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Carotid endarterectomy in asymptomatic patients

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https://www.readbyqxmd.com/read/29334161/the-role-of-neurosonology-in-the-diagnosis-and-management-of-patients-with-carotid-artery-disease-a-review
#1
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
#2
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
https://www.readbyqxmd.com/read/29246640/computational-fluid-dynamic-comparison-between-patch-based-and-primary-closure-techniques-after-carotid-endarterectomy
#3
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
https://www.readbyqxmd.com/read/29217445/factors-that-predict-failure-to-meet-mips-quality-measures-for-asymptomatic-carotid-endarterectomy
#4
Anahita Dua, Steven Koprowski, Fadwa Ali, Sapan S Desai
INTRODUCTION: The Physician Quality Reporting System (PQRS) created by the Centers for Medicare and Medicaid Services (CMS) 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 measures 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 2008-2012...
December 4, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/29217437/carotid-endarterectomy-performed-before-the-weekend-is-associated-with-increased-length-of-stay
#5
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
https://www.readbyqxmd.com/read/29205297/meta-analysis-of-the-procedural-risks-of-carotid-endarterectomy-and-carotid-artery-stenting-over-time
#6
REVIEW
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...
December 4, 2017: British Journal of Surgery
https://www.readbyqxmd.com/read/29198413/is-carotid-revascularization-worthwhile-in-patients-waiting-for-kidney-transplantation
#7
REVIEW
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
https://www.readbyqxmd.com/read/29197612/preoperative-cardiac-stress-testing-in-the-southern-california-vascular-outcomes-improvement-collaborative
#8
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
https://www.readbyqxmd.com/read/29163956/eversion-endarterectomy-under-full-prasugrel-treatment
#9
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
https://www.readbyqxmd.com/read/29153440/relationship-between-adamts4-and-carotid-atherosclerotic-plaque-vulnerability-in-humans
#10
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
https://www.readbyqxmd.com/read/29132196/carotid-endarterectomy-the-change-in-practice-over-11%C3%A2-years-in-a-stroke-centre
#11
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
https://www.readbyqxmd.com/read/29117272/risks-associated-with-primary-and-redo-carotid-endarterectomy-in-the-endovascular-era
#12
Isibor J Arhuidese, Muhammad Faateh, Besma J Nejim, Satinderjit Locham, Christopher J Abularrage, Mahmoud B Malas
Importance: Clinical experience suggests worse outcomes for redo carotid endarterectomy (CEA) relative to primary CEA. Objective quantification of the excess risk attributable to redo CEA in this era of proliferating endovascular therapy remains to be determined. Objective: To evaluate the risks of redo CEA relative to primary CEA. Design, Setting, and Participants: This study was a retrospective analysis of a prospective cohort of patients maintained by the Society for Vascular Surgery in the Vascular Quality Initiative between January 1, 2003, and April 30, 2016...
November 8, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/29101839/community-based-statins-and-advanced-carotid-plaque-role-of-cd163-positive-macrophages-in-lipoprotein-associated-phospholipase-a2-activity-in-atherosclerotic-plaque
#13
Fumiyuki Otsuka, XiaoQing Zhao, Hugh H Trout, Ye Qiao, Bruce A Wasserman, Masataka Nakano, Colin H Macphee, Martin Brandt, Sue Krug-Gourley, Liang Guo, Elena R Ladich, Qi Cheng, Harry R Davis, Aloke V Finn, Renu Virmani, Frank D Kolodgie
BACKGROUND AND AIMS: Lipoprotein-associated phospholipase A2 (Lp-PLA2), an enzymatic inflammatory biomarker primarily bound to low-density lipoprotein cholesterol, is associated with an approximate twofold increased risk of cardiovascular disease and stroke. Despite indications that circulating Lp-PLA2 is sensitive to statins, it remains largely unknown whether statin usage exerts local effects on Lp-PLA2 expression at the site of atheromatous plaque. METHODS: Carotid plaques (n = 38) were prospectively collected from symptomatic (n = 18) and asymptomatic (n = 20) patients with (n = 20) or without (n = 18) documented statin history...
October 14, 2017: Atherosclerosis
https://www.readbyqxmd.com/read/29100876/preoperative-antiplatelet-and-statin-use-does-not-affect-outcomes-after-carotid-endarterectomy
#14
Brianna M Krafcik, Alik Farber, Robert T Eberhardt, Jeffrey A Kalish, Denis Rybin, Gheorghe Doros, Steven L Pike, Jeffrey J Siracuse
OBJECTIVE: The use of statin and antiplatelet medications has been advocated in patients with cerebrovascular disease as primary medical therapy and as an adjunct to carotid endarterectomy (CEA). Our goal was to assess the prevalence of preoperative statin and antiplatelet use and its effect on perioperative outcomes after CEA. METHODS: The American College of Surgeons National Surgical Quality Improvement Program targeted CEA database was queried for patients undergoing CEA between 2011 and 2014...
October 31, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/29076745/cost-effectiveness-of-magnetic-resonance-carotid-plaque-imaging-for-primary-stroke-prevention-in-canada
#15
Lechtman E, Balki I, Thomas K, Chen K, Moody Ar, Tyrrell Pn
OBJECTIVE: Magnetic resonance of the carotid arteries provides important insight into plaque composition and vulnerability in addition to the traditional measure of stenosis. The purpose of this study was to evaluate the cost-effectiveness of MR imaging as a first-line modality to assess carotid disease and guide management for high-risk patients with <50% stenosis. METHODS: Using TreeAge Pro, a cost-effectiveness simulation was conducted comparing two strategies: (a) standard of care first-line carotid duplex ultrasound (DUS) with regular follow-up, vs (b) first-line MR assessment of stenosis and intraplaque haemorrhage (MRIPH) in which patients with IPH received annual DUS surveillance and immediate carotid endarterectomy in case of plaque progression...
November 21, 2017: British Journal of Radiology
https://www.readbyqxmd.com/read/29074118/an-update-on-the-incidence-of-perioperative-outcomes-after-carotid-endarterectomy-stratified-by-type-of-preprocedural-neurologic-symptom
#16
Alexander B Pothof, Emma S Zwanenburg, Sarah E Deery, Thomas F X O'Donnell, Gert J de Borst, Marc L Schermerhorn
OBJECTIVE: Perioperative complications after carotid endarterectomy (CEA) have decreased over time. Therefore, we aimed to provide an update on 30-day outcomes after CEA, stratified by type of preprocedural neurologic symptom. METHODS: We included all CEAs from the Targeted Vascular module of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP, 2011-2015) and stratified patients based on type of preprocedural neurologic symptom, that is, asymptomatic, ocular transient ischemic attack (TIA), hemispheric TIA, and stroke...
October 23, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/29046977/carotid-angioplasty-and-stenting-and-embolic-protection
#17
REVIEW
Enrico Giordan, Giuseppe Lanzino
PURPOSE OF REVIEW: We review the evidence on the safety and efficacy of carotid angioplasty and stenting (CAS) compared to carotid endarterectomy (CEA) and also summarizes emerging technical issues. RECENT FINDINGS: Randomized trials have demonstrated a progressive decrease of periprocedural strokes after CAS. Overall, in symptomatic patients, CAS is associated with a slightly higher risk of periprocedural strokes when compared to CEA. This is especially true after the age of 70 and immediately after a presenting symptomatic event...
October 18, 2017: Current Cardiology Reports
https://www.readbyqxmd.com/read/29019319/the-asymptomatic-carotid-surgery-trial-2-acst-2-an-ongoing-randomised-controlled-trial-comparing-carotid-endarterectomy-with-carotid-artery-stenting-to-prevent-stroke
#18
Richard Bulbulia, Alison Halliday
BACKGROUND: A successful open surgical operation to remove atheromatous carotid artery narrowing that has not yet caused a stroke (asymptomatic carotid stenosis) carries some procedural risk but, if completed successfully, halves patients' future annual stroke risk for at least 10 years. A newer, less invasive alternative is carotid stenting, which also carries some procedural risk, especially if the carotid lesion has recently given rise to a stroke (symptomatic carotid stenosis). For both surgery and stenting, improvements in technique (and in medication) have reduced risk...
October 2017: Health Technology Assessment: HTA
https://www.readbyqxmd.com/read/28994832/carotid-endarterectomy-for-treatment-of-carotid-in-stent-restenosis-long-term-follow-up-results-and-surgery-experiences-from-one-single-centre
#19
Le-Bao Yu, Wei Yan, Qian Zhang, Ji-Zong Zhao, Yan Zhang, Rong Wang, Jun-Shi Shao, Dong Zhang
OBJECTIVE: Few studies have reported the surgical treatment of carotid in-stent restenosis (ISR), more data and longer follow-up are needed. We describe the surgical treatment of ISR by standard carotid endarterectomy (CEA) with stent removal, including long-term follow-up in 10 patients from our centre. METHODS: Ten patients from our centre who underwent CEA with stent removal for ISR were retrospectively analysed, including nine symptomatic and one asymptomatic ISR of at least 70% with mean age 67...
September 2017: Stroke and Vascular Neurology
https://www.readbyqxmd.com/read/28990089/kinin-b1-receptor-as-a-novel-prognostic-progression-biomarker-for-carotid-atherosclerotic-plaques
#20
Tiantian Liu, Hengfang Liu, Li Feng, Bo Xiao
Stroke caused by atherosclerosis remains a leading cause of morbidity and mortality worldwide, associated with carotid plaque rupture and inflammation progression. However, the inflammatory biomarkers which aid in predicting the future course of plaques are less detailed. The present study investigated the association between plaque vulnerable and inflammatory biomarkers using blood and plaque specimens. Carotid plaque specimens were obtained from 80 patients following stroke, 14 patients suffering from transient ischaemic attack and 17 asymptomatic patients that underwent carotid endarterectomy...
December 2017: Molecular Medicine Reports
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