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Perioperative stroke

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https://www.readbyqxmd.com/read/28526648/somatosensory-evoked-potentials-during-temporary-arterial-occlusion-for-intracranial-aneurysm-surgery-predictive-value-for-perioperative-stroke
#1
Ahmed I Kashkoush, Brian T Jankowitz, Paul Gardner, Robert M Friedlander, Yue-Fang Chang, Donald J Crammond, Jeffrey R Balzer, Parthasarathy D Thirumala
BACKGROUND: Temporary arterial occlusion (TAO) is a valuable tool for minimizing intraoperative rupture risk during intracranial aneurysm microsurgery; however, it may also be associated with ischemic injury. OBJECTIVE: This study aims to identify surgical and intraoperative neurophysiological monitoring (IONM) factors that predict perioperative stroke risk after TAO. METHODS: We performed a retrospective chart review of 177 intracranial aneurysm surgeries at our institution, in which TAO was performed before the placement of a permanent clip under monitoring with somatosensory evoked potentials (SSEPs) and electroencephalography (EEG)...
May 16, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28515852/bilateral-vs-unilateral-internal-mammary-revascularization-in-patients-with-left-ventricular-dysfunction
#2
Batric Popovic, Pablo Maureira, Yves Juilliere, Nicolas Danchin, Damien Voilliot, Fabrice Vanhuyse, Jean Pierre Villemot
AIM: To investigate the survival benefit of bilateral internal mammary artery (BIMA) grafts in patients with left ventricular dysfunction. METHODS: Between 1996 and 2009, we performed elective, isolated, primary, multiple cardiac arterial bypass grafting in 430 consecutive patients with left ventricular ejection fraction ≤ 40%. The early and long-term results were compared between 167 patients undergoing BIMA grafting and 263 patients using left internal mammary artery (LIMA)-saphenous venous grafting (SVG)...
April 26, 2017: World Journal of Cardiology
https://www.readbyqxmd.com/read/28515742/the-use-of-intraoperative-epiaortic-ultrasonography-in-monitoring-patients-over-75-years-old-treated-with-aortic-valve-replacement
#3
Tomasz Niklewski, Michał Zembala, Dariusz Puszczewicz, Paweł Nadziakiewicz, Wojciech Karolak, Marian Zembala
INTRODUCTION: Epiaortic ultrasound scanning (EAS) extended the use of ultrasound to the intraoperative diagnosis of aortic pathology. Surgical palpation of the ascending aorta underestimates the presence and severity of atherosclerotic plaques. Epiaortic ultrasound scanning has been used as an adjunct to transesophageal echocardiography (TEE) or as a primary direct diagnostic tool for imaging the ascending aorta as well as the aortic arch, which gained prominence as part of a multipronged intraoperative strategy to reduce atherosclerotic emboli...
March 2017: Kardiochirurgia i Torakochirurgia Polska, Polish Journal of Cardio-Thoracic Surgery
https://www.readbyqxmd.com/read/28511557/impact-of-a-perioperative-prophylaxis-guideline-on-post-cardiothoracic-surgery-atrial-fibrillation
#4
Rosanna Li, C Michael White, Jola Mehmeti, Spencer T Martin, Laura C Hobbs
BACKGROUND: National practice guidelines do not provide clear recommendations on combination pharmacological regimens to reduce cardiothoracic surgery (CTS) postoperative atrial fibrillation (POAF). OBJECTIVE: This study examines if there is a reduction in POAF rates after implementing a perioperative prophylaxis guideline that includes amiodarone, β-blockers, and high-intensity statins. METHODS: Data were retrospectively collected on 400 adults (200 patients pre-guideline implementation and 200 patients post-guideline implementation) with a CHA2DS2-VASc (Congestive Heart Failure, Hypertension, Age, Diabetes Mellitus, and Vascular Disease) score of at least 3 points after CTS...
May 1, 2017: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/28502543/the-association-of-carotid-revascularization-endarterectomy-versus-stent-trial-crest-and-centers-for-medicare-and-medicaid-services-carotid-guideline-publication-on-utilization-and-outcomes-of-carotid-stenting-among-high-risk-patients
#5
Gregory G Salzler, Alik Farber, Denis V Rybin, Gheorghe Doros, Jeffrey J Siracuse, Mohammad H Eslami
OBJECTIVE: Since the 2004 approval by the United States Food and Drug Administration of carotid artery stenting (CAS), there have been two seminal publications about CAS reimbursement (Centers for Medicare and Medicaid Services guidelines; 2008) and clinical outcomes (Carotid Revascularization Endarterectomy versus Stent Trial [CREST]; 2010). We explored the association between these publications and national trends in CAS use among high-risk symptomatic patients. METHODS: The most recent congruent data sets of the Nationwide Inpatient Sample (NIS) were queried for patients undergoing carotid revascularization...
May 11, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28502542/contemporary-evaluation-of-mortality-and-stroke-risk-after-thoracic-endovascular-aortic-repair
#6
Frances Y Hu, Zachary B Fang, Bradley G Leshnower, Yazan Duwayri, William D Jordan, Theresa W Gillespie, Ravi K Veeraswamy
OBJECTIVE: During the past decade, thoracic endovascular aortic repair (TEVAR) has increased as a treatment option for a variety of aortic pathologic processes. Despite this rise in the use of thoracic stent grafts, real-world outcomes from a robust, adjudicated, contemporary data set have yet to be reported. Previous studies have shown periprocedural mortality rates between 1.5% and 9.5% and procedure-related stroke rates of 2.3% to 8.2%. With advances in device engineering and increased experience of physicians, we hypothesized that the rates of these complications would be reduced in a more recent sample set...
May 11, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28501656/perioperative-outcomes-of-open-versus-endovascular-repair-for-ruptured-thoracoabdominal-aneurysms
#7
Satinderjit S Locham, Joshua C Grimm, Isibor J Arhuidese, Besma Nejim, Tammam Obeid, James H Black, Mahmoud B Malas
OBJECTIVES: Open aneurysm repair (OAR) remains the gold standard for treating ruptured thoracoabdominal-aortic-aneurysms (TAAA). The aim of our study is to compare the 30-day post-operative outcomes among patients with ruptured TAAA undergoing OAR versus endovascular aneurysm repair. METHODS: Using the NSQIP database (2006-2015), we identified patients who underwent OAR and endovascular repair for a ruptured TAAA. Postoperative outcomes of interest included: mortality, renal failure, stroke, and cardiopulmonary complications...
May 10, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28498970/results-of-a-multimodal-approach-for-the-management-of-aortic-coarctation-and-its-complications-in-adults
#8
Pierre-Emmanuel Noly, Valéry Legris-Falardeau, Reda Ibrahim, Ismaïl El-Hamamsy, Raymond Cartier, Yoan Lamarche, Denis Bouchard, Jean-François Dorval, Nancy Poirier, Philippe Demers
OBJECTIVES: We aimed to assess the results of various tailored management strategies for adults with coarctation in our centre. METHODS: : We reviewed all adults patients treated for aortic caorctation between January 2000 and December 2015 in our institution. The primary end point was a composite of death, perioperative stroke, paraplegia, need for unplanned reoperation or occurrence of pseudoaneurysm during the follow-up. The mean follow-up was 82 ± 5 months...
May 11, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28495538/clinical-outcome-of-carotid-artery-stenting-according-to-provider-specialty-and-volume
#9
Ali F AbuRahma, John E Campbell, Nizar Hariri, Joseph AbuRahma, L Scott Dean, Mark C Bates, Aravinda Nanjundappa, Patrick A Stone, Ace O'vil
BACKGROUND: Several studies have demonstrated better outcomes for carotid endarterectomy (CEA) with high-volume hospitals and providers. However, only a few studies have reported on the impact of operator specialty/volume on the perioperative outcome of carotid artery stenting (CAS). This study will analyze the correlation of CAS outcomes and provider specialty and volume. METHODS: Prospectively collected data of CAS procedures done at our institution during a 10-year period were analyzed...
May 8, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28494900/perioperative-strokes-after-coronary-artery-bypass-grafting-with-staged-carotid-endarterectomy-a-nationwide-perspective
#10
Hannah Cheng, Reshmi Udesh, Amol Mehta, Parthasarathy D Thirumala
STUDY OBJECTIVE: To examine the risk of perioperative stroke on in-hospital morbidity and mortality in staged coronary artery bypass grafting (CABG) and carotid endarterectomy (CEA) procedures. DESIGN: The National Inpatient Sample (NIS) database was used to extract data on all patients who underwent staged CABG CEA procedures. They were identified using the ICD-9 (International Classification of Diseases, Ninth Revision-Clinical Modification) diagnosis and procedure codes...
June 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28489640/little-black-boxes-noncardiac-implantable-electronic-medical-devices-and-their-anesthetic-and-surgical-implications
#11
Una Srejic, Paul Larson, Philip E Bickler
Implanted electronic medical devices. or stimulators such as pacemakers and nerve stimulators have grown enormously in diversity and complexity over recent decades. The function and potential interaction of these devices with the perioperative environment is of increasing concern for anesthesiologists and surgeons. Because of the innate electromagnetic environment of the hospital (operating room, gastrointestinal procedure suite, and imaging suite), implanted device malfunction, reprogramming, or destruction may occur and cause physical harm (including nerve injury, blindness, deafness, burn, stroke, paralysis, or coma) to the patient...
May 4, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28480032/neuroprotection-provided-by-isoflurane-pre-conditioning-and-post-conditioning
#12
REVIEW
Ming Jiang, Liang Sun, Dong-Xia Feng, Zheng-Quan Yu, Rong Gao, Yuan-Zhao Sun, Gang Chen
Isoflurane, a volatile and inhalational anesthetic, has been extensively used in perioperative period for several decades. A large amount of experimental studies have indicated that isoflurane exhibits neuroprotective properties when it is administrated before or after (pre-conditioning and post-conditioning) neurodegenerative diseases (e.g., hypoxic ischemia, stroke and trauma). Multiple mechanisms are involved in isoflurane induced neuroprotection, including activation of glycine and γ-aminobutyric acid receptors, antagonism of ionic channels and alteration of the function and activity of other cellular proteins...
January 2017: Medical Gas Research
https://www.readbyqxmd.com/read/28478979/risk-factors-and-stroke-characteristic-in-patients-with-postoperative-strokes
#13
Yi Dong, Wenjie Cao, Xin Cheng, Kun Fang, Xiaolong Zhang, Yuxiang Gu, Bing Leng, Qiang Dong
BACKGROUND: Intravenous thrombolysis and intra-arterial thrombectomy are now the standard therapies for patients with acute ischemic stroke. In-house strokes have often been overlooked even at stroke centers and there is no consensus on how they should be managed. Perioperative stroke happens rather frequently but treatment protocol is lacking, In China, the issue of in-house strokes has not been explored. The aim of this study is to explore the current management of in-house stroke and identify the common risk factors associated with perioperative strokes...
May 3, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28475278/anticoagulation-bridge-therapy-in-patients-with-atrial-fibrillation-recent-updates-providing-a-rebalance-of-risk-and-benefit
#14
Candice L Garwood, Bianca Korkis, Domenico Grande, Claudia Hanni, Amy Morin, Lynette R Moser
In 2011, we provided a review of clinical updates and controversies surrounding anticoagulation bridge therapy in patients with atrial fibrillation. Since then, options for oral anticoagulation have expanded with the addition of four direct oral anticoagulant (DOAC) agents available in the United States. Nonetheless, vitamin K antagonist (VKA) therapy continues to be the treatment of choice for patients who are poor candidates for a DOAC and for whom bridge therapy remains a therapeutic dilemma. However, bridge therapy for patients taking a VKA remains a therapeutic dilemma...
May 5, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28474994/meta-analysis-of-the-surgical-outcomes-of-symptomatic-moyamoya-disease-in-adults
#15
Jin Pyeong Jeon, Jeong Eun Kim, Won-Sang Cho, Jae Seung Bang, Young-Je Son, Chang Wan Oh
OBJECTIVE The purpose of this study was to evaluate treatment outcomes of future stroke prevention, perioperative complications, and angiographic revascularization in adults with symptomatic moyamoya disease (MMD) according to treatment modalities and surgical techniques. METHODS A systemic literature review was performed based on searches of the PubMed, Embase, and Cochrane Central databases. A fixed-effects model was used in cases of heterogeneity less than 50%. Publication bias was determined by Begg's funnel plot, Egger's test of the intercept, and the Begg and Mazumdar rank correlation test...
May 5, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28472412/one-year-mortality-and-costs-associated-with-surgical-ablation-for-atrial-fibrillation-concomitant-to-coronary-artery-bypass-grafting%C3%A2
#16
J Scott Rankin, Daniel J Lerner, Mary Jo Braid-Forbes, Michael A Ferguson, Vinay Badhwar
OBJECTIVES: While surgical ablation (SA) for persistent atrial fibrillation (AF) can reduce recurrence of AF, its impact on longitudinal survival and health-care costs remains controversial. This study defines the clinical outcomes and costs associated with SA in patients with prior AF undergoing coronary artery bypass grafting (CABG). METHODS: A total of 3745 Medicare beneficiaries with prior AF who underwent CABG in 2013 were divided into 2 groups: those with and those without concomitant SA...
May 2, 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/28471152/endovascular-treatment-of-traumatic-thoracic-aortic-lesions-a-systematic-review-and-meta-analysis
#17
Cornelis P van der Zee, Tryfon Vainas, Freek A van Brussel, Ignace F Tielliu, Clark J Zeebregts, Maarten J van der Laan
BACKGROUND: To provide an overview of the experience of endovascular treatment for traumatic thoracic aortic lesions (TTAL). Thoracic aortic injury secondary to high-energy chest trauma constitutes an emergency situation with potentially devastating outcome. In the present time, the majority of patients are treated with thoracic endovascular aortic repair. The aim of this study was to provide a systematic overview of endovascular aortic repair in patients with TTAL with special attention to perioperative mortality, paraplegia, stroke, influence of left subclavian artery (LSA) coverage herein, and long term stent related complications...
May 3, 2017: Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/28464540/safety-and-feasibility-of-liver-resection-with-continued-antiplatelet-therapy-using-aspirin
#18
Kazuteru Monden, Hiroshi Sadamori, Masayoshi Hioki, Satoshi Ohno, Hiromi Saneto, Toru Ueki, Kazuhisa Yabushita, Kazumi Ono, Kousaku Sakaguchi, Norihisa Takakura
BACKGROUND: Aspirin is widely used for the secondary prevention of ischemic stroke and cardiovascular disease. Perioperative aspirin may decrease thrombotic morbidity, but may also increase hemorrhagic morbidity. In particular, liver resection carries risks of bleeding, leading to higher risks of hemorrhagic morbidity. Our institution has continued aspirin therapy perioperatively in patients undergoing liver resection. This study examined the safety and feasibility of liver resection while continuing aspirin...
May 2, 2017: Journal of Hepato-biliary-pancreatic Sciences
https://www.readbyqxmd.com/read/28463896/a-meta-analysis-of-the-impact-of-aspirin-clopidogrel-and-dual-antiplatelet-therapy-on-bleeding-complications-in-noncardiac-surgery
#19
Jesse A Columbo, Andrew J Lambour, Rebecca A Sundling, Nirali B Chauhan, Sarah Y Bessen, David L Linshaw, Ravinder Kang, Natalie B V Riblet, Philip P Goodney, David H Stone
OBJECTIVE: The aim of this study was to determine the bleeding risks associated with single (aspirin) and dual (aspirin + clopidogrel) antiplatelet therapy (DAPT) versus placebo or no treatment in adults undergoing noncardiac surgery. SUMMARY OF BACKGROUND DATA: The impact of antiplatelet therapy on bleeding during noncardiac surgery remains controversial. A meta-analysis was performed to examine the risk associated with single and DAPT. METHODS: A systematic review of antiplatelet therapy, noncardiac surgery, and perioperative bleeding was performed...
May 1, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28460624/dabigatran-metabolism-pharmacologic-properties-and-drug-interactions
#20
Nebojsa Antonijevic, Ivana Zivkovic, Ljubica Jovanovic, Dragan Matic, Mladen Kocica, Igor Mrdovic, Vladimir Kanjuh, Milica Culafic
The superiority of dabigatran has been well proven in the standard dosing regimen in prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation (NVAF) and extended venous thromboembolism (VTE) treatment. Dabigatran, an anticoagulant with a good safety profile, reduces intracranial bleeding in patients with atrial fibrillation and decreases major and clinically relevant non-major bleeding in acute VTE treatment. However, several important clinical issues are not fully covered by currently available directions with regard to dabigatran administration...
April 26, 2017: Current Drug Metabolism
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