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urgent carotid endarterectomy

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https://www.readbyqxmd.com/read/27683853/the-urgent-need-for-contemporary-clinical-trials-in-patients-with-asymptomatic-carotid-stenosis
#1
REVIEW
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
https://www.readbyqxmd.com/read/27670208/fast-track-systems-improve-timely-carotid-endarterectomy-in-stroke-prevention-outpatients
#2
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
https://www.readbyqxmd.com/read/27535948/urgent-carotid-endarterectomy-does-not-increase-risk-and-will-prevent-more-strokes
#3
Ian M Loftus, Kosmas I Paraskevas, A Ross Naylor
No abstract text is available yet for this article.
August 16, 2016: Angiology
https://www.readbyqxmd.com/read/27498092/gene-and-protein-expression-of-chemokine-c-c-motif-ligand-19-is-upregulated-in-unstable-carotid-atherosclerotic-plaques
#4
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
https://www.readbyqxmd.com/read/26907678/time-resolved-4-dimensional-computed-tomography-angiography-can-correctly-identify-carotid-pseudo-occlusion
#5
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
https://www.readbyqxmd.com/read/26798682/urgent-carotid-endarterectomy-in-patients-with-acute-neurological-symptoms-the-results-of-a-single-center-prospective-nonrandomized-study
#6
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.)
https://www.readbyqxmd.com/read/26771724/carotid-interventions-cea-and-cas-in-acute-stroke-patients-which-procedure-on-which-patient
#7
REVIEW
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
https://www.readbyqxmd.com/read/26763019/risk-of-early-recurrent-stroke-in-symptomatic-carotid-stenosis-after-best-medical-therapy-and-before-endarterectomy
#8
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
https://www.readbyqxmd.com/read/26747885/recurrent-stroke-in-symptomatic-carotid-stenosis-awaiting-revascularization-a-pooled-analysis
#9
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
https://www.readbyqxmd.com/read/26712132/very-early-carotid-endarterectomy-after-intravenous-thrombolysis
#10
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
https://www.readbyqxmd.com/read/26698036/carotid-interventions-cea-and-cas-in-acute-stroke-patients-which-procedure-on-which-patient
#11
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
https://www.readbyqxmd.com/read/26574485/a-multicenter-pilot-randomized-controlled-trial-of-remote-ischemic-preconditioning-in-major-vascular-surgery
#12
RANDOMIZED CONTROLLED TRIAL
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
https://www.readbyqxmd.com/read/26451018/acute-loss-of-mir-221-and-mir-222-in-the-atherosclerotic-plaque-shoulder-accompanies-plaque-rupture
#13
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
https://www.readbyqxmd.com/read/26412434/urgent-carotid-intervention-is-safe-after-thrombolysis-for-minor-to-moderate-acute-ischemic-stroke
#14
Hernan A Bazan, Nicolas Zea, Bethany Jennings, Taylor A Smith, Gabriel Vidal, W Charles Sternbergh
OBJECTIVE: Carotid intervention shortly after an acute neurologic ischemic event is being performed more frequently in stroke centers to reduce the risk of recurrent stroke. Thrombolysis with recombinant tissue plasminogen activator (tPA) is offered to select patients with ischemic stroke symptoms who present within 4.5 hours. However, there is a paucity of data as to whether tPA followed by urgent carotid endarterectomy (CEA) or carotid artery stenting (CAS) has an increased risk of complications, particularly intracerebral hemorrhage (ICH)...
December 2015: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/26284533/awareness-of-stroke-risk-after-tia-in-swiss-general-practitioners-and-hospital-physicians
#15
Sven Streit, Philippe Baumann, Jürgen Barth, Heinrich P Mattle, Marcel Arnold, Claudio L Bassetti, Damian N Meli, Urs Fischer
BACKGROUND: Transient ischemic attacks (TIA) are stroke warning signs and emergency situations, and, if immediately investigated, doctors can intervene to prevent strokes. Nevertheless, many patients delay going to the doctor, and doctors might delay urgently needed investigations and preventative treatments. We set out to determine how much general practitioners (GPs) and hospital physicians (HPs) knew about stroke risk after TIA, and to measure their referral rates. METHODS: We used a structured questionnaire to ask GPs and HPs in the catchment area of the University Hospital of Bern to estimate a patient's risk of stroke after TIA...
2015: PloS One
https://www.readbyqxmd.com/read/25883075/stroke-prevention-in-asymptomatic-carotid-artery-disease-revascularization-of-carotid-stenosis-is-not-the-solution
#16
Robert G Hart, Kuan H Ng
Asymptomatic carotid stenosis (ACS) exceeding 50% is present in about 2% of 60-year-old patients and an even higher fraction of older individuals. The major independent risk factors include advancing age, male sex, tobacco smoking, and a history of vascular disease. The best available evidence does not support either population screening for ACS or routine carotid revascularization when ACS is discovered. There is an urgent need to identify patients with ACS and a sufficiently high risk of ipsilateral stroke (despite contemporary medical management) to warrant invasive treatment...
2015: Polskie Archiwum Medycyny Wewnętrznej
https://www.readbyqxmd.com/read/25736512/peri-procedural-risk-with-urgent-carotid-artery-stenting-a-population-based-swedvasc-study
#17
M Jonsson, P Gillgren, A Wanhainen, S Acosta, D Lindström
OBJECTIVES: Current European Society for Vascular Surgery guidelines recommend that patients with a symptomatic carotid stenosis should be operated on within 14 days of onset of symptoms. Recent reports indicate that carotid endarterectomy (CEA) within 2 days of a neurological event may be associated with a higher peri-procedural risk of stroke. Whether urgent carotid artery stenting (CAS) carries a similar high risk is unclear. The aim of this study was to analyze if urgent CAS increases the peri-procedural risks...
May 2015: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/25726803/-cerebral-revascularization-for-the-treatment-of-patients-with-acute-ischemic-stroke
#18
V V Krylov, V A Luk'ianchikov
The effectiveness of surgical prevention of ischemic stroke has been demonstrated in several international randomized studies. Issues about the surgery time, patient selection criteria, surgery techniques remained unresolved. We have reviewed 46 publications in this field. The current vast arsenal of surgical techniques allows to conduct revascularization surgery procedures in patients with acute ischemic stroke and lesions of extra- and intracranial arteries. The benefits of early carotid endarterectomy in patients with mild stroke and transitory ischemic attacks (TIA) are undeniable fact...
2014: Zhurnal Nevrologii i Psikhiatrii Imeni S.S. Korsakova
https://www.readbyqxmd.com/read/25653229/emergency-placement-of-stent-graft-for-symptomatic-acute-carotid-artery-occlusion-after-endarterectomy
#19
Jun Kyeung Ko, Chang Hwa Choi, Sang Weon Lee, Tae Hong Lee
A patient underwent a left-sided carotid endarterectomy (CEA) for an asymptomatic 80% carotid artery (CA) stenosis. There were no signs of intolerance during the carotid cross-clamping and an initially uneventful awakening was observed. However, in the third postoperative hour he experienced left amaurosis and dysarthria. An urgent MRI showed an occluded internal CA on the operated site without evidence of acute infarction. To recanalize the occluded internal CA and minimize leakage from the arteriotomy site, a self-expandable stent-graft was placed, covering the dissection and the distal atherosclerotic lesions...
March 2016: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/25636626/emergency-placement-of-stent-graft-for-symptomatic-acute-carotid-artery-occlusion-after-endarterectomy
#20
Jun Kyeung Ko, Chang Hwa Choi, Sang Weon Lee, Tae Hong Lee
A patient underwent a left-sided carotid endarterectomy (CEA) for an asymptomatic 80% carotid artery (CA) stenosis. There were no signs of intolerance during the carotid cross-clamping and an initially uneventful awakening was observed. However, in the third postoperative hour he experienced left amaurosis and dysarthria. An urgent MRI showed an occluded internal CA on the operated site without evidence of acute infarction. To recanalize the occluded internal CA and minimize leakage from the arteriotomy site, a self-expandable stent-graft was placed, covering the dissection and the distal atherosclerotic lesions...
2015: BMJ Case Reports
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