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Carotid endarterectomy in asymptomatic patients

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https://www.readbyqxmd.com/read/29747016/carotid-endarterectomy-and-concurrent-clopidogrel-use-us-national-practice-patterns
#1
Eva A Mistry, Jane C Khoury, Dawn Kleindorfer
BACKGROUND: Patients diagnosed with high-grade carotid stenosis often receive a carotid endarterectomy (CEA) during their hospital stay and most receive antiplatelet medication. There is inter-surgeon variability in performing CEA in patients receiving clopidogrel given the potent antiplatelet effect. METHODS: Utilizing the PREMIER database, adults with principal discharge diagnosis of stroke, transient ischemic attack (TIA) or carotid artery stenosis or occlusion without stroke/TIA(CAS), who had a CEA during the same hospital stay, in 2014 were analyzed...
May 7, 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29740506/carotid-artery-stenting-vs-carotid-endarterectomy-in-the-management-of-carotid-artery-stenosis-lessons-learned-from-randomized-controlled-trials
#2
REVIEW
Mohamed M Salem, Abdulrahman Y Alturki, Matthew R Fusco, Ajith J Thomas, Bob S Carter, Clark C Chen, Ekkehard M Kasper
Background: Carotid artery stenosis, both symptomatic and asymptomatic, has been well studied with several multicenter randomized trials. The superiority of carotid endarterectomy (CEA) to medical therapy alone in both symptomatic and asymptomatic carotid artery stenosis has been well established in previous trials in the 1990s. The consequent era of endovascular carotid artery stenting (CAS) has offered another option for treating carotid artery stenosis. A series of randomized trials have now been conducted to compare CEA and CAS in the treatment of carotid artery disease...
2018: Surgical Neurology International
https://www.readbyqxmd.com/read/29701500/does-surgical-technique-influence-the-postoperative-hemodynamic-disturbances-and-neurological-outcomes-in-carotid-endarterectomy
#3
Serkan Burç Deşer, Mustafa Kemal Demirag, Fersat Kolbakir
INTRODUCTION: The carotid endarterectomy is already well established in patients with symptomatic or asymptomatic internal carotid artery (ICA) stenosis. The aim of this study was to determine whether there is a difference in postoperative blood pressure changes, stroke rate and postoperative complications following eversion carotid endarterectomy (E-CEA) and conventional carotid endarterectomy (C-CEA). METHODS: From 1 January 2010 to 31 March 2017 consecutive patients admitted to our department with symptomatic or asymptomatic ICA stenosis were included in this retrospective study...
April 27, 2018: Acta Chirurgica Belgica
https://www.readbyqxmd.com/read/29681577/carotid-artery-stenting-versus-carotid-endarterectomy-for-treatment-of-asymptomatic-carotid-artery-stenosis
#4
Guiyi Yuan, Shuxian Zhou, Wei Wu, Yuling Zhang, Juan Lei, Boshui Huang
Asymptomatic carotid stenosis is common and is associated with increased risk of stroke. The relative efficacy and safety of carotid endarterectomy (CEA) and carotid stenting (CAS) in patients with asymptomatic carotid stenosis remain unclear. Five studies that recruited patients with asymptomatic but significant carotid stenosis, who underwent CEA or CAS, were included in this systematic review and meta-analysis. The analyzed outcomes included risks of stroke, myocardial infarction (MI), and death. Risk ratio (RR) and 95% confidence interval (95% CI) were calculated and pooled for meta-analysis...
April 20, 2018: International Heart Journal
https://www.readbyqxmd.com/read/29598820/the-role-of-obesity-in-carotid-plaque-instability-interaction-with-age-gender-and-cardiovascular-risk-factors
#5
Valentina Rovella, Lucia Anemona, Marina Cardellini, Manuel Scimeca, Andrea Saggini, Giuseppe Santeusanio, Elena Bonanno, Manuela Montanaro, Iacopo Maria Legramante, Arnaldo Ippoliti, Nicola Di Daniele, Massimo Federici, Alessandro Mauriello
BACKGROUND: In the last decade, several studies have reported an unexpected and seemingly paradoxical inverse correlation between BMI and incidence of cardiovascular diseases. This so called "obesity paradox effect" has been mainly investigated through imaging methods instead of histologic evaluation, which is still the best method to study the instability of carotid plaque. Therefore, the purpose of our study was to evaluate by histology the role of obesity in destabilization of carotid plaques and the interaction with age, gender and other major cerebrovascular risk factors...
March 29, 2018: Cardiovascular Diabetology
https://www.readbyqxmd.com/read/29571620/regional-variation-in-patient-outcomes-in-carotid-artery-disease-treatment-in-the-vascular-quality-initiative
#6
Katie E Shean, Thomas F X O'Donnell, Sarah E Deery, Alexander B Pothof, Joseph R Schneider, Caron B Rockman, Brian W Nolan, Marc L Schermerhorn
OBJECTIVE: Quality metrics were developed to improve outcomes after carotid artery revascularization; however, few studies have evaluated regional differences in perioperative outcomes. This study aimed to evaluate regional variation in mortality and perioperative outcomes after carotid endarterectomy (CEA) and carotid artery stenting (CAS). METHODS: We identified all patients who underwent CEA or CAS from 2009 to 2016 in the Vascular Quality Initiative. Patients were analyzed on the basis of their symptom status...
March 20, 2018: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/29562638/characterization-of-carotid-smooth-muscle-cells-during-phenotypic-transition
#7
Haize Goikuria, Maria Del Mar Freijo, Reyes Vega Manrique, María Sastre, Elena Elizagaray, Ana Lorenzo, Koen Vandenbroeck, Iraide Alloza
Vascular smooth muscle cells (VSMCs) are central players in carotid atherosclerosis plaque development. Although the precise mechanisms involved in plaque destabilization are not completely understood, it is known that VSMC proliferation and migration participate in plaque stabilization. In this study, we analyzed expression patterns of genes involved in carotid atherosclerosis development (e.g., transcription factors of regulation of SMC genes) of VSMCs located inside or outside the plaque lesion that may give clues about changes in phenotypic plasticity during atherosclerosis...
March 18, 2018: Cells
https://www.readbyqxmd.com/read/29559195/safety-of-stenting-and-endarterectomy-for-asymptomatic-carotid-artery-stenosis-a-meta-analysis-of-randomised-controlled-trials
#8
REVIEW
Likun Cui, Yanshuo Han, Shuai Zhang, Xun Liu, Jian Zhang
OBJECTIVE/BACKGROUND: A meta-analysis of recently published randomised controlled trials (RCTs) was performed to evaluate the safety of carotid artery stenting (CAS) versus carotid endarterectomy (CEA) for asymptomatic carotid stenosis with average risk. METHODS: The MEDLINE, Embase, and Cochrane Library databases were systematically searched for RCTs that compared CAS with CEA for asymptomatic carotid stenosis. These publications reported clinical outcomes after revascularisation in patients with asymptomatic carotid stenosis during their primary intervention...
May 2018: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/29535395/systematic-review-and-network-meta-analysis-of-treatment-strategies-for-asymptomatic-carotid-disease
#9
Mohamed Barkat, Iain Roy, Stavros A Antoniou, Francesco Torella, George A Antoniou
We aim to perform a systematic review and meta-analysis to investigate outcomes of treatment strategies for asymptomatic carotid disease. We searched electronic bibliographic sources (MEDLINE, EMBASE, CINAHL and CENTRAL) to identify randomised controlled trials (RCT) reporting comparative outcomes of carotid endarterectomy (CEA), carotid stenting (CAS) and best medical therapy (BMT) in asymptomatic carotid disease. We performed pairwise meta-analysis applying random or fixed-effects models and reported the results as the odds ratio (OR) or risk difference (RD) and 95% confidence interval (CI)...
March 13, 2018: Scientific Reports
https://www.readbyqxmd.com/read/29501517/intraoperative-hypoglossal-nerve-mapping-during-carotid-endarterectomy-technical-note
#10
Atsuhiro Kojima, Isako Saga, Mami Ishikawa
BACKGROUND: Hypoglossal nerve deficit is a possible complication caused by carotid endarterectomy (CEA). The accidental injury of the hypoglossal nerve during surgery is one of the major reasons for permanent hypoglossal nerve palsy. In this study, we investigated the usefulness of intraoperative mapping of the hypoglossal nerve to identify this nerve during CEA. METHODS: Five consecutive patients who underwent CEA for the treatment of symptomatic or asymptomatic carotid artery stenosis were studied...
May 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29482877/the-impact-of-race-on-outcomes-after-carotid-endarterectomy-in-the-united-states
#11
Alexander B Pothof, Peter A Soden, Sarah E Deery, Thomas F X O'Donnell, Grace J Wang, Kakra Hughes, Gert J de Borst, Marc L Schermerhorn
OBJECTIVE: Black patients undergoing carotid endarterectomy (CEA) in the United States are more often symptomatic at presentation and have more comorbidities compared with white patients. However, the impact of race on outcomes after CEA is largely unknown. METHODS: We identified CEA patients in the Vascular Quality Initiative registry (2012-2017) and compared them by race (black vs white). All other nonwhite races (891 [1.4%]) and Hispanics (2222 [3.4%]) were excluded...
February 23, 2018: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/29482876/low-carotid-stump-pressure-as-a-predictor-for-ischemic-symptoms-and-as-a-marker-for-compromised-cerebral-reserve-in-octogenarians-undergoing-carotid-endarterectomy
#12
Sam C Tyagi, Matthew J Dougherty, Shinichi Fukuhara, Douglas A Troutman, Danielle M Pineda, Hong Zheng, Keith D Calligaro
BACKGROUND: Carotid artery occlusive disease can cause stroke by embolization, thrombosis, and hypoperfusion. The majority of strokes secondary to cervical carotid atherosclerosis are believed to be of embolic etiology. However, cerebral hypoperfusion could be an important factor in perioperative stroke. We retrospectively reviewed the stump pressure (SP) of carotid endarterectomy (CEA) of patients at Pennsylvania Hospital to identify whether physiologic perfusion differences account for differences in perioperative stroke rates, particularly in octogenarians...
February 23, 2018: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/29452833/endothelial-vascular-cell-adhesion-molecule-1-is-a-marker-for-high-risk-carotid-plaques-and-target-for-ultrasound-molecular-imaging
#13
Craig C Weinkauf, Kirsten Concha-Moore, Jonathan R Lindner, Edmund R Marinelli, Kyle P Hadinger, Sandipan Bhattacharjee, Scott S Berman, Kay Goshima, Luis R Leon, Terry O Matsunaga, Evan Unger
BACKGROUND: Molecular imaging of carotid plaque vulnerability to atheroembolic events is likely to lead to improvements in selection of patients for carotid endarterectomy (CEA). The aims of this study were to assess the relative value of endothelial inflammatory markers for this application and to develop molecular ultrasound contrast agents for their imaging. METHODS: Human CEA specimens were obtained prospectively from asymptomatic (30) and symptomatic (30) patients...
February 13, 2018: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/29405249/distinctive-peri-luminal-presence-of-agrin-in-murine-and-human-carotid-atherosclerotic-plaques
#14
Uwe Rauch, Eva Bengtsson, Isabel Gonçalves, Anna Hultgårdh-Nilsson
The clinical consequences of arterial atherosclerotic lesions depend, apart from their size, on their composition of cellular and extracellular components. While an intact endothelium at the interface of atherosclerotic plaques towards the blood can prevent its erosion, underlying smooth muscle cells within the plaque can reduce the risk of plaque ruptures, due to the deposition of stabilizing extracellular matrix. Basement membranes underlay and support the function of endothelial cells, and embed smooth muscle cells in the media, the source of most smooth muscle cells within atherosclerotic plaques...
February 6, 2018: Histology and Histopathology
https://www.readbyqxmd.com/read/29397311/cerebral-neuromonitoring-during-carotid-endarterectomy-and-impact-of-contralateral-internal-carotid-occlusion
#15
Davorin Sef, Andrija Skopljanac-Macina, Milan Milosevic, Anita Skrtic, Vinko Vidjak
BACKGROUND: The aim of this study was to identify the reliability of carotid artery stump pressure (SP) in predicting the neurologic changes and correlation with contralateral internal carotid artery (ICA) occlusion in patients undergoing eversion carotid endarterectomy (CEA). The optimal method for monitoring cerebral perfusion during CEA, performed under either local or general anesthesia, is still controversial. METHODS: We prospectively analyzed 118 consecutive patients undergoing eversion CEA under local anesthesia...
May 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29393758/risk-of-intracranial-hemorrhage-after-carotid-artery-stenting-versus-endarterectomy-a-population-based-study
#16
Mohamad A Hussain, Aziz S Alali, Muhammad Mamdani, Jack V Tu, Gustavo Saposnik, Konard Salata, Avery B Nathens, Charles de Mestral, Deepak L Bhatt, Subodh Verma, Mohammed Al-Omran
OBJECTIVE Intracranial hemorrhage (ICH) associated with cerebral hyperperfusion syndrome is a rare but major complication of carotid artery revascularization. The objective of this study was to compare the rate of ICH after carotid artery stenting (CAS) with that after endarterectomy (CEA). METHODS The authors performed a retrospective population-based cohort study of patients who underwent carotid artery revascularization in the province of Ontario, Canada, between 2002 and 2015. The primary outcome was the rate of ICH that occurred within 90 days after carotid artery intervention among patients who underwent CAS versus that of those who underwent CEA...
February 2, 2018: Journal of Neurosurgery
https://www.readbyqxmd.com/read/29376954/-an-efficacy-of-carotid-arteries-repair-for-tortuosity-combined-with-stenosis
#17
A V Gavrilenko, A V Abramyan, A V Kuklin
AIM: To assess an efficacy of carotid arteries reconstruction in patients with internal carotid artery stenosis combined with tortuosity. MATERIAL AND METHODS: 86 patients with ICA tortuosity and stenosis were enrolled. All patients were divided into groups depending on type of surgery: group I - open carotid endarterectomy (CEA) followed by obligatory repair with synthetic patch (31 (36%) patients); group II - eversion CEA with ICA resection, redressation and reimplantation into own ostium (35 (40...
2018: Khirurgiia
https://www.readbyqxmd.com/read/29334161/the-role-of-neurosonology-in-the-diagnosis-and-management-of-patients-with-carotid-artery-disease-a-review
#18
REVIEW
Odysseas Kargiotis, Apostolos Safouris, Georgios Magoufis, Maria Georgala, Andromachi Roussopoulou, Eleftherios Stamboulis, Konstantinos G Moulakakis, Andreas Lazaris, George Geroulakos, Spyros Vasdekis, Georgios Tsivgoulis
Carotid artery disease (CAD) is a common cause of ischemic stroke with high rates of recurrence. Carotid endarterectomy (CEA) or carotid artery stenting (CAS) are highly recommended for the secondary prevention of symptomatic CAD during the first 14 days following the index event of transient ischemic attack or minor stroke. CEA or CAS may also be offered in selected cases with severe asymptomatic stenosis. Herein, we review the utility of neurosonology in the diagnosis and pre-/peri-interventional assessment of CAD patients who undergo carotid revascularization procedures...
January 15, 2018: Journal of Neuroimaging: Official Journal of the American Society of Neuroimaging
https://www.readbyqxmd.com/read/29315509/carotid-plaque-volume-in-patients-undergoing-carotid-endarterectomy
#19
S Ball, S Rogers, K Kanesalingam, R Taylor, E Katsogridakis, C McCollum
BACKGROUND: The main indication for carotid endarterectomy (CEA) is severity of carotid artery stenosis, even though most strokes in carotid disease are embolic. The relationship between carotid plaque volume (CPV) and symptoms of cerebral ischaemia, and the measurement of CPV by minimally invasive tomographic ultrasound imaging, were investigated. METHODS: The volume of the endarterectomy specimen was measured using a validated saline suspension technique in patients undergoing CEA...
February 2018: British Journal of Surgery
https://www.readbyqxmd.com/read/29246640/computational-fluid-dynamic-comparison-between-patch-based-and-primary-closure-techniques-after-carotid-endarterectomy
#20
Maurizio Domanin, Daniele Bissacco, Davide Le Van, Christian Vergara
OBJECTIVE: The aim of the study was to provide, by means of computational fluid dynamics, a comparative analysis after carotid endarterectomy (CEA) between patch graft (PG) and primary closure (PC) techniques performed in real carotid geometries to identify disturbed flow conditions potentially involved in the development of restenosis. METHODS: Eight carotid geometries in seven asymptomatic patients who underwent CEA were analyzed. In six cases (A-F), CEA was performed using PG closure; in two cases (G and H), PC was performed...
March 2018: Journal of Vascular Surgery
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