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urgent carotid endarterectomy

Yuji Matsumaru, Eiichi Ishikawa, Tetsuya Yamamoto, Akira Matsumura
The efficacy of mechanical thrombectomy with stent retrievers for emergent large vessel occlusion has been proved by randomized trials. Mechanical thrombectomy is increasingly being adopted in Japan since stent retrievers were first approved in 2014. An urgent clinical task is to offer structured systems of care to provide this treatment in a timely fashion to all patients with emergent large vessel occlusion. Treatment with flow-diverting stents is currently a preferred treatment option worldwide for large and giant unruptured aneurysms...
May 1, 2017: Neurologia Medico-chirurgica
Gabriele Piffaretti, Antonino Tarallo, Marco Franchin, Alessandro Bacuzzi, Nicola Rivolta, Massimo Ferrario, Stefania Ferraro, Matteo Bossi, Patrizio Castelli, Matteo Tozzi
OBJECTIVES: To analyze the predictors and describe the outcomes of cross-clamp intolerance (CCI), and the results of the use of carotid endarterectomy (CEA) with shunting or a shift strategy to immediate carotid artery stenting (CAS) in this setting. MATERIALS AND METHODS: Between January 2008 and December 2015, 385 patients were elected for single sided, isolated CEA under loco-regional anesthesia. In case of CCI, CEA with shunt was used selectively, whereas indication to immediate conversion to CAS was the immediate onset and severe persistent deterioration of the neurologic status, and/or local technical difficulties to perform endarterectomy...
April 4, 2017: Annals of Vascular Surgery
Stefano Forlivesi, Elia Pancheri, Giuseppe Moretto, Paolo Bovi, Manuel Cappellari
The most effective treatment of patients with stroke due to tandem occlusion is still unclear. We report the case of a man with stroke due to tandem internal carotid artery/middle cerebral artery occlusion, who underwent initially ineffective intravenous thrombolysis (IVT) and endovascular treatment. Early anticoagulation with apixaban was started after 48 h of IVT, given a newly diagnosed nonvalvular atrial fibrillation. Spontaneous partial recanalization of the cervical internal carotid artery was noted, and carotid endarterectomy was performed 72 h after IVT and 8 h after the last dose of apixaban...
March 17, 2017: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
Joseph R Schneider, Cheryl R Jackson, Irene B Helenowski, Michael J Verta, Julia B Wilkinson, Stanley Kim, Andrew W Hoel
OBJECTIVE: Carotid endarterectomy (CEA) reduces stroke risk in selected patients. However, CEA risk profile may be different in older patients. We compared characteristics and outcomes of octogenarians and nonagenarians with those of younger patients. METHODS: Deidentified data from CEA patients were obtained from the Society for Vascular Surgery Vascular Quality Initiative (VQI) database. Prior CEA, carotid artery stent, or combined CEA and coronary artery bypass were excluded, yielding 7390 CEAs in octogenarians and nonagenarians (≥80 years of age) and 35,303 CEAs in younger patients (<80 years of age)...
June 2017: Journal of Vascular Surgery
Ryu Fukumitsu, Kazumichi Yoshida, Yoshitaka Kurosaki, Koichi Torihashi, Nobutake Sadamasa, Masaomi Koyanagi, Osamu Narumi, Tsukasa Sato, Masaki Chin, Akira Handa, Sen Yamagata, Susumu Miyamoto
OBJECTIVE: Although carotid artery stenting (CAS) has been gaining popularity as an alternative to carotid endarterectomy (CEA), perioperative stroke rate following contemporary CAS remains significantly higher than stroke rate after CEA. The purpose of this study was to assess perioperative (within 30 days) therapeutic results in patients with carotid stenosis (CS) after introduction of preoperative carotid magnetic resonance imaging plaque evaluation in a single center performing both CEA and CAS...
May 2017: World Neurosurgery
J D Kakisis, C N Antonopoulos, G Mantas, K G Moulakakis, G Sfyroeras, G Geroulakos
OBJECTIVE/BACKGROUND: Τo review the incidence of post-carotid endarterectomy (CEA) cranial nerve injury (CNI), and to evaluate the risk factors associated with increased CNI risk. METHODS: The study was a meta-analysis. Pooled rates with 95% confidence intervals (CIs) were calculated for CNIs after primary CEA. Odds ratios (ORs) were calculated for potential risk factors. A fixed-effects model or a random effects model (Mantel-Haenszel method) was used for non-heterogeneous and heterogeneous data, respectively...
January 21, 2017: European Journal of Vascular and Endovascular Surgery
Kosmas I Paraskevas, Frank J Veith, Dimitri P Mikhailidis, Christos D Liapis
The identification/selection of appropriate patient subgroups with asymptomatic carotid artery stenosis and the performance of prophylactic carotid endarterectomy (CEA)/carotid artery stenting (CAS) exclusively on these asymptomatic patient subgroups is currently one of the "hottest" topics in vascular surgery. It is now clear that offering CEA/CAS to asymptomatic carotid patients based only on the degree of carotid stenosis is unjustified and scientifically flawed. On the other hand, offering only best medical therapy to every asymptomatic patient, irrespective of certain high-risk criteria (such as the detection of microemboli by transcranial Doppler, intraplaque hemorrhage, silent embolic infarcts on brain computed tomography/magnetic resonance imaging, elevated biomarkers, family history), is equally wrong...
January 1, 2017: Angiology
Seemant Chaturvedi, Marc Chimowitz, Robert D Brown, Brajesh K Lal, James F Meschia
Asymptomatic extracranial internal carotid artery atherosclerotic stenosis increases with age and is more common in men. Studies performed more than 2 decades ago showed that carotid endarterectomy reduced the rate of stroke in carefully selected patients with asymptomatic carotid stenosis compared with medical therapy in the long term. Those trials were completed more than 20 years ago and with advances in the treatment of atherosclerotic disease, the question has been raised to as to whether endarterectomy is still of value for patients with asymptomatic narrowing...
November 22, 2016: Neurology
Sophia Gocan, Aline Bourgoin, Dylan Blacquiere, Rany Shamloul, Dar Dowlatshahi, Grant Stotts
BACKGROUND: For optimal stroke prevention, best practices guidelines recommend carotid endarterectomy (CEA) for symptomatic patients within two weeks; however, 2013 Ontario data indicated that only 9% of eligible patients from outpatient Stroke Prevention Clinics (SPCs) achieved this target. The goal of our study was to identify modifiable system factors that could enhance the quality and timeliness of care among patients needing urgent CEA. METHODS: We conducted a retrospective chart review of transient ischemic attack/stroke patients assessed in Champlain Local Health Integrated Network SPCs between 2011 and 2014 who subsequently underwent CEA...
September 2016: Canadian Journal of Neurological Sciences. le Journal Canadien des Sciences Neurologiques
Ian M Loftus, Kosmas I Paraskevas, A Ross Naylor
No abstract text is available yet for this article.
August 16, 2016: Angiology
M K Salem, H Z Butt, E Choke, D Moore, K West, T G Robinson, R D Sayers, A R Naylor, M J Bown
OBJECTIVE/BACKGROUND: The aim was to investigate the expression of genes associated with carotid plaque instability and their protein products at a local and systemic level. METHODS: Carotid plaques from 24 patients undergoing carotid endarterectomy (CEA) were classified as stable or unstable using clinical, histological, ultrasound, and transcranial Doppler criteria, and compared using whole genome microarray chips. Initial results of differentially expressed genes were validated by quantitative reverse transcriptase polymerase chain reaction in an independent group of 96 patients undergoing CEA...
October 2016: European Journal of Vascular and Endovascular Surgery
Felix C Ng, Mineesh Datta, Philip M C Choi
Correct identification of symptomatic high-grade internal carotid artery stenosis from low-grade or total chronic occlusion is critical for patient selection for urgent carotid endarterectomy. Carotid pseudo-occlusion is a flow-related artifact on noninvasive imaging that can lead to an incorrect diagnosis of total internal carotid artery occlusion, thereby denying an eligible patient for appropriate surgical treatment. We present an 82-year-old man with a symptomatic critical internal carotid artery, which was detected on time-resolved 4-dimensional computed-tomography angiography, whereas single-phase computed-tomography angiography, magnetic resonance angiography, and Doppler ultrasonography suggested apparent occlusion...
April 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Samuel Bruls, Philippe Desfontaines, Jean-Olivier Defraigne, Natzi Sakalihasan
BACKGROUND: To evaluate the feasibility and the safety of performing urgent (within 24 hours) carotid endarterectomy in patients with carotid stenosis presenting with repetitive transient ischemic attacks or progressing stroke. METHODS: Thirty consecutive patients underwent urgent carotid endarterectomy for repetitive transient ischemic attacks (N = 12) or progressing stroke (N = 18) according to the following criteria: two or more transient ischemic attacks or a fluctuating neurological deficit over a period of less than 24 hours (progressing stroke), no impairment of consciousness, no cerebral infarct larger than 1...
July 2013: Aorta (Stamford, Conn.)
Ralph C Darling, Courtney Warner, Chin C Yeh, Melissa D Shah, Jeffrey C Hnath, Dhiraj M Shah
Treatment of carotid bifurcation disease in patients presenting with acute stroke has been a controversial issue over the past four decades. Classically, patients were asked to wait four to six weeks before intervention was entertained in order for the brain to stabilize and the risks of intervention to be minimized. Unfortunately, up to 20% of patients will have a secondary event after their index event and the window of opportunity to save potentially salvageable ischemic tissue will be missed. Early reports had demonstrated poor results with intervention...
February 2016: Journal of Cardiovascular Surgery
S Shahidi, A Owen-Falkenberg, B Gottschalksen, K Ellemann
BACKGROUND: The early recurrence of neurological symptoms (NR) after urgent aggressive best medical therapy (BMT) in symptomatic carotid stenosis is not well documented. AIMS: To investigate the risk of ipsilateral NR after urgent aggressive BMT in patients with symptomatic (50-99%) carotid stenosis up to carotid endarterectomy (CEA), with emphasis on the first 14 days after index-event. METHODS: Prospective population based study, covering a period of 4½ years...
January 2016: International Journal of Stroke: Official Journal of the International Stroke Society
Elias Johansson, Elisa Cuadrado-Godia, Derek Hayden, Jakob Bjellerup, Angel Ois, Jaume Roquer, Per Wester, Peter J Kelly
OBJECTIVE: We aimed to quantify the risk and predictors of ipsilateral ischemic stroke in patients with symptomatic carotid stenosis awaiting revascularization (carotid endarterectomy [CEA] or carotid artery stenting) by pooling individual patient data from recent prospective studies with high rates of treatment with modern stroke prevention medications. METHODS: Data were included from 2 prospective hospital-based registries (Umeå, Barcelona) and one prospective population-based study (Dublin)...
February 9, 2016: Neurology
C Azzini, M Gentile, A De Vito, L Traina, E Sette, E Fainardi, F Mascoli, I Casetta
OBJECTIVE/BACKGROUND: The timing of carotid endarterectomy (CEA) after thrombolysis is still a matter of debate. The aim of this study was to analyse a cohort of patients undergoing urgent endarterectomy after intravenous thrombolysis for acute ischaemic stroke. METHODS: This was an observational study. Prospective databases were reviewed and matched to identify patients who underwent CEA early after intravenous thrombolysis (2009-14). The focus was carotid surgery performed within 12 hours of stroke onset in patients with a high grade (≥70%) symptomatic carotid stenosis, associated with vulnerable plaques or stroke in evolution, and evidence of a significant salvageable ischaemic penumbra on perfusion computed tomography scan...
April 2016: European Journal of Vascular and Endovascular Surgery
R C Darling, C Warner, C C Yeh, M D Shah, J C Hnath, D M Shah
Treatment of carotid bifurcation disease in patients presenting with acute stroke has been a controversial issue over the past four decades. Classically, patients were asked to wait four to six weeks before intervention was entertained in order for the brain to stabilize and the risks of intervention to be minimized. Unfortunately, up to 20% of patients will have a secondary event after their index event and the window of opportunity to save, potentially salvageable ischemic tissue will be missed. Early reports had demonstrated poor results with intervention...
December 23, 2015: Journal of Cardiovascular Surgery
D A Healy, E Boyle, D McCartan, M Bourke, M Medani, J Ferguson, H Yagoub, K Bashar, M O'Donnell, J Newell, C Canning, M McMonagle, J Dowdall, S Cross, S O'Daly, B Manning, G Fulton, E G Kavanagh, P Burke, P A Grace, M Clarke Moloney, S R Walsh
A pilot randomized controlled trial that evaluated the effect of remote ischemic preconditioning (RIPC) on clinical outcomes following major vascular surgery was performed. Eligible patients were those scheduled to undergo open abdominal aortic aneurysm repair, endovascular aortic aneurysm repair, carotid endarterectomy, and lower limb revascularization procedures. Patients were randomized to RIPC or to control groups. The primary outcome was a composite clinical end point comprising any of cardiovascular death, myocardial infarction, new-onset arrhythmia, cardiac arrest, congestive cardiac failure, cerebrovascular accident, renal failure requiring renal replacement therapy, mesenteric ischemia, and urgent cardiac revascularization...
November 2015: Vascular and Endovascular Surgery
Hernan A Bazan, Samuel A Hatfield, Chasity B O'Malley, Ashton J Brooks, Daniel Lightell, T Cooper Woods
BACKGROUND AND PURPOSE: Atherosclerotic plaque vulnerability is accompanied by changes in the molecular and cellular function in the plaque shoulder, including a decrease in vascular smooth muscle cell proliferation. We aimed to determine whether the expression of 3 miRNAs that regulate vascular smooth muscle cell proliferation (miR-145, miR-221, and miR-222) is altered with plaque rupture, suggesting a role in regulating plaque stability. METHODS: miRNAs were measured in the plaque shoulder of carotid plaques obtained from patients undergoing carotid endarterectomy (CEA) for 3 distinct clinical scenarios: (1) patients without previous neurological events but high-grade carotid stenosis (asymptomatic), (2) patients with an acute neurological event within 5 days of the CEA (urgent), and (3) patients undergoing CEA>5 days after a neurological event (symptomatic)...
November 2015: Stroke; a Journal of Cerebral Circulation
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