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carotid endarterectomy(CEA)

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https://www.readbyqxmd.com/read/28431821/near-infrared-spectroscopy-as-a-predictor-for-shunt-requirement-during-carotid-endarterectomy
#1
M Jonsson, D Lindström, A Wanhainen, K Djavani Gidlund, P Gillgren
OBJECTIVE/BACKGROUND: Near infrared spectroscopy (NIRS) continuously monitors regional cerebral oxygenation (rSO2) in the frontal lobes. This method may be used in patients during carotid endarterectomy to indicate the need for shunting. The aim of the study was to evaluate the value of NIRS in determining the need for selective shunting during CEA. A secondary aim was to compare NIRS with stump pressure. METHODS: Between January 2013 and October 2016, 185 patients from two vascular units, undergoing CEA under local anaesthesia were prospectively included...
April 18, 2017: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28409735/quantitative-magnetic-resonance-angiography-as-a-potential-predictor-for-cerebral-hyperperfusion-syndrome-a-preliminary-study
#2
Lukas Andereggen, Sepideh Amin-Hanjani, Marwan El-Koussy, Rajeev K Verma, Kenya Yuki, Daniel Schoeni, Kety Hsieh, Jan Gralla, Gerhard Schroth, Juergen Beck, Andreas Raabe, Marcel Arnold, Michael Reinert, Robert H Andres
OBJECTIVE Cerebral hyperperfusion syndrome (CHS) is a rare but devastating complication of carotid endarterectomy (CEA). This study sought to determine whether quantitative hemodynamic assessment using MR angiography can stratify CHS risk. METHODS In this prospective trial, patients with internal carotid artery (ICA) stenosis were randomly selected for pre- and postoperative quantitative phase-contrast MR angiography (QMRA). Assessment was standardized according to a protocol and included Doppler/duplex sonography, MRI, and/or CT angiography and QMRA of the intra- and extracranial supplying arteries of the brain...
April 14, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28400487/vascular-anatomy-predicts-the-risk-of-cerebral-ischemia-in-patients-randomized-to-carotid-stenting-versus-endarterectomy
#3
Mandy D Müller, Frank J Ahlhelm, Alexander von Hessling, David Doig, Paul J Nederkoorn, Sumaira Macdonald, Philippe A Lyrer, Aad van der Lugt, Jeroen Hendrikse, Christoph Stippich, H Bart van der Worp, Toby Richards, Martin M Brown, Stefan T Engelter, Leo H Bonati
BACKGROUND AND PURPOSE: Complex vascular anatomy might increase the risk of procedural stroke during carotid artery stenting (CAS). Randomized controlled trial evidence that vascular anatomy should inform the choice between CAS and carotid endarterectomy (CEA) has been lacking. METHODS: One-hundred eighty-four patients with symptomatic internal carotid artery stenosis who were randomly assigned to CAS or CEA in the ICSS (International Carotid Stenting Study) underwent magnetic resonance (n=126) or computed tomographic angiography (n=58) at baseline and brain magnetic resonance imaging before and after treatment...
April 11, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28389285/outcome-analysis-of-carotid-cross-clamp-intolerance-during-carotid-endarterectomy-under-loco-regional-anesthesia
#4
Gabriele Piffaretti, Antonino Tarallo, Marco Franchin, Alessandro Bacuzzi, Nicola Rivolta, Massimo Ferrario, Stefania Ferraro, Matteo Bossi, Patrizio Castelli, Matteo Tozzi
OBJECTIVES: To analyze the predictors and describe the outcomes of cross-clamp intolerance (CCI), and the results of the use of carotid endarterectomy (CEA) with shunting or a shift strategy to immediate carotid artery stenting (CAS) in this setting. MATERIALS AND METHODS: Between January 2008 and December 2015, 385 patients were elected for single sided, isolated CEA under loco-regional anesthesia. In case of CCI, CEA with shunt was used selectively, whereas indication to immediate conversion to CAS was the immediate onset and severe persistent deterioration of the neurologic status, and/or local technical difficulties to perform endarterectomy...
April 4, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28389123/circulating-gdf-15-levels-predict-future-secondary-manifestations-of-cardiovascular-disease-explicitly-in-women-but-not-men-with-atherosclerosis
#5
Aisha Gohar, Isabel Gonçalves, Joyce Vrijenhoek, Saskia Haitjema, Ian van Koeverden, Jan Nilsson, Gert J de Borst, Jean-Paul de Vries, Gerard Pasterkamp, Hester M den Ruijter, Harry Björkbacka, Saskia C A de Jager
BACKGROUND: Elevated serum levels of growth differentiation factor-15 (GDF-15), is an established risk factor for a range of cardiovascular diseases. We aimed to evaluate the predictive value of plasma GDF-15 as a biomarker for secondary cardiovascular events (CVE) in patients with atherosclerosis undergoing carotid endarterectomy (CEA). Secondly, we determined whether plasma GDF-15 was associated with carotid plaque characteristics. METHODS: Circulating GDF-15 levels were determined by Luminex assay in a cohort of 1056 patients from the Athero-Express biobank...
March 22, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28387821/ipsilateral-pupillary-dilation-following-carotid-endarterectomy-a-temporary-and-benign-phenomenon
#6
Jeffrey A Steinberg, Bob S Carter, Marco B Lee, Gary K Steinberg
BACKGROUND AND IMPORTANCE: Cases of post carotid endarterectomy (CEA) Horner's syndrome have been reported, with symptoms attributed to manipulation of the sympathetic plexus situated along the carotid artery; however, these patients presented with the typical constricted pupil. We report the first 3 cases to our knowledge of mydriasis following CEA. CLINICAL PRESENTATION: We present 3 cases of CEA followed by immediate postoperative development of ipsilateral mydriasis...
April 6, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28384835/validation-of-the-automated-electronic-microemboli-detection-system-in-patients-undergoing-carotid-endarterectomy
#7
Tesse Leunissen, Daniel van Vriesland, Hester den Ruijter, Frans Moll, Werner Mess, Gert Jan de Borst
Purpose To assess the diagnostic value of automatic embolus detection software (AEDS) in transcranial Doppler (TCD) monitoring for the detection of solid microemboli in patients at risk for perioperative stroke during carotid endarterectomy (CEA). Materials and Methods In 50 patients undergoing CEA, perioperative TCD registration was recorded. All recorded events, identified and saved by the AEDS, were analyzed off-line doubly by two human experts (HEs) within a time frame of > 4 months. The inter- and intraobserver variability was assessed...
April 6, 2017: Ultraschall in der Medizin
https://www.readbyqxmd.com/read/28378467/compared-effects-on-cerebral-oxygenation-of-ephedrine-vs-phenylephrine-to-treat-hypotension-during-carotid-endarterectomy
#8
Jugurtha Aliane, Christian Dualé, Nader Guesmi, Charlotte Baud, Eugenio Rosset, Bruno Pereira, Damien Bouvier, Pierre Schoeffler
While both ephedrine and phenylephrine are currently used to treat hypotension occurring during carotid endarterectomy (CEA) under general anaesthesia, phenylephrine may have deleterious effects on the cerebral watershed, due to its exclusively vasoconstrictive action. In this controlled, double-blind randomised trial, we compared the effects of ephedrine and phenylephrine administered in a standardised algorithm to treat the first hypotensive event occurring since induction of anaesthesia until carotid cross-clamping...
April 4, 2017: Clinical and Experimental Pharmacology & Physiology
https://www.readbyqxmd.com/read/28368914/intraoperative-neurological-monitoring-with-evoked-potentials-during-carotid-endarterectomy-versus-cooperative-patients-under-general-anesthesia-technique-a-retrospective-study
#9
Valeria Marinò, Fulvio Aloj, Maria Vargas, Gianmario Spinelli, Francesco Pompeo, Luigi Chiacchiari, Giuseppe Servillo, Elio Franco
INTRODUCTION: The best technique to evaluate contralateral carotid flow during carotid endarterectomy (CEA) is still debated; an accurate detection of efficient contralateral blood flow can avoid unnecessary shunt placement and its complications. The aim of this retrospective observational study was to evaluate and compare the safety and efficacy of general anesthesia with motor-evoked potential and somatosensory-evoked potentials (mSSEP and tcMEP) versus cooperative patients under general anesthesia (CPGA) technique for CEA...
March 31, 2017: Journal of Neurosurgical Anesthesiology
https://www.readbyqxmd.com/read/28368527/analysis-of-recurrent-stenosis-after-carotid-endarterectomy-featuring-primary-plaque-calcification
#10
Hiroyuki Katano, Mitsuhito Mase, Yusuke Nishikawa, Hiroshi Yamada, Kazuo Yamada
BACKGROUND: The relationship between calcification in primary plaque and restenosis after carotid endarterectomy (CEA) has been seldom investigated. OBJECTIVE: To clarify the relationship between characteristics of calcified carotid plaque and recurrent stenosis after CEA, as well as the disease's natural course. METHODS: Ninety-four plaques out of 107 consecutive CEAs were retrospectively analyzed with regard to calcification, employing calcium score as well as shape, location, and other characteristics of original plaques...
March 23, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28363431/restenosis-after-carotid-interventions-and-its-relationship-with-recurrent-ipsilateral-stroke-a-systematic-review-and-meta-analysis
#11
REVIEW
R Kumar, A Batchelder, A Saratzis, A F AbuRahma, P Ringleb, B K Lal, J L Mas, M Steinbauer, A R Naylor
OBJECTIVE: Do asymptomatic restenoses > 70% after carotid endarterectomy (CEA) and carotid stenting (CAS) increase the risk of late ipsilateral stroke? METHODS: Systematic review identified 11 randomised controlled trials (RCTs) reporting rates of restenosis > 70% (and/or occlusion) in patients who had undergone CEA/CAS for the treatment of primary atherosclerotic disease, and nine RCTs reported late ipsilateral stroke rates. Proportional meta-analyses and odds ratios (OR) at end of follow-up were performed...
March 28, 2017: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28363131/preoperative-cervical-carotid-artery-contrast-enhanced-ultrasound-findings-are-associated-with-development-of-microembolic-signals-on-transcranial-doppler-during-carotid-exposure-in-endarterectomy
#12
Kohki Oikawa, Tadayoshi Kato, Kazumasa Oura, Shinsuke Narumi, Makoto Sasaki, Shunrou Fujiwara, Masakazu Kobayashi, Yoshiyasu Matsumoto, Jun-Ichi Nomura, Kenji Yoshida, Yasuo Terayama, Kuniaki Ogasawara
BACKGROUND AND AIMS: Emboli from the surgical site during exposure of the carotid arteries cause new cerebral ischemic lesions or neurological deficits after carotid endarterectomy (CEA). The purpose of the present study was to determine whether preoperative contrast-enhanced ultrasound findings of the cervical carotid arteries are associated with the development of microembolic signals (MES) on transcranial Doppler, during exposure of the arteries in CEA, and to compare the predictive accuracy of contrast-enhanced ultrasound findings with that of gray-scale median (GSM)...
March 19, 2017: Atherosclerosis
https://www.readbyqxmd.com/read/28359719/regional-variation-in-patient-selection-and-treatment-for-carotid-artery-disease-in-the-vascular-quality-initiative
#13
Katie E Shean, John C McCallum, Peter A Soden, Sarah E Deery, Joseph R Schneider, Brian W Nolan, Caron B Rockman, Marc L Schermerhorn
OBJECTIVE: Previous studies involving large administrative data sets have revealed regional variation in the demographics of patients selected for carotid endarterectomy (CEA) and carotid artery stenting (CAS) but lacked clinical granularity. This study aimed to evaluate regional variation in patient selection and operative technique for carotid artery revascularization using a detailed clinical registry. METHODS: All patients who underwent CEA or CAS from 2009 to 2015 were identified in the Vascular Quality Initiative (VQI)...
March 27, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28323231/carotid-endarterectomy-in-the-southern-california-vascular-outcomes-improvement-collaborative
#14
Kaelan Chan, Ahmed Abouzamzam, Karen Woo
OBJECTIVE: The objective of this study is to examine the variation in practice patterns and associated outcomes for carotid endarterectomy (CEA) within the Southern California Vascular Outcomes Improvement Collaborative (So Cal VOICe), a regional quality group of the Vascular Quality Initiative (VQI). METHODS: All cases entered in the CEA registry by the So Cal VOICe were included in the study. RESULTS: From September 2010 through September 2015, 1110 CEA cases were entered by nine centers in the So Cal VOICe...
March 17, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28318997/diastolic-blood-pressure-is-a-risk-factor-for-peri-procedural-stroke-following-carotid-endarterectomy-in-asymptomatic-patients
#15
D D de Waard, G J de Borst, R Bulbulia, A Huibers, A Halliday
OBJECTIVE/BACKGROUND: Carotid endarterectomy (CEA) prevents future stroke, but this benefit depends on detection and control of high peri-operative risk factors. In symptomatic patients, diastolic hypertension has been causally related to procedural stroke following CEA. The aim was to identify risk factors causing peri-procedural stroke in asymptomatic patients and to relate these to timing of surgery and mechanism of stroke. METHODS: In the first Asymptomatic Carotid Surgery Trial (ACST-1), 3,120 patients with severe asymptomatic carotid stenosis were randomly assigned to CEA plus medical therapy or to medical therapy alone...
March 16, 2017: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28318956/carotid-endarterectomy-to-remove-retained-solitaire-stent-retriever-inside-carotid-stent-after-mechanical-thrombectomy
#16
Mary In-Ping Huang Cobb, Tony P Smith, Patrick A Brown, L Fernando Gonzalez, Ali R Zomorodi
BACKGROUND: Tandem occlusions of the internal carotid artery (ICA) and middle cerebral artery (MCA) occur in up to a third of patients with acute ischemic strokes undergoing endovascular mechanical thrombectomy. Understanding open neurosurgical management of associated complications with this procedure is important. CASE REPORT: A 67-year-old man with acute onset of left hemiparesis and a tandem right ICA and MCA occlusion. He underwent carotid stent angioplasty of a stenotic ICA, followed by attempted Solitaire stent retrieval of an MCA clot...
March 16, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28318887/multi-focus-beamforming-for-thermal-strain-imaging-using-a-single-ultrasound-linear-array-transducer
#17
Man M Nguyen, Xuan Ding, Steven A Leers, Kang Kim
Ultrasound-induced thermal strain imaging (TSI) has been used successfully to identify lipid- and water-based tissues in atherosclerotic plaques in some research settings. However, TSI faces several challenges to be realized in clinics. These challenges include motion artifacts and displacement tracking accuracy, as well as limited heating capability, which contributes to low thermal strain signal-to-noise ratio, and a limited field of view. Our goal was to address the challenge in heating tissue in TSI. Current TSI systems use separate heating and imaging transducers, which require physical alignment of the heating and imaging beams and result in a bulky setup that limits in vivo operation...
March 15, 2017: Ultrasound in Medicine & Biology
https://www.readbyqxmd.com/read/28289241/symptomatic-patients-remain-at-substantial-risk-of-arterial-disease-complications-before-and-after-endarterectomy-or-stenting
#18
Cristina Hobeanu, Philippa C Lavallée, Peter M Rothwell, Leila Sissani, Gregory W Albers, Natan M Bornstein, Louis R Caplan, Geoffrey A Donnan, José M Ferro, Michael G Hennerici, Julien Labreuche, Carlos Molina, Philippe Gabriel Steg, Pierre-Jean Touboul, Shinichiro Uchiyama, Éric Vicaut, Lawrence K S Wong, Pierre Amarenco
BACKGROUND AND PURPOSE: After carotid endarterectomy (CEA) or carotid artery stenting (CAS) in patients with transient ischemic attack or minor ischemic stroke, recurrent stroke risk falls to a low rate on modern medical treatment. METHODS: We used data from 4583 patients with recent transient ischemic attack or minor stroke enrolled in the TIAregistry.org to perform a nested case-control analysis to evaluate pre- and post-CEA/CAS risk. Cases were defined as patients with a CEA/CAS during the 1-year follow-up period...
March 13, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28268107/prosthetic-bypass-for-restenosis-after-endarterectomy-or-stenting-of-the-carotid-artery
#19
Giulio Illuminati, Romain Belmonte, Fabrice Schneider, Giulia Pizzardi, Francesco G Calió, Jean-Baptiste Ricco
OBJECTIVE: The objective of this study was to evaluate the results of prosthetic carotid bypass (PCB) with polytetrafluoroethylene (PTFE) grafts as an alternative to carotid endarterectomy (CEA) in treatment of restenosis after CEA or carotid artery stenting (CAS). METHODS: From January 2000 to December 2014, 66 patients (57 men and 9 women; mean age, 71 years) presenting with recurrent carotid artery stenosis ≥70% (North American Symptomatic Carotid Endarterectomy Trial [NASCET] criteria) were enrolled in a prospective study in three centers...
March 4, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28268070/post-carotid-endarterectomy-hypertension-part-1-association-with-pre-operative-clinical-imaging-and-physiological-parameters
#20
J E Newman, M J Bown, R D Sayers, J P Thompson, T G Robinson, B Williams, R Panerai, P Lacy, A R Naylor
OBJECTIVE/BACKGROUND: Post-endarterectomy hypertension (PEH) is a well recognised, but poorly understood, phenomenon after carotid endarterectomy (CEA) that is associated with post-operative intracranial haemorrhage, hyperperfusion syndrome, and cardiac complications. The aim of the current study was to identify pre-operative clinical, imaging, and physiological parameters associated with PEH. METHODS: In total, 106 CEA patients undergoing CEA under general anaesthesia underwent pre-operative evaluation of 24 hour ambulatory arterial blood pressure (BP), baroreceptor sensitivity, cerebral autoregulation, and transcranial Doppler measurement of cerebral blood flow velocity (CBFv) and pulsatility index...
March 3, 2017: European Journal of Vascular and Endovascular Surgery
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