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https://www.readbyqxmd.com/read/28433337/increased-resource-utilization-and-overall-morbidity-are-associated-with-general-versus-regional-anesthesia-for-carotid-endarterectomy-in-data-collected-by-the-michigan-surgical-quality-collaborative
#1
Ahmad S Hussain, Andrew Mullard, William F Oppat, Kevin D Nolan
OBJECTIVE: Advocates for performing carotid endarterectomy (CEA) under regional anesthesia (RA) cite reduction in hemodynamic instability and the ability for neurologic monitoring, but many still prefer general anesthesia (GA) as benefits of RA have not been clearly demonstrated, reliable RA may not be available in all centers, and a certain amount of movement by the patient during the procedure may not be uniformly tolerated. We evaluated the association of anesthesia type and perioperative morbidity and mortality as well as resource utilization in patients undergoing CEA using the Michigan Surgical Quality Collaborative (MSQC) database...
April 19, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28432519/carotid-plaque-with-expansive-arterial-remodeling-is-a-risk-factor-for-ischemic-complication-following-carotid-artery-stenting
#2
Daina Kashiwazaki, Naoya Kuwayama, Naoki Akioka, Kyo Noguchi, Satoshi Kuroda
BACKGROUND: Carotid artery stenting (CAS) is associated with a higher risk of periprocedural stroke than carotid endarterectomy. For better patient selection, more accurate risk factors should be identified. The aim of this study was to determine whether expansive arterial remodeling can predict ischemic complications in patients undergoing CAS. METHODS: This retrospective study included 82 patients with carotid stenosis treated by CAS. The plaque component was evaluated using MR plaque imaging before the procedure...
April 21, 2017: Acta Neurochirurgica
https://www.readbyqxmd.com/read/28431821/near-infrared-spectroscopy-as-a-predictor-for-shunt-requirement-during-carotid-endarterectomy
#3
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/28431820/commentary-on-near-infrared-spectroscopy-as-a-predictor-for-shunt-requirement-during-carotid-endarterectomy
#4
S K Kakkos, I A Tsolakis
No abstract text is available yet for this article.
April 18, 2017: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28420842/the-development-of-marked-collateral-circulation-due-to-inferior-vena-cava-filter-occlusion-in-a-patient-with-chronic-thromboembolic-pulmonary-hypertension-complicated-with-anti-phospholipid-syndrome
#5
Hajime Kasai, Nobuhiro Tanabe, Ken Koshikawa, Yasutaka Hirasawa, Toshihiko Sugiura, Seiichiro Sakao, Koichiro Tatsumi
A 30-year-old Japanese man was diagnosed with chronic thromboembolic pulmonary hypertension (CTEPH) with lupus anticoagulants (LAs) in 2003. He underwent pulmonary endarterectomy after the placement of an inferior vena cava filter (IVCF) in 2004, and treatment with warfarin was continued. In 2014, IVCF occlusion and marked collateral circulation were noted during an examination for transient dyspnea; however, his warfarin level was within the therapeutic range for 88.9% of the time from 2003 to 2014. We herein report a rare case of CTEPH and LAs with IVCF occlusion; in such cases, intense treatment may be required...
2017: Internal Medicine
https://www.readbyqxmd.com/read/28409735/quantitative-magnetic-resonance-angiography-as-a-potential-predictor-for-cerebral-hyperperfusion-syndrome-a-preliminary-study
#6
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/28400904/extensive-mobile-thrombus-of-the-internal-carotid-discovered-after-intravenous-thrombolysis-what-do-i-do-now
#7
Eugene L Scharf, Jennifer E Fugate, Sara E Hocker
This case report describes a rare presentation of ischemic stroke secondary to an extensive internal carotid artery thrombus, subsequent therapeutic dilemma, and clinical management. A 58-year-old man was administered intravenous (IV) thrombolysis for right middle cerebral artery territory ischemic stroke symptoms. A computed tomography angiogram of the head and neck following thrombolysis showed a longitudinally extensive internal carotid artery thrombus originating at the region of high-grade calcific stenosis...
April 2017: Neurohospitalist
https://www.readbyqxmd.com/read/28400487/vascular-anatomy-predicts-the-risk-of-cerebral-ischemia-in-patients-randomized-to-carotid-stenting-versus-endarterectomy
#8
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
#9
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
#10
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/28388659/identification-of-neovascularization-by-contrast-enhanced-ultrasound-to-detect-unstable-carotid-stenosis
#11
Charlotte Schmidt, Thomas Fischer, Ralph-Ingo Rückert, Timm Oberwahrenbrock, Lutz Harms, Golo Kronenberg, Hagen Kunte
BACKGROUND: Plaque neovascularization accompanies local inflammation and critically contributes to plaque instability. Correct identification of intraplaque neovascularization by contrast-enhanced ultrasound (CEUS) may provide an additional risk marker in carotid stenosis. This pilot study investigates the correlation between histological evaluation of carotid plaque specimens and pre-surgery CEUS to identify neovascularization. METHODS: 17 patients with high-grade internal carotid artery (ICA) stenosis were studied...
2017: PloS One
https://www.readbyqxmd.com/read/28387821/ipsilateral-pupillary-dilation-following-carotid-endarterectomy-a-temporary-and-benign-phenomenon
#12
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
#13
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/28382271/acute-limb-ischemia-and-coronary-artery-disease-in-a-case-of-kimura-s-disease
#14
Woon Heo, Hee Jae Jun, Do Kyun Kang, Ho-Ki Min, Youn-Ho Hwang, Ji Yong Kim, Kyung Han Nam
Kimura disease (KD) is an immune-mediated chronic inflammatory disease of unknown etiology. KD has many complications associated with hypereosinophilia, including various forms of allergic reactions and eosinophilic lung disease. Additionally, hypereosinophilia is associated with hypercoagulability, which may lead to thromboembolic events. A 36-year-old man with KD presented with acute limb ischemia and coronary artery occlusion. He underwent thrombectomy, partial endarterectomy of both popliteal arteries, and coronary artery stent insertion...
April 2017: Korean Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28382267/dual-monitoring-with-stump-pressure-and-electroencephalography-during-carotid-endarterectomy
#15
Jee Won Chang, Su Wan Kim, Seogjae Lee, Jonggeun Lee, Min Jung Ku
BACKGROUND: Intraoperative monitoring during carotid endarterectomy is crucial for cerebral protection. We investigated the results of carotid endarterectomy under dual monitoring with stump pressure and electroencephalography. METHODS: We retrospectively reviewed the medical records of 50 patients who underwent carotid endarterectomy between March 2010 and February 2016. We inserted a temporary shunt if the stump pressure was lower than 35 mm Hg or if any intraoperative change was observed on electroencephalography...
April 2017: Korean Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28380656/early-results-of-surgical-simultaneous-therapy-for-significant-carotid-artery-stenosis-and-heart-disease
#16
Marc Irqsusi, Alessandro Vannucchi, Julius Beckers, Stefan Kasseckert, Stefan Waldhans, Sebastian Vogt, Rainer G H Moosdorf
Background The purpose of this single-center, retrospective study was to review the early outcome with defined endpoints of myocardial infarction, brain injury, and death after coronary bypass grafting and simultaneous carotid endarterectomy with or without combined valve replacement. Methods During the preoperative investigation 52 (44 males, 8 females) patients were examined by cardiac catheterization within the scope of their coronary status. In addition, all patients underwent echocardiography, CT angiography of the supra-aortic vessels, and full description of their neurologic status...
April 5, 2017: Thoracic and Cardiovascular Surgeon
https://www.readbyqxmd.com/read/28379549/asymptomatic-extracranial-vertebral-artery-disease-in-patients-with-internal-carotid-artery-stenosis
#17
Adnan I Qureshi, Saqib A Chaudhry, Henning Eckstein, Olav Jansen, Peter A Ringleb
BACKGROUND: Extracranial vertebral artery disease is seen in patients with internal carotid artery stenosis, although the clinical significance is not well understood. OBJECTIVE: To determine the prevalence and natural history of extracranial vertebral artery disease in patients with recently symptomatic internal carotid artery stenosis. METHODS: We analyzed data collected for patients with recently symptomatic internal carotid artery stenosis in the Stent-Protected Angioplasty vs Carotid Endarterectomy trial...
March 30, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28378467/compared-effects-on-cerebral-oxygenation-of-ephedrine-vs-phenylephrine-to-treat-hypotension-during-carotid-endarterectomy
#18
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/28377486/p2x7-deficiency-blocks-lesional-inflammasome-activity-and-ameliorates-atherosclerosis-in-mice
#19
Peter Stachon, Adrian Heidenreich, Julian Merz, Ingo Hilgendorf, Dennis Wolf, Florian Willecke, Sunaina von Garlen, Philipp Albrecht, Carmen Härdtner, Nicolas Ehrat, Natalie Hoppe, Jochen Reinöhl, Constantin von Zur Mühlen, Christoph Bode, Marco Idzko, Andreas Zirlik
Background -Extracellular ATP binds as a danger signal to purinergic receptor P2X7, promotes inflammasome assembly, and IL-1β expression. We hypothesized a functional role of the signal axis ATP - P2X7 in inflammasome activation and the chronic inflammation driving atherosclerosis. Methods -P2X7-competent and -deficient macrophages were isolated and stimulated with LPS, ATP, or both. To assess whether P2X7 may have a role in atherosclerosis, P2X7 expression was analyzed in aortic arches from LDLR(-/-) mice consuming high cholesterol diet (HCD) or chow diet...
April 4, 2017: Circulation
https://www.readbyqxmd.com/read/28376704/management-of-isolated-atherosclerotic-stenosis-of-the-common-femoral-artery-a-review-of-the-literature
#20
David Halpin, Young Erben, Sasanka Jayasuriya, Bennett Cua, Sunny Jhamnani, Carlos Mena-Hurtado
OBJECTIVE: Common femoral endarterectomy (CFE) remains the standard of care for treatment of atherosclerotic stenosis of the common femoral artery (CFA). Endovascular interventions have become the first-line therapy for atherosclerotic disease of the aortoiliac and femoropopliteal systems. Recent reports have documented high rates of technical success and low rates of complications with endovascular management of CFA stenosis. This study is a contemporary review of the surgical and endovascular literature on the management CFA stenosis and compares the results of these methods...
May 2017: Vascular and Endovascular Surgery
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