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Perioperative stroke

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https://www.readbyqxmd.com/read/28926782/enterprise-stent-in-recanalizing-non-acute-atherosclerotic-intracranial-internal-carotid-artery-occlusion
#1
Xiaofei Wang, Zhigang Wang, Yong Ji, Xuan Ding, Yizheng Zang, Chengwei Wang
OBJECTIVE: To investigate the safety and effectiveness of recanalization in non-acute occlusion of intracranial internal carotid arteries using the flexible Enterprise self-expanding stent. PATIENTS AND METHODS: From June 2014 to June 2016, 12 consecutive patients with non-acute occlusion of intracranial internal carotid arteries received endovascular recanalization with Enterprise stenting. All patients received medication for anti-platelet aggregation therapy before and after the operation...
June 27, 2017: Clinical Neurology and Neurosurgery
https://www.readbyqxmd.com/read/28923240/national-survey-on-perioperative-anaesthetic-management-in-the-endovascular-treatment-of-acute-ischaemic-stroke
#2
O Romero Kräuchi, L Valencia, F Iturri, A Mariscal Ortega, A López Gómez, R Valero
OBJECTIVE: To assess the anaesthetic management of treatment for endovascular acute ischaemic stroke (AIS) in Spain. MATERIALS AND METHOD: A survey was designed by the SEDAR Neuroscience Section and sent to the Spanish anaesthesiology departments with a primary stroke centre between July and November 2016. RESULTS: Of the 47 hospitals where endovascular treatment of AIS is performed, 37 anaesthesiology departments participated. Thirty responses were obtained; three of which were eliminated due to duplication (response rate of 72...
September 15, 2017: Revista Española de Anestesiología y Reanimación
https://www.readbyqxmd.com/read/28913483/the-prevalence-of-perioperative-complications-in-patients-with-and-without-obstructive-sleep-apnoea-a-prospective-cohort-study
#3
Tatiana Ambrosii, Serghei Şandru, Adrian Belîi
BACKGROUND AND AIMS: Patients with obstructive sleep apnoea (OSA) have a high risk of postoperative complications. The purpose of the study was to record the spectrum and frequency of postoperative complications in patients with OSA versus (vs.) without OSA depending on the type of surgery and type of anaesthesia in a large cohort of patients. METHODS: We conducted a prospective, descriptive study (n = 400). Ethics Committee approval was obtained and written informed consent was signed...
October 2016: Rom J Anaesth Intensive Care
https://www.readbyqxmd.com/read/28902823/-comparing-the-risks-for-the-development-of-perioperative-complications-in-carotid-endarterectomy-and-carotid-angioplasty
#4
R A Vinogradov, K A Lashevich, V S Pykhteev
The article is a literature review presenting a comparative analysis of 30-day risks of mortality and complications after carotid endarterectomy and carotid angioplasty with stenting. The risks studied were as follows: myocardial infarction, stroke, transitory ischaemic attacks, bradycardia, hypotension, postoperative haematomas, and damages to the craniocerebral nerves. The authors analysed a series of recently published foreign studies and meta-analyses dedicated to the problem concerned. The obtained findings revealed that carotid endarterectomy turned out to be associated with a higher perioperative risk for the development of myocardial infarction, postoperative haematomas and damages to the craniocerebral nerves, whereas carotid angioplasty with stenting appeared to be associated with an increased risk for the development of stroke, bradycardia and hypotension within the first 30 postoperative days...
2017: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
https://www.readbyqxmd.com/read/28901120/perioperative-stroke-incidence-etiologic-factors-and-prevention
#5
Sher-Lu Pai, R Doris Wang, Stephen Aniskevich
INTRODUCTION: Stroke is a devastating complication that is difficult to diagnose in the perioperative setting because of the effects of anesthetic and analgesic agents. Lingering anesthesia effects hinder clinicians in identifying stroke symptoms, frequently resulting in a delay in diagnosis and treatment and in unfavorable outcomes. EVIDENCE ACQUISITION: The authors performed a systematic search in PubMed and the Cochrane Central Register. The search aimed to identify studies published between January 1990 and December 2015 related to the common etiologic factors, incidence, risk factors, risk modifiers, and early management of perioperative stroke...
September 13, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28895447/early-experience-with-endovascular-aneurysm-sealing-in-combination-with-parallel-grafts-for-the-treatment-of-complex-abdominal-aneurysms-the-ascend-registry
#6
Matt Thompson, Marwan Youssef, Rudolf Jacob, Sebastian Zerwes, Michel Reijnen, Piotr Szopinski, Patrick Berg, Grzegorz Oszkinis, Andrew Holden
PURPOSE: To report the results of the ASCEND Registry of cases involving endovascular aneurysm sealing (EVAS) in combination with chimney grafts (chEVAS) for the treatment of para- and juxtarenal aortic aneurysms (AAA). METHODS: A retrospective, multicenter registry established in 8 vascular centers between 2013 and 2016 recorded the treatment results and follow-up of chEVAS procedures for nonruptured AAAs; data were analyzed using standardized outcome measures...
September 1, 2017: Journal of Endovascular Therapy
https://www.readbyqxmd.com/read/28894414/hemodynamic-perturbations-in-deep-brain-stimulation-surgery-first-detailed-description
#7
Tumul Chowdhury, Marshall Wilkinson, Ronald B Cappellani
Background: Hemodynamic perturbations can be anticipated in deep brain stimulation (DBS) surgery and may be attributed to multiple factors. Acute changes in hemodynamics may produce rare but severe complications such as intracranial bleeding, transient ischemic stroke and myocardium infarction. Therefore, this retrospective study attempts to determine the incidence of hemodynamic perturbances (rate) and related risk factors in patients undergoing DBS surgery. Materials and Methods: After institutional approval, all patients undergoing DBS surgery for the past 10 years were recruited for this study...
2017: Frontiers in Neuroscience
https://www.readbyqxmd.com/read/28890062/national-utilization-and-outcomes-of-redo-lower-extremity-bypass-vs-endovascular-intervention-after-previous-failed-bypass-redo-lower-extremity-bypass-superior-to-endovascular-intervention
#8
J Hunter Mehaffey, Alexander Shannon, Robert B Hawkins, Anna Fashandi, Margret C Tracci, Irving L Kron, Gilbert R Upchurch, William P Robinson
BACKGROUND: Redo Lower extremity bypass (LEB) and infrainguinal endovascular intervention (IEI) are options to treat critical limb ischemia after a failed prior lower extremity bypass but the utilization and outcomes of each are poorly described. The purpose of this study was to compare 30-day Major Adverse Limb Events (MALE) and Major Adverse Cardiovascular Events (MACE) after LEB and IEI in patients with a failed prior ipsilateral LEB and determine risk factors for each composite outcome...
September 7, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28890012/ethnicity-race-and-post-operative-stroke-risk-among-53-593-patients-with-asymptomatic-carotid-stenosis-undergoing-revascularization
#9
Roxanna M Garcia, Seungwon Yoon, Tene Cage, Matthew B Potts, Michael T Lawton
BACKGROUND: The incidence of post-operative stroke following carotid endarterectomy is an uncommon event and differences by racial and ethnic subgroups are not fully described in the literature. OBJECTIVE: To investigate the impact of race and ethnicity on post-operative stroke risk among patients with asymptomatic carotid stenosis undergoing carotid endarterectomy. METHODS: The ACS-NSQIP database between 2008 and 2015 was used to identify patients undergoing carotid endarterectomy with no stroke history...
September 7, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28884980/perioperative-stroke-in-hospital-mortality-and-postoperative-morbidity-following-transcatheter-aortic-valve-implantation-a-nationwide-study
#10
Parthasarathy D Thirumala, Felix D Nguyen, Amol Mehta, John Schindler, Suresh Mulukutla, Vinodh Jeevanantham, Lawrence Wechsler, Thomas Gleason
BACKGROUND AND PURPOSE: Perioperative stroke is a significant complication of transcatheter aortic valve implantation (TAVI). This study aimed to quantify perioperative stroke as an independent risk factor for in-hospital mortality and postoperative morbidity in patients receiving TAVI. METHODS: A retrospective cohort study was conducted using the National Inpatient Sample. Patients undergoing TAVI during 2012 and 2013 were identified using diagnostic codes of International Classification of Diseases, ninth revision...
September 4, 2017: Journal of Clinical Neurology
https://www.readbyqxmd.com/read/28882333/trends-and-outcomes-of-aortic-valve-replacement-in-patients-with-end-stage-renal-disease-on-hemodialysis
#11
Sami Aljohani, Fahad Alqahtani, Ahmad Almustafa, Khaled Boobes, Sujal Modi, Mohamad Alkhouli
Hemodialysis (HD) patients with aortic stenosis are less likely to undergo aortic valve replacement (AVR) due to their excess perioperative mortality. We aimed to evaluate contemporary utilization and outcomes of combined and isolated AVR in HD patients. The Nationwide Inpatient Sample was used to identify 142,046 patients who underwent AVR in 2005 to 2014, of whom 2,264 (1.6%) were on HD. Crude and adjusted in-hospital outcomes and costs were assessed in unmatched and propensity-matched cohorts of HD and non-HD patients, respectively...
August 4, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28872355/the-role-of-stump-pressure-and-cerebral-oximetry-in-predicting-ischaemic-brain-damage-during-carotid-endarterectomy
#12
Kuzhuget Rossi, Starodubtsev Vladimir, Ignatenko Pavel, Starodubtseva Alexandra, Voroshilina Olga, Ruzankin Pavel, Karpenko Andrey
Objective is to compare the predictive value of stump pressure (SP) and cerebral oximetry (rSO2) levels in the evaluation of ischaemic injury of the cerebrum during clamping of the carotid artery (CCA) without temporary shunt (TS). Methods We included 84 patients with an asymptomatic stenosis (>70%) of the internal carotid artery (ICA) who underwent carotid endarterectomy (CEA) under GA. Cerebral ischaemic tolerance (CIT) was determined on the basis of SP, rSO2 and ∆rSO2 (↓rSO2 from baseline) during CCA...
September 5, 2017: Brain Injury: [BI]
https://www.readbyqxmd.com/read/28868314/cause-of-death-following-surgery-for-acute-type-a-dissection-evidence-from-the-canadian-thoracic-aortic-collaborative
#13
R Scott McClure, Maral Ouzounian, Munir Boodhwani, Ismail El-Hamamsy, Michael W A Chu, Zlatko Pozeg, Francois Dagenais, Khokan C Sikdar, Jehangir J Appoo
BACKGROUND: Surgery confers the best chance of survival following acute Type A dissection (ATAD), yet perioperative mortality remains high. Although perioperative risk factors for mortality have been described, information on the actual causes of death is sparse. In this study, we aimed to characterize the inciting events causing death during surgical repair of ATAD. METHODS: Nine centers participated in the study. We included all patients who died following surgical repair for ATAD between January 2007 and December 2013...
April 2017: Aorta (Stamford, Conn.)
https://www.readbyqxmd.com/read/28852575/a-protocol-for-diagnosis-and-management-of-aortic-atherosclerosis-in-cardiac-surgery-patients
#14
REVIEW
Wouter W Jansen Klomp, George J Brandon Bravo Bruinsma, Arnoud W J Van 't Hof, Jan G Grandjean, Arno P Nierich
In patients undergoing cardiac surgery, use of perioperative screening for aortic atherosclerosis with modified TEE (A-View method) was associated with lower postoperative mortality, but not stroke, as compared to patients operated on without such screening. At the time of clinical implementation and validation, we did not yet standardize the indications for modified TEE and the changes in patient management in the presence of aortic atherosclerosis. Therefore, we designed a protocol, which combined the diagnosis of atherosclerosis of thoracic aorta and the subsequent considerations with respect to the intraoperative management and provides a systematic approach to reduce the risk of cerebral complications...
2017: International Journal of Vascular Medicine
https://www.readbyqxmd.com/read/28826895/effect-of-preoperative-beta-blocker-use-on-outcomes-following-cardiac-surgery
#15
Jason B O'Neal, Frederic T Billings, Xulei Liu, Matthew S Shotwell, Yafen Liang, Ashish S Shah, Jesse M Ehrenfeld, Jonathan P Wanderer, Andrew D Shaw
Recent studies suggest that the use of preoperative β blockers in cardiac surgery may not provide improved mortality rates and may even contribute to negative clinical outcomes. We therefore assessed the role of β blockers on several outcomes after cardiac surgery (delirium, acute kidney injury [AKI], stroke, atrial fibrillation (AF), mortality, and hospital length of stay) in 4,076 patients who underwent elective coronary artery bypass grafting, coronary artery bypass grafting + valve, or valve cardiac surgery from November 1, 2009, to September 30, 2015, at Vanderbilt Medical Center...
July 24, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28821337/intraoperative-cerebral-perfusion-disturbances-during-transcatheter-aortic-valve-replacement
#16
Jonathon P Fanning, Darren L Walters, Allan J Wesley, Chris Anstey, Samuel Huth, Judith Bellapart, Caroline Collard, Ivan L Rapchuk, Sarvesh Natani, Michael Savage, John F Fraser
BACKGROUND: Transcatheter aortic valve replacement entails profound and unavoidable hemodynamic perturbations that may contribute to the neurological injury associated with the procedure. METHODS: Thirty-one patients were monitored with cerebral oximetry as a surrogate marker of perfusion while undergoing transcatheter aortic valve replacement via a transfemoral approach under general anesthesia to detect intraoperative hypoperfusion insult. Serial neurologic, cognitive, and cerebral magnetic resonance imaging assessments were administered to objectively quantify perioperative neurologic injury and ascertain any association with significant cerebral oximetry disturbances...
August 16, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28818256/will-mesh-covered-stents-help-reduce-stroke-associated-with-carotid-stent-angioplasty
#17
REVIEW
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
#18
REVIEW
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/28803335/intraoperative-ventilation-during-thoracoscopic-repair-of-neonatal-congenital-diaphragmatic-hernia
#19
Tadaharu Okazaki, Manabu Okawada, Junya Ishii, Hiroyuki Koga, Go Miyano, Takashi Doi, Yuki Ogasawara, Geoffrey J Lane, Atsuyuki Yamataka
PURPOSE: To evaluate the optimal ventilation mode during thoracoscopic repair (TR) of neonatal congenital diaphragmatic hernia (CDH), we compared high-frequency oscillatory ventilation (HFOV) with conventional mechanical ventilation (CMV). METHODS: Twenty-three neonatal CDH cases who underwent TR without intraoperative inhalation of nitric oxide at our institution between 2007 and 2016 were reviewed. Patients were initially ventilated with HFOV, which was converted to CMV if the HFOV settings were decreased to FiO2 <0...
August 12, 2017: Pediatric Surgery International
https://www.readbyqxmd.com/read/28793822/dose-response-head-to-head-comparison-of-inodilators-dobutamine-milrinone-and-levosimendan-in-chronic-experimental-pulmonary-hypertension
#20
Marta Tavares-Silva, Mohamed Alaa, Sara Leite, José Oliveira-Pinto, Lucas Lopes, Adelino F Leite-Moreira, André P Lourenço
The choice of inodilator drug in the acute management of patients with pulmonary hypertension (PH) having right ventricular (RV) failure remains unsettled and challenging. Comprehensive experimental evaluations may provide further insight and fundamental translational research clues to support inodilator selection and clinical trial design. Our aim was to compare acute dose-response hemodynamic effects of inodilators dobutamine (DOB), milrinone (MIL), and levosimendan (LEV) in chronic experimental PH. Seven-week-old male Wistar rats were randomly injected with 60 mg·kg(-1) monocrotaline (MCT) or vehicle (Ctrl, n = 7) and underwent systemic and pulmonary artery (PA) pressure and RV pressure-volume (PV) hemodynamic evaluation under halogenate anesthesia 24 to 30 days after injection...
September 2017: Journal of Cardiovascular Pharmacology and Therapeutics
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