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Carotid endarterectomy in asymptomatic patients

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
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
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
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
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
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
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...
September 28, 2016: Neurology
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
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
Maria Antonella Ruffino, Riccardo Faletti, Laura Bergamasco, Paolo Fonio, Dorico Righi
AIMS: Several randomized trials of patients with carotid stenosis show increased adverse neurological events with stenting versus endarterectomy in the 30-day post-procedure. This study examines the incidence of new ischaemic lesions in patients treated in our centre using the new Roadsaver stent. METHODS AND RESULTS: Between September 2015 and January 2016, 23 consecutive patients (age 74.3 ± 7.3 years, 17.4 % female) underwent carotid artery stenting with the Roadsaver stent, a nitinol double-layer micromesh device...
November 2016: Cardiovascular and Interventional Radiology
J David Spence
In recent years, there have been a number of advances in the pathogenesis and treatment of atherosclerosis and in assessing prognosis in carotid atherosclerosis. Risk stratification to improve vascular prevention by identifying patients most likely to benefit from intensive therapy is much improved by measuring carotid plaque burden. In patients with asymptomatic carotid stenosis, a number of modalities can be used to identify the 10-15% who could benefit from endarterectomy or stenting. Transcranial Doppler embolus detection, echolucency and ulceration on 3D ultrasound, intraplaque hemorrhage on magnetic resonance imaging (MRI), and reduced cerebrovascular reserve are useful already; new approaches including plaque texture on ultrasound and imaging of plaque inflammation and early calcification on positron emission tomography/computed tomography (PET/CT) are in development...
2016: F1000Research
Isibor Arhuidese, Rebecca Craig-Schapiro, Tammam Obeid, Besma Nejim, Caitlin W Hicks, Mahmoud B Malas
BACKGROUND: In multiple studies, chronic renal insufficiency has been associated with increased risk of periprocedural stroke, cardiac complications, and death following carotid revascularization. Renal transplantation has been shown to reduce cardiovascular risk and improve survival; outcomes after carotid revascularization in renal transplant patients however are unknown. In this study, we evaluate periprocedural and long-term risks after carotid endarterectomy (CEA) and carotid artery stenting (CAS) in a cohort of renal transplant patients...
August 12, 2016: Annals of Vascular Surgery
Brajesh K Lal, James F Meschia, George Howard, Thomas G Brott
Although rapidly expanding in its use, carotid artery stenting remains a relatively new procedure. Its growth is due, at least in part, to the perceived advantages of a less invasive technique. However, the clinical effectiveness and specific role for stenting in the treatment of carotid occlusive disease are still under evaluation. The primary aim of the randomized clinical trial, Carotid Revascularization Endarterectomy versus Stenting Trial (CREST), was to contrast the relative efficacy of carotid stenting versus carotid endarterectomy in preventing stroke, myocardial infarction, or death during a 30-day periprocedural period or ipsilateral stroke over the follow-up period in patients with symptomatic and asymptomatic extracranial carotid stenosis...
August 9, 2016: Angiology
Jonathan Y Streifler, Anne G den Hartog, Samuel Pan, Hongchao Pan, Richard Bulbulia, Dafydd J Thomas, Martin M Brown, Alison Halliday
BACKGROUND: Silent brain infarcts are common in patients at increased risk of stroke and are associated with a poor prognosis. In patients with asymptomatic carotid stenosis, similar adverse associations were claimed, but the impact of previous infarction or symptoms on the beneficial effects of carotid endarterectomy is not clear. Our aim was to evaluate the impact of prior cerebral infarction in patients enrolled in the Asymptomatic Carotid Surgery Trial, a large trial with 10-year follow-up in which participants whose carotid stenosis had not caused symptoms for at least six months were randomly allocated either immediate or deferred carotid endarterectomy...
July 19, 2016: International Journal of Stroke: Official Journal of the International Stroke Society
L M J Best, A C Webb, K S Gurusamy, S F Cheng, T Richards
OBJECTIVE: Identification of patients who will benefit from carotid endarterectomy is not entirely effective, primarily utilising degree of carotid stenosis. This study aimed at determining if microembolic signals (MES) detected by transcranial Doppler ultrasound (TCD) can provide clinically useful information regarding stroke risk in patients with carotid atherosclerosis. METHODS: A meta-analysis of prospective studies was performed. Three analyses were proposed investigating MES detection as a predictor of: stroke or TIA, stroke alone, and stroke or TIA but with an increased positivity threshold...
July 5, 2016: European Journal of Vascular and Endovascular Surgery
Faisal Aziz, Erik B Lehman, Amy B Reed
BACKGROUND: Carotid endarterectomy is the gold standard operation to prevent stroke in patients with symptomatic carotid artery stenosis and asymptomatic high-grade carotid artery stenosis. Longer operative times for different operations have been shown to affect the outcomes adversely. The purpose of this study was to determine the incidence of postoperative complications after carotid endarterectomy, and their relation to the operative times. METHODS: The American College of Surgeons database was queried for all patients who underwent carotid endarterectomies from 2005 to 2007...
October 2016: Annals of Vascular Surgery
Michol Cooper, Isibor J Arhuidese, Tammam Obeid, Caitlin W Hicks, Joseph Canner, Mahmoud B Malas
Importance: Early landmark trials excluding dialysis patients showed carotid endarterectomy (CEA) decreased stroke risk compared with medical management. Dialysis dependence has been associated with poor outcomes after CEA in small studies, but, to our knowledge, there are no large studies evaluating outcomes of CEA in this patient group. Objective: To delineate perioperative and long-term outcomes after CEA in dialysis-dependent patients in a large national database...
June 29, 2016: JAMA Surgery
Sven Rupprecht, Sigrid Finn, Jens Ehrhardt, Dirk Hoyer, Thomas Mayer, Juergen Zanow, Albrecht Guenther, Matthias Schwab
OBJECTIVE: Carotid endarterectomy and stenting have comparable efficacy in stroke prevention in asymptomatic carotid stenosis. In patients with carotid stenosis, cardiac events have a more than threefold higher incidence than cerebrovascular events. Autonomic dysfunction predicts cardiovascular morbidity and mortality, and carotid stenosis interferes with baroreceptor and chemoreceptor function. We assessed the effect of elective carotid revascularization (endarterectomy vs stenting) on autonomic function as a major prognostic factor of cardiovascular health...
October 2016: Journal of Vascular Surgery
Adrian Brun, Hélène Rangé, Bastien Prouvost, Olivier Meilhac, Mikael Mazighi, Pierre Amarenco, Guy Lesèche, Philippe Bouchard, Jean-Baptiste Michel
Periodontal diseases are multifactorial inflammatory diseases, caused by a bacterial biofilm involving both innate and adaptative immunity, characterized by the destruction of tooth-supporting tissues. In the context of periodontitis, the spread of weak pathogenic bacteria into the bloodstream has been described. These bacteria will preferentially localize to existing clot within the circulation. Atherothrombosis of the carotid arteries is a local pathology and a common cause of cerebral infarction. Intraplaque hemorrhages render the lesion more prone to clinical complications such as stroke...
2016: Bulletin du Groupèment International Pour la Recherche Scientifique en Stomatologie & Odontologie
Carina Wendorff, Heiko Wendorff, Andreas Kuehnl, Pavlos Tsantilas, Michael Kallmayer, Hans-Henning Eckstein, Jaroslav Pelisek
BACKGROUND: It is still a controversial issue whether carotid endarterectomy (CEA) for asymptomatic carotid stenosis is superior to best medical treatment. The aim of this study was therefore to analyze the impact of sex and age on carotid plaque instability in asymptomatic patients undergoing CEA. PATIENTS AND METHODS: Atherosclerotic plaques from 465 asymptomatic patients with high-grade carotid artery stenosis (2004 - 2013) at the Munich Vascular Biobank were analyzed...
September 2016: VASA. Zeitschrift Für Gefässkrankheiten
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