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By Jianing Yue Attending Vascular Surgeon, Zhongshan Hospital Fudan University, Shanghai, China
Wesley S Moore, Jeffrey J Popma, Gary S Roubin, Jenifer H Voeks, Donald E Cutlip, Michael Jones, George Howard, Thomas G Brott
OBJECTIVE: The Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) demonstrated a higher periprocedural stroke and death (S+D) rate among patients randomized to carotid artery stenting (CAS) than to carotid endarterectomy (CEA). Herein, we seek factors that affect the CAS-CEA treatment differences and potentially to identify a subgroup of patients for whom CAS and CEA have equivalent periprocedural S+D risk. METHODS: Patient and arterial characteristics were assessed as effect modifiers of the CAS-CEA treatment difference in 2502 patients by the addition of factor-by-treatment interaction terms to a logistic regression model...
April 2016: Journal of Vascular Surgery
D Doig, E L Turner, J Dobson, R L Featherstone, R T H Lo, P A Gaines, S Macdonald, L H Bonati, A Clifton, M M Brown
OBJECTIVES: Stroke, myocardial infarction (MI), and death are complications of carotid artery stenting (CAS). The effect of baseline patient demographic factors, processes of care, and technical factors during CAS on the risk of stroke, MI, or death within 30 days of CAS in the International Carotid Stenting Study (ICSS) were investigated. METHODS: In ICSS, suitable patients with recently symptomatic carotid stenosis > 50% were randomly allocated to CAS or endarterectomy...
March 2016: European Journal of Vascular and Endovascular Surgery
N P Lynch, E G Kavanagh
No abstract text is available yet for this article.
January 2016: European Journal of Vascular and Endovascular Surgery
Tammam Obeid, Dean J Arnaoutakis, Isibor Arhuidese, Umair Qazi, Christopher J Abularrage, James Black, Bruce Perler, Mahmoud Malas
BACKGROUND: Whereas carotid endarterectomy (CEA) remains the "gold standard" treatment, given its low complication rate, carotid artery stenting (CAS) has emerged as a valid alternative in patients with prohibitive surgical risks. However, the application of CAS has been scrutinized, given its increased perioperative risk in comparison to CEA. Operators follow general guidelines in intraoperative techniques in CAS. However, few of those are evidence based. We believe that a specific outcome-driven examination of the effect of pre- and poststent deployment ballooning is warranted...
September 2015: Journal of Vascular Surgery
A F AbuRahma
No abstract text is available yet for this article.
June 2015: European Journal of Vascular and Endovascular Surgery
A R Naylor
No abstract text is available yet for this article.
June 2015: European Journal of Vascular and Endovascular Surgery
Gareth J Harrison, Thien V How, Robert J Poole, John A Brennan, Jagjeeth B Naik, S Rao Vallabhaneni, Robert K Fisher
BACKGROUND: Meta-analysis supports patch angioplasty after carotid endarterectomy (CEA); however, studies indicate considerable variation in practice. The hemodynamic effect of a patch is unclear and this study attempted to elucidate this and guide patch width selection. METHODS: Four groups were selected: healthy volunteers and patients undergoing CEA with primary closure, trimmed patch (5 mm), or 8-mm patch angioplasty. Computer-generated three-dimensional models of carotid bifurcations were produced from transverse ultrasound images recorded at 1-mm intervals...
August 2014: Journal of Vascular Surgery
Jeffrey Jim, Ellen D Dillavou, Gilbert R Upchurch, Nicholas H Osborne, Christopher T Kenwood, Flora S Siami, Rodney A White, Joseph J Ricotta
OBJECTIVE: Although the optimal treatment of carotid stenosis remains unclear, available data suggest that women have higher risk of adverse events after carotid revascularization. We used data from the Society for Vascular Surgery Vascular Registry to determine the effect of gender on outcomes after carotid endarterectomy (CEA) and carotid artery stenting (CAS). METHODS: There were 9865 patients (40.6% women) who underwent CEA (n = 6492) and CAS (n = 3373). The primary end point was a composite of death, stroke, and myocardial infarction at 30 days...
March 2014: Journal of Vascular Surgery
Iacopo Barbetta, Michele Carmo, Giulio Mercandalli, Patrizia Lattuada, Daniela Mazzaccaro, Alberto M Settembrini, Raffaello Dallatana, Piergiorgio G Settembrini
OBJECTIVE: The aim of the study was to assess the outcomes of carotid endarterectomy (CEA) performed in an urgent setting on acutely symptomatic patients selected through a very simple protocol. METHODS: From January 2002 to January 2012, 193 symptomatic patients underwent CEA. Of these, 90 presented with acute symptoms, and after a congruous carotid stenosis was identified, underwent urgent operations (group 1): 27 patients had transient ischemic attack (group 1A), 52 patients had mild to moderate stroke (group 1B), and 11 patients had stroke in evolution (group 1C)...
February 2014: Journal of Vascular Surgery
Ichiro Nakagawa, Takeshi Wada, Hun Soo Park, Fumihiko Nishimura, Syuichi Yamada, Hiroyuki Nakagawa, Kimihiko Kichikawa, Hiroyuki Nakase
OBJECTIVE: Optimal platelet inhibition is an important therapeutic adjunct in patients with carotid artery stenosis undergoing carotid artery stenting (CAS). Clopidogrel resistance is associated with increased periprocedural thromboembolic complications from neurovascular stent placement procedures. The addition of cilostazol to dual antiplatelet therapy (DAT) has been reported to reduce platelet reactivity and to improve clinical outcomes after percutaneous coronary intervention. This study was undertaken to evaluate the impact of adjunctive cilostazol in patients with CAS...
March 2014: Journal of Vascular Surgery
Alison Halliday, Richard Bulbulia, William Gray, Ally Naughten, Anne den Hartog, Antonella Delmestri, Carol Wallis, Stephanie le Conte, Sumaira Macdonald
OBJECTIVES: ACST-2 is currently the largest trial ever conducted to compare carotid artery stenting (CAS) with carotid endarterectomy (CEA) in patients with severe asymptomatic carotid stenosis requiring revascularization. METHODS: Patients are entered into ACST-2 when revascularization is felt to be clearly indicated, when CEA and CAS are both possible, but where there is substantial uncertainty as to which is most appropriate. Trial surgeons and interventionalists are expected to use their usual techniques and CE-approved devices...
November 2013: European Journal of Vascular and Endovascular Surgery
Tze-Woei Tan, Mohammad H Eslami, Jeffrey A Kalish, Robert T Eberhardt, Gheorghe Doros, Philip P Goodney, Jack L Cronenwett, Alik Farber
OBJECTIVE: The objective of this study was to evaluate the outcomes of patients after carotid endarterectomy (CEA) who developed postoperative hypertension or hypotension requiring the administration of intravenous vasoactive medication (IVMED). METHODS: We examined consecutive, primary elective CEA performed by 128 surgeons within the Vascular Study Group of New England (VSGNE) database (2003-2010) and compared outcomes of patients who required postoperative IVMED to treat hyper- or hypotension with those who did not...
January 2014: Journal of Vascular Surgery
Margriet Fokkema, Gert Jan de Borst, Brian W Nolan, Ruby C Lo, Robert A Cambria, Richard J Powell, Frans L Moll, Marc L Schermerhorn
BACKGROUND: Outcomes for patients undergoing intervention for restenosis after prior ipsilateral carotid endarterectomy (CEA) in the era of carotid angioplasty and stenting (CAS) are unclear. We compared perioperative results and durability of CAS vs CEA in patients with symptomatic or asymptomatic restenosis after prior CEA and investigated the risk of reintervention compared with primary procedures. METHODS: Patients undergoing CAS and CEA for restenosis between January 2003 and March 2012 were identified within the Vascular Study Group of New England (VSGNE) database...
January 2014: Journal of Vascular Surgery
Enzo Ballotta, Annalisa Angelini, Franco Mazzalai, Giacomo Piatto, Antonio Toniato, Claudio Baracchini
OBJECTIVE: Although the management of carotid disease is well established for symptomatic lesions ≥ 70%, the surgical treatment for a symptomatic ≤ 50% stenosis is not supported by data from randomized trials. Factors other than lumen narrowing, such as plaque instability, seem to be involved in cerebral and retinal ischemic events. This study analyzes the early-term and long-term outcomes of carotid endarterectomy (CEA) performed in patients with low-grade (≤ 50% on North American Symptomatic Carotid Endarterectomy Trial criteria) symptomatic carotid stenosis...
January 2014: Journal of Vascular Surgery
B L Reichmann, W E Hellings, H B van der Worp, A Algra, M M Brown, W P Mali, F L Moll, G J de Borst
OBJECTIVE: To study the changes in peak systolic velocities of the ipsilateral external carotid artery (ECA) following carotid revascularization. METHODS: All patients randomized to carotid artery stenting (CAS) or carotid endarterectomy (CEA) in the International Carotid Stenting Study (ICSS; ISRCTN25337470) in our center were included. Peak systolic velocities (PSV) were assessed with duplex ultrasound (DUS) at baseline, at 30 days, and at 12 and 24 months after treatment...
October 2013: European Journal of Vascular and Endovascular Surgery
R J Doonan, A J Dawson, E Kyriacou, A N Nicolaides, M M Corriveau, O K Steinmetz, K S Mackenzie, D I Obrand, M E Daskalopoulos, S S Daskalopoulou
OBJECTIVES: Our objective was to estimate the correlation of echodensity and textural features, using ultrasound and digital image analysis, between plaques in patients with bilateral carotid stenosis. DESIGN: Cross-sectional observational study. METHODS: Patients undergoing carotid endarterectomy were recruited from Vascular Surgery at the Royal Victoria and Jewish General hospitals in Montreal, Canada. Bilateral pre-operative carotid ultrasound and digital image analysis was performed to extract echodensity and textural features using a commercially available Plaque Texture Analysis software (LifeQMedical Ltd)...
September 2013: European Journal of Vascular and Endovascular Surgery
A R Naylor, R D Sayers, M J McCarthy, M J Bown, A Nasim, M J Dennis, N J M London, P R F Bell
The objective of this review was to identify causes of stroke/death after carotid endarterectomy (CEA) and to develop transferable strategies for preventing stroke/death after CEA, via an overview of a 21-year series of themed research and audit projects. Three preventive strategies were identified: (i) intra-operative transcranial Doppler (TCD) ultrasound and completion angioscopy which virtually abolished intra-operative stroke, primarily through the removal of residual luminal thrombus prior to restoration of flow; (ii) dual antiplatelet therapy with a single 75-mg dose of clopidogrel the night before surgery in addition to regular 75 mg aspirin which virtually abolished post-operative thromboembolic stroke and may also have contributed towards a decline in stroke/death following major cardiac events; and (iii) the provision of written guidance for managing post-CEA hypertension which was associated with virtual abolition of intracranial haemorrhage and stroke as a result of hyperperfusion syndrome...
August 2013: European Journal of Vascular and Endovascular Surgery
A H Y Lee, J Busby, M Brooks, W Hollingworth
OBJECTIVE: We report the uptake, length of stay and vascular readmission rates of carotid endarterectomy (CEA) and CAS among patients with symptomatic or asymptomatic carotid artery disease in the English National Health Service (NHS). METHODS: Retrospective cohort study based on routinely collected Hospital Episode Statistics (HES) inpatient data. We identified individual admissions for CEA (n = 15996) or CAS (n = 632) between 2006 and 2009. Summary data were used to describe procedure volumes between 2009 and 2012...
September 2013: European Journal of Vascular and Endovascular Surgery
Gowri Raman, Denish Moorthy, Nira Hadar, Issa J Dahabreh, Thomas F O'Donnell, David E Thaler, Edward Feldmann, Joseph Lau, Georgios D Kitsios
BACKGROUND: Adults with asymptomatic carotid artery stenosis are at increased risk for ipsilateral carotid territory ischemic stroke. PURPOSE: To examine comparative evidence on management strategies for asymptomatic carotid stenosis and the incidence of ipsilateral stroke with medical therapy alone. DATA SOURCES: MEDLINE, Cochrane Central Register of Controlled Trials, U.S. Food and Drug Administration documents, and review of references through 31 December 2012...
May 7, 2013: Annals of Internal Medicine
Jeffrey S Berger, Judith Hochman, Iryna Lobach, Mark A Adelman, Thomas S Riles, Caron B Rockman
BACKGROUND: The precise relationship between risk factor burden and prevalence of peripheral artery disease (PAD) in different vascular territories (PAD, carotid artery stenosis [CAS], and abdominal aortic aneurysms [AAAs]) is unclear. METHODS: We investigated the association of modifiable risk factors (hypertension, hypercholesterolemia, smoking, diabetes, and sedentary lifestyle) with any and type-specific peripheral vascular disease (PVD) among 3.3 million patients in the U...
September 2013: Journal of Vascular Surgery
2016-01-05 02:29:25
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