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https://www.readbyqxmd.com/read/29224943/outcomes-after-early-and-delayed-carotid-endarterectomy-in-patients-with-symptomatic-carotid-artery-stenosis
#1
Ying Huang, Peter Gloviczki, Audra A Duncan, Manju Kalra, Gustavo S Oderich, Randall R DeMartino, William S Harmsen, Thomas C Bower
OBJECTIVE: The objective of this study was to define outcomes after carotid endarterectomy (CEA) in patients with symptomatic carotid artery stenosis (CAS) when patients are operated on within 14 days after onset of symptoms. METHODS: Clinical data of consecutive patients who underwent CEA between 2003 and 2012 for symptomatic CAS were reviewed. Patients were classified into group 1, CEA ≤14 days of minor stroke or transient ischemic attack, and group 2, CEA >14 days...
December 7, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/29223846/clinical-features-and-surgical-outcomes-of-pulmonary-artery-sarcoma
#2
Kanhua Yin, Zhiqi Zhang, Rongkui Luo, Yuan Ji, Difan Zheng, Yi Lin, Chunsheng Wang
OBJECTIVE: Pulmonary artery sarcoma is an exceedingly rare malignancy. There is a lack of consensus regarding its diagnosis and treatment. We reviewed our experience in the surgical management of pulmonary artery sarcoma over an 11-year period. METHODS: From January 2005 to February 2016, 12 patients with pulmonary artery sarcoma (age 51 ± 14 years, 5 male) underwent surgical treatment at our center. Nine patients (75%) exhibited pulmonary trunk involvement on computed tomography angiography...
November 10, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29217445/factors-that-predict-failure-to-meet-mips-quality-measures-for-asymptomatic-carotid-endarterectomy
#3
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
#4
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 (VQI) database was queried for elective weekday CEAs performed for asymptomatic carotid stenosis from 2005 to 2017...
December 4, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/29217363/positional-brain-single-photon-emission-computed-tomography-findings-in-a-case-of-limb-shaking-syndrome
#5
Caroline Bund, Céline Heimburger, Valérie Wolff, Izzie Jacques Namer
An 84-year-old man, who presented lower limbs limb-shaking syndrome at orthostatism lasting a few seconds, was referred in our stroke unit. Magnetic resonance imaging showed an acute infarction in the right thalamus and the insular cortex, left extracranial carotid stenosis at 80%, and low flow in the right middle cerebral artery but did not explain limb-shaking syndrome symptomatology. We performed comparative positional brain perfusion single-photon emission computed tomography (SPECT), in the upright and in the supine position, to explore and localize hypoperfusion-endangered brain structures that may be involved in the presenting symptoms...
December 4, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29217008/endovascular-versus-surgical%C3%A2-revascularization-for-chronic%C3%A2-mesenteric%C3%A2-ischemia-insights-from-the-national-inpatient-sample-database
#6
Fabio V Lima, Dhaval Kolte, Kevin F Kennedy, David W Louis, J Dawn Abbott, Peter A Soukas, Omar N Hyder, Shafiq T Mamdani, Herbert D Aronow
OBJECTIVES: This study sought to compare in-hospital major adverse cardiac and cerebrovascular events (MACCE) following endovascular therapy with open surgery for chronic mesenteric ischemia (CMI). BACKGROUND: There are limited contemporary data on in-hospital cardiovascular outcomes among patients with CMI undergoing revascularization via endovascular therapy versus open surgery in the United States. METHODS: Patients with CMI undergoing endovascular or surgical (mesenteric bypass or endarterectomy) revascularization between 2007 and 2014 were identified from the National Inpatient Sample...
December 11, 2017: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/29215061/local-production-of-activated-factor-x-in-atherosclerotic-plaque-induced-vascular-smooth-muscle-cell-senescence
#7
Fumihiro Sanada, Jun Muratsu, Rei Otsu, Hideo Shimizu, Nobutaka Koibuchi, Kazutaka Uchida, Yoshiaki Taniyama, Shinichi Yoshimura, Hiromi Rakugi, Ryuichi Morishita
Our previous study demonstrated that coagulation factor Xa (FXa) induced endothelial cell senescence, resulting in inflammation and impaired angiogenesis. This mechanism is dictated through protease-activated receptors, PARs, insulin-like growth factor-binding protein 5 (IGFBP-5), and p53. Activation of PARs contributes to the pathophysiology of several chronic inflammatory diseases, including atherosclerosis. Thus, we speculated that similar mechanism might participate in the progression of atherosclerotic plaques...
December 7, 2017: Scientific Reports
https://www.readbyqxmd.com/read/29209949/18f-fdg-pet-ct-for-the-quantification-of-inflammation-in-large-carotid-artery-plaques
#8
Kjersti Johnsrud, Karolina Skagen, Therese Seierstad, Mona Skjelland, David Russell, Mona-Elisabeth Revheim
BACKGROUND: There is currently no consensus on the methodology for quantification of 18F-FDG uptake in inflammation in atherosclerosis. In this study, we explore different methods for quantification of 18F-FDG uptake in carotid atherosclerotic plaques and correlate the uptake values to histological assessments of inflammation. METHODS AND RESULTS: Forty-four patients with atherosclerotic stenosis ≥70% of the internal carotid artery underwent 18F-FDG PET/CT. Maximum standardized uptake values (SUVmax) from all plaque-containing slices were collected...
December 5, 2017: Journal of Nuclear Cardiology: Official Publication of the American Society of Nuclear Cardiology
https://www.readbyqxmd.com/read/29208678/microrna-100-suppresses-chronic-vascular-inflammation-by-stimulation-of-endothelial-autophagy
#9
Franziska Pankratz, Catherine Hohnloser, Xavier Bemtgen, Caterina Jaenich, Sheena Kreuzaler, Imo E Hoefer, Gerard Pasterkamp, Justin Mastroianni, Robert Zeiser, Christian Smolka, Laura A Schneider, Julien Martin, Maike Juschkat, Thomas Helbing, Martin Moser, Christoph Bode, Sebastian Grundmann
Rationale: The interaction of circulating cells within the vascular wall is a critical event in chronic inflammatory processes such as atherosclerosis, but the control of the vascular inflammatory state is still largely unclear. Objective: This study was undertaken to characterize the function of the endothelial-enriched microRNA miR-100 during vascular inflammation and atherogenesis. Methods and Results: Based on a transcriptome analysis of endothelial cells after miR-100 overexpression, we identified miR-100 as potent suppressor of endothelial adhesion molecule expression, resulting in attenuated leukocyte-endothelial interaction in vitro and in vivo as shown by flow cytometry and intravital imaging approach...
December 5, 2017: Circulation Research
https://www.readbyqxmd.com/read/29205995/volume-and-health-outcomes-evidence-from-systematic-reviews-and-from-evaluation-of-italian-hospital-data
#10
Laura Amato, Danilo Fusco, Anna Acampora, Katia Bontempi, Alessandro Cesare Rosa, Paola Colais, Fabio Cruciani, Mariangela D'Ovidio, Francesca Mataloni, Silvia Minozzi, Zuzana Mitrova, Luigi Pinnarelli, Rosella Saulle, Salvatore Soldati, Chiara Sorge, Simona Vecchi, Martina Ventura, Marina Davoli
BACKGROUND Improving quality and effectiveness of healthcare is one of the priorities of health policies. Hospital or physician volume represents a measurable variable with an impact on effectiveness of healthcare. An Italian law calls for the definition of «qualitative, structural, technological, and quantitative standards of hospital care». There is a need for an evaluation of the available scientific evidence in order to identify qualitative, structural, technological, and quantitative standards of hospital care, including the volume of care above or below which the public and private hospitals may be accredited (or not) to provide specific healthcare interventions...
September 2017: Epidemiologia e Prevenzione
https://www.readbyqxmd.com/read/29205297/meta-analysis-of-the-procedural-risks-of-carotid-endarterectomy-and-carotid-artery-stenting-over-time
#11
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/29204653/national-patterns-of-carotid-revascularization-before-and-after-the-carotid-revascularization-endarterectomy-vs-stenting-trial-crest
#12
Fadar Oliver Otite, Priyank Khandelwal, Amer M Malik, Seemant Chaturvedi
Importance: The Carotid Revascularization Endarterectomy vs Stenting Trial (CREST) showed greater safety of carotid artery stenting (CAS) in patients younger than 70 years and carotid endarterectomy (CEA) in those older than 70 years. It is unknown how the result of CREST has influenced carotid revascularization choices in the United States. Objective: To evaluate national patterns in CAS performance in patients older than 70 years in the post-CREST (2011-2014) compared with the pre-CREST (2007-2010) era...
December 4, 2017: JAMA Neurology
https://www.readbyqxmd.com/read/29198413/is-carotid-revascularization-worthwhile-in-patients-waiting-for-kidney-transplantation
#13
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/pre-operative-cardiac-stress-testing-in-the-southern-california-vascular-outcomes-improvement-collaborative
#14
Kaelan Chan, Ahmed M Abou-Zamzam, Karen Woo
OBJECTIVE: The objective of this study is to examine the use of pre-operative cardiac stress testing (PCST) in the Southern California Vascular Outcomes Improvement Collaborative (So Cal VOICe). METHODS: A retrospective review was performed of 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 post-operative 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/29196199/midt-term-results-after-fast-track-prophylactic-carotid-surgery-program-the-risk-of-overlooking-occult-cancer
#15
Liv Schoellhammer, Alan Owen-Falkenberg, Bo Gottschalksen, Saeid Shahidi
BACKGROUND: Most guidelines recommend fast-track carotid endarterectomy (CEA) within 14 days of the last ischemic event. Long-term survival after fast-track CEA is unknown. The purpose of this study was to determine whether the fast-track CEA program in our region was associated with a reduced or increased 2-year survival and overall complication rate in our population. METHODS: Prospective 2-year follow-up in patients after the implementation of a fast-track CEA program during a period of 3½ years...
November 28, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29191874/ct-attenuation-analysis-of-carotid-intraplaque-hemorrhage
#16
L Saba, M Francone, P P Bassareo, L Lai, R Sanfilippo, R Montisci, J S Suri, C N De Cecco, G Faa
BACKGROUND AND PURPOSE: Intraplaque hemorrhage is considered a leading parameter of carotid plaque vulnerability. Our purpose was to assess the CT characteristics of intraplaque hemorrhage with histopathologic correlation to identify features that allow for confirming or ruling out the intraplaque hemorrhage. MATERIALS AND METHODS: This retrospective study included 91 patients (67 men; median age, 65 ± 7 years; age range, 41-83 years) who underwent CT angiography and carotid endarterectomy from March 2010 to May 2013...
November 30, 2017: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/29191852/challenge-and-yield-of-enrolling-racially-and-ethnically-diverse-patient-populations-in-low-event-rate-clinical-trials
#17
Alice J Sheffet, George Howard, Albert Sam, Zafar Jamil, Fred Weaver, David Chiu, Jenifer H Voeks, Virginia J Howard, Susan E Hughes, Linda Flaxman, Mary E Longbottom, Thomas G Brott
BACKGROUND AND PURPOSE: We report patient enrollment and retention by race and ethnicity in the CREST (Carotid Revascularization Endarterectomy versus Stent Trial) and assess potential effect modification by race/ethnicity. In addition, we discuss the challenge of detecting differences in study outcomes when subgroups are small and the event rate is low. METHODS: We compared 2502 patients by race, ethnicity, baseline characteristics, and primary outcome (any periprocedural stroke, death, or myocardial infarction and subsequent ipsilateral stroke up to 10 years)...
November 30, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29186602/intraoperative-computed-tomography-angiography-a-novel-completion-imaging-modality-for-carotid-endarterectomy
#18
Anish N Sen, Jared Fridley, Sherly Sebastian, Edward A M Duckworth
BACKGROUND: Intraoperative computed tomography angiography (ICTA) is a novel completion imaging modality for carotid endarterectomy (CEA). No studies exist in the literature describing ICTA use in CEA. OBJECTIVE: To evaluate the feasibility and efficacy of ICTA as a method of immediately evaluating the technical results of CEA. METHODS: Twenty-three consecutive CEAs were performed by a single neurosurgeon over an 8-month period. Of this series, 12 utilized ICTA for completion imaging, 10 utilized duplex ultrasonography (US), and 1 utilized no intraoperative completion imaging...
December 1, 2017: Operative Neurosurgery (Hagerstown, Md.)
https://www.readbyqxmd.com/read/29181992/the-significance-of-the-pharyngeal-veins-during-carotid-endarterectomy-description-of-an-anatomical-triangle
#19
J Aldoori, V Mahadevan, M Aldoori
Injuries to the hypoglossal and vagus nerves are the most commonly reported injuries during carotid endarterectomy. While unilateral single nerve injury is usually well tolerated, bilateral or combined nerve injuries can pose a serious threat to life. This study aims to increase awareness of the inferior pharyngeal vein, which usually passes posterior to the internal carotid artery but sometimes crosses anterior to it. Injury to either or both hypoglossal and vagus nerves can occur during control of unexpected haemorrhage from the torn and retracted edges of the inferior pharyngeal vein...
November 28, 2017: Annals of the Royal College of Surgeons of England
https://www.readbyqxmd.com/read/29180284/reoperative-pulmonary-endarterectomy-past-failures-of-patient-selection-can-assist-in-future-practice-of-informed-consent
#20
EDITORIAL
Mara B Antonoff
The Pavia group reports their experience with reoperative pulmonary endarterectomy for patients with chronic thromboembolic pulmonary hypertension. They achieved impressive results in terms of hemodynamic parameters and functional status; however, a mortality rate of 40% represents inappropriate patient selection. Recommendations are made for identifying ideal operative candidates.
November 24, 2017: Seminars in Thoracic and Cardiovascular Surgery
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