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Carotid endarterectomy in asymptomatic patients

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https://www.readbyqxmd.com/read/27922252/update-on-new-stents-and-protection-devices-for-carotid-artery-stenting-what-we-know-what-we-learnt-recently-and-what-we-need-to-know
#1
Dimitrios N Nikas, Xenofon Makos, Tomoyuki Umemoto, George Liappas, Andrea Pacchioni, Narek Zakarian, Bernhard Reimers
Carotid artery stenting (CAS) is considered an alternative option to carotid endarterectomy (CEA) for significant carotid stenosis, in both symptomatic and asymptomatic patients. Comparing to CEA, CAS offers significant advantages. The most important arise from the minimally invasive nature of the procedure, which reduces the surgical complications and adds significant comfort to the patient, without compromising the efficacy. Nowadays, CAS can achieve acute and long-term outcome results comparable to CEA, maintaining low rates of periprocedural embolic events...
December 6, 2016: Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/27913124/lower-expression-of-genes-involved-in-protection-against-oxidative-stress-in-symptomatic-carotid-atherosclerosis
#2
Nuria Zamora-González, Jesús Crespo-Sanjuán, M Dolores Calvo-Nieves, Diego Sánchez, M Dolores Ganfornina, Gerardo Martínez, Beatriz Aguirre-Gervás, J Antonio González-Fajardo
OBJECTIVE: Oxidative stress is increased in atherosclerosis, manifested both in blood and tissue (atherosclerotic plaque). We aim at describing the expression of a number of genes related to oxidative stress response in carotid atherosclerotic plaques and their relation to symtomatic state. MATERIALS AND METHODS: We have studied the mRNA expression levels for genes related to oxidative stress in a population of 44 patients undergoing carotid endarterectomy, according to the presence (24 patients) or absence (20 patients) of symptoms...
November 29, 2016: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/27905692/remote-pre-procedural-ischemic-stroke-was-the-strongest-risk-for-stroke-and-death-associated-with-carotid-stenting-a-single-center-experience
#3
Mária Rašiová, Ľubomír Špak, Ľudmila Farkašová, Štefan Pataky, Martin Koščo, Marek Hudák, Matej Moščovič, Norbert Leško
BACKGROUND: The goal of carotid artery stenting (CAS) is to decrease the stroke risk in patients with carotid stenosis. This procedure carries an immediate risk of stroke and death and many patients do not benefit from it, especially asymptomatic patients. Patient selection for carotid procedure who benefit from procedure and who is the procedure hazardous for is important. Remote ischemic stroke is known risk factor for stroke reccurence during surgery. The aim of our study was to determine the periprocedural complication risk (within 30 days after CAS) associated with carotid stenting (stroke, death) between patients with remote pre- procedural ischemic stroke and without it; to analyse periprocedural risk in other specific patient subgroups treated with CAS and to determine the impact of observed variables on all- cause mortality during long-term follow-up...
December 1, 2016: International Angiology: a Journal of the International Union of Angiology
https://www.readbyqxmd.com/read/27904004/delayed-diagnosis-of-blunt-carotid-trauma-in-a-seat-belt-syndrome-with-associated-abdominal-wall-injury-a-case-report
#4
Savino Occhionorelli, Dario Andreotti, Daniela Tartarini, Lorenzo Cappellari, Rocco Stano, Lucia Morganti, Giorgio Vasquez
: The aim of this case report is to be aware of occult carotid lesions in thoracic- abdominal trauma because, carotid artery injury consequent to blunt trauma is rare, affecting less than 1% of patients as reported in literature. A 45-years-old female, involved in a traffic accident, arrived to Emergency Room hemodynamically stable, with a Glasgow Coma Scale of 15, complaining abdominal pain, without any neurological signs. She underwent Computed Tomography (CT) scan that showed a complete disruption of left abdominal wall muscles, associated with massive bowel loops herniation...
November 28, 2016: Annali Italiani di Chirurgia
https://www.readbyqxmd.com/read/27898402/recent-update-on-carotid-endarterectomy-versus-carotid-artery-stenting
#5
Raywat Noiphithak, Anusak Liengudom
Carotid artery stenosis (CS) is a major cause of ischemic stroke. Treatment of CS consists of best medical treatment and carotid revascularization (CR), including carotid endarterectomy (CEA) and carotid artery stenting (CAS). Both CR techniques have their own procedural risks. Therefore, selection of the appropriate treatment for patients with CS is relatively complicated. Many studies and guidelines have reported the efficacy of each treatment for both symptomatic and asymptomatic patients. However, the results are still controversial, especially concerning the efficacy and safety of CEA and CAS...
November 30, 2016: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/27881699/multicenter-experience-of-surgical-explantation-of-carotid-stents-for-recurrent-stenosis
#6
Jesse A Columbo, John C McCallum, Philip P Goodney, Thomas C Bower, Marc L Schermerhorn, Richard J Powell, Randall R DeMartino
OBJECTIVE: A significant cohort of patients who have undergone carotid artery stenting (CAS) will have in-stent restenosis (ISR). The optimal management of symptomatic or severe ISR remains poorly defined. The purpose of this study was to describe the indications, treatment, and mid- to long-term outcomes of patients undergoing CAS explantation for ISR. METHODS: All patients undergoing internal carotid artery stent explantation with carotid artery reconstruction at Mayo Clinic Rochester, Dartmouth-Hitchcock Medical Center, and Beth-Israel Deaconess Medical Center from 2003 to 2013 were retrospectively reviewed...
November 22, 2016: Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/27881360/an-observational-registry-of-carotid-endarterectomy-and-carotid-artery-stenting-in-brazil-study-protocol
#7
Edwaldo Edner Joviliano, Winston Bonetti Yoshida, Marcone Lima Sobreira, Regina Moura, Ana Terezinha Guillaumon, Selma Regina De Oliveira Raymundo, Daniel Gustavo Miquelin, Ludvig Hafner, Marcelo Jose Almeida
BACKGROUND: Carotid artery stenting (CAS) and carotid endarterectomy (CEA) are alternative strategies for stroke prevention in patients with atherosclerotic carotid disease. CEA has been considered the first-line treatment for carotid stenosis worldwide, and the safety and efficacy of CAS compared to CEA remains in question. OBJECTIVE: The purpose of this study is to compare the practice and outcomes of CAS and CEA in a real-world setting within public university hospitals in Brazil...
November 23, 2016: JMIR Research Protocols
https://www.readbyqxmd.com/read/27875340/which-patients-with-asymptomatic-carotid-stenosis-benefit-from-revascularization
#8
A Ross Naylor
PURPOSE OF THE REVIEW: To summarize why there are polarized opinions regarding the management of patients with asymptomatic carotid disease and whether it is possible to identify patients who might benefit from carotid interventions. RECENT FINDINGS: Carotid Revascularization Endarterectomy Versus Stenting Trial and Asymptomatic Carotid Trial 1 (ACT-1) recently concluded that outcomes after carotid endarterectomy and carotid stenting were not significantly different in asymptomatic patients and that procedural risks were below the accepted 3% threshold...
November 21, 2016: Current Opinion in Neurology
https://www.readbyqxmd.com/read/27829964/safety-of-dual-antiplatelet-therapy-after-carotid-endarterectomy-for-prevention-of-restenosis-a-single-center-experience
#9
Miguel A Barboza, José Chang, Alvaro Hernández, Emmanuel Martínez, Huberth Fernández, Gerardo Quirós, Johanna Salazar, Allan Ramos-Esquivel, Alberto Maud
INTRODUCTION: The incidence of recurrent carotid stenosis after carotid endarterectomy varies from 1% to 37% with only 0-8% symptomatic restenosis. Safety of short-term (30 days) dual-antiplatelet therapy has not been established in this type of procedure. AIMS: To investigate the safety of dual antiplatelet therapy after carotid endarterectomy to prevent restenosis. METHODS: We retrospectively identified all the patients who underwent carotid endarterectomy (symptomatic or asymptomatic) treated at our center between July 2010 and July 2013 according to local protocols...
October 2016: Journal of Vascular and Interventional Neurology
https://www.readbyqxmd.com/read/27776704/technical-options-for-treatment-of-in-stent-restenosis-after-carotid-artery-stenting
#10
REVIEW
Vanessa E C Pourier, Gert J de Borst
OBJECTIVE: This review summarizes the available evidence and analyzes the current trends on treatments for carotid in-stent restenosis (ISR) after carotid artery stenting (CAS). METHODS: An update of a 2010 review of the literature (which included 20 articles) was conducted using PubMed and Embase. All studies published from inception until January 2016 reporting original data on ISR treatments were included. Treatment trends before and after 2005 were compared...
November 2016: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/27776697/perioperative-and-long-term-impact-of-chronic-kidney-disease-on-carotid-artery-interventions
#11
Derek Klarin, Robert T Lancaster, Emel Ergul, Daniel Bertges, Philip Goodney, Marc L Schermerhorn, Richard P Cambria, Virendra I Patel
OBJECTIVE: Chronic kidney disease (CKD) increases morbidity and mortality after vascular procedures and adversely affects late survival of patients. The presence of CKD also confers increased risk of stroke in patients with asymptomatic carotid stenosis. Patients undergoing carotid intervention in the Vascular Study Group of New England database were stratified by CKD status referable to periprocedural and late outcomes. METHODS: All carotid artery stenting and carotid endarterectomies (CEAs) performed from 2003 to 2013 were stratified by CKD severity as mild (estimated glomerular filtration rate [eGFR] >60 mL/min/1...
November 2016: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/27744460/clinical-results-of-carotid-artery-stenting-versus-carotid-endarterectomy
#12
Tuba Akinci, Eda Derle, Seda Kibaroğlu, Ali Harman, Feride Kural, Pınar Cınar, Munire Kilinc, Hakki T Akay, Ufuk Can, Ulku S Benli
OBJECTIVE: To review our results of carotid artery stenting (CAS) and carotid endarterectomy (CEA). METHODS: We evaluated the medical records of patients undergoing carotid artery revascularization procedure, between 2001 and 2013 in Baskent University Hospital, Ankara, Turkey. Carotid artery stenting or CEA procedures were performed in patients with asymptomatic carotid stenosis (>/=70%) or symptomatic stenosis (>/=50%). Demographic data, procedural details, and clinical outcomes were recorded...
October 2016: Neurosciences: the Official Journal of the Pan Arab Union of Neurological Sciences
https://www.readbyqxmd.com/read/27743954/quantification-of-lipid-rich-core-in-carotid-atherosclerosis-using-magnetic-resonance-t2%C3%A2-mapping-relation-to-clinical-presentation
#13
Joshua T Chai, Luca Biasiolli, Linqing Li, Mohammad Alkhalil, Francesca Galassi, Chris Darby, Alison W Halliday, Linda Hands, Timothy Magee, Jeremy Perkins, Ed Sideso, Ashok Handa, Peter Jezzard, Matthew D Robson, Robin P Choudhury
OBJECTIVES: The aim of this study was to: 1) provide tissue validation of quantitative T2 mapping to measure plaque lipid content; and 2) investigate whether this technique could discern differences in plaque characteristics between symptom-related and non-symptom-related carotid plaques. BACKGROUND: Noninvasive plaque lipid quantification is appealing both for stratification in treatment selection and as a possible predictor of future plaque rupture. However, current cardiovascular magnetic resonance (CMR) methods are insensitive, require a coalesced mass of lipid core, and rely on multicontrast acquisition with contrast media and extensive post-processing...
October 6, 2016: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/27726853/frequency-of-increase-in-cardiac-troponin-levels-after-peripheral-arterial-operations-carotid-endarterectomy-abdominal-aorta-procedure-distal-bypass-and-their-effect-on-medical-management
#14
Yader Sandoval, Marina Zakharova, Thomas S Rector, Emmanouil S Brilakis, Todd Drexel, Edward O McFalls, Santiago Garcia
The utility of measuring cardiac troponins (cTn) in asymptomatic patients during the perioperative period has been controversial. In the present substudy of the Cardiac Remote Ischemic Preconditioning Prior to Elective Vascular Surgery Trial (NCT01558596), we hypothesized that surveillance of myocardial injury with cTnI in the perioperative period would lead to initiation or intensification of medical therapies for coronary artery disease. Increases in cTnI ≥0.01 μg/l in the perioperative period were considered clinically significant...
September 15, 2016: American Journal of Cardiology
https://www.readbyqxmd.com/read/27707618/insight-into-the-cerebral-hyperperfusion-syndrome-following-carotid-endarterectomy-from-the-national-vascular-quality-initiative
#15
Grace J Wang, Adam W Beck, Randall R DeMartino, Philip P Goodney, Caron B Rockman, Ronald M Fairman
BACKGROUND: Cerebral hyperperfusion syndrome (CHS), characterized by severe ipsilateral headache, seizures, and intracranial hemorrhage, is a rare, poorly understood complication that can be fatal following carotid endarterectomy (CEA). The purpose of the study was to determine the factors associated with CHS as captured in the Vascular Quality Initiative. METHODS: Analysis was conducted on 51,001 procedures captured from the CEA module of the Vascular Quality Initiative from 2003 to 2015...
October 1, 2016: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/27707617/stenting-versus-endarterectomy-after-prior-ipsilateral-carotid-endarterectomy
#16
Isibor Arhuidese, Tammam Obeid, Besma Nejim, Satinderjit Locham, Caitlin W Hicks, Mahmoud B Malas
BACKGROUND: Restenosis after carotid endarterectomy (CEA) is associated with an increased risk of stroke, and the management of critical or symptomatic restenotic lesions poses a treatment challenge. The superiority of CEA vs carotid angioplasty and stenting (CAS) for restenosis remains debatable because existing studies are few and limited by small sample size or the inability to align interventions with ipsilateral events beyond the periprocedural period. We performed a population-based evaluation of CEA vs CAS in a large contemporary cohort of patients with carotid artery restenosis...
October 1, 2016: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/27696001/perioperative-stroke-after-carotid-endarterectomy-etiology-and-implications
#17
Nicolas K Khattar, Robert M Friedlander, Rabih A Chaer, Efthymios D Avgerinos, Eric S Kretz, Jeffrey R Balzer, Donald J Crammond, Miguel H Habeych, Parthasarathy D Thirumala
BACKGROUND: Carotid endarterectomy (CEA) is the procedure of choice for reducing the risk of stroke in both symptomatic and asymptomatic carotid artery stenoses. Stroke is associated with significant morbidity and mortality peri-operatively (2-3 %). Our primary aim is to evaluate the etiology of these strokes after CEA and their impact on morbidity by comparing the length of stay in the hospital. METHODS: A total of 584 patients with documented neurological status evaluations who underwent CEAs were included in the study...
September 30, 2016: Acta Neurochirurgica
https://www.readbyqxmd.com/read/27683853/the-urgent-need-for-contemporary-clinical-trials-in-patients-with-asymptomatic-carotid-stenosis
#18
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/27631489/differential-expression-of-micrornas-in-endarterectomy-specimens-taken-from-patients-with-asymptomatic-and-symptomatic-carotid-plaques
#19
Birgit Markus, Karsten Grote, Michael Worsch, Behnoush Parviz, Andreas Boening, Bernhard Schieffer, Mariana S Parahuleva
OBJECTIVE: Stroke and transient ischemic attacks are considered as clinical manifestations of atherosclerotic disease due to on-going vascular inflammation and finally atherothrombosis of the carotid arteries. MicroRNAs (miRNA/miR) are known to be involved in vascular inflammation and plaque destabilization. The aim of this study was to analyze the expression profile of selected miRNAs in endarterectomy specimen from carotid arteries that were taken from patients with asymptomatic and symptomatic atherosclerotic plaques...
2016: PloS One
https://www.readbyqxmd.com/read/27611997/anatomical-and-technical-factors-influence-the-rate-of-in-stent-restenosis-following-carotid-artery-stenting-for-the-treatment-of-post-carotid-endarterectomy-stenosis
#20
Marine Gaudry, Jean-Michel Bartoli, Laurence Bal, Roch Giorgi, Mariangela De Masi, Pierre-Edouard Magnan, Philippe Piquet
BACKGROUND: Carotid artery stenting (CAS) has been advocated as an alternative to redo surgery for the treatment of post-carotid endarterectomy (CEA) stenosis. This study analyzed the efficacy of CAS for post-CEA restenosis, focusing on an analysis of technical and anatomical predictive factors for in-stent restenosis. METHODS: We performed a retrospective monocentric study. We included all patients who underwent CAS for post-CEA restenosis at our institution from July 1997 to November 2013...
2016: PloS One
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