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Carotid endarterectomy in asymptomatic patients

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https://www.readbyqxmd.com/read/28716303/early-results-of-endovascular-treatment-of-patients-with-bilateral-stenoses-of-the-internal-carotid-arteries-using-proximal-protection-systems-at-30-day-follow-up
#1
Paweł Latacz, Marian Simka, Tadeusz Popiela, Marek Kazibudzki, Tomasz Mrowiecki
BACKGROUND: Although surgical endarterectomy remains the treatment of choice for carotid artery stenosis, carotid artery stenting (CAS) with use of proximal protection systems (PPS) plays an very important role as alternative treatment modality, especially in patients with critical, symptomatic lesions. This study was single-centre study to evaluate the technical and clinical success of proximal protection devices as the first choice for embolic protection in symptomatic and asymptomatic carotid stenosis in patients with bilateral, advanced lesions of carotid arteries (bilateral stenoses or stenosis and occlusion)...
July 8, 2017: Neurologia i Neurochirurgia Polska
https://www.readbyqxmd.com/read/28697713/an-update-of-the-italian-stroke-organization-stroke-prevention-awareness-diffusion-group-guidelines-on-carotid-endarterectomy-and-stenting-a-personalized-medicine-approach
#2
Gaetano Lanza, Carlo Setacci, Stefano Ricci, Patrizio Castelli, Alberto Cremonesi, Jessica Lanza, Claudio Novali, Carlo Pratesi, Paola Santalucia, Francesco Speziale, Augusto Zaninelli, Gian Franco Gensini
Although proof-based medicine has generated much valid evidence for the drawing up of guidelines and recommendations for best clinical practice in symptomatic and asymptomatic carotid stenosis, whether and when it is better to employ endarterectomy or stenting as the intervention of choice still remain matters of debate. Moreover, guidelines have been targeted up to now to the 'representative' patient, as resulting from the statistical analyses of the studies conducted on the safety and efficacy of both interventions as well as on medical therapy alone...
July 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28689950/an-accumulated-deficits-model-predicts-perioperative-and-long-term-adverse-events-after-carotid-endarterectomy
#3
Natalie D Sridharan, Rabih A Chaer, Bryan Boyuan Wu, Mohammad H Eslami, Michel S Makaroun, Efthymios D Avgerinos
OBJECTIVE: There is increasing recognition that decreased reserve in multiple organ systems, known as accumulated deficits, may better stratify perioperative risk than traditional risk indices. We hypothesized that an AD model would predict both perioperative adverse events and long-term survival after carotid endarterectomy (CEA), particularly important in asymptomatic patients. METHODS: Consecutive patients undergoing CEA between 1/1/2000 and 12/31/2010 were retrospectively identified...
July 6, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28688468/evaluation-and-management-of-atherosclerotic-carotid-stenosis
#4
REVIEW
James F Meschia, James P Klaas, Robert D Brown, Thomas G Brott
Medical therapies for the prevention of stroke have advanced considerably in the past several years. There can also be a role for mechanical restoration of the lumen by endarterectomy or stenting in selected patients with high-grade atherosclerotic stenosis of the extracranial carotid artery. Endarterectomy is generally recommended for patients with high-grade symptomatic carotid stenosis. Stenting is considered an option for patients at high risk of complications with endarterectomy. Whether revascularization is better than contemporary medical therapy for asymptomatic extracranial carotid stenosis is a subject of several ongoing randomized clinical trials in the United States and internationally...
July 2017: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/28679848/carotid-stenting-versus-endarterectomy-for-asymptomatic-carotid-artery-stenosis-a-systematic-review-and-meta-analysis
#5
Paola Moresoli, Bettina Habib, Pauline Reynier, Matthew H Secrest, Mark J Eisenberg, Kristian B Filion
BACKGROUND AND PURPOSE: There is no consensus on the comparative efficacy and safety of carotid artery stenting (CAS) versus carotid endarterectomy (CEA) in patients with asymptomatic carotid artery stenosis. To evaluate CAS versus CEA in asymptomatic patients, we conducted a systematic review and meta-analysis of randomized controlled trials. METHODS: We systematically searched EMBASE, PubMed, MEDLINE, and the Cochrane Library for randomized controlled trials comparing CAS to CEA in asymptomatic patients using a pre-specified protocol...
July 5, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28666824/carotid-artery-revascularization-in-patients-with-contralateral-carotid-artery-occlusion-stent-or-endarterectomy
#6
Besma Nejim, Hanaa Dakour Aridi, Satinderjit Locham, Isibor Arhuidese, Caitlin Hicks, Mahmoud B Malas
BACKGROUND: The Centers for Medicare and Medicaid Services (CMS) considers that contralateral carotid artery occlusion puts the patients at high risk for carotid endarterectomy (CEA) and agrees to reimburse for carotid artery stenting (CAS) in these patients. However, there is a paucity of evidence that support the superiority of CAS compared with CEA in patients with contralateral carotid occlusion. METHODS: All patients who underwent CEA or CAS with contralateral carotid artery occlusion were identified in the Vascular Quality Initiative (VQI) registry between 2005 and 2016...
June 27, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28655552/the-impact-of-contralateral-carotid-artery-stenosis-on-outcomes-after-carotid-endarterectomy
#7
Alexander B Pothof, Peter A Soden, Margriet Fokkema, Sara L Zettervall, Sarah E Deery, Thomas C F Bodewes, Gert J de Borst, Marc L Schermerhorn
OBJECTIVE: Patients with contralateral carotid occlusion (CCO) have been excluded from randomized clinical trials because of a deemed high risk for adverse neurologic outcomes with carotid endarterectomy (CEA). Evidence for this rationale is limited and conflicting. Therefore, we aimed to compare outcomes after CEA between patients with and without CCO and varying degrees of contralateral carotid stenosis (CCS). METHODS: We identified patients undergoing CEA from 2003 to 2015 in the Vascular Study Group of New England (VSGNE) registry...
June 24, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28651865/pre-operative-carotid-plaque-echolucency-assessment-has-no-predictive-value-for-long-term-risk-of-stroke-or-cardiovascular-death-in-patients-undergoing-carotid-endarterectomy
#8
D de Waard, G J de Borst, R Bulbulia, H Pan, A Halliday
INTRODUCTION: In patients with carotid stenosis receiving medical treatment, carotid plaque echolucency has been thought to predict risk of future stroke and of other cardiovascular events. This study evaluated the prognostic value of pre-operative plaque echolucency for future stroke and cardiovascular death in patients undergoing carotid endarterectomy in the first Asymptomatic Carotid Surgery Trial (ACST-1). METHODS: In ACST-1, 1832/3120 patients underwent carotid endarterectomy (CEA), of whom 894 had visual echolucency assessment according to the Gray-Weale classification...
June 23, 2017: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28645797/transcranial-doppler-and-microemboli-detection-relationships-to-symptomatic-status-and-histopathology-findings
#9
Carol C Mitchell, Stephanie M Wilbrand, Bornali Kundu, Catherine N Steffel, Tomy Varghese, Nirvedh H Meshram, Geng Li, Thomas D Cook, M Shahriar Salamat, Robert J Dempsey
The purpose of this study was to determine the relationship between symptomatic status, transcranial Doppler (TCD) microemboli presence and plaque histopathology findings. TCD was performed on 60 patients (37 symptomatic, 23 asymptomatic) before undergoing clinically indicated carotid endarterectomy. The frequency of microemboli signals was not significantly different between symptomatic and asymptomatic subject groups (p = 0.88) and there were no differences observed in the macroscopic or histopathology scoring of these plaques (p-values all > 0...
June 20, 2017: Ultrasound in Medicine & Biology
https://www.readbyqxmd.com/read/28623378/carotid-stenting-in-neuroradiology-a%C3%A2-short-journey-from-the-past-to-current-debates
#10
REVIEW
Joachim Berkefeld, Marlies Wagner, Richard du Mesnil
After a period of stagnation due to negative results of randomized trials for patients with symptomatic stenosis, the relevance of carotid artery stenting (CAS) is increasing again. CAS has become an important and evidence-based part of interventional stroke treatment. Our ability to manage acute recanalization of carotid occlusions and other niche indications properly led some skeptical neurologists to trust in carotid intervention for elective cases as well. The evolution of CAS from initial euphoria to more realistic views under consideration of trial results and guidelines is reviewed...
June 16, 2017: Clinical Neuroradiology
https://www.readbyqxmd.com/read/28623117/open-heart-surgery-does-not-increase-the-incidence-of-ipsilateral-ischemic-stroke-in-patients-with-asymptomatic-severe-carotid-stenosis
#11
John E Castaldo, Hussam A Yacoub, Yuebing Li, Hope Kincaid, Donna Jenny
BACKGROUND AND PURPOSE: We evaluated the incidence of perioperative stroke following the institution's 2007 practice change of discontinuing combined carotid endarterectomy and open heart surgery (OHS) for patients with severe carotid stenosis. METHODS: In this retrospective cohort study, we compared 113 patients undergoing coronary artery bypass grafting, aortic valve replacement, or both from 2007 to 2011 with data collected from 2001 to 2006 from a similar group of patients...
June 13, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28603515/factors-influencing-decision-making-for-carotid-endarterectomy-versus-stenting-in-the-very-elderly
#12
REVIEW
Sung Hyuk Heo, Cheryl D Bushnell
As the population ages worldwide, the number of elderly patients with carotid stenosis is also increasing. There have been many large clinical trials comparing carotid endarterectomy (CAE) versus stenting, but the inclusion criteria (i.e., symptomatic or asymptomatic), stenting methods (i.e., protection device), and primary end point (i.e., the definition of myocardial infarction and follow-up period) were different between trials. Therefore, the interpretation of those results is difficult and requires attention...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28596038/predictors-of-30-day-postoperative-major-adverse-clinical-events-after-carotid-artery-stenting-an-analysis-of-the-procedure-targeted-american-college-of-surgeons-national-surgical-quality-improvement-program
#13
Kyla M Bennett, John R Hoch, John E Scarborough
BACKGROUND: Information about carotid artery stenting (CAS) is largely derived from clinical trials, consensus statements, and outcomes comparisons between CAS and carotid endarterectomy. Given these limitations, the goal of this study was to identify risk factors for adverse outcomes after CAS among hospitals participating in the CAS-targeted American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). METHODS: Our study sample consisted of patients from the 2012 to 2015 CAS-targeted ACS NSQIP data set...
June 5, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28583737/development-of-a-validated-model-to-predict-30-day-stroke-and-1-year-survival-after-carotid-endarterectomy-for-asymptomatic-stenosis-using-the-vascular-quality-initiative
#14
Randall R DeMartino, Benjamin S Brooke, Dan Neal, Adam W Beck, Mark F Conrad, Shipra Arya, Sapan Desai, Faisal Aziz, Patrick Ryan, Jack L Cronenwett, Larry W Kraiss
OBJECTIVE: Carotid endarterectomy (CEA) has been shown to be an effective treatment for patients with asymptomatic carotid artery stenosis when perioperative stroke rates are low and patients survive long enough to benefit from the intervention. Our objective was to develop and to validate a simple risk prediction model for 30-day stroke and 1-year mortality to guide optimal selection of patients for CEA. METHODS: Asymptomatic patients undergoing first-time elective CEA within the Vascular Quality Initiative (VQI) from 2010 to 2015 were selected...
June 2, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28577790/impact-of-provider-characteristics-on-outcomes-of-carotid-endarterectomy-for-asymptomatic-carotid-stenosis-in-new-york-state
#15
Andrew J Meltzer, Christopher Agrusa, Peter H Connolly, Darren B Schneider, Art Sedrakyan
OBJECTIVE: (s)The purpose of this study was to explore the impact of surgeon characteristics (including annual volume, specialty, and years in practice) on outcomes of carotid endarterectomy (CEA) for asymptomatic carotid atherosclerosis in New York State. METHODS: The New York Statewide Planning and Cooperation System (SPARCS) database was utilized to identify patients undergoing CEA from 2004-2011. Provider characteristics were determined by linkage to the New York Office of Professions and National Provider Identification databases...
May 31, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28575478/the-preservation-of-cognition-1-yr-after-carotid-endarterectomy-in-patients-with-prior-cognitive-decline
#16
Robert J Dempsey, Daren C Jackson, Stephanie M Wilbrand, Carol C Mitchell, Sara E Berman, Sterling C Johnson, Nirvedh H Meshram, Tomy Varghese, Bruce P Hermann
BACKGROUND: Vascular cognitive decline is critically important in the course of atherosclerosis and stroke. OBJECTIVE: To explore the hypothesis that carotid endarterectomy (CEA) by removing an unstable plaque may slow the course of vascular cognitive decline in both symptomatic and asymptomatic patients. METHODS: Patients with clinically significant (>60%) carotid stenosis were studied preop and 1 yr post-CEA for clinical symptoms, vascular cognitive decline, instability of carotid plaque-presence of microemboli, brain white matter changes, and medical risk factors...
June 1, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28560568/outcome-of-carotid-artery-stenting-in-the-hands-of-vascular-surgeons
#17
Carola Marie Wieker, S Demirel, N Attigah, M Hakimi, U Hinz, D Böckler
OBJECTIVES: To analyze the procedural and clinical outcomes of carotid artery stenting (CAS) in the hands of endovascular trained vascular surgeons. METHODS: Between April 2008 to May 2013, 1197 patients were treated for extracranial internal carotid artery (ICA) stenosis. The proportion of endovascular treated patients was 5.0% (CAS n = 60 vs. carotid endarterectomy (CEA) n = 1137). All patients in the CAS group (44 males, median age 70 years) were treated by two senior vascular surgeons experienced in endovascular methods...
August 2017: Langenbeck's Archives of Surgery
https://www.readbyqxmd.com/read/28539213/medical-management-of-asymptomatic-carotid-artery-stenosis
#18
REVIEW
Aaron W Aday, Joshua A Beckman
Carotid artery atherosclerosis is a major risk factor for both stroke and cardiovascular disease. Appropriate management of asymptomatic patients with carotid artery stenosis (CAS) remains unclear. Although several randomized clinical trials support revascularization in asymptomatic patients with severe CAS to reduce stroke risk, the participants in these trials did not receive optimal medical therapy (OMT) by today's standards. For many individuals, medical therapy may provide excellent risk reduction without the periprocedural risk of endarterectomy or stenting...
May 2017: Progress in Cardiovascular Diseases
https://www.readbyqxmd.com/read/28513115/endarterectomy-or-stenting-in-severe-asymptomatic-carotid-stenosis
#19
Dallit Mannheim, Batla Falah, Ron Karmeli
BACKGROUND: Stroke is a major cause of death in the western world, and carotid endarterectomy has been shown to be effective in treating both symptomatic and asymptomatic carotid stenosis. Carotid stenting is a relatively new form of treatment for carotid stenosis and few studies have looked specifically at asymptomatic patients. OBJECTIVES: To retrospectively examine short- and long-term results in the treatment of asymptomatic carotid artery stenosis with surgery or stenting...
May 2017: Israel Medical Association Journal: IMAJ
https://www.readbyqxmd.com/read/28502543/the-association-of-carotid-revascularization-endarterectomy-versus-stent-trial-crest-and-centers-for-medicare-and-medicaid-services-carotid-guideline-publication-on-utilization-and-outcomes-of-carotid-stenting-among-high-risk-patients
#20
COMPARATIVE STUDY
Gregory G Salzler, Alik Farber, Denis V Rybin, Gheorghe Doros, Jeffrey J Siracuse, Mohammad H Eslami
OBJECTIVE: Since the 2004 approval by the United States Food and Drug Administration of carotid artery stenting (CAS), there have been two seminal publications about CAS reimbursement (Centers for Medicare and Medicaid Services guidelines; 2008) and clinical outcomes (Carotid Revascularization Endarterectomy versus Stent Trial [CREST]; 2010). We explored the association between these publications and national trends in CAS use among high-risk symptomatic patients. METHODS: The most recent congruent data sets of the Nationwide Inpatient Sample (NIS) were queried for patients undergoing carotid revascularization...
July 2017: Journal of Vascular Surgery
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