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Carotid endarterectomy in asymptomatic patients

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https://www.readbyqxmd.com/read/28919313/periprocedural-outcomes-of-carotid-artery-stenting-in-elderly-patients
#1
Masataka Nanto, Yudai Goto, Hiroyuki Yamamoto, Seisuke Tanigawa, Michiko Takado, Takahiro Ogawa, Yoshikazu Nakahara
BACKGROUND: Carotid artery stenting has emerged as an alternative to carotid endarterectomy especially in patients with high risk of carotid endarterectomy. Older age (≥80 years old) was recognized as one of the high risk factors of carotid endarterectomy. However, the association between older age and increased risk of adverse events for carotid artery stenting has been reported. The purpose of this study was to evaluate the association between age and periprocedural outcomes after carotid artery stenting...
September 14, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28916863/intracerebral-hemorrhage-as-a-manifestation-of-cerebral-hyperperfusion-syndrome-after-carotid-revascularization-systematic-review-and-meta-analysis
#2
REVIEW
Pedro Abreu, Jerina Nogueira, Filipe Brogueira Rodrigues, Ana Nascimento, Mariana Carvalho, Ana Marreiros, Hipólito Nzwalo
BACKGROUND: Intracerebral hemorrhage (ICH) in the context of cerebral hyperperfusion syndrome (CHS) is an uncommon but potentially lethal complication after carotid revascularization for carotid occlusive disease. Information about its incidence, risk factors and fatality is scarce. Therefore, we aimed to perform a systematic review and meta-analysis focusing on the incidence, risk factors and outcomes of ICH in the context of CHS after carotid revascularization. METHODS: We searched the PubMed and EBSCO hosts for all studies published in English about CHS in the context of carotid revascularization...
September 15, 2017: Acta Neurochirurgica
https://www.readbyqxmd.com/read/28916664/safety-of-simultaneous-coronary-artery-bypass-grafting-and-carotid-endarterectomy-versus-isolated-coronary-artery-bypass-grafting-a-randomized-clinical-trial
#3
Christian Weimar, Konstantinos Bilbilis, Jan Rekowski, Torulv Holst, Friedhelm Beyersdorf, Martin Breuer, Manfred Dahm, Anno Diegeler, Arne Kowalski, Sven Martens, Friedrich W Mohr, Jiri Ondrášek, Beate Reiter, Peter Roth, Ralf Seipelt, Markus Siggelkow, Gustav Steinhoff, Anton Moritz, Mathias Wilhelmi, Gerhard Wimmer-Greinecker, Hans-Christoph Diener, Heinz Jakob, Claudia Ose, Andre Scherag, Stephan C Knipp
BACKGROUND AND PURPOSE: The optimal operative strategy in patients with severe carotid artery disease undergoing coronary artery bypass grafting (CABG) is unknown. We sought to investigate the safety and efficacy of synchronous combined carotid endarterectomy and CABG as compared with isolated CABG. METHODS: Patients with asymptomatic high-grade carotid artery stenosis ≥80% according to ECST (European Carotid Surgery Trial) ultrasound criteria (corresponding to ≥70% NASCET [North American Symptomatic Carotid Endarterectomy Trial]) who required CABG surgery were randomly assigned to synchronous carotid endarterectomy+CABG or isolated CABG...
September 15, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28893482/comparison-of-early-outcomes-and-restenosis-rate-between-carotid-endarterectomy-and-carotid-artery-stenting-using-propensity-score-matching-analysis
#4
Seon-Hee Heo, Kyoung-Won Yoon, Shin-Young Woo, Yang-Jin Park, Young-Wook Kim, Keon-Ha Kim, Chin-Sang Chung, Oh-Young Bang, Dong-Ik Kim
OBJECTIVE/BACKGROUND: Despite randomised evidence, the debate continues about the preferred treatment strategy for carotid stenosis in routine clinical practice. The aim of this study was to compare early outcomes and restenosis rates after carotid endarterectomy (CEA) and carotid stenting (CAS) in unselected patients using propensity score matching (PSM). METHODS: The 30 day incidence of major adverse clinical events (MACE; defined as stroke, transient ischaemic attack, myocardial infarction, or death) and procedure related complications, as well as restenosis rates during follow-up were compared between unselected patients undergoing CEA or CAS between January 2002 and December 2015 at a single institution...
September 8, 2017: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28890063/the-value-of-carotid-endarterectomy-as-a-learning-tool-for-trainees
#5
L M Cacioppa, R Pini, M Longhi, A Vacirca, E Gallitto, G L Faggioli, M Gargiulo, A Stella
INTRODUCTION: Carotid endarterectomy (CEA) intervention needs a specific training and a sufficient learning curve to obtain optimal results in terms of outcome. A formative program was settled up in a single academic center in order to optimize training of standard CEA procedures. This study aims to evaluate the 11-year results of the teaching CEA program. METHODS: The trainees CEA teaching program is carried on during the 5-year vascular surgery residency period and it is stratified as follows: learning theory and intervention assistance (minimum 50 procedures per-year) in the first and second residency-year; performing CEA as second operator in the third and fourth residency-year (minimum 50 procedures per-year); CEA execution as first operator with attending supervision in the last residency-year...
September 7, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28890012/ethnicity-race-and-post-operative-stroke-risk-among-53-593-patients-with-asymptomatic-carotid-stenosis-undergoing-revascularization
#6
Roxanna M Garcia, Seungwon Yoon, Tene Cage, Matthew B Potts, Michael T Lawton
BACKGROUND: The incidence of post-operative stroke following carotid endarterectomy is an uncommon event and differences by racial and ethnic subgroups are not fully described in the literature. OBJECTIVE: To investigate the impact of race and ethnicity on post-operative stroke risk among patients with asymptomatic carotid stenosis undergoing carotid endarterectomy. METHODS: The ACS-NSQIP database between 2008 and 2015 was used to identify patients undergoing carotid endarterectomy with no stroke history...
September 7, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28877387/recommendations-for-low-grade-carotid-stenosis-follow-up-based-on-a-single-institution-database
#7
Garrett M Bennett, Edward I Bluth, Michael L Larson, Qingyang Luo
OBJECTIVES: The purpose of this study was to determine the incidences and rates of progression of varying degrees of carotid stenosis that do not require intervention according to the Asymptomatic Carotid Atherosclerosis Study, the European Carotid Surgery Trial, and the North American Symptomatic Carotid Endarterectomy Trial, and from this information, to provide evidence-based recommendations for follow-up imaging. METHODS: A retrospective review was performed of all carotid ultrasound examinations performed at a single institution from January 1995 through April 2015...
September 6, 2017: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
https://www.readbyqxmd.com/read/28872355/the-role-of-stump-pressure-and-cerebral-oximetry-in-predicting-ischaemic-brain-damage-during-carotid-endarterectomy
#8
Kuzhuget Rossi, Starodubtsev Vladimir, Ignatenko Pavel, Starodubtseva Alexandra, Voroshilina Olga, Ruzankin Pavel, Karpenko Andrey
Objective is to compare the predictive value of stump pressure (SP) and cerebral oximetry (rSO2) levels in the evaluation of ischaemic injury of the cerebrum during clamping of the carotid artery (CCA) without temporary shunt (TS). Methods We included 84 patients with an asymptomatic stenosis (>70%) of the internal carotid artery (ICA) who underwent carotid endarterectomy (CEA) under GA. Cerebral ischaemic tolerance (CIT) was determined on the basis of SP, rSO2 and ∆rSO2 (↓rSO2 from baseline) during CCA...
September 5, 2017: Brain Injury: [BI]
https://www.readbyqxmd.com/read/28845749/patterns-of-acute-ischemic-strokes-after-carotid-endarterectomy-and-therapeutic-implications
#9
Fabien Lareyre, Juliette Raffort, Caroline Weill, Claire Marsé, Laurent Suissa, Julien Chikande, Réda Hassen-Khodja, Elixène Jean-Baptiste
AIM: Acute ischemic strokes following surgical treatment of carotid stenosis lead to substantial disability and mortality, and vascular mechanisms underlying their development are not fully elucidated. The goal of this study was to analyze the topographic patterns of acute ischemic stroke following carotid endarterectomy (CEA) on diffusion-weighted and perfusion-weighted magnetic resonance imaging (MRI). MATERIAL AND METHODS: Data were retrospectively collected from consecutive patients who underwent CEA and developed postoperative acute ischemic stroke...
January 1, 2017: Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28822658/preoperative-anemia-is-associated-with-mortality-after-carotid-endarterectomy-in-symptomatic-patients
#10
Alexander B Pothof, Thomas C F Bodewes, Thomas F X O'Donnell, Sarah E Deery, Katie Shean, Peter A Soden, Gert J de Borst, Marc L Schermerhorn
OBJECTIVE: Preoperative anemia and blood transfusions are associated with worse outcomes after surgery. However, the impact of preoperative anemia and transfusions on outcomes after carotid endarterectomy (CEA) is unknown. METHODS: CEA patients from 2011 to 2015 in the American College of Surgeons National Surgical Quality Improvement Program Targeted Vascular module were compared by the presence of preoperative anemia (hematocrit <36%) after stratification by symptom status...
August 16, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28818260/transcranial-doppler-monitoring-for-microemboli-a-marker-of-a-high-risk-carotid-plaque
#11
REVIEW
J David Spence
In the United States, 90% of carotid intervention is being performed for asymptomatic carotid stenosis, even though 90% of patients would be better treated with intensive medical therapy. This is being justified by comparing risks of stroke or death with medical therapy during clinical trials completed decades ago (approximately 2% per year) with risks of intervention with carotid artery stenting (CAS) versus carotid endarterectomy in recent trials that did not have a medical arm. Such extrapolations are, simply put, invalid...
March 2017: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/28818255/clinical-need-design-and-goals-for-the-carotid-revascularization-and-medical-management-for-asymptomatic-carotid-stenosis-trial
#12
RANDOMIZED CONTROLLED TRIAL
Brajesh K Lal, James F Meschia, Thomas G Brott
Prior clinical trials produced evidence-based treatment recommendations for patients with asymptomatic carotid stenosis that may not be appropriate for clinical decision-making today. High-quality patient outcomes data to allow informed decision making regarding the optimal management of high-grade asymptomatic internal carotid artery stenosis is lacking. The results of the Asymptomatic Carotid Atherosclerosis Study were published in 1995 based on a randomized patient enrollment in the 1990s. Outcomes after endarterectomy, stenting, and medical treatment for these patients have all improved in the subsequent 2 decades...
March 2017: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/28798785/simultaneous-vertebral-and-subclavian-artery-stenting
#13
Damian R Maciejewski, Łukasz Tekieli, Roman Machnik, Anna Kabłak-Ziembicka, Tadeusz Przewłocki, Piotr Paluszek, Mariusz Trystuła, Robert Musiał, Karolina Dzierwa, Piotr Pieniążek
INTRODUCTION: Vertebrobasilar territory ischemia leads to disabling neurological symptoms and may be caused both by vertebral artery (VA) and subclavian artery (SA) stenosis. The coexisting symptomatic ipsilateral VA and proximal SA stenosis should be considered as a true bifurcation lesion for percutaneous treatment. AIM: To evaluate the safety and efficacy of simultaneous angioplasty of vertebral and subclavian stenosis. MATERIAL AND METHODS: Fifteen patients (age 69...
2017: Postępy W Kardiologii Interwencyjnej, Advances in Interventional Cardiology
https://www.readbyqxmd.com/read/28798779/one-swallow-does-not-a-summer-make-but-many-swallows-do-accumulating-clinical-evidence-for-nearly-eliminated-peri-procedural-and-30-day-complications-with-mesh-covered-stents-transforms-the-carotid-revascularisation-field
#14
REVIEW
Piotr Musiałek, L Nelson Hopkins, Adnan H Siddiqui
Atherosclerotic carotid artery stenosis (CS) continues to be a common cause of acute ischaemic stroke. Optimised medical therapy (OMT), the first-line treatment modality in CS, may reduce or delay - but it does not abolish - CS-related strokes. As per current AHA/ASA and ESC/ESVS/ESO guidelines, carotid artery stenting (CAS) is a less-invasive alternative to carotid endarterectomy (CEA) for CS revascularisation in primary and secondary stroke prevention. Ten-year follow-up from the CREST trial in patients with symptomatic and asymptomatic CS confirmed equipoise of CAS and CEA in the primary endpoint...
2017: Postępy W Kardiologii Interwencyjnej, Advances in Interventional Cardiology
https://www.readbyqxmd.com/read/28789657/neutrophil-gelatinase-associated-lipocalin-ngal-is-elevated-in-type-2-diabetics-with-carotid-artery-stenosis-and-reduced-under-metformin-treatment
#15
W Eilenberg, S Stojkovic, A Piechota-Polanczyk, A Kaider, N Kozakowski, W J Weninger, J Nanobachvili, J Wojta, I Huk, S Demyanets, C Neumayer
BACKGROUND: Neutrophil gelatinase-associated lipocalin (NGAL), an acute phase protein released by neutrophils, has been described as biomarker of inflammatory states. Type 2 diabetes mellitus (T2DM) is characterized by increased inflammation and an elevated risk for embolization of carotid artery stenosis (CAS). We aimed to explore the role of NGAL systemically and in plaques of diabetics undergoing carotid endarterectomy. Moreover, the potential anti-inflammatory effect of metformin on NGAL was addressed in diabetics...
August 8, 2017: Cardiovascular Diabetology
https://www.readbyqxmd.com/read/28768800/factors-associated-with-time-to-site-activation-randomization-and-enrollment-performance-in-a-stroke-prevention-trial
#16
Bart M Demaerschalk, Robert D Brown, Gary S Roubin, Virginia J Howard, Eldina Cesko, Kevin M Barrett, Mary E Longbottom, Jenifer H Voeks, Seemant Chaturvedi, Thomas G Brott, Brajesh K Lal, James F Meschia, George Howard
BACKGROUND AND PURPOSE: Multicenter clinical trials attempt to select sites that can move rapidly to randomization and enroll sufficient numbers of patients. However, there are few assessments of the success of site selection. METHODS: In the CREST-2 (Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trials), we assess factors associated with the time between site selection and authorization to randomize, the time between authorization to randomize and the first randomization, and the average number of randomizations per site per month...
September 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28767806/extracranial-carotid-stenosis-evidence-based-review
#17
Carolina Dutra Queiroz Flumignan, Ronald Luiz Gomes Flumignan, Túlio Pinho Navarro
Extracranial cerebrovascular disease is one of the most important causes of death and disability worldwide and its treatment is based on clinical and surgical strategies, the latter being performed by conventional or endovascular techniques. The management of stenosis of the carotid bifurcation is mainly aimed at preventing stroke and has been the subject of extensive investigation. The role of clinical treatment has been re-emphasized, but carotid endarterectomy remains the first-line treatment for symptomatic patients with 50% to 99% stenosis and for asymptomatic patients with 60% to 99% stenosis...
May 2017: Revista do Colégio Brasileiro de Cirurgiões
https://www.readbyqxmd.com/read/28757518/pathological-quantification-of-carotid-artery-plaque-instability-in-patients-undergoing-carotid-endarterectomy
#18
Takao Konishi, Naohiro Funayama, Tadashi Yamamoto, Tohru Morita, Daisuke Hotta, Ryota Nomura, Yusuke Nakagaki, Takeo Murahashi, Kenji Kamiyama, Tetsuyuki Yoshimoto, Takeshi Aoki, Hiroshi Nishihara, Shinya Tanaka
BACKGROUND: Unstable atherosclerotic carotid plaques cause cerebral thromboemboli and ischemic events. However, this instability has not been pathologically quantified, so we sought to quantify it in patients undergoing carotid endarterectomy (CEA).Methods and Results:Carotid plaques were collected during CEA from 67 symptomatic and 15 asymptomatic patients between May 2015 and August 2016. The specimens were stained with hematoxylin-eosin and elastica-Masson. Immunohistochemistry was performed using an endothelial-specific antibody to CD31, CD 34 and PDGFRβ...
July 29, 2017: Circulation Journal: Official Journal of the Japanese Circulation Society
https://www.readbyqxmd.com/read/28746385/quantification-of-carotid-plaque-lipid-content-with-magnetic-resonance-t2-mapping-in-patients-undergoing-carotid-endarterectomy
#19
Mohammad Alkhalil, Luca Biasiolli, Joshua T Chai, Francesca Galassi, Linqing Li, Christopher Darby, Alison Halliday, Linda Hands, Timothy Magee, Jeremy Perkins, Ed Sideso, Peter Jezzard, Matthew D Robson, Ashok Handa, Robin P Choudhury
BACKGROUND AND PURPOSE: Techniques to stratify subgroups of patients with asymptomatic carotid artery disease are urgently needed to guide decisions on optimal treatment. Reliance on estimates of % luminal stenosis has not been effective, perhaps because that approach entirely disregards potentially important information on the pathological process in the wall of the artery. METHODS: Since plaque lipid is a key determinant of plaque behaviour we used a newly validated, high-sensitivity T2-mapping MR technique for a systematic survey of the quantity and distribution of plaque lipid in patients undergoing endarterectomy...
2017: PloS One
https://www.readbyqxmd.com/read/28735954/endarterectomy-achieves-lower-stroke-and-death-rates-compared-with-stenting-in-patients-with-asymptomatic-carotid-stenosis
#20
REVIEW
Stavros K Kakkos, Ioannis Kakisis, Ioannis A Tsolakis, George Geroulakos
BACKGROUND: It is currently unclear if carotid artery stenting (CAS) is as safe as carotid endarterectomy (CEA) for patients with significant asymptomatic stenosis. The aim of our study was to perform a systematic review and meta-analysis of trials comparing CAS with CEA. METHODS: On March 17, 2017, a search for randomized controlled trials was performed in MEDLINE and Scopus databases with no time limits. We performed meta-analyses with Peto odds ratios (ORs) and 95% confidence intervals (CIs)...
August 2017: Journal of Vascular Surgery
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