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Carotid endarterectomy in asymptomatic patients

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
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...
February 28, 2018: World Neurosurgery
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
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
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
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
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...
January 31, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
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
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
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
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...
January 8, 2018: British Journal of Surgery
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...
December 12, 2017: Journal of Vascular Surgery
Anahita Dua, Steven Koprowski, Fadwa Ali, Sapan S Desai
BACKGROUND: The Physician Quality Reporting System (PQRS) created by the Centers for Medicare and Medicaid Services financially penalizes providers who fail to meet expected quality of care measures. The purpose of this study is to evaluate the factors that predict failure to meet PQRS measures for carotid endarterectomy (CEA). METHODS: PQRS measure 260 (discharge by postoperative day 2 following CEA in asymptomatic patients) and 346 (rate of postoperative stroke or death following CEA in asymptomatic patients) were evaluated using hospital records from the state of Florida from 2008 to 2012...
December 5, 2017: Annals of Vascular Surgery
Thomas W Cheng, Alik Farber, Jeffrey A Kalish, Douglas W Jones, Myriam Castagne, Denis Rybin, Stephen J Raulli, Jeffrey J Siracuse
OBJECTIVE: Length of stay (LOS) is commonly used to gauge hospital resource utilization and can affect hospital profit margin. Other fields of surgery have showed that operations performed close to the weekend have longer LOS and higher patient morbidity. Our goal was to investigate whether asymptomatic patients undergoing elective carotid endarterectomy (CEA) earlier in the week had a shorter LOS and improved clinical outcomes compared to those treated before the weekend. METHODS: The Vascular Quality Initiative database was queried for elective weekday CEAs performed for asymptomatic carotid stenosis from 2005 to 2017...
December 5, 2017: Annals of Vascular Surgery
K Lokuge, D D de Waard, A Halliday, A Gray, R Bulbulia, B Mihaylova
BACKGROUND: Stroke/death rates within 30 days of carotid endarterectomy (CEA) and carotid artery stenting (CAS) in RCTs inform current clinical guidelines. However, the risks may have changed in recent years with wider use of effective stroke prevention therapies, especially statins, improved patient selection and growing operator expertise. The aim of this study was to investigate whether the procedural stroke/death risks from CEA and CAS have changed over time. METHODS: MEDLINE and Embase were searched systematically from inception to May 2016 for observational cohort studies of CEA and CAS...
January 2018: British Journal of Surgery
Peter Balaz, Petrut Gogalniceanu, Chris Callaghan
Renal failure and haemodialysis are associated with an increased risk of cardiovascular disease. Patients undergoing renal transplantation undergo rigorous pre-operative vascular assessment, including optimisation of risk factors for stroke. The indication for carotid intervention and the threshold for carotid endarterectomy in asymptomatic patients with incidental carotid disease has not been clarified in the context chronic kidney disease (CKD). This review aims to analyse outcomes following carotid endarterectomy in patients with CKD, in order to ascertain whether general guidelines for carotid artery revascularisation apply to this specific cohort...
November 16, 2017: Transplantation Reviews
Kaelan Chan, Ahmed M Abou-Zamzam, Karen Woo
BACKGROUND: The objective of this study was to examine the use of preoperative cardiac stress testing (PCST) in the Southern California Vascular Outcomes Improvement Collaborative (So Cal VOICe). METHODS: A retrospective review was performed on data in all modules of the So Cal VOICe from September 2012 through May 2016. PCST was defined as stress echocardiogram or nuclear stress test. A new postoperative myocardial infarction (MI) was defined as troponin elevation and/or electrocardiogram/imaging changes with or without ischemic symptoms...
November 29, 2017: Annals of Vascular Surgery
Thomas Kotsis, Panagitsa Christoforou, Nikolaos Asaloumidis, Erifyli Argyra
The third-generation thienopyridine prasugrel has much stronger antiplatelet effect compared to other current antiplatelet inhibitors and exhibits practically zero resistance in healthy people. Prasugrel is used as a pre- and post-treatment in percutaneous coronary or neurovascular interventions with parallel aspirin regime. However, as there is a higher reported bleeding with intraluminal interventions and meticulous technique is recommended, there is nearly non-existent international experience of open surgery under full prasugrel treatment...
2017: SAGE Open Medical Case Reports
Honglin Dong, Tian Du, Shyamal Premaratne, Cynthia X Zhao, Qinqin Tian, Yongjun Li, Sheng Yan, Wayne W Zhang
BACKGROUND: Rupture of atherosclerotic plaques and the resulting thrombosis are vital causes of clinical ischemic events. Recent studies have shown that ADAMTS4 (a disintegrin and metalloproteinase with thrombospondin motifs 4) is a pathogenic factor of plaque vulnerability in mice. However, the relationship between ADAMTS4 and carotid atherosclerotic vulnerable plaques in humans remains unclear. METHODS: Forty-eight carotid atherosclerotic plaque specimens were obtained from 48 carotid artery stenosis inpatients undergoing carotid endarterectomy...
November 15, 2017: Journal of Vascular Surgery
Gabrielle T W Tse, Monique F Kilkenny, Chris Bladin, Michael Grigg, Helen M Dewey
BACKGROUND: Recent research evidence has impacted the practice of carotid endarterectomy (CEA). We aim to characterize changes in the practice and outcome of CEA over time in a single large-volume stroke centre. METHODS: All patients who underwent CEA from 2004 to 2014 and carotid angioplasty and stenting (CAS) from 2003 to 2008 at an Australian metropolitan tertiary stroke centre hospital were included. Clinical data were analysed to identify time trends in choice of intervention, patient selection, preoperative imaging utilization, surgical timing and outcome...
November 13, 2017: ANZ Journal of Surgery
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