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https://www.readbyqxmd.com/read/28818260/transcranial-doppler-monitoring-for-microemboli-a-marker-of-a-high-risk-carotid-plaque
#1
J David Spence
In the United States, 90% of carotid intervention is being performed for asymptomatic carotid stenosis, even though 90% of patients would be better treated with intensive medical therapy. This is being justified by comparing risks of stroke or death with medical therapy during clinical trials completed decades ago (approximately 2% per year) with risks of intervention with carotid artery stenting (CAS) versus carotid endarterectomy in recent trials that did not have a medical arm. Such extrapolations are, simply put, invalid...
March 2017: Seminars in 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/28818255/clinical-need-design-and-goals-for-the-carotid-revascularization-and-medical-management-for-asymptomatic-carotid-stenosis-trial
#3
Brajesh K Lal, James F Meschia, Thomas G Brott
Prior clinical trials produced evidence-based treatment recommendations for patients with asymptomatic carotid stenosis that may not be appropriate for clinical decision-making today. High-quality patient outcomes data to allow informed decision making regarding the optimal management of high-grade asymptomatic internal carotid artery stenosis is lacking. The results of the Asymptomatic Carotid Atherosclerosis Study were published in 1995 based on a randomized patient enrollment in the 1990s. Outcomes after endarterectomy, stenting, and medical treatment for these patients have all improved in the subsequent 2 decades...
March 2017: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/28818254/medical-treatment-strategies-to-reduce-perioperative-morbidity-and-mortality-after-carotid-surgery
#4
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/28814639/deposition-and-hydrolysis-of-serine-dipeptide-lipids-of-bacteroidetes-bacteria-in-human-arteries-relationship-to-atherosclerosis
#5
Reza Nemati, Christopher Dietz, Emily J Anstadt, Jorge Cervantes, Yaling Liu, Floyd E Dewhirst, Robert B Clark, Sydney Finegold, James J Gallagher, Michael B Smith, Xudong Yao, Frank C Nichols
Multiple reaction monitoring mass spectrometry (MRM-MS) analysis of lipid extracts from human carotid endarterectomy and carotid artery samples from young individuals consistently demonstrated the presence of bacterial serine dipeptide lipid classes including Lipid 654, an agonist for human and mouse Toll-like receptor 2, and Lipid 430, the deacylated product of Lipid 654. The relative levels of Lipid 654 and Lipid 430 were also determined in common oral and intestinal bacteria from the phylum Bacteroidetes, and human serum and brain samples from healthy adults...
August 16, 2017: Journal of Lipid Research
https://www.readbyqxmd.com/read/28811230/commentary-on-late-dacron-patch-inflammatory-reaction-after-carotid-endarterectomy
#6
J-B Ricco, M Gargiulo
No abstract text is available yet for this article.
August 12, 2017: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28810271/outcomes-of-patients-with-beh%C3%A3-et-s-syndrome-after-pulmonary-endarterectomy
#7
Şehnaz Olgun Yıldızeli, Mehmed Yanartaş, Serpil Taş, Haner Direskeneli, Bülent Mutlu, Berrin Ceyhan, Bedrettin Yıldızeli
No abstract text is available yet for this article.
August 15, 2017: Thoracic and Cardiovascular Surgeon
https://www.readbyqxmd.com/read/28804624/carotid-endarterectomy-for-in-stent-restenosis-a-case-report-and-literature-review
#8
Baofeng Xu, Rui Liu, Liqun Jiao, Jinlu Yu
It is relatively difficult to treat restenosis when restenosis occurs following carotid artery stenting. Endarterectomy with simultaneous stent removal is an effective approach when restenosis occurs. The treatment method is still not well known. The present paper reports a case of restenosis after stenting that was treated with endarterectomy with a satisfactory treatment outcome. The patient, a 74-year-old male, underwent stenting 10 months before he was re-hospitalized. He seemed to recover well after stenting until one month before he was re-hospitalized, when he presented symptoms of cerebral ischemia...
August 2017: Biomedical Reports
https://www.readbyqxmd.com/read/28803399/blood-purine-measurements-as-a-rapid-real-time-indicator-of-reversible-brain-ischaemia
#9
Faming Tian, Fakhra Bibi, Nicholas Dale, Christopher H E Imray
To preserve the disequilibrium between ATP and ADP necessary to drive cellular metabolism, enzymatic pathways rapidly convert ADP to adenosine and the downstream purines inosine and hypoxanthine. During ischaemia, these same pathways result in the production of purines. We performed a prospective observational study to test whether purine levels in arterial blood might correlate with brain ischaemia. We made real-time perioperative measurements, via microelectrode biosensors, of the purine levels in untreated arterial blood from 18 patients undergoing regional anaesthetic carotid endarterectomy...
August 12, 2017: Purinergic Signalling
https://www.readbyqxmd.com/read/28801300/-carotid-artery-stenosis-treated-with-modified-carotid-endarterectomy-report-of-two-cases
#10
Zheng-Jun Liu, Jing-Bo Lu, Hao Liu, Zhi-Qi Lin, Xian-Ying Huang, Heng Wan, Fang-Yong Fu, Shui-Chuan Huang
Based on standard carotid endarterectomy, we performed modified carotid endarterectomy in two cases of carotid artery stenosis by changing the direction of the carotid artery incision to avoid restenosis of the internal carotid artery without using a patch. The two patients recovered smoothly without any complications. Compared with eversion or patch endarterectomy, this modified carotid endarterectomy avoids restenosis of the carotid artery and shortens operation time.
August 20, 2017: Nan Fang Yi Ke da Xue Xue Bao, Journal of Southern Medical University
https://www.readbyqxmd.com/read/28798785/simultaneous-vertebral-and-subclavian-artery-stenting
#11
Damian R Maciejewski, Łukasz Tekieli, Roman Machnik, Anna Kabłak-Ziembicka, Tadeusz Przewłocki, Piotr Paluszek, Mariusz Trystuła, Robert Musiał, Karolina Dzierwa, Piotr Pieniążek
INTRODUCTION: Vertebrobasilar territory ischemia leads to disabling neurological symptoms and may be caused both by vertebral artery (VA) and subclavian artery (SA) stenosis. The coexisting symptomatic ipsilateral VA and proximal SA stenosis should be considered as a true bifurcation lesion for percutaneous treatment. AIM: To evaluate the safety and efficacy of simultaneous angioplasty of vertebral and subclavian stenosis. MATERIAL AND METHODS: Fifteen patients (age 69...
2017: Postępy W Kardiologii Interwencyjnej, Advances in Interventional Cardiology
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
#12
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/28797682/intimal-sarcoma-of-the-pulmonary-trunk-showing-broad-intimal-extension-and-focal-chondrosarcomatous-differentiation-an-autopsy-case
#13
Kosuke Miyai, Hiroaki Takeo, Susumu Matsukuma
We report an autopsy case of intimal sarcoma arising in the pulmonary artery with focal chondrosarcomatous differentiation. A 77-year-old woman presented with a thrombosis-like mass in the pulmonary trunk and underwent endarterectomy. Macroscopically, solid and myxomatous tumor expanded to the pulmonary valve and bilateral main pulmonary arteries. Microscopically, the tumor comprised atypical spindle cells proliferating in a fascicular fashion, as well as occasional bizarre multinucleated cells, within a myxomatous stroma...
July 8, 2017: Cardiovascular Pathology: the Official Journal of the Society for Cardiovascular Pathology
https://www.readbyqxmd.com/read/28797613/visual-aids-for-improving-patient-decision-making-in-severe-symptomatic-carotid-stenosis
#14
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/28795615/international-survey-on-the-perioperative-management-of-pulmonary-endarterectomy-the-perfusion-perspective
#15
Roger D P Stanzel, Johannes Gehron, Matthias Wolff, Natalie Striegl, Peter Roth, Rolf-Hasso Boedeker, Christine Scheibelhut, Johannes Herrmann, Ingeborg Welters, Eckhard Mayer, Matthias Scheffler
INTRODUCTION: Pulmonary endarterectomy (PEA) is the most effective treatment available for chronic thromboembolic pulmonary hypertension (CTEPH). Patient selection, surgical technique and perioperative management have improved patient outcomes, which are traditionally linked to surgical and center experience. However, optimal perfusion care has not been well defined. The goal of the international survey was to better characterize the contemporary perfusion management of PEA and highlight similarities and controversies...
August 1, 2017: Perfusion
https://www.readbyqxmd.com/read/28794387/carotid-endarterectomy-with-routine-shunt-for-patients-with-contralateral-carotid-occlusion
#16
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
#17
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/28790288/-management-of-pulmonary-thromboembolism
#18
Taijiro Mishina, Masahiro Miyajima, Atsushi Watanabe
Pulmonary thromboembolism is a fatal perioperative complication in general thoracic surgery. There is a report on its incidence of 2.68 cases out of 10,000 general thoracic surgeries. To prevent pulmonary thromboembolism, risk evaluation of an individual case and steady implementation of recommended preventive techiques are required. Because of the prevalence of guidelines for prevention, the incidence of pulmonary thromboembolism in the perioperative period is reducing. However, maximum prevention of deep vein thrombosis(DVT), which can lead to pulmonary thromboembolism, is impossible even if preventive measures are strictly implemented in the perioperative period...
July 2017: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/28790270/-severe-carotid-artery-disease-preoperative-assessment-and-perioperative-management
#19
Kaoru Matsuura, Goro Matsumiya
Cerebrovascular complication is the one of the most dreadful complication after open heart surgery which leads to significant decrease of quality of life even if the patients survived. To decrease these complications, carotid doppler echo as one of the non-invasive carotid screening modalities is effective. Carotid artery stenosis is common in the patients with coronary artery disease, and it is more frequent in the patients with more complexed coronary artery lesions. The more the patients indicated for coronary artery bypass grafting has complexed lesions these days, the more the patients have carotid artery lesions...
July 2017: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/28789657/neutrophil-gelatinase-associated-lipocalin-ngal-is-elevated-in-type-2-diabetics-with-carotid-artery-stenosis-and-reduced-under-metformin-treatment
#20
W Eilenberg, S Stojkovic, A Piechota-Polanczyk, A Kaider, N Kozakowski, W J Weninger, J Nanobachvili, J Wojta, I Huk, S Demyanets, C Neumayer
BACKGROUND: Neutrophil gelatinase-associated lipocalin (NGAL), an acute phase protein released by neutrophils, has been described as biomarker of inflammatory states. Type 2 diabetes mellitus (T2DM) is characterized by increased inflammation and an elevated risk for embolization of carotid artery stenosis (CAS). We aimed to explore the role of NGAL systemically and in plaques of diabetics undergoing carotid endarterectomy. Moreover, the potential anti-inflammatory effect of metformin on NGAL was addressed in diabetics...
August 8, 2017: Cardiovascular Diabetology
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