchen, Baranya county, Hungary