MedWorm: Carotid Endarterectomy

TGF‐β1 content in atherosclerotic plaques, TGF‐β1 serum concentrations and incident coronary events

European Journal of Clinical Investigation — Tue, 07 Feb 2012 02:06:30 +0100

Conclusion Our results indicate that high TGF‐β1 content in human atherosclerotic plaques and high serum levels of TGF‐β1 are not associated with reduced risk of coronary events. (Source: European Journal of Clinical Investigation)

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Long‐term results of cephalad arteries percutanoeus transluminal angioplasty with stent implantation (The CAPTAS registry)

Catheterization and Cardiovascular Interventions — Mon, 06 Feb 2012 05:00:00 +0100

Conclusions: CAS is safe and successful procedure with low early and long‐term adverse events. Special attention should be put on patients with bilateral and left ICA stenoses. If possible, longer stents should be applied. © 2011 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)

Prospective Neurocognitive Evaluation of Patients Undergoing Carotid Interventions

Journal of Vascular Surgery — Fri, 27 Jan 2012 11:25:16 +0100

During carotid interventions there is a risk of distal cerebral embolization. Here we prospectively investigate whether subclinical microembolization seen on postoperative MRI leads to cognitive deficits in a cohort of patients undergoing carotid endarterectomy (CEA) or carotid artery stenting (CAS). (Source: Journal of Vascular Surgery)

Increased Hospital Use of Carotid Artery Stenting (CAS) Over Carotid Endarterectomy (CEA) is Associated With Inferior Outcomes in Asymptomatic Patients

Journal of Vascular Surgery — Fri, 27 Jan 2012 11:25:16 +0100

CAS has been shown to have higher perioperative stroke and death (PSD) rates than CEA in symptomatic, but less convincingly in asymptomatic patients. Limited CAS experience has been blamed for worse outcomes. We sought to compare the PSD rate of CAS vs CEA in an administrative database to determine if CAS usage variation is linked to PSD in asymptomatic patients at the hospital level. (Source: Journal of Vascular Surgery)

The War Against Error: A 15Year Experience of Completion Angioscopy Following Carotid Endarterectomy

Journal of Vascular Surgery — Fri, 27 Jan 2012 11:25:15 +0100

A policy of intra-operative transcranial Doppler (TCD) and completion angioscopy was previously associated with virtual abolition of intra-operative stroke (apparent upon recovery from anaesthesia) following carotid endarterectomy (CEA). The aims of this study were to determine whether the prevalence of technical error has diminished with experience and whether our monitoring/quality control policy was still associated with low rates of intra-operative stroke 20 years after its introduction. (Source: Journal of Vascular Surgery)

Circulating Lipoprotein-associated Phospholipase A2 in High-grade Carotid Stenosis: A New Biomarker for Predicting Unstable Plaque

Journal of Vascular Surgery — Fri, 27 Jan 2012 11:25:15 +0100

To test plasma levels of lipoprotein-associated phospholipase A2 (Lp-PLA2) in patients with high-grade carotid stenosis according to plaque histology. This cross-sectional single-centre study included patients with ≥70% North American Symptomatic Carotid Endarterectomy Trial (NASCET) carotid stenosis, who were treated surgically. Serum Lp-PLA2 and high-sensitivity C-reactive protein (hs-CRP) were determined on the day of surgery. Histopathological analysis classified carotid plaque as stable or unstable, according to AHA classification. (Source: Journal of Vascular Surgery)

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Overuse of Health Care Services in the United States: An Understudied Problem [Special Article]

Archives of Internal Medicine — Mon, 23 Jan 2012 05:00:00 +0100

Conclusions The robust evidence about overuse in the United States is limited to a few services. Reducing inappropriate care in the US health care system likely requires a more substantial investment in overuse research. (Source: Archives of Internal Medicine)

Carotid stenting versus endarterectomy.

Annual Review of Medicine — Fri, 20 Jan 2012 09:00:58 +0100

Authors: Doig D, Brown MM Abstract Since the landmark NASCET and ECST trials demonstrated the superiority of carotid endarterectomy over medical therapy in the prevention of stroke for patients with symptomatic carotid artery stenosis, surgical intervention as a part of secondary prevention of stroke has become widespread. However, the newer technology of carotid artery angioplasty and stenting challenges this mode of intervention, promising the benefits of a procedure under local anesthesia and potentially avoiding the surgical complications of cranial nerve palsy and hematoma. Pooled evidence from randomized controlled trials of endarterectomy versus stenting shows a higher rate of stroke or death in the stenting groups-but this finding is mitigated to an extent by the lower inci...

Carotid artery stenting: the 2011 NICE guidelines

Heart — Fri, 20 Jan 2012 05:00:00 +0100

Death and disability as a result of cerebrovascular disease are a significant and growing problem in our ageing society. Surgery for significant carotid artery stenosis (>50%) in the form of carotid endarterectomy (CEA) reduces the subsequent risk of ipsilateral stroke. This benefit is particularly evident in recently symptomatic patients with minor stroke or transient ischaemic attack.1 2 Asymptomatic subjects with significant carotid artery stenosis (>70%) also benefit from surgery (stroke risk at 10 years 10.8% vs 16.9% with medical treatment (gain of 6.1%, 95% CI 2.7% to 9.4%)).3 Carotid artery stenting (CAS) is a less invasive alternative to CEA avoiding the morbidity associated with a surgical incision. However, CAS is a technically demanding procedure and some early resul...

Outcomes of combined oncologic resection and carotid endarterectomy in patients with head and neck cancer

Head and Neck — Fri, 20 Jan 2012 05:00:00 +0100

ConclusionCollaboration of head and neck surgeons with vascular surgeons provides the patient with an oncologic resection and revascularization with a low perioperative risk of stroke. This improves the patient's quality of life by lessening the possibility of a stroke postoperatively. © 2012 Wiley Periodicals, Inc. Head Neck, 2012 (Source: Head and Neck)

Estrogen Replacement Attenuates Exaggerated Neointimal Hyperplasia Following Carotid Endarterectomy in Rats

Vascular and Endovascular Surgery — Thu, 19 Jan 2012 05:00:00 +0100

Conclusion: Estradiol treatment in this ovariectomized hyperhomocysteinemia carotid endarterectomy and resultant attenuation of homocysteine and neointima may have relevance to the beneficial effects of estrogen on hyperplastic response. (Source: Vascular and Endovascular Surgery)

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Prediction of Cerebral Hyperperfusion after Carotid Endarterectomy with Transcranial Doppler.

PubMed: Eur J Vasc Endovasc ... — Wed, 18 Jan 2012 05:00:00 +0100

CONCLUSIONS: Besides the commonly used intra-operative TCD monitoring additional TCD measurement in the early postoperative phase is useful to more accurately predict CHS after CEA. PMID: 22264422 [PubMed - as supplied by publisher] (Source: PubMed: Eur J Vasc Endovasc ...)

Early outcomes of carotid artery stenting.

Perfusion — Mon, 16 Jan 2012 05:00:00 +0100

CONCLUSION: No major complication was observed during the early follow-up period in patients who underwent CAS in our clinic. Only 2 (2.5%) patients showed transient numbness and weakness and these did not lead to morbidity. In the management guide of extracranial carotid and vertebral artery diseases, CAS, in the light of recent studies, is recommended as an alternative to CEA in recommendations for revascularization. One of the important issues emphasized in this guide is the experience of centers. Very low complication rates after CAS suggested that, with suitable patient selection and an experienced team, similar results may be obtained. PMID: 22249963 [PubMed - as supplied by publisher] (Source: Perfusion)

Age-based Differences in the Prevalence and Clinical Outcome of Carotid Endarterectomy as a Primary Procedure: a 5-year Analysis of 118,947 Patients from the Nationwide Inpatient Sample Database

Journal of Surgical Research — Sat, 14 Jan 2012 22:30:17 +0100

(Source: Journal of Surgical Research)

Regional Versus General Anesthesia for Carotid Endarterectomy: The NSQIP Perspective

Journal of Surgical Research — Sat, 14 Jan 2012 22:29:19 +0100

Introduction: The ideal anesthetic technique for carotid endarterectomy (CEA) is a source of continued controversy. Most studies comparing anesthesia used during CEA are retrospective in nature and draw from relatively small numbers of patients from single centers. With its inclusion of prospectively collected information about surgical patients from over 250 participating hospitals, the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database offers the opportunity to re-evaluate the potential impact of anesthesia modality on outcomes after CEA. Methods: All ACS-NSQIP patients undergoing CEA for carotid stenosis from 2005-2009 were included for analysis unless they had undergone a prior operation within 30 days of CEA or received another major proced...

Hospital Characteristics and Participation in the National Surgical Quality Improvement Program

Journal of Surgical Research — Sat, 14 Jan 2012 22:29:02 +0100

Conclusions: NSQIP participants do not represent the diversity of hospitals performing high-risk general and vascular surgery nationwide. to enable quality improvement efforts in small, rural, and critical access hospitals, which may have high surgical mortality rates and limited resources, other methods of outcome feedback are needed. (Source: Journal of Surgical Research)

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The impact of general versus local anesthesia on early subclinical cognitive function following carotid endarterectomy evaluated using P3 event-related potentials

Acta Neurochirurgica — Sat, 14 Jan 2012 16:41:39 +0100

Conclusions Our study showed that general anesthesia, used for patients undergoing CEA, negatively influenced cognitive function during the immediate period after surgery (the first postoperative day). However, by the sixth postoperative day, this cognitive impairment was no longer being detected. POCD occurring shortly after carotid endarterectomy is the result of general anesthesia, which is probably an independent evoking factor in itself. The cognitive deficit recorded only during the immediate postoperative period, is not a negative effect of GA but merely a side-effect and thus GA should not be considered inferior to LA for use during CEA. Content Type Journal ArticleCategory Clinical ArticlePages 1-6DOI 10.1007/s00701-011-1270-4Authors Jan Mracek, Departme...

In vitro and in vivo evidence for the role of elastase shedding of CD163 in human atherothrombosis

European Heart Journal — Sat, 14 Jan 2012 05:00:00 +0100

Conclusion Our results suggest that neutrophil elastase promotes CD163 shedding, resulting in a decreased clearance of Hb by macrophages, which may favour plaque destabilization. This may be reflected by increased plasma levels of sCD163 and elastase/α1-AT complexes which are positively correlated in patients with coronary artery disease. (Source: European Heart Journal)

[Endovascular treatment of carotid stenosis: an experience in the Hospital Universitario Central de Asturias].

Revista de Neurologia — Fri, 13 Jan 2012 18:28:21 +0100

CONCLUSIONS. In our hospital CAS is considered an effective and safe technique, with a rate of complications that is within the parameters that justify its indication. PMID: 22234567 [PubMed - in process] (Source: Revista de Neurologia)

Preserved consciousness in general anesthesia during carotid endarterectomy: a six-year experience

Interactive CardioVascular and Thoracic Surgery — Thu, 12 Jan 2012 05:00:00 +0100

Conclusions: The six-year results for GA using remifentanil conscious sedation were very satisfactory and highlighted the advantages of both GA (hemodynamic stability and excellent control of ventilation) and local anesthesia (ease of evaluation of neurological status) in a calm and relaxed environment for both patient and surgeon. (Source: Interactive CardioVascular and Thoracic Surgery)

Advances in the Management of Carotid Artery Disease: Focus on Recent Evidence and Guidelines

Journal of Cardiothoracic and Vascular Anesthesia — Wed, 04 Jan 2012 16:41:50 +0100

Recent landmark randomized trials and society guidelines have significantly revised the management of carotid artery disease. Duplex ultrasonography is the recommended initial diagnostic test for the assessment of extracranial carotid artery stenosis. Carotid artery imaging is reasonable in select patients scheduled for coronary artery bypass graft (CABG) surgery. Carotid revascularization can be achieved safely and effectively with carotid endarterectomy or carotid artery stenting. Because each procedure has a different risk/benefit profile, the optimal approach is to match the particular patient to the intervention that maximizes outcome benefit. Carotid revascularization is recommended in patients scheduled for CABG surgery when the carotid artery stenosis is symptomatic and/or bilatera...

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Revascularization of carotid artery stenosis - a brief update on current evidence.

VASA. Zeitschrift fur Gefasskrankheiten. Journal for Vascular Diseases — Sun, 01 Jan 2012 05:00:00 +0100

Authors: Koennecke HC Abstract Major and long-awaited trials comparing carotid endarterectomy (CEA) with carotid stenting (CAS) were published in recent years. Both, ICSS and CREST, documented a higher rate of periprocedural stroke and death in CAS, in particular in elderly patients, thereby confirming the results of prior trials and meta-analyses. In CREST, the composite endpoint included myocardial infarction (MI), which led to statistical equipoise between the treatment arms due to a higher rate of MI with CEA. However, whether MI is a relevant endpoint in trials for stroke prevention remains debatable. The stroke preventive benefit seems equally sustained after CEA and CAS, although the significance of restenoses, whose frequency is twice as high after CAS compared to CEA, is u...

Stenting Versus Surgery in Patients With Carotid Stenosis After Previous Cervical Radiation Therapy: Systematic Review and Meta-Analysis.

Stroke — Thu, 29 Dec 2011 05:00:00 +0100

CONCLUSIONS: Both CAS and CEA proved to be feasible revascularization techniques with low risk for CVE. Although patients undergoing CEA had more temporary CNI, higher rates of late CVE and restenosis were identified after CAS. PMID: 22207504 [PubMed - as supplied by publisher] (Source: Stroke)

The posterior cervical triangle approach for high carotid artery exposure in carotid endarterectomy.

Journal of Neurosurgery — Fri, 23 Dec 2011 05:00:00 +0100

Authors: Sasaki T, Nakamura Y, Yomo S, Sekiguchi Y, Kodama K, Ichikawa Y, Hongo K Abstract A new approach in carotid endarterectomy (CEA) was developed for high carotid artery lesions. With the authors' use of the posterior cervical triangle approach, 20 patients with a high carotid artery lesion were successfully treated with CEA. Accessory nerve palsy in 1 patient and hoarseness in 4 patients were encountered postoperatively as transient complications. There were no permanent procedure-related complications. Although this method has some risks, it is a useful method in CEA for high carotid artery lesions. PMID: 22196095 [PubMed - as supplied by publisher] (Source: Journal of Neurosurgery)

Meta-Analysis of Calcineurin-Inhibitor-Sparing Regimens in Kidney Transplantation

Nephrology Now — Fri, 23 Dec 2011 03:58:50 +0100

This is a meta-analysis of papers using a variety of approaches to reduce the toxicity of calcineurin inhibitors (CnI) in renal transplantation. Papers include a variety of approaches, such as CnI minimization, delayed introduction and avoidance. All strategies showed improvements in graft function. However, while CnI minimization or use of newer agents such as belatacept was associated with improved graft survival, use of mTOR inhibitors such as belatacept were associated with worse graft survival. Free full text kindly provided by the American Society of Nephrology. : Five-Year Safety and Efficacy of Belatacept in Renal Transplantation Topics in Transplantation Medicine for General Nephrologists Carotid Endarterectomy Benefits Patients with CKD and Symptomatic High-Grade Stenosis (Sour...

Obesity is an Independent Risk Factor for Death and Cardiac Complications after Carotid Endarterectomy

Journal of the American College of Surgeons — Thu, 22 Dec 2011 05:00:00 +0100

Background: The role of obesity as a risk factor after carotid endarterectomy is not well-described. We undertook a study of the association of obesity with 30-day outcomes after carotid endarterectomy. Study Design: After obtaining Institutional Review Board approval, we retrospectively analyzed prospectively collected data from carotid endarterectomies in the 2005−2006 Veterans Affairs Surgical Quality Improvement Program database. The association of body mass index (BMI; calculated as kg/m2) on 30-day outcomes was assessed using multivariable logistic regression. Results: From 3,706 carotid endarterectomies, we excluded 22 for missing BMI and 39 for emergency status; 3,645 carotid endarterectomies were analyzed. BMI was underweight ( (Source: Journal of the American College of Su...

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Cost implications of more widespread carotid artery stenting consistent with the American College of Cardiology/American Heart Association Guideline

Journal of Vascular Surgery — Thu, 22 Dec 2011 05:00:00 +0100

The recent American College of Cardiology/American Heart Association guideline recommended carotid artery stenting (CAS) as an alternative to carotid endarterectomy (CEA) for symptomatic patients. This and the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) form the basis for seeking more liberalized indications and reimbursement for CAS. For the years 2005-2007, >130,000 carotid interventions/year were performed, 88.6% of which were CEAs and 11.4% were CAS. For the same years, each CAS procedure had on average $12,000-$13,500 more expensive mean total hospital charges than each CEA. If the percentages of CAS and CEA had been equal (ie, 50% CAS and 50% CEA), this would translate into an additional $2,000,000,000 in charges for these 3 years. It seems unreasonable to ...

Current practice of carotid endarterectomy in the UK

British Journal of Surgery — Wed, 21 Dec 2011 05:00:00 +0100

Conclusion:CEA is performed less commonly in the UK than in other European countries and probably remains underutilized in the prevention of stroke. Increasing the number of CEAs done in the UK, together with reducing surgical waiting times, could prevent more strokes. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. (Source: British Journal of Surgery)

Regarding “Short-term results of a randomized trial examining timing of carotid endarterectomy in patients with severe asymptomatic unilateral carotid stenosis undergoing coronary artery bypass grafting”

Journal of Vascular Surgery — Mon, 19 Dec 2011 23:06:58 +0100

As a supporter of randomized trials in determining evidence-based practice, I congratulate the authors on undertaking this study, albeit within a cohort of patients who would previously have been thought to be one of the lowest-risk subgroups for having stroke after coronary artery bypass graft (CABG). Yet, despite having excluded emergency procedures, non-CABG cardiac surgery and those with significant aortic arch disease (52% of the original cohort), patients with a unilateral asymptomatic 70% to 99% stenosis undergoing isolated CABG followed by delayed carotid endarterectomy (CEA) incurred a 9% rate of death/stroke at 90 days, compared with only 1% in those randomized to prior/synchronous CEA. (Source: Journal of Vascular Surgery)

Myocardial Infarction After Carotid Stenting and Endarterectomy: Results From the Carotid Revascularization Endarterectomy Versus Stenting Trial

Journal of Vascular Surgery — Mon, 19 Dec 2011 23:06:57 +0100

Patients in the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST) trial randomized to carotid endarterectomy (CEA) had higher rates of myocardial infarction (MI) and cardiac biomarker positive-only events for myocardial ischemia than those randomized to carotid artery stenting (CAS). MI and cardiac biomarker-only elevations were independently associated with increased future mortality. (Source: Journal of Vascular Surgery)

Appropriateness Criteria to Assess Variations in Surgical Procedure Use in the United States [Review Article]

Archives of Surgery — Mon, 19 Dec 2011 05:00:00 +0100

Conclusions Most existing AC are outdated, and AC have never been developed for most common surgical procedures. A broad and coordinated effort to develop and maintain AC would be required to implement this tool to address variation in the use of surgical procedures. (Source: Archives of Surgery)

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Sex-Related Differences in Embolic Potential During Carotid Angioplasty and Stenting

Annals of Vascular Surgery — Fri, 16 Dec 2011 23:24:35 +0100

Conclusions: Preoperative cerebrovascular symptoms are associated with a greater mean particle size in symptomatic women compared with asymptomatic women. This difference in mean particle size was not observed in men. These results provide evidence that may help in better selection of CAS patients, but the impact of an increased mean particle size in symptomatic women during carotid stenting requires further investigation. (Source: Annals of Vascular Surgery)

Results of Staged Carotid Endarterectomy and Coronary Artery Bypass Graft in Patients With Severe Carotid and Coronary Disease

Annals of Vascular Surgery — Fri, 16 Dec 2011 23:24:35 +0100

Conclusions: Staging of CEA followed by CABG in the immediate perioperative period may be an acceptable approach to patients with severe carotid and coronary disease. Despite the presence of known severe coronary disease, the performance of CEA under general anesthesia as the initial procedure was well tolerated. We propose that this strategy may be a possible option for patients who present with severe disease in both coronary and carotid distributions. The results of our study, though based on a limited cohort, suggest that this approach of staged CEA–CABG within the perioperative period (Source: Annals of Vascular Surgery)

Patients with Recurrent Ischaemic Events from Carotid Artery Disease have a Large Lipid Core and Low GSM

European Journal of Vascular and Endovascular Surgery — Fri, 09 Dec 2011 05:00:00 +0100

Conclusion: Within a cohort of patients presenting with recent onset cerebral ischaemic events undergoing CEA, the plaques of patients with recurrent events following admission to hospital had evidence a large lipid core and a low GSM. (Source: European Journal of Vascular and Endovascular Surgery)

SPREAD‐STACI study: A protocol for a randomized multicenter clinical trial comparing urgent with delayed endarterectomy in symptomatic carotid artery stenosis

International Journal of Stroke — Thu, 08 Dec 2011 05:00:00 +0100

RationaleIn patients with >50% carotid artery stenosis (as measured by North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria) suffering a transient ischemic attack or a minor ipsilateral stroke, carotid endarterectomy exerts maximum benefits, when performed within the first 15 days from the initial ischemic symptom. It is also known that the probability of a major stroke spikes within the first few days after a transient ischemic attack/minor stroke and then flattens out in the following days and weeks. It could be hypothesized that urgent carotid endarterectomy has greater benefit than delayed procedure.AimsDemonstrate that urgent carotid endarterectomy is more effective than delayed interventions.DesignCenters employing neurolgist/stroke physicians and vascular s...

Patients with Recurrent Ischaemic Events from Carotid Artery Disease have a Large Lipid Core and Low GSM.

PubMed: Eur J Vasc Endovasc ... — Wed, 07 Dec 2011 05:00:00 +0100

CONCLUSION: Within a cohort of patients presenting with recent onset cerebral ischaemic events undergoing CEA, the plaques of patients with recurrent events following admission to hospital had evidence a large lipid core and a low GSM. PMID: 22154152 [PubMed - as supplied by publisher] (Source: PubMed: Eur J Vasc Endovasc ...)

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Preserved consciousness in general anesthesia during carotid endarterectomy: a six-year experience [ESCVS article - Carotid and imaging]

Interactive CardioVascular and Thoracic Surgery — Mon, 05 Dec 2011 05:00:00 +0100

Staged Versus Synchronous Carotid Endarterectomy and Coronary Artery Bypass Grafting: Analysis of 10-Year Nationwide Outcomes

Journal of Vascular Surgery — Thu, 01 Dec 2011 05:00:00 +0100

Patients undergoing staged or synchronous approaches to carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) have no significant differences with respect to mortality or neurologic complications. (Source: Journal of Vascular Surgery)

The von Willebrand Inhibitor ARC1779 Reduces Cerebral Embolization After Carotid Endarterectomy a Randomized Trial

Journal of Vascular Surgery — Thu, 01 Dec 2011 05:00:00 +0100

von Willebrand factor inhibition reduces thromboembolism and may play a role in treatment of stroke and myocardial ischemia. Minor stroke and transient ischemic attacks are followed by a high early risk of recurrent stroke. Risk is highest in patients with larger artery disease. Aspirin can reduce recurrent stroke, but actually fails to prevent 80% of stroke recurrences (Antithrombotic Trialists' Collaboratio. BMJ 2002;324:71-86). There are now novel antiplatelet therapies that may be considered. It appears inhibition of platelet receptor glycoprotein (GPIb) or absence of von Willebrand factor (vWF) may, in an animal model, protect against brain infarction without increasing intercerebral hemorrhage despite prolongation of bleeding time (Kleinschnitz C et al. Blood 2009;113:3600-3). The a...

Correlations Between Clinical Variables and Gene-expression Profiles in Carotid Plaque Instability

Journal of Vascular Surgery — Thu, 01 Dec 2011 05:00:00 +0100

Strokes, a major cause of disability, are often caused by embolism from unstable carotid plaques. The aim of this study was to validate a biobank of human carotid endarterectomies as a platform for further exploration of pathways for plaque instability. For this purpose, we investigated the relationship between clinical parameters of plaque instability and expression of genes previously shown to be associated with either plaque instability or healing processes in the vessel wall. (Source: Journal of Vascular Surgery)

Eversion versus Conventional Carotid Endarterectomy: A Meta-analysis of Randomised and Non-randomised Studies

Journal of Vascular Surgery — Thu, 01 Dec 2011 05:00:00 +0100

To compare eversion (ECEA) and conventional (CCEA) carotid endarterectomy from randomised and non-randomised studies. Pooled odds ratios (ORs) with 95% confidence intervals (95%CIs) and numbers needed to treat (NNTs) were appropriately calculated. A sub-analysis was performed on studies directly comparing ECEA vs. patch CEA (PCEA). Meta-regression analysis was performed to examine the effect of potentially meaningful patient-related, procedure-related and definition-related modifiers. Power calculations were also conducted. (Source: Journal of Vascular Surgery)

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Carotid Endarterectomy is More Cost-Effective Than Carotid Artery Stenting

Journal of Vascular Surgery — Thu, 01 Dec 2011 05:00:00 +0100

In a clinical environment where there may be emerging clinical equipoise between two therapies, the cost of delivering that intervention becomes increasingly important. Carotid Endarterectomy (CEA) and carotid artery stenting (CAS) have both demonstrated a reduction in long-term stroke risk after successful intervention. While the CREST trial demonstrated no significant differences between CAS and CEA regarding the peri-operative risk when the primary endpoint of CVA, death or MI was examined, a meta-analysis of European randomized prospective trials in symptomatic patients strongly favored CEA as the safer procedure. In the United States, the percentage of gross domestic product (GDP) devoted to medical care continues to rise at a rate that is unsustainable. Going forward, more efficient ...

Contralateral Occlusion is not a Clinically Important Reason for Choosing Carotid Artery Stenting for Patients with Significant Carotid Artery Stenosis

Journal of Vascular Surgery — Thu, 01 Dec 2011 05:00:00 +0100

Patients with internal carotid artery occlusion contralateral to a diseased carotid artery are at an increased risk of stroke. It is our practice to offer carotid intervention to symptomatic patients and patients with severe ipsilateral carotid stenosis and contralateral occlusion. Both carotid endarterectomy (CEA) and carotid artery stenting (CAS) are acceptable modes of therapy. Contralateral carotid occlusion has been suggested as an indication for CAS because of the theoretical advantages of reduced ischemic procedural time and the lack of need for a vascular shunt or the assistance of general anesthesia. However, CEA can also be done safely in this population and has been associated with a decreased procedural stroke rate. Thus, it is not clear if contralateral occlusion by itself is ...

Early Versus Delayed Carotid Endarterectomy for Symptomatic Carotid Stenosis: A Single-Institution Experience

Journal of Vascular Surgery — Thu, 01 Dec 2011 05:00:00 +0100

Delayed carotid endarterectomy (CEA) after a recent stroke or transient ischemic attack (TIA) is associated with risks of recurrent neurologic symptoms. In an effort to preserve cerebral function, urgent early CEA has been recommended in some instances. (Source: Journal of Vascular Surgery)

Spontaneous Expulsion of a Dacron Patch After Carotid Endarterectomy

Journal of Vascular Surgery — Thu, 01 Dec 2011 05:00:00 +0100

We report a case of a spontaneous Dacron patch expulsion without any stenosis or pseudoaneurysm formation. This is a late complication that has not been previously reported in the literature. (Source: Journal of Vascular Surgery)

Use of CT Angiography and CT Perfusion Imaging in the Selection of Hyperacute Stroke Patients to Undergo Emergent Carotid Endarterectomy Versus Intra-Cranial Thrombectomy

Journal of Vascular Surgery — Thu, 01 Dec 2011 05:00:00 +0100

Patients with acute stroke symptoms due to carotid disease are typically not considered for emergent carotid endarterectomy (CEA) due to the risk of fatal intracranial hemorrhage secondary to reperfusion injury. Past studies have failed to show consistent benefit of early operative intervention, presumably due to a high rate of unrecognized intracranial thromboembolism. The emergence of neuro-endovascular clot retrieval has revolutionized acute stroke treatment since initial device clearance by FDA in 2004. While approximately 1 in 10 patients in the national registry undergoing emergent intracranial embolectomy required simultaneous carotid revascularization (typically angioplasty), this ratio increased to approximately 1 in 3 for patients in the southern Stroke Belt. In this setting, a s...

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Carotid artery stenting may be contraindicated in female patients with symptomatic carotid artery stenosis

Journal of Vascular Surgery — Thu, 01 Dec 2011 05:00:00 +0100

Carotid artery stenting (CAS) has reported inferior outcomes compared with carotid endarterectomy (CEA) for the management of symptomatic carotid artery stenosis. The 2011 guidelines by the American Heart Association/American Stroke Association (AHA/ASA) and several other associations recommended CAS as an “alternative to CEA for symptomatic patients” (class I; level of evidence B). The AHA/ASA Guidelines used the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) to support this recommendation. (Source: Journal of Vascular Surgery)

Reply

Journal of Vascular Surgery — Thu, 01 Dec 2011 05:00:00 +0100

Ever since the Asymptomatic Carotid Atherosclerosis Study (ACAS) Study reported that an increased perioperative stroke rate following carotid endarterectomy (CEA) in female patients greatly diminished or possibly eliminated the potential benefit of prophylactic CEA, there has been controversy and concern regarding the outcome of cerebrovascular interventions in female patients. In a subsequent large single-institutional study addressing this specific issue, men and women were found to have equal rates of perioperative myocardial infarction (MI), mortality and stroke following CEA. However, the cohort of patients with the highest perioperative stroke rate was symptomatic female patients, with a stroke incidence of 3.0% following CEA. Clearly, symptomatic women may represent a cohort of pati...

Atherosclerotic plaque evaluation based on the results of ultrasound duplex scanning (DS), multispectral resonance imaging (MRI), multispiral computed tomography (MSCT) and histochemical analysis in asymptomatic patients with marked carotid atherosclerosis

Artery Research — Thu, 01 Dec 2011 05:00:00 +0100

Aim: To evaluate morphological and functional characteristics of an atherosclerotic plaque (ASP) in patients with marked carotid atherosclerosis. Materials and methods: Forty patients (25 males, age 68.9±6.6 years) with marked carotid atherosclerosis (stenosis ≥ 70%, based on ultrasound DS, MSCT and MRI data) were examined before carotid endarterectomy (16 cases with history of cerebral stroke, CS – Group 1; 24 cases without – Group2). All the patients were asymptomatic (no acute cerebrovascular events in the last 6 months). Histochemical examination of the excised carotid ASP was performed in 21 cases (9 cases in Group 1 and 12 cases in Group 2). (Source: Artery Research)

Clinical considerations in the management of asymptomatic carotid artery stenosis.

Neurosurgical Focus — Thu, 01 Dec 2011 05:00:00 +0100

Authors: Taussky P, Hanel RA, Meyer FB Abstract Incidental findings pose considerable management dilemmas for the treating physician and psychological burden for the respective patient. With an aging population, more patients will be diagnosed with asymptomatic internal carotid artery stenosis. Patients will have to be counseled with regard to treatment options according to their individual risk profile and according to professionals' knowledge of evidence-based data derived from large randomized control trials. Treatment consensus has long been lacking for patients with asymptomatic carotid artery stenosis prior to any randomized controlled trials. Additionally, an individual's risk profile may be hard to assess according to knowledge gained from randomized controlled trials. More...

Strategies for asymptomatic carotid artery stenosis.

Neurosurgical Focus — Thu, 01 Dec 2011 05:00:00 +0100

Authors: Doe C, Jethwa PR, Gandhi CD, Prestigiacomo CJ Abstract The treatment of asymptomatic carotid artery stenosis (ACAS) has continued to evolve for the past 3 decades. With rapidly advancing technology, the results of old trials have become obsolete. While there has been little change in the efficacy of carotid endarterectomy, there have been vast improvements in both medical management and carotid angioplasty with stenting. Finding the best therapy for a given patient can therefore be difficult. In this article, the authors review the current literature regarding treatment options for ACAS and the methods available for stratifying patients who would benefit from surgical versus medical treatment. PMID: 22133168 [PubMed - in process] (Source: Neurosurgical Focus)

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Potential adverse effects of norepinephrine on cortical somatosensory-evoked potentials during carotid endarterectomy: a case report

Journal of Clinical Anesthesia — Thu, 01 Dec 2011 05:00:00 +0100

Abstract: The cerebral metabolic and vascular effects of intravenous norepinephrine have been shown in an animal model using somatosensory-evoked potentials (SSEPs). A case of intravenous norepinephrine resulting in a decrease in SSEP amplitude (of greater than 50%) despite no significant change in blood pressure, prior to cross-clamping during a carotid endarterectomy is presented. This finding may have implications for the use of norepinephrine in the critical care unit as well as the operating room. (Source: Journal of Clinical Anesthesia)

Vial Mistakes Involving Heparin

AORN Journal — Mon, 28 Nov 2011 15:06:36 +0100

A 65-year-old man was admitted to the hospital for a left carotid endarterectomy. During the procedure, the surgeon requested 5,000 units of IV heparin. The anesthesiologist administered 5 mL of heparin from what he believed was a 1,000 units/mL concentration vial. After three minutes, an activated clotting time (ACT) was drawn while the surgeon clamped the carotid artery and proceeded with the surgery. When the ACT returned as normal rather than prolonged (as it should have been after heparin administration), the anesthesiologist repeated the ACT to confirm the result. (Source: AORN Journal)

Color Duplex Sonography in the Detection of Internal Carotid Artery Restenosis After Carotid Endarterectomy: Comparison With Computed Tomographic Angiography

Journal of Ultrasound in Medicine — Mon, 28 Nov 2011 05:00:00 +0100

Conclusions— Color duplex sonography can be effectively used as a primary diagnostic tool for evaluation of patients with suspected internal carotid artery restenosis after carotid endarterectomy. (Source: Journal of Ultrasound in Medicine)

Comments regarding ‘The War Against Error: A 15 Year Experience of Completion Angioscopy Following Carotid Endarterectomy’

European Journal of Vascular and Endovascular Surgery — Mon, 28 Nov 2011 05:00:00 +0100

Professor Naylor and his team should be congratulated on both the thoroughness of this audit and the excellent results that they have achieved. The principle ethos for all surgeons who perform carotid endarterectomy (CEA) should be an on-going commitment to increase the safety of surgery. For these authors quality control, both intra- and post-operatively has been the focus of improved outcomes during an extensive experience. So why haven’t we all adopted the methods that Professor Naylor proposes? Is it laziness, overconfidence, lack of resources or a belief that the problem is not as great as the authors lead us to believe? (Source: European Journal of Vascular and Endovascular Surgery)

Restenosis after microsurgical non-patch carotid endarterectomy in 586 patients

Acta Neurochirurgica — Thu, 24 Nov 2011 06:51:16 +0100

Conclusions The midterm rate of restenosis was low when using a microscope-assisted non-patch endarterectomy technique. The 30-day morbidity and mortality rate was comparable or lower than those in recently published surgical series. Content Type Journal ArticleCategory Clinical ArticlePages 1-9DOI 10.1007/s00701-011-1233-9Authors Michael Reinert, Department of Neurosurgery, Inselspital Bern, University of Bern, 3010 Bern, SwitzerlandMarie-Louise Mono, Department of Neurology, Inselspital Bern, University of Bern, Bern, SwitzerlandDominique Kuhlen, Department of Neurosurgery, Inselspital Bern, University of Bern, 3010 Bern, SwitzerlandLuigi Mariani, Department of Neurosurgery, Inselspital Bern, University of Bern, 3010 Bern, SwitzerlandAlain Barth, Department of Neur...

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Comments regarding 'The War Against Error: A 15 Year Experience of Completion Angioscopy Following Carotid Endarterectomy'

PubMed: Eur J Vasc Endovasc ... — Wed, 23 Nov 2011 05:00:00 +0100

Authors: Gough MJ PMID: 22119414 [PubMed - as supplied by publisher] (Source: PubMed: Eur J Vasc Endovasc ...)

Randomized comparison of synchronous CABG and carotid endarterectomy vs. isolated CABG in patients with asymptomatic carotid stenosis: The CABACS trial

International Journal of Stroke — Tue, 22 Nov 2011 05:00:00 +0100

The objective of this study is to compare the safety and efficacy of isolated coronary artery bypass grafting vs. synchronous coronary artery bypass grafting and carotid endarterectomy in patients with asymptomatic high‐grade carotid artery stenosis.DesignCoronary Artery Bypass graft surgery in patients with Asymptomatic Carotid Stenosis (CABACS) is a randomized, controlled, open, multicenter, group sequential trial with two parallel arms and outcome adjudication by blinded observers. Patients with asymptomatic high‐grade carotid stenosis scheduled for elective coronary artery bypass grafting will be assigned to either isolated coronary artery bypass grafting or synchronous coronary artery bypass grafting and carotid endarterectomy by 1 : 1 block‐stratified randomization with thr...

Carotid Artery Stenting and Cardiac Surgery in Symptomatic Patients

Journal of the American College of Cardiology: Cardiovascular Interventions — Mon, 21 Nov 2011 05:00:00 +0100

Conclusions This is the first single-center study reporting the combined outcome of CAS-CABG in symptomatic patients. The periprocedural complication rate and long-term results of the CAS-CABG strategy in this high-risk population support the reliability of this approach. In such a high-risk population, this strategy might offer a valuable alternative to the combined surgical approach; however, a large randomized trial is clearly warranted. (Source: Journal of the American College of Cardiology: Cardiovascular Interventions)

External Carotid Artery to Internal Carotid Artery Transposition with Patch Resection to Treat an Infected Carotid Endarterectomy Dacron Patch: A Novel Technique

EJVES Extra — Mon, 21 Nov 2011 05:00:00 +0100

Discussion: This case highlights a mode of late presentation of patch infection and introduces a novel surgical technique that has not been described in the contemporary literature reviews. (Source: EJVES Extra)

Gender-based outcomes after eversion carotid endarterectomy from 1998 to 2009

Journal of Vascular Surgery — Mon, 21 Nov 2011 05:00:00 +0100

Conclusions: This single-center university hospital study shows that although women have a different cardiovascular risk profile from men when they undergo eCEA, there is no evidence of a different gender effect on perioperative and long-term outcomes. (Source: Journal of Vascular Surgery)

Assessment of Carotid Plaque Stability Based on the Dynamic Enhancement Pattern in Plaque Components With Multidetector CT Angiography.

Stroke — Thu, 17 Nov 2011 05:00:00 +0100

CONCLUSIONS: Delayed-phase images provide information regarding the dynamic change in contrast media from the early arterial phase. An increase in HU from the early phase on multidetector CT angiography indicates plaque stability with more fibrous tissue and a less lipid-rich necrotic core, intraplaque hemorrhage, and neovascularization. PMID: 22096033 [PubMed - as supplied by publisher] (Source: Stroke)

Researchers Examine Outcomes Of Carotid Artery Stenting Following Prior Carotid Endarterectomy Or Stenting

Health News from Medical News Today — Tue, 15 Nov 2011 09:00:00 +0100

This study received "Best of Session" recognition and will be presented in an abstract format at the American Heart Association annual meeting on November 14 at 9:30 AM in Orlando, FL. "The optimal management of carotid artery stenosis following prior revascularization is unclear in the available literature," said Nicholas J... (Source: Health News from Medical News Today)

Carotid Artery Pseudoaneurysm after Carotid Endarterectomy and Bovine Pericardial Patch Angioplasty: Case Report

EJVES Extra — Mon, 14 Nov 2011 05:00:00 +0100

We describe a case of bovine patch infection with Serratia marcescens with acute pseudoaneurysm formation following CEA. Successful interposition vein graft was performed. (Source: EJVES Extra)

Increased secretion of Gas6 by smooth muscle cells in human atherosclerotic carotid plaques.

Thrombosis and Haemostasis — Thu, 10 Nov 2011 05:00:00 +0100

Authors: Clauser S, Meilhac O, Bieche I, Raynal P, Bruneval P, Michel JB, Borgel D Abstract Vitamin K-dependent protein Gas6 (growth-arrest specific gene 6) plays a role in vascular smooth muscle cell (VSMC) survival and migration, as well as in endothelium and leukocyte activation, and could therefore be involved in atherosclerosis. However, the study of mouse models has led to contradictory results regarding the pro- or anti-atherogenic properties of Gas6, and relatively few data are available in human pathophysiology. To better understand the implication of Gas6 in human atherosclerosis, we studied Gas6 expression and secretion in vitro in human VSMC, and analysed the effect of Gas6 on inflammatory gene expression in these cells. We show that Gas6 secretion in VSMC is strongly ...

Age differential between outcomes of carotid angioplasty and stent placement and carotid endarterectomy in general practice

Journal of Vascular Surgery — Thu, 10 Nov 2011 05:00:00 +0100

Background: Data derived from prospective randomized clinical trials suggest differential comparative benefit between carotid angioplasty and stent (CAS) placement and carotid endarterectomy (CEA) in various age strata. We sought to investigate the impact of age on outcomes of CAS and CEA in general practice. Methods: We analyzed the data from the Nationwide Inpatient Sample (NIS), which is representative of all admissions in the United States from 2005 to 2008. The primary end point was occurrence of stroke, cardiac complications, or death during the postprocedural period. Outcomes of interest were compared between patients aged ≥70 years and (Source: Journal of Vascular Surgery)

Circulating Lipoprotein-associated Phospholipase A2 in High-grade Carotid Stenosis: A New Biomarker for Predicting Unstable Plaque

European Journal of Vascular and Endovascular Surgery — Thu, 10 Nov 2011 05:00:00 +0100

Abstract: Objective: To test plasma levels of lipoprotein-associated phospholipase A2 (Lp-PLA2) in patients with high-grade carotid stenosis according to plaque histology.Methods: This cross-sectional single-centre study included patients with ≥70% North American Symptomatic Carotid Endarterectomy Trial (NASCET) carotid stenosis, who were treated surgically. Serum Lp-PLA2 and high-sensitivity C-reactive protein (hs-CRP) were determined on the day of surgery. Histopathological analysis classified carotid plaque as stable or unstable, according to AHA classification.Results: Of the 42 patients (mean age 70.4 ± 10.5 years; 67% men), neurological symptoms were present in 16 (38%). Unstable plaques were found in 23 (55%). Median plasma level of Lp-PLA2 was significantly higher in patients ...

An innovative method for detecting surgical errors using indocyanine green angiography during carotid endarterectomy: a preliminary investigation

Acta Neurochirurgica — Wed, 09 Nov 2011 07:01:33 +0100

Conclusions Intraoperative ICG angiography before arteriotomy is useful to determine the precise stenotic area and the shape of the associated plaque. ICG angiography after an arteriotomy site is sutured is also useful for detecting residual stenosis or fluttering atheroma. ICG angiography could be an alternative method to Doppler ultrasonography for ensuring a complete and successful operation and preventing complications. Content Type Journal ArticleCategory Clinical ArticlePages 1-7DOI 10.1007/s00701-011-1212-1Authors Chang-Hyun Lee, Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam city, KoreaYoung Sub Jung, Department of Neurosurgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, 39 Boramae-gil, D...

Circulating Lipoprotein-associated Phospholipase A2 in High-grade Carotid Stenosis: A New Biomarker for Predicting Unstable Plaque.

PubMed: Eur J Vasc Endovasc ... — Tue, 08 Nov 2011 05:00:00 +0100

CONCLUSIONS: This study showed that circulating Lp-PLA2 was increased in patients with high-grade carotid stenosis and unstable plaque. Lp-PLA2 may be a relevant biomarker to guide for invasive therapy in asymptomatic patients with carotid artery disease. PMID: 22075154 [PubMed - as supplied by publisher] (Source: PubMed: Eur J Vasc Endovasc ...)

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Carotid stents: which is the best option?

The Journal of Cardiovascular Surgery — Sun, 06 Nov 2011 18:52:15 +0100

Authors: Nikas DN, Kompara G, Reimers B Abstract Nowadays, carotid artery stenting (CAS) offers a potential alternative to carotid endarterectomy (CEA). CAS main advantages over CEA are the less invasive approach and the almost equal performance to CEA in terms of stroke prevention and complications. One of the most important factors which played significant role to CAS evolution is the progress in design of modern materials, especially stents. Today, several types of dedicated carotid stents have specific mechanical properties, which provide stents with individual characteristics making each of them suitable for specific carotid lesions and anatomies. The present review analyses the specific design and construction of modern stents, trying to point out their particular mechanical ...

Imaging for carotid stenting.

The Journal of Cardiovascular Surgery — Sun, 06 Nov 2011 18:52:05 +0100

Authors: Lee CJ, Eskandari MK Abstract Carotid artery stenting (CAS) using embolic protection devices (EPD) has emerged as a viable alternative to carotid endarterectomy (CEA) in select patients. Imaging plays a critical role in the selection of patients for CAS. Duplex ultrasonography alone is insufficient to assess patients for CAS suitability. Advancements in computed tomography angiography (CTA) and magnetic resonance angiography (MRA) techniques are helping to identify lesions vulnerable to cerebral embolization during carotid interventions - a more prevalent event during CAS in comparison to CEA. Here we review the relevant data on the various imaging techniques available to improve patient selection and minimize neurologic adverse events during carotid artery stenting. P...

A review of the main trials and registries: what we think we do and do not know about carotid artery stenting.

The Journal of Cardiovascular Surgery — Sun, 06 Nov 2011 18:51:33 +0100

Authors: Brightwell RE, Van Herzeele I, Cheshire NJ Abstract Despite many randomised controlled trials there are none that recommend carotid artery stenting (CAS) replaces carotid endarterectomy (CEA) for preventing stroke in patients with atherosclerotic carotid artery stenosis. CAS continues to be attractive due to its minimally-invasive nature and potential benefit in those patients at 'high risk' during open surgery. The belief that CAS will replace CEA is likely misplaced; a complimentary role for each mode of treatment is a more realistic vision for the future. Assessment of the existing data may provide useful information as to the subgroups that have most to benefit from each treatment type, therefore allowing a patient-specific approach to the management of individual lesi...

Impact of practice patterns in shunt use during carotid endarterectomy with contralateral carotid occlusion

Journal of Vascular Surgery — Fri, 04 Nov 2011 04:00:00 +0100

This study investigated the association between surgeon practice pattern in shunt placement and 30-day stroke/death in patients undergoing carotid endarterectomy (CEA) with contralateral carotid occlusion (CCO). Methods: Among 6379 CEAs performed in the Vascular Study Group of New England (VSGNE) between 2002 and 2009, we identified 353 patients who underwent CEA with CCO and compared the 30-day stroke/death rate with 5279 patients who underwent primary, isolated CEA with a patent contralateral carotid artery. Within patients with CCO, we examined the 30-day stroke/death rate across the reason for shunt placement and two distinct surgeon practice patterns in shunt placement: surgeons who selectively used a shunt (≤95% of CEAs) or routinely used a shunt (>95% of CEAs). We used observed/...

Diabetes is not a predictor of outcome for carotid revascularization with stenting as it may be for carotid endarterectomy

Journal of Vascular Surgery — Fri, 04 Nov 2011 04:00:00 +0100

Conclusions: Diabetic patients are not at greater risk of perioperative morbidity and mortality or late stroke after CAS, however, the perioperative risk can be higher after CEA. This may help in selecting the appropriate technique for carotid revascularization in patients best suited for the type of procedure. (Source: Journal of Vascular Surgery)

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Characterization of resident surgeon participation during carotid endarterectomy and impact on perioperative outcomes

Journal of Vascular Surgery — Thu, 03 Nov 2011 04:00:00 +0100

Conclusions: Resident surgeon participation during CEA is not associated with risk of adverse perioperative events. (Source: Journal of Vascular Surgery)

Multidisciplinary approach to carotid stenting

Internal Medicine Journal — Tue, 01 Nov 2011 04:00:00 +0100

Conclusion: A multidisciplinary approach is a useful strategy for initiating and sustaining a CAS programme. (Source: Internal Medicine Journal)

Complete transposition of carotid bifurcation: can it be an additional risk factor of injury to the cranial nerves during carotid endarterectomy?

Interactive CardioVascular and Thoracic Surgery — Tue, 01 Nov 2011 04:00:00 +0100

The internal carotid artery (ICA) usually, lies posterolaterally to the external carotid artery (ECA). Sometimes a complete carotid transposition can occur, with the ECA in a lateral position and the ICA on the medial side can occur. Our study evaluated the significance and impact that this anomaly may have on cranial nerve injuries. From January 2008 to November 2010, 296 patients underwent 360 consecutive primary carotid endarterectomy (CEA) procedures. During carotid isolation, we detected an unexpected lateral position of the ECA in 11 cases (3.6%). 2 analysis and the Student's t-test were used to compare the incidence of cranial nerve injuries between the 11 patients with the lateral ECA who underwent CEA (group A) and 11 randomized patients with a normal bifurcation (group B). Statis...

The Nationwide Inpatient Sample may contain inaccurate data for carotid endarterectomy and carotid stenting

Journal of Vascular Surgery — Mon, 31 Oct 2011 04:00:00 +0100

The Nationwide Inpatient Sample (NIS) contains information from discharge abstracts submitted by hundreds of community hospitals across the United States, and it frequently has been used as a resource for population-based research comparing the safety of carotid artery stenting (CAS) to that of carotid endarterectomy (CEA). However, at least two findings from the NIS dataset seem open to question. First, several NIS studies have indicated that more than 90% of CEAs and CAS procedures now are being done in asymptomatic patients, a figure that substantially exceeds the prevalence of asymptomatic patients that has been reported elsewhere. Second, these studies also have suggested that the periprocedural stroke rate for CEA and CAS is lower at community hospitals contributing to the NIS than i...

Decreased Kidney Function an Unrecognized and Often Untreated Risk Factor for Secondary Cardiovascular Events After Carotid Surgery

Journal of Vascular Surgery — Thu, 27 Oct 2011 11:45:46 +0100

Patients with moderate kidney failure have an increased risk of cardiovascular death and an increased risk of myocardial infarction 3 years after carotid endarterectomy (CEA) compared with patients with normal or mild renal impairment. (Source: Journal of Vascular Surgery)

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Hybrid Repair of an Infected Carotid Artery Pseudoaneurysm in a High-Risk Patient

Journal of Vascular Surgery — Thu, 27 Oct 2011 11:45:46 +0100

Background: Infected carotid artery pseudoaneurysm (CAP) is a rare complication following carotid endarterectomy. Continued risk of expansion and rupture necessitates urgent repair. Surgical therapy for infected CAP can be challenging with associated risk of disabling stroke and death. Recent reports in the literature describe endovascular therapy as a safer alternative to repair of infected CAP. (Source: Journal of Vascular Surgery)

Floating Thrombus as a Marker of Unstable Atheromatous Carotid Plaque

Annals of Vascular Surgery — Thu, 27 Oct 2011 11:40:48 +0100

We present three patients diagnosed with acute stroke, with a floating thrombus complicating an atheromatous plaque, who were treated with anticoagulants and statins. Although two patients had satisfactory results, one patient suffered a stroke related to plaque progression nearly 3 years after initial presentation. Medical treatment seems to be a good initial option, although late cerebral ischemic complications may be seen due to carotid plaque instability. Delayed carotid endarterectomy or stenting should be considered in cases with subsequent plaque progression. (Source: Annals of Vascular Surgery)

Carotid Artery Stenting After Carotid Endarterectomy

Annals of Vascular Surgery — Thu, 27 Oct 2011 11:40:48 +0100

We present a patient with residual stenosis of the distal internal carotid artery following carotid endarterectomy that was treated with stenting. The case highlights the potential complimentary benefits of carotid endarterectomy and carotid stenting. (Source: Annals of Vascular Surgery)

An Alternative Surgical Procedure for a Patient with Critically Restenosed and Kinked Carotid Artery: Graft Interposition

EURASIP Journal on Bioinformatics and Systems Biology — Mon, 24 Oct 2011 13:11:48 +0100

We present our surgical approach to a case with significant stenosis and kinking of internal carotid artery. We performed a 6-mm-PTFE graft interposition between common and internal carotid artery and resection of the kinking segment. (Source: EURASIP Journal on Bioinformatics and Systems Biology)

Complete transposition of carotid bifurcation: can it be an additional risk factor of injury to the cranial nerves during carotid endarterectomy? [Institutional report - Vascular general]

Interactive CardioVascular and Thoracic Surgery — Fri, 21 Oct 2011 04:00:00 +0100

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A Surgeon’s View on Endarterectomy and Stenting in 2011: Lest We Forget, It’s All About Preventing Stroke

CardioVascular and Interventional Radiology — Tue, 18 Oct 2011 06:00:48 +0100

This article reviews the history of invasive interventions in the treatment of carotid disease and makes a plea to both the surgical and interventional communities that the fundamental priority must always be the prevention of stroke. It concludes with an appeal for colleagues to collaborate to determine how best to treat patients during the hyperacute period after the onset of symptoms and to identify a smaller cohort of asymptomatic patients who are truly at high risk for stroke in whom to target CAS or CEA. Content Type Journal ArticleCategory ReviewPages 1-9DOI 10.1007/s00270-011-0282-zAuthors A. Ross Naylor, Vascular Surgery Group, Division of Cardiovascular Sciences, Leicester Royal Infirmary, Clinical Sciences Building, Leicester, LE2 7LX UK Journal CardioVascular ...

Influence of Chronic Renal Insufficiency on Outcomes Following Carotid Revascularization [Original Article]

Archives of Surgery — Mon, 17 Oct 2011 04:00:00 +0100

Conclusions Chronic kidney disease is prevalent among patients undergoing carotid revascularization. Overall, patients with moderate renal function have similar outcomes. However, those with severe renal insufficiency have significantly higher 30-day mortality when undergoing carotid revascularization. (Source: Archives of Surgery)

The safety and feasibility of outpatient carotid endarterectomy

Clinical Neurology and Neurosurgery — Fri, 14 Oct 2011 04:00:00 +0100

Abstract: Background: Carotid endarterectomy (CEA) is one of the most commonly performed and studied surgical procedures for extracranial ischemic disease.Objective: The authors reviewed the outcome of 39 consecutive carotid endarterectomy procedures performed by a single surgeon with emphasis on the safety of discharging patients the same day of the procedure.Methods: Retrospective analysis was performed over a two-year period on patients who were admitted as outpatients and underwent CEA. Following CEA, patients were observed for 4–6h in the recovery room and Duplex ultrasonography was completed to assess the endarterectomy repair. Determination was then made whether patients could be safely discharged home.Results: Over a two year period, CEA was performed 39 times in 37 outpatients. ...

Effects of Carotid Endarterectomy or Stenting on Blood Pressure in the International Carotid Stenting Study (ICSS).

Stroke — Thu, 13 Oct 2011 04:00:00 +0100

CONCLUSIONS: CAS leads to a larger early decrease in BP than CEA, but this effect does not persist over time. CAS may lessen the requirement for antihypertensive medication more than CEA.Clinical Trial Registration-URL: www.controlled-trials.com. Unique identifier: ISRCTN25337470. PMID: 21998053 [PubMed - as supplied by publisher] (Source: Stroke)

General or Local Anesthesia for Carotid Endarterectomy--The "Real-World" Experience

Angiology — Tue, 11 Oct 2011 04:00:00 +0100

Perioperative complications from carotid endarterectomy (CEA) are the main drawbacks of the procedure. The aim of this study was to assess the complication rates in patients undergoing CEA under general anesthesia (GA) or regional anesthesia (local anesthesia [LA]) at our institution. Patients undergoing CEA at our regional vascular unit between 2000 and 2004 were included. Data were collated retrospectively from a prospective database. Follow-up was up to 62 months. In all, 383 endarterectomies were performed, 260 of which were under LA. Outcome measures included 30-day death (2.1%), stroke (1.8%), and combined stroke and death (2.8%). A 30-day incidence of stroke, death, and combined stroke and death was lower in the LA group. Incidence of myocardial infarction and transient ischemic att...

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Stroke: Consider age when treating patients with carotid stenosis

Cardiovascular Business News — Mon, 10 Oct 2011 13:52:48 +0100

Elderly patients treated with carotid artery stenting (CAS) faced a higher risk of stroke with increasing age compared with patients treated with carotid endarterectomy (CEA), according to a study published Oct. 6 in the online issue of Stroke. Based on the results, the authors recommend physicians take patient age into consideration when choosing a treatment for carotid stenosis. (Source: Cardiovascular Business News)

Inflammation as a Marker for the Prediction of Internal Carotid Artery Restenosis Following Eversion Endarterectomy--Evidence From Clinical Studies

Angiology — Fri, 07 Oct 2011 04:00:00 +0100

The role of inflammation is well established in the pathogenesis of atherosclerosis and an increased level of circulating inflammatory markers may predict the future risk of atherosclerosis progression and plaque rupture. C-reactive protein (CRP) identification by hypersensitive methods (high-sensitivity CRP [hsCRP]) has become a clinical and laboratory inflammation marker. Carotid endarterectomy (CEA) is a well-established procedure for carotid stenosis treatment which can reduce stroke rate. Internal carotid artery (ICA) restenosis reduction may be prevented by the anti-inflammatory effect of statins. This review considers the recent findings on the presence of hsCRP and C3 complement concentration and inflammatory plaque composition as well as their effects on ICA restenosis rate, follo...

Percutaneous and Open Retrograde Endovascular Stenting of Symptomatic High-Grade Innominate Artery Stenosis: Technique and Follow-Up [INTERVENTIONAL]

American Journal of Neuroradiology — Fri, 07 Oct 2011 04:00:00 +0100

CONCLUSIONS: Percutaneous and open retrograde stenting of high-grade stenosis of the IA is a viable less invasive alternatives to open bypass surgery with good midterm clinical results and patency rates. (Source: American Journal of Neuroradiology)

Low-Dose (1 {micro}g/kg) Clonidine Premedication and Hypotension After Carotid Artery Surgery

Vascular and Endovascular Surgery — Fri, 07 Oct 2011 04:00:00 +0100

We investigated the role of low-dose clonidine intravenous (IV) premedication in arterial pressure variation during and after carotid endarterectomy (CEA). A total of 84 patients, American Society of Anesthesiologists (ASA) II-III, scheduled for elective CEA under general anesthesia participated in this study. The patients were divided into 2 groups: group P (n = 42) and group C (n = 42) and received N/S 0.9% (placebo) or clonidine 1 µg/kg IV, respectively, 15 minutes before induction of anesthesia. Recovery times, number of patients needed to be treated for circulatory events (hypertension, hypotension, and bradycardia), number of circulatory events per patient, and consumption of vasoactive drugs (nitroglycerine, phenylphrine, and atropine) intraoperatively and the first 6 hours po...

Are symptomatic TIA patients being appropriately referred for carotid endarterectomy?

International Journal of Surgery — Thu, 06 Oct 2011 22:52:32 +0100

Aim: During 2009, 42 patients underwent carotid endarterectomy (CEA) despite 1700 carotid Doppler ultrasound scans (cDUSS) being performed within the Morecambe Bay University Teaching Hospitals Trust for symptoms of transient ischaemic attack (TIA). We aimed to find out why the CEA rate is so low. (Source: International Journal of Surgery)

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Hypertension and the post-carotid endarterectomy cerebral hyperperfusion syndrome

International Journal of Surgery — Thu, 06 Oct 2011 22:52:31 +0100

Introduction: Cerebral hyperperfusion syndrome (CHS) is a preventable cause of haemmorhagic stroke after carotid endarterectomy. There is no consensus on blood pressure thresholds, choice of antihypertensive or duration of treatment. (Source: International Journal of Surgery)

The patients’ perspective of carotid endarterectomy

International Journal of Surgery — Thu, 06 Oct 2011 22:52:31 +0100

Objectives: Carotid endarterectomy (CEA) has level 1 evidence for prevention of embolic stroke in high-risk carotid stenosis. Despite this, no studies as yet have directly evaluated the patients’ perspective of this treatment. Here, for the first time, we determine patient satisfaction and perception of CEA. (Source: International Journal of Surgery)

Hypertension and the post-carotid endarterectomy cerebral hyperperfusion syndrome

International Journal of Surgery — Thu, 06 Oct 2011 22:52:31 +0100

Objective: Cerebral hyperperfusion syndrome is a preventable cause of stroke after carotid endarterectomy. The purpose of this review was to identify the optimal blood pressure control strategy post-operatively. (Source: International Journal of Surgery)

Patient preference in the management of asymptomatic carotid stenosis

International Journal of Surgery — Thu, 06 Oct 2011 22:52:31 +0100

Background: Carotid stenosis accounts for approximately 20% of ischaemic strokes and can be managed using best medical therapy, carotid endarterectomy or carotid artery stenting. The management of asymptomatic carotid stenosis remains a topic of debate amongst clinicians. The aim of this study was to explore patient preference in the management of asymptomatic carotid stenosis. (Source: International Journal of Surgery)

The value of a stroke/TIA pathway (STP) for symptomatic carotid surgical patients

International Journal of Surgery — Thu, 06 Oct 2011 22:52:31 +0100

We examined the utility of a STP in order to achieve NICE stroke targets. (Source: International Journal of Surgery)

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Age and Outcomes After Carotid Stenting and Endarterectomy: The Carotid Revascularization Endarterectomy Versus Stenting Trial.

Stroke — Thu, 06 Oct 2011 04:00:00 +0100

CONCLUSIONS: Outcomes after CAS versus CEA were related to patient age, attributable to increasing risk for stroke after CAS at older ages. Patient age should be an important consideration when choosing between the 2 procedures for treating carotid stenosis.Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00004732. PMID: 21980205 [PubMed - as supplied by publisher] (Source: Stroke)

The War Against Error: A 15 Year Experience of Completion Angioscopy Following Carotid Endarterectomy

European Journal of Vascular and Endovascular Surgery — Wed, 05 Oct 2011 04:00:00 +0100

Conclusion: Most intra-operative strokes probably follow embolisation of thrombus following restoration of flow. This can be prevented by angioscopy which has the advantage of being performed prior to flow restoration. Increasing experience was associated with a decline in the detection of intimal flaps, but not in the prevalence of retained thrombus. Even the most experienced of surgeons can still be responsible for inadvertent technical error. (Source: European Journal of Vascular and Endovascular Surgery)

Report: Endo devices replacing open surgery

Cardiovascular Business News — Tue, 04 Oct 2011 15:00:21 +0100

Endovascular surgical techniques may outshine conventional open methods, according to an Frost & Sullivan analysis, “Endovascular Surgical Intervention—Technology Market Penetration Analysis.” The analysis outlined how intravascular balloons, stents and coils for varied endo procedures have become the wave of the future and have provided alternatives to CABG, carotid endarterectomy (CEA) and aneurysm clipping procedures. (Source: Cardiovascular Business News)

The War Against Error: A 15 Year Experience of Completion Angioscopy Following Carotid Endarterectomy.

PubMed: Eur J Vasc Endovasc ... — Tue, 04 Oct 2011 04:00:00 +0100

CONCLUSION: Most intra-operative strokes probably follow embolisation of thrombus following restoration of flow. This can be prevented by angioscopy which has the advantage of being performed prior to flow restoration. Increasing experience was associated with a decline in the detection of intimal flaps, but not in the prevalence of retained thrombus. Even the most experienced of surgeons can still be responsible for inadvertent technical error. PMID: 21978466 [PubMed - as supplied by publisher] (Source: PubMed: Eur J Vasc Endovasc ...)

Life quality similar 1 year after CAS, CEA

MedWire News - Stroke — Mon, 03 Oct 2011 12:56:27 +0100

Long-term health-related quality of life is not a major consideration when choosing between carotid artery stenting and carotid endarterectomy, show findings from CREST. (Source: MedWire News - Stroke)

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Defining the type of surgeon volume that influences the outcomes for open abdominal aortic aneurysm repair

Journal of Vascular Surgery — Mon, 03 Oct 2011 04:00:00 +0100

Conclusions: The current study suggests that composite surgeon volume—not operation-specific volume—is a key determinant of in-hospital mortality for open AAA repair. This finding needs to be considered for future credentialing of surgeons. (Source: Journal of Vascular Surgery)

Health-Related Quality of Life After Carotid Stenting Versus Carotid Endarterectomy: Results From CREST (Carotid Revascularization Endarterectomy Versus Stenting Trial)

Journal of the American College of Cardiology — Mon, 03 Oct 2011 01:34:52 +0100

Conclusions: Among patients undergoing carotid revascularization, CAS is associated with better HRQOL during the early recovery period as compared with CEA—particularly with regard to physical limitations and pain—but these differences diminish over time and are not evident after 1 year. Although CAS and CEA are associated with similar overall HRQOL at 1 year, event-specific analyses confirm that stroke has a greater and more sustained impact on HRQOL than MI. (Carotid Revascularization Endarterectomy versus Stenting Trial [CREST]; NCT00004732) (Source: Journal of the American College of Cardiology)

[Risk of stroke and death after carotid endarterectomy].

Medicina (Kaunas) — Sun, 02 Oct 2011 01:15:02 +0100

CONCLUSIONS. Diabetes mellitus, any stroke, and low-volume vascular surgeon were significant predictors for poor outcome after carotid endarterectomy. PMID: 21956139 [PubMed - in process] (Source: Medicina (Kaunas))

Regarding carotid endarterectomy in asymptomatic patients (Re: ANZ J. Surg. 2011; 81: 211–3)

ANZ Journal of Surgery — Sat, 01 Oct 2011 04:00:00 +0100

(Source: ANZ Journal of Surgery)

Comparative Analysis of Endarterectomy and Stenting For the Treatment of Carotid Stenosis in Women

Journal of Vascular Surgery — Sat, 01 Oct 2011 04:00:00 +0100

Although large randomized studies have established the efficacy and safety of carotid endarterectomy (CEA) and stenting (CAS), the under-representation of women leaves the comparison of risks to benefits of performing these procedures on women an open question. To address this issue, we delineated patient characteristics predicting outcomes in women undergoing carotid interventions. (Source: Journal of Vascular Surgery)

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Comparison of Carotid Endarterectomy and Stenting in Real-World Practice Using a Regional Quality-Improvement Registry

Journal of Vascular Surgery — Sat, 01 Oct 2011 04:00:00 +0100

This study compared the outcomes of CAS and carotid endarterectomy (CEA) in real-world practice. (Source: Journal of Vascular Surgery)

Patients Considered “High Risk” For Carotid Endarterectomy are at Increased Risk of Adverse Events After Carotid Artery Stenting

Journal of Vascular Surgery — Sat, 01 Oct 2011 04:00:00 +0100

Current guidelines allow stenting as an alternative in patients considered “high risk” for carotid endarterectomy (CEA). There is conflicting evidence regarding high-risk criteria for CEA and the safety of stenting in these patients. Using CMS inclusion criteria for carotid artery stenting (CAS), we stratified patients that underwent CAS or CEA by risk status and compared their outcomes. (Source: Journal of Vascular Surgery)

A strategy to meet the 'two-week' target for carotid endarterectomy in symptomatic patients.

Clinical Medicine — Sat, 01 Oct 2011 04:00:00 +0100

This study assesses the impact of institution-wide policy changes on CEA performance in symptomatic patients. Between two study periods (1 January 2007 and 31 December 2007; 1 August 2008 and 31 July 2009) transient ischaemic attack (TIA) clinics, an acute stroke protocol and utilisation of vascular operating lists, were adopted. Following the changes, the interval between the INE and CEA fell from 23 (n = 65; interquartile range (IQR) 9-66) to 6.5 (n = 52; IQR 2-13.5) days (p < 0.001) with 32.3% v 82.7% performed within two weeks (p < 0.001). Significant improvements were seen in the time taken from onset of symptoms to presentation, and presentation to a carotid duplex and surgical review. Univariate analyses suggest this improvement is associated with the type of INE, point of pre...

Carotid endarterectomy for symptomatic complete occlusion of the internal carotid artery.

Acta Med Okayama — Sat, 01 Oct 2011 04:00:00 +0100

This study evaluated the association of WRN Leu1074Phe (rs1801195), a common missense single nucleotide polymorphism in WRN, with prostate cancer susceptibility in Chinese subjects. One hundred and forty-seven prostate cancer patients and 111 male cancer-free control subjects from 3 university hospitals in China were included. Blood samples were obtained from each subject, and the single nucleotide polymorphism WRN Leu1074Phe was genotyped by using a Snapshot assay. The results showed that WRN Leu1074Phe was associated with the risk of prostate cancer in Chinese men and that the TG/GG genotype displayed a decreased prevalence of prostate cancer compared with the TT genotype (OR＝0.58, 95%CI:0.35-0.97, p＝0.039). Through stratified analysis, more significant associations were revealed for...

A Quantitative EEG Method for Detecting Post Clamp Changes During Carotid Endarterectomy

Journal of Clinical Monitoring and Computing — Fri, 30 Sep 2011 06:31:34 +0100

Conclusion By applying automatic data-driven feature extraction and classification to short EEG records, it is possible to construct subject-independent computational models that can detect subtle post clamp changes possibly caused by small perturbations in cerebral blood flow. These subtle changes are missed by visual inspection of the EEG and by other quantitative EEG techniques such as r-sBSI and r-tBSI. Within our subject group, the intricate post-clamp EEG signatures were predominantly anterior, bilateral, and had a strong delta rhythm presence. Content Type Journal ArticlePages 1-14DOI 10.1007/s10877-011-9308-yAuthors Meenakshi Mishra, Department of Computer Science and Electrical Engineering, School of Computing and Engineering, University of Missouri at Ka...

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Does a Contralateral Carotid Occlusion Adversely Impact Carotid Artery Stenting Outcomes?

Annals of Vascular Surgery — Fri, 30 Sep 2011 04:00:00 +0100

Conclusion: A preexisting contralateral carotid artery occlusion does not seem to adversely impact CAS outcomes. (Source: Annals of Vascular Surgery)

Comments regarding ‘Correlations Between Clinical Variables and Gene-expression Profiles in Carotid Plaque Instability’

European Journal of Vascular and Endovascular Surgery — Thu, 29 Sep 2011 04:00:00 +0100

A clever and effective idea from the Karolinska Institute in Stockholm, Sweden, with collaborations between a center of Molecular Medicine and the clinical divisions of Surgery and Internal Medicine, generated this paper, capitalising on an interesting project generating a “bio-bank” (BIKE) of gene expression profiles and clinical information from 106 patients undergoing carotid endarterectomy (CE). (Source: European Journal of Vascular and Endovascular Surgery)

Comments regarding ‘Carotid Endarterectomy within Seven Days after the Neurological Index Event is Safe and Effective in Stroke Prevention’

European Journal of Vascular and Endovascular Surgery — Mon, 26 Sep 2011 04:00:00 +0100

The conclusions drawn in the large retrospective study of Rantner and coworkers (early carotid endarterectomy (CEA) is safe and will prevent stroke in the majority of patients) are clear, but might need some refinements. At present, we cannot tar every patient with a symptomatic carotid stenosis with the same brush. Rerkasem et al. performed a systemic review of the operative risks of CEA for recently symptomatic patients in relation to timing of surgery. The pooled absolute risks of stroke and death after urgent CEA were up to 20% in patients with stroke-in-progress, and 11.4% in patients with crescendo transient ischemic attacks (TIA). Only in the group of neurologically stable patients (TIA or minor stroke) no differences were found between early ( (Source: European Journal of Vascular...

Case-matched Comparison of Early and Long-term Outcomes of Everted Cervical Vein and Saphenous Vein Carotid Patch Angioplasty

European Journal of Vascular and Endovascular Surgery — Mon, 26 Sep 2011 04:00:00 +0100

Conclusions: CV is a good alternative to SV patching, particularly when the SV needs to be preserved for further use or is unsuitable. (Source: European Journal of Vascular and Endovascular Surgery)

Carotid endarterectomy protects elderly patients from cognitive decline: A prospective study

Surgery — Mon, 26 Sep 2011 04:00:00 +0100

Background: Carotid endarterectomy (CEA) reduces the risk of stroke in selected patients with symptomatic and asymptomatic carotid disease, but its beneficial influence on cognitive performance in the elderly remains debatable. This prospective study sought to determine early and long-term neurocognitive outcomes after CEA for severe unilateral carotid artery stenosis.Methods: From July 2006 to December 2008, 75 symptomatic (group A) and 70 asymptomatic patients (group B) aged 65 years and older underwent CEA under general anesthesia. Sixty-eight age- and sex-matched individuals who underwent laparoscopic cholecystectomy during the same period at our institution served as a control group (group H). Patients with contralateral severe carotid stenosis or occlusion and those with dementia, de...

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In vivo and ex vivo measurements of the mean ADC values of lipid necrotic core and hemorrhage obtained from diffusion weighted imaging in human atherosclerotic plaques

Journal of Magnetic Resonance Imaging — Fri, 16 Sep 2011 04:00:00 +0100

Conclusion:ADC values of the carotid plaque components in vivo are consistent with values obtained from ex vivo endarterectomy specimens. The ability to obtain consistent plaque ADC values in vivo indicates that this technique could be an integral part of the basis for plaque component identification in conjunction with other MRI techniques. J. Magn. Reson. Imaging 2011;. © 2011 Wiley‐Liss, Inc. (Source: Journal of Magnetic Resonance Imaging)

Collagenase matrix metalloproteinase-8 expressed in atherosclerotic carotid plaques is associated with systemic cardiovascular outcome

European Heart Journal — Wed, 14 Sep 2011 04:00:00 +0100

Conclusion In contrast with MMP-2, increased carotid MMP-8 and MMP-9 plaque levels are associated with an unstable plaque phenotype. High collagenase MMP-8 levels in the carotid plaque are associated with the occurrence of systemic cardiovascular outcome during follow-up. (Source: European Heart Journal)

Cognition after carotid endarterectomy or stenting: A randomized comparison

Neurology — Mon, 12 Sep 2011 04:00:00 +0100

Conclusions: Differences between CAS and CEA in effect on cognition were not statistically significant, despite a substantially higher rate of new ischemic lesions after CAS than after CEA. Classification of Evidence: This study provides Class III evidence that any difference between the effects of CAS and CEA on cognition at 6 months after revascularization is small. (Source: Neurology)

Novel serum biomarkers in carotid artery stenosis: Useful to identify the vulnerable plaque?

Clinical Biochemistry — Mon, 12 Sep 2011 04:00:00 +0100

CONCLUSION: Our findings suggest that serum neopterin and sTREM-1 levels may be related to the presence of atherosclerotic disease, but not to carotid plaque vulnerability. PMID: 21939648 [PubMed - as supplied by publisher] (Source: Clinical Biochemistry)

Shunting during carotid endarterectomy

Journal of Vascular Surgery — Mon, 12 Sep 2011 04:00:00 +0100

Conclusions: The use of routine shunting and selective shunting was associated with a low stroke rate. Both methods are acceptable, and the individual surgeon should select the method with which they are more comfortable. (Source: Journal of Vascular Surgery)

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Eversion versus Conventional Carotid Endarterectomy: A Meta-analysis of Randomised and Non-randomised Studies

European Journal of Vascular and Endovascular Surgery — Fri, 09 Sep 2011 04:00:00 +0100

Conclusions: ECEA compared to CCEA may be associated with a lower incidence in both short-term and long-term outcomes, which does not seem to be hampered by potentially meaningful modifiers. (Source: European Journal of Vascular and Endovascular Surgery)

Assessment of the Genetic Effects of Polymorphisms in the Osteoprotegerin Gene, TNFRSF11B, on Serum Osteoprotegerin Levels and Carotid Plaque Vulnerability.

Stroke — Thu, 08 Sep 2011 04:00:00 +0100

CONCLUSIONS: The TNFRSF11B gene polymorphisms studied are associated with high serum OPG levels and might be potential markers for plaque instability. PMID: 21903966 [PubMed - as supplied by publisher] (Source: Stroke)

Eversion versus Conventional Carotid Endarterectomy: A Meta-analysis of Randomised and Non-randomised Studies.

PubMed: Eur J Vasc Endovasc ... — Wed, 07 Sep 2011 04:00:00 +0100

CONCLUSIONS: ECEA compared to CCEA may be associated with a lower incidence in both short-term and long-term outcomes, which does not seem to be hampered by potentially meaningful modifiers. PMID: 21903425 [PubMed - as supplied by publisher] (Source: PubMed: Eur J Vasc Endovasc ...)

Carotid Endarterectomy within Seven Days after the Neurological Index Event is Safe and Effective in Stroke Prevention

European Journal of Vascular and Endovascular Surgery — Mon, 05 Sep 2011 04:00:00 +0100

Conclusion: An infarction on the preoperative CCT leads to an increased risk for a postoperative deterioration after CEA. Patients should be treated at an early point in time with bland CCTs. (Source: European Journal of Vascular and Endovascular Surgery)

The results of a simplified technique for safe carotid stenting in the elderly

Journal of Vascular Surgery — Mon, 05 Sep 2011 04:00:00 +0100

Conclusion: The results of this preliminary study indicate that the transcervical approach with flow reversal during the insertion of the protecting filter allows CAS with minimal interruption of cerebral circulation and is simple and safe in patients unsuitable for CEA and transfemoral CAS for anatomic reasons. Further research with randomization and with pre-procedure and post-procedure diffusion-weighted magnetic resonance imaging (DW-MRI) is required in order to expand the indications of this method. (Source: Journal of Vascular Surgery)

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‘Small’ differences in cognitive outcomes after CAS, CEA

MedWire News - Stroke — Mon, 05 Sep 2011 00:00:00 +0100

Patients requiring carotid revascularization are unlikely to suffer significantly more cognitive impairment if they undergo carotid artery stenting rather than carotid endarterectomy, say researchers. (Source: MedWire News - Stroke)

Carotid Endarterectomy within Seven Days after the Neurological Index Event is Safe and Effective in Stroke Prevention.

PubMed: Eur J Vasc Endovasc ... — Fri, 02 Sep 2011 04:00:00 +0100

CONCLUSION: An infarction on the preoperative CCT leads to an increased risk for a postoperative deterioration after CEA. Patients should be treated at an early point in time with bland CCTs. PMID: 21890386 [PubMed - as supplied by publisher] (Source: PubMed: Eur J Vasc Endovasc ...)

The use of formal and informal knowledge sources in patients’ treatment decisions in secondary stroke prevention: qualitative study

Health Expectations — Thu, 01 Sep 2011 04:00:00 +0100

Conclusions In addition to formal evidence, patients use other sources of informal or ‘non‐evidentiary’ knowledge to support their decisions about treatment after TIA or recovered stroke. To enable evidence‐based patient choice, health professionals need to appreciate the diverse types of evidence which patients use, to help them to access relevant and high‐quality evidence, to balance evidence from different sources and to make choices which are congruent with their values and expectations. (Source: Health Expectations)

Post‐operative risk factor control following internal carotid artery intervention

ANZ Journal of Surgery — Thu, 01 Sep 2011 04:00:00 +0100

Conclusion: Future strategy targeted at achieving optimal post‐CEA and carotid angioplasty with adjuvant stenting risk factor control should consider incorporating themes that increase the level of accurate patient insight into their disease (particularly their post‐operative risk factor control), for instance, patient education and effective doctor–patient communication. (Source: ANZ Journal of Surgery)

Carotid endarterectomy in patients with foetal-type posterior circle of Willis: Is there an indication for local anaesthesia?

VASA. Zeitschrift fur Gefasskrankheiten. Journal for Vascular Diseases — Thu, 01 Sep 2011 04:00:00 +0100

We present a case of CEA under local anaesthesia (LA) in a 52-year-old female patient with symptomatic stenosis of the right ICA and coexistent foetal-type posterior circle of Willis. There were no post-operative complications and she was discharged free from symptoms. She was seen again 3 months later and was free from complications. This case higlights that LA should be strongly considered to enable better intra-operative neurological monitoring in the event of foetal-type posterior circle of Willis. PMID: 21948784 [PubMed - in process] (Source: VASA. Zeitschrift fur Gefasskrankheiten. Journal for Vascular Diseases)

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Comparison between carotid stenting and carotid endarterectomy in early outcome.

Collegium Antropologicum — Thu, 01 Sep 2011 04:00:00 +0100

Authors: Kovacić S, Kovacević M, Strenja-Linić I, Budiselić B, Knezević S Abstract Carotid artery stenting (CAS) is a widely used method in prevention of stroke for carotid artery stenosis as an alternative to surgical treatment. Initial studies reveal higher morbidity and mortality rates for CAS than acceptable standards for carotid endarterectomy (CEA). The aim of this study was to compare results in a series of CAS with concurrent risk-matched group of CEA patients. The study included two groups of 50 patients with internal carotid artery stenosis. We compared early outcome (30 days after procedure) in risk-matched groups of patients that underwent these procedures. Post procedural complications were equally frequent in both groups. There was no significant difference in pe...

Early identification of patients with the risk for postoperative carotid restenosis development.

Collegium Antropologicum — Thu, 01 Sep 2011 04:00:00 +0100

Authors: Strenja-Linić I, Kovacević M, Kovacić S, Ivancić A, Budiselić B Abstract Multiple randomized trials over the last decade for both symptomatic and asymptomatic carotid stenosis have proven the efficacy of carotid endarterectomy (CEA) in reducing the risk of stroke. The aim of this prospective non-randomizing cohort study was to determine the incidence of carotid arteries restenosis after CEA as well as to ascertain the clinical and etiological characteristics for the development of restenosis. Treatment data from 178 KBC Rijeka patients that had undergone CEA in the period 1. 09. 2005-30. 8. 2009 has been processed. All patients are monitored trough our Neurosonology laboratory algorythm--first Doppler ultrasound examination within the first week after CEA and the foll...

Reprinted article "carotid artery disease and stroke during coronary artery bypass: a critical review of the literature".

PubMed: Eur J Vasc Endovasc ... — Wed, 31 Aug 2011 23:00:00 +0100

CONCLUSIONS: Carotid disease is an important aetiological factor in the pathophysiology of post-CABG stroke. However, even assuming that prophylactic carotid endarterectomy carried no additional risk, it could only ever prevent about 40-50% of procedural strokes. PMID: 21855029 [PubMed - in process] (Source: PubMed: Eur J Vasc Endovasc ...)

Reprinted Article "Carotid Artery Plaque Composition-Relationship to Clinical Presentation and Ultrasound B-mode Imaging".

PubMed: Eur J Vasc Endovasc ... — Wed, 31 Aug 2011 23:00:00 +0100

CONCLUSION: Ultrasound B-mode characteristics are related to the histological composition of carotid artery plaques and to patient's history. These results may imply that patients with distant symptoms may be regarded and treated as asymptomatic patients whereas asymptomatic patients with echolucent plaques should be considered for carotid endarterectomy. PMID: 21855017 [PubMed - in process] (Source: PubMed: Eur J Vasc Endovasc ...)

Updated Society for Vascular Surgery guidelines for management of extracranial carotid disease: Executive summary

Journal of Vascular Surgery — Wed, 31 Aug 2011 23:00:00 +0100

In 2008, the Society for Vascular Surgery published guidelines for the treatment of carotid bifurcation stenosis. Since that time, a number of prospective randomized trials have been completed and have shed additional light on the best treastment of extracranial carotid disease. This has prompted the Society for Vascular Surgery to form a committee to update and expand guidelines in this area. The review was done using the GRADE methodology.In contrast to the multispecialty guidelines recently published, the committee recommends carotid endarterectomy (CEA) as first line treatment for most symptomatic patients with stenosis 50% to 99% and asymptomatic patients with stenosis 60% to 99%. The perioperative risk of stroke and death in asymptomatic patients must be below 3% to ensure benefit fo...

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Updated Society for Vascular Surgery guidelines for management of extracranial carotid disease

Journal of Vascular Surgery — Wed, 31 Aug 2011 23:00:00 +0100

Management of carotid bifurcation stenosis is a cornerstone of stroke prevention and has been the subject of extensive clinical investigation, including multiple controlled randomized trials. The appropriate treatment of patients with carotid bifurcation disease is of major interest to the community of vascular surgeons. In 2008, the Society for Vascular Surgery published guidelines for treatment of carotid artery disease. At the time, only one randomized trial, comparing carotid endarterectomy (CEA) and carotid stenting (CAS), had been published. Since that publication, four major randomized trials comparing CEA and CAS have been published, and the role of medical management has been re-emphasized. The current publication updates and expands the 2008 guidelines with specific emphasis on s...

Predictors of neck bleeding after eversion carotid endarterectomy

Journal of Vascular Surgery — Wed, 31 Aug 2011 23:00:00 +0100

After carotid endarterectomy (CEA), an individual may be brought back to the operating room for infection, bleeding, or neurologic deficit in the immediate postoperative period or at a later date for recurrent arterial occlusive disease. This review details the former condition, whereas the latter scenario has been described in a previous CPT Advisor article. (Source: Journal of Vascular Surgery)

Anatomical and Technical factors Associated With Stroke or Death During Carotid Angioplasty and Stenting Results from the Endarterectomy Versus Angioplasty in Patients With Symptomatic Severe Carotid Stenosis (EVA-3S) Trial and Systematic Review

Journal of Vascular Surgery — Wed, 31 Aug 2011 23:00:00 +0100

Conclusion: There are technical and anatomic factors, especially extreme angulation of the carotid artery, that impact the risk of carotid artery angioplasty and stenting. Summary: It seems clear, at this point, that large randomized clinical trials of 30-day stroke and death rates favor carotid endarterectomy (CEA) over carotid artery stenting (CAS). However, once the perioperative period has passed, CAS and CEA both appear effective in preventing midterm stroke. The implication is decreasing periprocedural rates of CAS would make the procedure more attractive because long-term stroke prevention after CAS or CEA is more equivalent. The authors sought to assess relationships between anatomic and technical factors and 30-day risk of stroke and death after CAS. The authors included patients...

The Efficacy and Outcomes of Somatosensory-Evoked Potential and Electroencephalography Monitoring During Carotid Endarterectomy: A Single-Center Experience

Journal of Vascular Surgery — Wed, 31 Aug 2011 23:00:00 +0100

Although much is written about multiple methods of neuromonitoring during carotid endarterectomy (CEA), there is relatively little discussion of the use of somatosensory-evoked potentials (SEPs) especially multinerve SEPs in conjunction with electroencephalography (EEG). Our objective was to evaluate the rate of detection and prevention of neurologic events by multinerve SEP and EEG in patients undergoing CEA while under general anesthesia. (Source: Journal of Vascular Surgery)

Class I Obesity is Associated With Decreased Risk of Stroke After Carotid Endarterectomy

Journal of Vascular Surgery — Wed, 31 Aug 2011 23:00:00 +0100

This study examined the relationship between body mass index (BMI) and outcomes after carotid endarterectomy (CEA). (Source: Journal of Vascular Surgery)

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Stroke Prevention: Carotid Stenting and Carotid Endarterectomy Go Neck and Neck

Journal of Radiology Nursing — Wed, 31 Aug 2011 23:00:00 +0100

This article will compare carotid stenting with CEA as a treatment for stroke prevention. The pre-, intra-, and postmonitoring of the patient undergoing this new neurointerventional procedure will be emphasized. (Source: Journal of Radiology Nursing)

Carotid revascularization outcomes comparing distal filters, flow reversal, and endarterectomy

Journal of Vascular Surgery — Fri, 26 Aug 2011 04:00:00 +0100

Introduction: Contradictory outcomes exist for different methods of carotid artery revascularization. Here we provide the comparative rates of adverse events in patients after carotid endarterectomy (CEA), carotid artery stenting (CAS) with a distal embolic protection device (EPD), and CAS with a proximal flow reversal system (FRS) from a single institution by various specialists treating carotid artery disease.Methods: Procedural billing codes and the electronic medical records of patients undergoing revascularization for carotid artery stenosis from February 2007 through March 2010 were used for data collection. Primary outcome was the incidence of cerebrovascular accident (CVA), myocardial infarction (MI), or death after CEA and CAS. Each practitioner determined the choice of therapy, w...

Preprocedural imaging strategies in symptomatic carotid artery stenosis

Journal of Vascular Surgery — Fri, 26 Aug 2011 04:00:00 +0100

Conclusions: DUS is the optimum screening tool due to its sensitivity and specificity, availability, and low cost. When CEA appears indicated, confirmatory imaging with CE-MRA is the most reliable and cost-effective method of investigation. (Source: Journal of Vascular Surgery)

High-Intensity Signal on Time-of-Flight Magnetic Resonance Angiography Indicates Carotid Plaques at High Risk for Cerebral Embolism During Stenting.

Stroke — Wed, 24 Aug 2011 23:00:00 +0100

CONCLUSIONS: HIS in the plaque on TOF-MRA performed for screening could discriminate plaques at high risk for cerebral embolism during CAS. PMID: 21868725 [PubMed - as supplied by publisher] (Source: Stroke)