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carotid endarterectomy(CEA)

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https://www.readbyqxmd.com/read/28822658/preoperative-anemia-is-associated-with-mortality-after-carotid-endarterectomy-in-symptomatic-patients
#1
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/28818256/will-mesh-covered-stents-help-reduce-stroke-associated-with-carotid-stent-angioplasty
#2
Carly N Richards, Peter A Schneider
Carotid stent angioplasty (CAS) has been shown to protect patient from future stroke long-term efficacy similar to carotid endarterectomy (CEA). The risk of minor stroke in the perioperative period is higher than with CEA and not related to cerebral protection during the CAS procedure since a significant portion of the neurologic events occur between 1 and 30 days following stent deployment. This observation suggests mechanisms integral to the stent itself may be pertinent such as plaque embolization thru the stent struts may occur...
March 2017: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/28818254/medical-treatment-strategies-to-reduce-perioperative-morbidity-and-mortality-after-carotid-surgery
#3
A Ross Naylor
There is a paucity of high-quality evidence regarding what constitutes "optimal medical therapy" for the purposes of reducing morbidity/mortality after carotid endarterectomy (CEA). All patients should be prescribed antiplatelet therapy. Low-dose aspirin (75 to 325 mg) should be continued throughout the perioperative period and there is no evidence that higher doses confer additional benefit. There is emerging evidence that early implementation of dual antiplatelet therapy in recently symptomatic patients (aspirin 75 mg plus clopidogrel 75 mg) can reduce recurrent cerebral events before CEA and that dual antiplatelet therapy will significantly reduce stroke due to early postoperative carotid thrombosis...
March 2017: Seminars in Vascular Surgery
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
#4
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/28797613/visual-aids-for-improving-patient-decision-making-in-severe-symptomatic-carotid-stenosis
#5
Sebastian Fridman, Gustavo Saposnik, Luciano A Sposato
BACKGROUND: Because of the large amount of information to process and the limited time of a clinical consult, choosing between carotid endarterectomy (CEA) and carotid angioplasty with stenting (CAS) can be confusing for patients with severe symptomatic internal carotid stenosis (ICA). GOAL: We aim to develop a visual aid tool to help clinicians and patients in the decision-making process of selecting between CEA and CAS. MATERIALS AND METHODS: Based on pooled analysis from randomized controlled trials including patients with symptomatic and severe ICA (SSICA), we generated visual plots comparing CEA with CAS for 3 prespecified postprocedural time points: (1) any stroke or death at 4 months, and (2) any stroke or death in the first 30 days and ipsilateral stroke thereafter at 5 years and (3) at 10 years...
August 7, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28794387/carotid-endarterectomy-with-routine-shunt-for-patients-with-contralateral-carotid-occlusion
#6
Jie Kong, Jinyong Li, Zhidong Ye, Xueqiang Fan, Jianyan Wen, Jianbin Zhang, Peng Liu
This study aimed to report the clinical features and early and long-term outcomes of patients treated with carotid endarterectomy (CEA) combined with a routine shunt for carotid stenosis with the occlusion of the contralateral carotid artery (CCO), and to compare them with patients without contralateral occlusion (NO-CCO). A retrospective analysis included 301 patients who had carotid artery stenosis treated with CEA using a routine shunt. Of these patients, 35 patients and 266 patients were categorized into a CCO group and NO-CCO group, respectively...
August 9, 2017: Annals of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28790536/comparison-of-results-classical-and-eversion-carotid-endarterectomy
#7
Muhamed Djedovic, Emir Mujanovic, Amel Hadzimehmedagic, Dragan Totic, Haris Vukas, Haris Vranic
INTRODUCTION: Atherosclerosis blood vessels, be it on extra-cranial or intra-cranial circulation, the most common cause of incidents such as cerebro-vascular insult (ICV). Carotid endarterectomy (CEA) is a preventive operation to reduce the risk of stroke and it can be performed by eversion carotid endarterectomy (E-CEA) or a classical carotid endarterectomy (C-CEA). The aim of this study was to investigate the influence of the used techniques in basic perioperative results and the incidence of postoperative complications...
April 2017: Medical Archives
https://www.readbyqxmd.com/read/28783225/meta-analysis-of-the-costs-of-carotid-artery-stenting-and-carotid-endarterectomy
#8
REVIEW
E E de Vries, V G M Baldew, H M den Ruijter, G J de Borst
BACKGROUND: Carotid artery stenting (CAS) is currently associated with an increased risk of 30-day stroke compared with carotid endarterectomy (CEA), whereas both interventions seem equally durable beyond the periprocedural period. Although the clinical outcomes continue to be scrutinized, there are few data summarizing the costs of both techniques. METHODS: A systematic search was conducted in MEDLINE, Embase and Cochrane databases in August 2016 identifying articles comparing the costs or cost-effectiveness of CAS and CEA in patients with carotid artery stenosis...
September 2017: British Journal of Surgery
https://www.readbyqxmd.com/read/28757518/pathological-quantification-of-carotid-artery-plaque-instability-in-patients-undergoing-carotid-endarterectomy
#9
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/28757054/late-dacron-patch-inflammatory-reaction-after-carotid-endarterectomy
#10
M Alawy, W Tawfick, M ElKassaby, A Shalaby, M Zaki, N Hynes, S Sultan
OBJECTIVE: The aim was to analyse the incidence and presentation of carotid patch inflammatory reactions following carotid endarterectomy (CEA). METHODS: This was a cohort study using a prospectively maintained database. All patients who underwent elective CEA at a tertiary vascular centre between 2002 and 2016 were included. Computed tomography scan angiogram, duplex scan, and leucocyte scintigraphy were used to assess patients with suspected inflammatory patch complications...
July 27, 2017: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28755855/very-urgent-carotid-endarterectomy-is-associated-with-an-increased-procedural-risk-the-carotid-alarm-study
#11
A Nordanstig, L Rosengren, S Strömberg, K Österberg, L Karlsson, G Bergström, Z Fekete, K Jood
OBJECTIVE/BACKGROUND: The aim of the Carotid Alarm Study was to compare the procedural risk of carotid endarterectomy (CEA) performed within 48 hours with that after 48 hours to 14 days following an ipsilateral cerebrovascular ischaemic event. METHODS: Consecutive patients with symptomatic carotid stenosis undergoing CEA were prospectively recruited. Time to surgery was calculated as time from the most recent ischaemic event preceding surgery. A neurologist examined patients before and, after CEA...
July 26, 2017: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28739521/effective-intraluminal-shunt-in-carotid-endarterectomy-for-carotid-artery-near-occlusion-a-technical-report
#12
Yoichiro Kawamura, Daisuke Maruyama, Yojiro Akagi, Koji Iihara
BACKGROUND: Carotid artery near occlusion is a critical degree of stenosis whereby blood flow is decreased and the distal cervical and intracranial internal carotid arteries (ICAs) are prone to collapse. Considering the diminished perfusion and the risk of progression to total occlusion and periocclusive embolism, we performed carotid endarterectomy (CEA) for carotid artery near occlusion. METHODS: Accurate evaluation of tandem stenosis or patency of the post-stenotic ICA in carotid artery near occlusion is often difficult preoperatively...
July 21, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28735954/endarterectomy-achieves-lower-stroke-and-death-rates-compared-with-stenting-in-patients-with-asymptomatic-carotid-stenosis
#13
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
https://www.readbyqxmd.com/read/28733710/a-matched-case-control-study-on-early-and-late-results-of-carotid-endarterectomy-performed-in-young-patients
#14
Walter Dorigo, Aaron Fargion, Elena Giacomelli, Giulia Bassoli, Raffaele Pulli, Giovanni Pratesi, Gabriele Piffaretti, Carlo Pratesi
OBJECTIVE: The aim of the study was to describe the perioperative and long-term results of carotid endarterectomy (CEA) in patients aged 60 or less and compare them to patients of more advanced age in a retrospective single-centre case-control study. METHODS: From January 1996 to December 2014, 5893 consecutive CEAs were performed in our institution. Data concerning these interventions were prospectively inserted in a dedicated database. A retrospective analysis of that database was performed and 457 interventions performed in patients aged 60 or less were found (group 1)...
July 21, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/28724881/effect-of-carotid-endarterectomy-on-retinal-function-in-asymptomatic-patients-with-hemodynamically-significant-carotid-artery-stenosis
#15
Anna Machalińska, Aleksandra Kowalska-Budek, Miłosz Piotr Kawa, Arkadiusz Kazimierczak, Krzysztof Safranow, Marta Kirkiewicz, Paweł Rynio, Grażyna Wilk, Wojciech Lubiński, Piotr Gutowski, Bogusław Machaliński
INTRODUCTION    The corrective effect of carotid endarterectomy (CEA) on disturbed ophthalmic artery flow in patients with a significant internal carotid artery stenosis (ICAS) presenting with ocular ischemic syndrome (i.e., symptomatic patients) is well established. However, no clear evidence exists regarding the efficacy of CEA for improvement of neuro-retinal function in patients without symptoms of ocular ischemic syndrome. OBJECTIVES    We determined the effects of CEA on retinal function in asymptomatic patients with hemodynamically significant internal carotid artery stenosis...
July 19, 2017: Polish Archives of Internal Medicine
https://www.readbyqxmd.com/read/28712813/factors-affecting-operative-time-and-outcome-of-carotid-endarterectomy-in-the-vascular-quality-initiative
#16
Jennifer L Perri, Brian W Nolan, Philip P Goodney, Randall R DeMartino, Benjamin S Brooke, Shipra Arya, Mark F Conrad, Jack L Cronenwett
OBJECTIVE: Prior studies have suggested a relationship between operative (Op) time and outcome after major vascular procedures. This study analyzed factors associated with Op time and outcome after carotid endarterectomy (CEA) in the Vascular Quality Initiative (VQI) registry. METHODS: Elective, primary CEAs without high anatomic risk or concomitant procedures from 2012 to 2015 in the VQI were analyzed (N = 26,327, performed by 1188 surgeons from 249 centers). Multivariable analysis was used to identify patient, procedure, and surgeon factors associated with Op time and major adverse events (MAEs), categorized as either technical (ipsilateral stroke, cranial nerve injury, reoperation) or cardiac (myocardial infarction, congestive heart failure, dysrhythmia requiring treatment, surgical site infection, and death)...
July 13, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28697940/characterization-of-perioperative-contralateral-stroke-after-carotid-endarterectomy
#17
W Darrin Clouse, Emel A Ergul, Virendra I Patel, R Todd Lancaster, Glenn M LaMuraglia, Richard P Cambria, Mark F Conrad
OBJECTIVE: Contralateral stroke is an infrequent cause of perioperative stroke after carotid endarterectomy (CEA). Whereas the risks of ipsilateral stroke complicating CEA have been discriminated, factors that lead to contralateral stroke are poorly defined. The purpose of this study was to identify the risk of perioperative (30-day) contralateral stroke after CEA as well as predisposing preoperative and operative factors. Its specific effect on long-term survival was interrogated. METHODS: The Vascular Study Group of New England (VSGNE) was queried from April 1, 2003, to February 29, 2016, for all CEAs...
July 8, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28689950/an-accumulated-deficits-model-predicts-perioperative-and-long-term-adverse-events-after-carotid-endarterectomy
#18
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/28688529/predictors-of-cross-clamp-induced-intraoperative-monitoring-changes-during-carotid-endarterectomy-using-both-electroencephalography-and-somatosensory-evoked-potentials
#19
Natalie Domenick Sridharan, Partha Thirumala, Rabih Chaer, Jeffrey Balzer, Becky Long, Donald Crammond, Michel Makaroun, Efthymios Avgerinos
OBJECTIVE: The efficacy of selective shunting during carotid endarterectomy (CEA) using intraoperative monitoring (IOM) for detection of cerebral ischemia is well established. There is mounting evidence that monitoring of both electroencephalography (EEG) and somatosensory evoked potentials (SSEPs) increases the sensitivity of cerebral ischemia detection. Predictors of cerebral ischemia requiring selective shunt placement using IOM of both EEG and SSEPs have not been previously identified...
July 5, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28679848/carotid-stenting-versus-endarterectomy-for-asymptomatic-carotid-artery-stenosis-a-systematic-review-and-meta-analysis
#20
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...
August 2017: Stroke; a Journal of Cerebral Circulation
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