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european carotid endarterectomy trial

Arslane Alilet, Pascal Petit, Benedicte Devaux, Corinne Joly, Emmanuel Samain, Sebastien Pili-Floury, Guillaume Besch
INTRODUCTION: The value of ultrasound guidance for intermediate cervical blocks in patients undergoing carotid artery endarterectomy is poorly described. This study aimed at comparing the efficacy of ultrasound-guided intermediate cervical block to superficial cervical block for carotid artery endarterectomies. PATIENTS AND METHODS: We conducted a single-centre randomized-controlled study in a French University Hospital, from April 2011 to March 2012. The anaesthesia technique was randomly allocated to patients scheduled for carotid artery endarterectomy under regional anaesthesia (ropivacaine 4...
July 29, 2016: Anaesthesia, Critical Care & Pain Medicine
David Netuka, Tomáš Belšán, Karolina Broulíková, Václav Mandys, František Charvát, Josef Malík, Lucie Coufalová, Ondřej Bradáč, Svatopluk Ostrý, Vladimír Beneš
BACKGROUND: Carotid endarterectomy (CEA) is accepted as a primary modality to treat carotid stenosis. The accuracy of measuring carotid stenosis is important for indication of the CEA procedure. Different diagnostic tools have been developed and used in the past 2 decades for the diagnosis of carotid stenosis. Only a few studies, however, have focused on the comparison of different diagnostic tools to histological findings of carotid plaque. METHOD: Patients with internal carotid artery (ICA) stenosis were investigated primarily by computed tomography angiography (CTA)...
August 2016: Acta Neurochirurgica
Roland L Featherstone, Joanna Dobson, Jörg Ederle, David Doig, Leo H Bonati, Stephen Morris, Nishma V Patel, Martin M Brown
BACKGROUND: Carotid artery stenting (CAS) is an alternative to carotid endarterectomy (CEA) for the treatment of carotid stenosis, but safety and long-term efficacy were uncertain. OBJECTIVE: To compare the risks, benefits and cost-effectiveness of CAS versus CEA for symptomatic carotid stenosis. DESIGN: International, multicentre, randomised controlled, open, prospective clinical trial. SETTING: Hospitals at 50 centres worldwide...
March 2016: Health Technology Assessment: HTA
Jahan Mohebali, Virendra I Patel, Javier M Romero, Kathleen M Hannon, Michael R Jaff, Richard P Cambria, Glenn M LaMuraglia
OBJECTIVE: Duplex ultrasonography (DUS) has been the mainstay for diagnosing carotid artery stenosis and is often the sole diagnostic modality used prior to intervention. Highly calcified plaque, however, results in an acoustic shadow (AcS) that obscures the vessel lumen and inhibits the sonographer's ability to obtain Doppler velocity measurements. It is unknown whether DUS can accurately determine the degree of carotid stenosis in these settings. METHODS: From July 2012 to December 2013, all patients with AcS on DUS measuring ≥5 mm in the longitudinal axis were cross-referenced with multidetector computed tomographic angiography (MD-CTA) images of the neck to define the study population...
November 2015: Journal of Vascular Surgery
A V Alexandrov, C F Bladin, J Murphy, P Hamilton, R Maggisano
The North American (NASCET) and European (ECST) trials of carotid endarterectomy used discrepant methods to measure carotid stenosis on angiography. The aim of this study was to evaluate clinical applicability of currently available angiographic methods to measure carotid stenosis. Consecutive patients undergoing carotid angiography were evaluated. To estimate the normal internal carotid artery (ICA) bulb diameter on angiography, the common carotid artery (CCA) was used (ICA bulb diameter = 1.2 X CCA diameter measured 3-5 cm below the bifurcation) and the ICA diameter reduction was calculated: 1 - (d/1...
1994: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Coney Bae, Mauricio Szuchmacher, John B Chang
The treatment of carotid stenosis entails three methodologies, namely, medical management, carotid angioplasty and stenting (CAS), as well as carotid endarterectomy (CEA). The North American Symptomatic Carotid Endarterectomy Trial (NASCET) and European Carotid Surgery Trial (ECST) have shown that symptomatic carotid stenosis greater than 70% is best treated with CEA. In asymptomatic patients with carotid stenosis greater than 60%, CEA was more beneficial than treatment with aspirin alone according to the Asymptomatic Carotid Atherosclerosis (ACAS) and Asymptomatic Carotid Stenosis Trial (ACST) trials...
September 2015: International Journal of Angiology: Official Publication of the International College of Angiology, Inc
Andreas Koköfer, Jürgen Nawratil, Thomas K Felder, Ottokar Stundner, Nina Mader, Peter Gerner
BACKGROUND: Carotid endarterectomy is widely performed under regional anaesthesia. Ultrasound guidance is increasingly used in many regional anaesthetic procedures to improve safety and efficacy, and because it can reduce the amount of local anaesthetic required. Despite this, an ideal approach and dosing regimen for cervical plexus block remain elusive. OBJECTIVE: The aim of this study was to compare two different concentrations of ropivacaine in terms of analgesic adequacy, haemodynamic effects and plasma concentration using an ultrasound-guided triple approach for intermediate cervical plexus blockade...
November 2015: European Journal of Anaesthesiology
Travis Benzing, Cameron Wilhoit, Sharee Wright, P Aaron McCann, Susan Lessner, Thomas E Brothers
OBJECTIVE: The eversion technique for carotid endarterectomy (eCEA) offers an alternative to longitudinal arteriotomy and patch closure (pCEA) for open carotid revascularization. In some reports, eCEA has been associated with a higher rate of >50% restenosis of the internal carotid when it is defined as peak systolic velocity (PSV) >125 cm/s by duplex imaging. Because the conformation of the carotid bifurcation may differ after eCEA compared with native carotid arteries, it was hypothesized that standard duplex criteria might not accurately reflect the presence of restenosis after eCEA...
June 2015: Journal of Vascular Surgery
Leo H Bonati, Joanna Dobson, Roland L Featherstone, Jörg Ederle, H Bart van der Worp, Gert J de Borst, Willem P Th M Mali, Jonathan D Beard, Trevor Cleveland, Stefan T Engelter, Philippe A Lyrer, Gary A Ford, Paul J Dorman, Martin M Brown
BACKGROUND: Stenting is an alternative to endarterectomy for treatment of carotid artery stenosis, but long-term efficacy is uncertain. We report long-term data from the randomised International Carotid Stenting Study comparison of these treatments. METHODS: Patients with symptomatic carotid stenosis were randomly assigned 1:1 to open treatment with stenting or endarterectomy at 50 centres worldwide. Randomisation was computer generated centrally and allocated by telephone call or fax...
February 7, 2015: Lancet
Ashley K Vavra, Mark K Eskandari
Stroke is a major cause of morbidity and mortality and up to 15-20% of ischemic strokes can be attributed to atherosclerotic internal carotid artery disease. The treatment of carotid artery disease has been the subject of a wealth of literature in the past twenty years since the publication of the landmark randomized controlled trials, the North American Symptomatic Carotid Endarterectomy Trial and the European Carotid Surgery Trial, in the early 1990s. Although these landmark trials have helped establish the current guidelines for treatment of patients with symptomatic carotid artery disease, there have since been major advancements in the medical treatment of cardiovascular disease and there still remains a great deal of controversy regarding the timing and technical approach to carotid revascularization...
February 2015: Surgeon: Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
Mark N Rubin, Kevin M Barrett, Thomas G Brott, James F Meschia
Stroke remains an exceedingly incident and prevalent public health burden across the globe, with an estimated 16 million new strokes per annum and prevalence over 60 million, and extracranial internal carotid artery atherosclerotic disease is an important risk factor for stroke. Randomized trials of surgical treatment were conducted (North American Symptomatic Carotid Endarterectomy Trial, European Carotid Surgery Trial) and demonstrated efficacy of carotid endarterectomy for secondary prevention of stroke in patients with cerebrovascular events (e...
January 2014: JRSM Cardiovascular Disease
Nishath Altaf, Neghal Kandiyil, Akram Hosseini, Rajnikant Mehta, Shane MacSweeney, Dorothee Auer
BACKGROUND: The European Carotid Surgery Trial (ECST) risk model is a validated tool for predicting cerebrovascular risk in patients with symptomatic carotid disease. Carotid plaque hemorrhage as detected by MRI (MRIPH) and microembolic signals (MES) detected by transcranial Doppler (TCD) are 2 emerging modalities in assessing instability of the carotid plaque. The aim of this study was to assess the strength of association of MES and MRIPH with cerebrovascular recurrence in patients with symptomatic carotid artery disease in comparison with the ECST risk prediction model...
June 2014: Journal of the American Heart Association
B Dharmarajah, A Thapar, J Salem, T R A Lane, E L S Leen, A H Davies
BACKGROUND: Benefit from carotid endarterectomy (CEA) in symptomatic moderate (50-69 per cent) carotid stenosis remains marginal. The Fourth National Clinical Guideline for Stroke recommends use of the risk score from the European Carotid Surgery Trial (ECST) to aid decision-making in symptomatic carotid disease. It is not known whether clinicians are, in fact, influenced by it. METHODS: Using the ECST risk prediction model, three scenarios of patients with a low (less than 10 per cent), moderate (20-25 per cent) and high (40-45 per cent) 5-year risk of stroke were devised and validated...
April 2014: British Journal of Surgery
Stavros K Kakkos, Andrew N Nicolaides, Ioanna Charalambous, Dafydd Thomas, Argyrios Giannopoulos, A Ross Naylor, George Geroulakos, Anne L Abbott
OBJECTIVE: To determine baseline clinical and ultrasonographic plaque factors predictive of progression or regression of asymptomatic carotid stenosis and the predictive value of changes in stenosis severity on risk of first ipsilateral cerebral or retinal ischemic events (including stroke). METHODS: A total of 1121 patients with asymptomatic carotid stenosis of 50% to 99% in relation to the bulb diameter (European Carotid Surgery Trial [ECST] method) underwent six monthly clinical assessments and carotid duplexes for up to 8 years (mean follow-up, 4 years)...
April 2014: Journal of Vascular Surgery
Hubertus Fritz Georg Müller, Aurélien Viaccoz, Igor Kuzmanovic, Christophe Bonvin, Karim Burkhardt, Marie-Luce Bochaton-Piallat, Roman Sztajzel
The aim of our study was to evaluate whether neo-vascularization of the carotid plaque can be accurately assessed by visual analysis of contrast-enhanced ultrasound images and whether these findings correlate with intensity-over-time curve analysis (ITC) and histopathology. Patients with ≥50% symptomatic or ≥60% asymptomatic stenosis according to European Carotid Surgery Trial criteria were included. Four investigators evaluated contrast enhancement visually (three grades), with positive agreement when three or more investigators were unanimous...
January 2014: Ultrasound in Medicine & Biology
Jörg Ederle, Indran Davagnanam, H Bart van der Worp, Graham S Venables, Philippe A Lyrer, Roland L Featherstone, Martin M Brown, H Rolf Jäger
BACKGROUND: Findings from randomised trials have shown a higher early risk of stroke after carotid artery stenting than after carotid endarterectomy. We assessed whether white-matter lesions affect the perioperative risk of stroke in patients treated with carotid artery stenting versus carotid endarterectomy. METHODS: Patients with symptomatic carotid artery stenosis included in the International Carotid Stenting Study (ICSS) were randomly allocated to receive carotid artery stenting or carotid endarterectomy...
September 2013: Lancet Neurology
Hakan Demirtaş, Can Özkaynak, Mehmet Sedat Durmaz
OBJECTIVE: We aim to determine the relationship between leukoaraiosis and carotid artery stenosis. METHODS: Carotid-cerebral multislice computed tomography angiographies of 194 patients (mean age, 63.5 years) were retrospectively evaluated. Presence and severity of leukoaraiosis and carotid artery stenosis were compared to each other. Carotid artery stenosis was defined by the criteria of the North American Symptomatic Carotid Endarterectomy Trial; leukoaraiosis was evaluated based on the European Task Force on Age-Related White Matter Changes criteria...
May 2013: Journal of Computer Assisted Tomography
Juan Guillermo Barrera, Kristin E Rojas, Carlos Balestrini, Camilo Espinel, Antonio Figueredo, Jose Federico Saaibi, Santiago Machuca, Adriana Murcia
BACKGROUND: The optimal management of patients with combined carotid and coronary artery disease requiring cardiac surgery is still unknown. Staged carotid endarterectomy and carotid artery stenting (CAS), each followed by coronary artery bypass graft (CABG), are options frequently employed. However, for patients with severe carotid artery disease in urgent need of open cardiac revascularization, staged operations may not be the most appropriate alternative. The aim of this study was to describe our experience using a synchronous CAS-CABG method with minimal interprocedural time...
February 2013: Journal of Vascular Surgery
Emmanuel Touzé
Carotid stenosis is frequent in the general population, especially in elderly people and is associated with a high risk of stroke and vascular events. In patients with asymptomatic carotid stenosis the overall annual risk of ipsilateral stroke has dramatically decreased over the past decades, due to improvement in medical management. Asymptomatic carotid stenosis is probably a better indicator of generalized atherosclerotic disease than of stroke risk, with an average risk of nonstroke death (mainly due to ischemic heart disease) generally higher than the risk of ipsilateral stroke...
November 2012: Current Vascular Pharmacology
J D Kakisis, E D Avgerinos, C N Antonopoulos, T G Giannakopoulos, K Moulakakis, C D Liapis
BACKGROUND AND PURPOSE: Many medical societies now recommend carotid stenting as an alternative to endarterectomy which raises the question of whether the ESVS guidelines are still valid. This review addresses the validity of the ESVS guidelines that refer to carotid stenting based on the evidence available today. METHODS: We conducted a review and meta-analysis based on the original ESVS guidelines paper and articles published over the past 2 years. RESULTS: For symptomatic patients, surgery remains the best option, since stenting is associated with a 61% relative risk increase of periprocedural stroke or death compared to endarterectomy...
September 2012: European Journal of Vascular and Endovascular Surgery
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