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Carotid Endarterectomy (carotid + endarterectomy)

Distribution by Scientific Domains

Medical Sciences	98%

Distribution within Medical Sciences

Surgery & Surgical Specialties	53%
Cardiovascular Disease	17%
Neurology	5%
Anesthesia & Pain Management	4%
6 Other Subdomains	16%

Terms modified by Carotid Endarterectomy

carotid endarterectomy specimen

Selected Abstracts

A PHYSIOLOGICAL EXPLANATION FOR AN UNEXPECTED BENEFIT OF CAROTID ENDARTERECTOMY

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 8 2007
Emre Noteroglu MD
No abstract is available for this article. [source]

RISK FACTORS FOR PERI-OPERATIVE STROKE COMPLICATING CAROTID ENDARTERECTOMY: SELECTIVE ANALYSIS OF A PROSPECTIVE AUDIT OF 1000 CONSECUTIVE OPERATIONS

ANZ JOURNAL OF SURGERY, Issue 1 2000
J. E. Frawley
Background: The aim of the present study was to investigate the role of potential clinical risk factors in the causation of peri-operative stroke associated with carotid endarterectomy. With the change in carotid endarterectomy practice from the use of a shunt to high-dose thiopental for cerebral protection (a previously undocumented method), it was essential to identify accurately the causes of all peri-operative strokes. Methods: A prospective audit was undertaken of 1000 carotid endarterectomies in which the causes and pathology of all peri-operative strokes were documented. The roles of advanced age, female gender, hypertension, previous stroke, contralateral carotid stenosis > 70%, and contralateral carotid occlusion as potential causes of peri-operative stroke were defined. Results were statistically analysed using odds ratio and Fisher's exact test. Results: None of the potential risk factors was statistically significant for peri-operative stroke. Female gender was associated with a significant risk of peri-operative stroke due to operative site thrombosis. Complications at the endarterectomy site were the commonest cause of stroke. Conclusions: Prospective audit is a useful tool for identifying causes of peri-operative stroke and indicating the need for modifications to surgical clinical management which might improve outcomes for carotid endarterectomy. [source]

Guidelines for patient selection and performance of carotid artery stenting

ANZ JOURNAL OF SURGERY, Issue 6 2010
The Carotid Stenting Guidelines Committee
Abstract Background:, The endovascular treatment of carotid atherosclerosis with carotid artery stenting (CAS) remains controversial. Carotid endarterectomy remains the benchmark in terms of procedural mortality and morbidity. At present, there are no consensus Australasian guidelines for the safe performance of CAS. Methods:, We applied a modified Delphi consensus method of iterative consultation between the College representatives on the Carotid Stenting Guidelines Committee (CSGC). Results:, Selection of patients suitable for CAS needs careful consideration of clinical and patho-anatomical criteria and cannot be directly extrapolated from clinical indicators for carotid endarterectomy (CEA). Randomized controlled trials (including pooled analyses of results) comparing CAS with CEA for treatment of symptomatic stenosis have demonstrated that CAS is more hazardous than CEA. On current evidence, the CGSC therefore recommends that CAS should not be performed in the majority of patients requiring carotid revascularisation. The evidence for CAS in patients with symptomatic severe carotid stenosis who are considered medically high risk is weak, and there is currently no evidence to support CAS as a treatment for asymptomatic carotid stenosis. The use of distal protection devices during CAS remains controversial with increased risk of clinically silent stroke. The knowledge requirements for the safe performance of CAS include an understanding of the evidence base from randomized controlled trials, carotid and aortic arch anatomy and pathology, clinical stroke syndromes, the differing treatment options for stroke and carotid atherosclerosis, and recognition and management of periprocedural complications. It is critical that all patients being considered for a carotid intervention have adequate pre-procedural neuro-imaging and an independent, standardized neurological assessment before and after the procedure. Maintenance of proficiency in CAS requires active involvement in surgical/endovascular audit and continuing medical education programs. These standards should apply in the public and private health care settings. Conclusion:, These guidelines represent the consensus of an inter-collegiate committee in order to direct appropriate patient selection and the range of cognitive and technical requirements to perform CAS. Advances in endovascular technologies and the results of randomized controlled trials will guide future revisions of these guidelines. [source]

Why do some patients with > 80% stenosis of the internal carotid artery not undergo surgery?

ANZ JOURNAL OF SURGERY, Issue 11 2001
A retrospective review
Background: Carotid endarterectomy is known to benefit both symptomatic and asymptomatic patients with high-grade internal carotid artery stenosis. Duplex scanning is the ,gold standard' for non-invasive preoperative investigation of carotid artery stenosis. The aim of the present study was to analyse the indications for duplex scanning and to identify other factors that influenced the management of patients with high-grade stenosis who did not undergo carotid endarterectomy. Methods: A total of 271 patients was observed to have > 80% stenosis of the internal carotid artery on duplex scanning during the period of review. Of these patients, 85 did not undergo carotid endarterectomy. The vascular laboratory database and hospital records of these patients were retrospectively reviewed. Results: The indications for requesting a carotid duplex scan in the 85 patients were transient ischaemic attack (22%), stroke (25%), symptomatic bruit (7%), asymptomatic bruit (12%), and stroke and symptomatic bruit combined (7%). Falls and preoperative carotid assessment prior to coronary surgery were the commonest indications in the remaining patients. The main risk factors were cardiac (68%), hypertension (60%), respiratory (21%), diabetes (25%), peripheral vascular disease (19%), neoplasm (16%) and renal disease (16%). Twenty-five per cent of the patients were over 80 years of age. Conclusion: In the present study risk factors associated with increased perioperative morbidity and mortality were the commonest explanation for patients with high-grade stenosis of the internal carotid artery not undergoing surgery. These patients would generally not meet the inclusion criteria for the major carotid endarterectomy trials. [source]

Sequential cohort study of Dacron® patch closure following carotid endarterectomy

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 3 2005
T. Ali
Background: Carotid endarterectomy reduces the risk of stroke and death in patients with severe carotid artery stenosis. This study examined whether the technique used to close the arteriotomy influenced the rate of perioperative transient ischaemic attack (TIA), stroke or death. Methods: A cohort of 236 patients undergoing carotid endarterectomy at a single centre was studied; 117 patients had primary closure of the arteriotomy and 119 patients in a sequential series had closure with a Dacron® patch. A standard endarterectomy with completion intraoperative duplex imaging and digital subtraction angiography was used throughout. Results: Patch closure was associated with a significant reduction in the 30-day combined death, stroke and TIA rate: 10·3 per cent for primary closure versus 2·5 per cent for patch closure (P = 0·017). The risk of any cerebral event (stroke or TIA) was also significantly reduced (7·7 versus 1·7 per cent; P = 0·033). Residual stenosis on completion angiography was more common after primary closure (24·6 versus 7·4 per cent; P = 0·003). Conclusion: Dacron® patch closure had a higher technical success rate on completion imaging and was associated with a significant reduction in the risk of perioperative stroke, TIA and death. Copyright © 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Carotid endarterectomy with simultaneous retrograde common carotid artery stenting: Technical Considerations,

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 7 2008
Hernan A. Bazan MD
Abstract Carotid endarterectomy with simultaneous retrograde common carotid artery stenting (CEA-RCCAS) is performed with increasing frequency to treat tandem common and internal carotid artery stenoses. Technical details are not clearly delineated in the literature. Our procedure aims to maximize procedural ease and cerebral protection. Although the need for the endovascular component being performed first, followed by shunt placement, and the use of short wires and sheaths has been advocated, we describe the avoidance of shunt placement and the use of long sheaths to facilitate the procedure using local anesthesia and cervical blockade. Use of local anesthesia, avoidance of a shunt, and use of a long sheath may increase the procedural applicability and safety in some patients. CEA-RCCAS permits safe simultaneous treatment of tandem common and internal carotid artery stenoses. The use of technical adjuncts described here will permit further expansion of the procedure to allow additional patients to be treated in this hybrid fashion. © 2008 Wiley-Liss, Inc. [source]

Role of Chlamydia pneumoniae -infected macrophages in atherosclerosis developments of the carotid artery

NEUROPATHOLOGY, Issue 1 2003
Satoshi Kuroda
Chlamydia pneumoniae (C. pneumoniae) infection has been recently accepted as an important cause of atherosclerosis. However, the precise mechanisms remain unclear. The present study was aimed to clarify the distribution link among C. pneumoniae, chlamydial HSP 60, and activated macrophages. Atheromatous carotid plaques were obtained from 40 consecutive carotid endarterectomies (CEA). The specimens were prepared for HE and elastica,van Gieson staining. Parallel sections were stained immunocytochemically with monoclonal antibodies for a C. pneumoniae -specific antigen, chlamydial HSP 60, activated macrophages, and smooth muscle cells. Immunoreactivity for the C. pneumoniae -specific antigen was observed within the endothelial cells, activated macrophages, and smooth muscle cells in 36 of 40 specimens (90%). Chlamydial HSP 60 was found in all specimens positive for the C. pneumoniae -specific antigen, and mainly co-localized with the C. pneumoniae -specific antigen within the activated macrophages. The present results suggest that C. pneumoniae is a key microbial organ that causes atheroma developments in the carotid artery. Chlamydia pneumoniae -infected macrophages may come into the arterial intima and mediate inflammatory and autoimmune processes through the production of chlamydial HSP 60, leading to atherosclerosis. [source]

Regional anaesthesia and propofol sedation for carotid endarterectomy

ANZ JOURNAL OF SURGERY, Issue 7 2005
Christopher Barringer
Background: Many surgeons now perform carotid endarterectomy under regional anaesthesia. The aim of the present study was to review a sedation technique using a computer-controlled infusion of propofol. Methods: A consecutive series of 84 carotid endarterectomies done by a single surgeon and commenced under regional anaesthesia with sedation was studied. There were 54 men and 27 women (three bilateral procedures), with a median age of 71 years (range 48,87 years). All patients had carotid stenosis >70% 80 procedures were done for symptomatic disease and three asymptomatic patients were treated before cardiac surgery (one bilateral). Results: Seventy-seven procedures were completed under regional anaesthesia and sedation alone; seven required conversion to general anaesthetic, usually for intolerance of the operation. An intraoperative shunt was required on only four occasions (5%). Postoperatively eight patients required critical care monitoring, usually for blood pressure control. The remainder were nursed on the vascular ward, and 68% were discharged home on the day after surgery. No patient died, but there were two neurological complications. One patient had a cerebellar stroke 10 days after surgery, but recovered fully after 4 months. A second developed cerebral oedema due to severe intraoperative hypertension and required intensive care for 15 days. He too recovered fully. Five patients had a further episode of transient cerebral ischaemia within 1 month of operation, but in all cases duplex imaging showed a widely patent carotid and there were no sequelae. Conclusion: Target controlled propofol infusion is an effective method of sedation in patients undergoing carotid endarterectomy. [source]

Carotid redo surgery: both safe and durable

ANZ JOURNAL OF SURGERY, Issue 12 2003
Richard A. Harris
Aim: To examine the outcomes and complications of surgery for recurrent carotid stenosis. Methods: From 1974 to 2000, 1922 carotid endarterectomies were performed in our unit. A retrospective cohort analysis of these records identified 24 patients (1.2%) who underwent surgery for recurrent stenosis. Results: There were 13 men and 11 women in the group. Median follow up was 7.2 years (interquartile range 4.4,12.4 years). The indication for redo surgery was either symptomatic severe (80,99%) or moderate (50,79%) restenosis, or severe asymptomatic (80,99%) restenosis. Repair was performed by patch angioplasty (88%), endarterectomy alone (8%) or interposition grafting (4%). Within the 30 day perioperative period there were no deaths, no strokes (major or minor), or significant cardiac morbidity. One patient (4%) developed a permanent spinal accessory nerve deficit. Another patient (4%) required further re-intervention for recurrent disease. Conclusions: Very low surgical morbidity and mortality was achieved in our unit by implementing a policy of selective re-intervention for carotid restenosis. Redo carotid endarterectomy can therefore be recommended as having no greater morbidity than primary carotid endarterectomy. Carotid angioplasty and stenting are not recommended as a routine alternative treatment. [source]

RISK FACTORS FOR PERI-OPERATIVE STROKE COMPLICATING CAROTID ENDARTERECTOMY: SELECTIVE ANALYSIS OF A PROSPECTIVE AUDIT OF 1000 CONSECUTIVE OPERATIONS

Cognitive performance following endarterectomy in asymptomatic severe carotid stenosis

EUROPEAN JOURNAL OF NEUROLOGY, Issue 5 2003
J. Aharon-Peretz
Cognition and the effects of carotid endarterectomy (CEA) were evaluated in 22 non-demented subjects with vascular risk factors (VRF) and asymptomatic severe carotid artery stenosis (ASCAS), 14 volunteers with VRF but without stenosis, and 24 healthy controls (HC) without VRF. Non-demented subjects with VRF, with or without carotid stenosis scored inferior to HC. It is concluded that carotid stenosis is not a primary cause of cognitive deterioration and CEA does not improve cognition in patients with ASCAS. [source]

Stent-protected angioplasty in asymptomatic carotid artery stenosis vs. endarterectomy: SPACE2 , a three-arm randomised-controlled clinical trial

INTERNATIONAL JOURNAL OF STROKE, Issue 4 2009
T. Reiff
Moderate to severe (,70%) asymptomatic stenosis of the extracranial carotid artery leads to an increased rate of stroke of approximately 11% in 5 years. Patients with asymptomatic carotid stenosis, however, are also at a higher risk of nonstroke vascular events. The estimated annual risks of such events in patients with asymptomatic stenosis are 7% for a coronary ischaemic event and 4,7% for overall mortality. The superiority of carotid endarterectomy compared with medical treatment in symptomatic carotid disease is established, provided that the surgical procedure can be performed with a perioperative morbidity and mortality of <6%. The advantage of carotid endarterectomy for asymptomatic patients is less established. An alternative treatment, carotid artery stenting, has been developed. This treatment is used frequently in both symptomatic and asymptomatic patients. In the last decade, major advantages in medical primary prevention of cerebrovascular and cardiovascular disease have been accomplished. The control groups in the large trials for asymptomatic carotid artery disease (ACAS and ACST) originate from more than a decade ago and, for the most part, have not received a medical primary prevention strategy that would now be considered the standard according to current national and international guidelines. For this reason, a three-arm trial (SPACE2; http://www.space-2.de) with a hierarchical design and a recruitment target of 3640 patients is chosen. Firstly, a superior trial of intervention (carotid artery stenting or carotid endarterectomy) vs. state-of-the-art conservative treatment is designed. In case of superiority of the interventions, a noninferiority end-point will be tested between carotid artery stenting and carotid endarterectomy. This trial is registered at Current Controlled Trials ISRCTN 78592017. [source]

Estimating nurses' workload using the Diagnosis Procedure Combination in Japan

INTERNATIONAL NURSING REVIEW, Issue 3 2008
Y. Kamijo rn
Aim:, To examine the methods used to estimate nurse staffing levels in acute care settings with Diagnosis Related Groups, which in Japan are called the Diagnosis Procedure Combination (DPC). Methods:, For estimating staffing requirements, the study used four DPC groups: (1) acute or recurrent myocardial infarction (AMI) with stenting, (2) angina pectoris with coronary artery bypass grafting (CABG), (3) sub-arachnoid haemorrhage (SAH) with clipping surgery, and (4) cerebral infarction with carotid endarterectomy (CEA). Registered nurses with more than 3-year nursing experience in nine university hospitals in the Tokyo metropolitan area completed self-report questionnaires in order to obtain nursing care time and care intensity per each DPC. The concordance rate was measured by Kendall's coefficient of concordance. The relationship between the care time and the care intensity was examined by a time series graph per DPC. Care intensity consisted of professional judgement, mental effort for helping patients, professional skill, physical effort for providing activities of daily living support, and nurse stress, based on the Hsiao and colleagues' model of resource-based relative value scale. Results:, Twenty-five nurses in nine university hospitals answered for a hypothetical typical patient with AMI and with CABG, and 28 nurses in nine university hospitals answered for a hypothetical typical patient with SAH and with CEA. Kendall's coefficient of concordance was 0.896 for AMI, 0.855 for CABG, 0.848 for SAH, 0.854 for CEA. The time series data of the care time and the care intensity items showed different patterns for each DPC. Conclusion:, The DPC for cardiovascular and cerebral surgical procedures can be used for estimating nurses' workload. [source]

Color Doppler sonographic evaluation of flow volume of the internal carotid and vertebral arteries after carotid endarterectomy

JOURNAL OF CLINICAL ULTRASOUND, Issue 5 2010
Anka Mitrasinovic MD
Abstract Background. To measure by Doppler sonography the blood flow volume (BFV) of the ipsilateral and contralateral extracranial internal carotid arteries (ICAs) and both vertebral arteries (VAs) before and after a carotid endarterectomy (CEA) of the ICA. We correlated the result with the degree of stenosis of the ICA. Method. One hundred seven patients who had a CEA were divided into 2 groups. Group I consisted of subjects with stenosis of ipsilateral ICA of ,70% to near occlusion and Group II included subjects with near occlusion. The Doppler sonographic examinations were performed 1 day before the CEA, 7 days after the CEA, and 1 month after the CEA. The peak systolic velocity, end-diastolic velocity, time-averaged maximum blood flow velocity, resistance index of the ipsilateral ICA, and the BFV of both ICAs and both VAs were calculated. Result. There was a significant increase in the peak systolic velocity, maximum blood flow velocity, and the BFV of the ipsilateral ICA after the CEA. The BFV of the contralateral ICA and both VAs were not significantly altered after the CEA in both groups. Conclusion. The main CEA hemodynamic effect was an increase in the BFV of the ipsilateral ICA regardless of the degree of stenosis. © 2010 Wiley Periodicals, Inc. J Clin Ultrasound, 2010 [source]

Carotid sonography and transesophageal echocardiography in patients with ischemic stroke or transient ischemic attack in the territory of the carotid artery

JOURNAL OF CLINICAL ULTRASOUND, Issue 8 2006
Marjatta Strandberg MD
Abstract Purpose. To assess the benefit of combining carotid sonography and transesophageal echocardiography (TEE) for the evaluation of patients with stroke or transient ischemic attack (TIA) in the territory of the carotid artery. Methods. During a 2-year period in Turku University Hospital, consecutive in patients with stroke or TIA who were candidates for carotid endarterectomy and for oral anticoagulation were evaluated with carotid sonography for symptomatic moderate (50,69%) or severe (,70%) internal carotid artery (ICA) stenosis, and with TEE for potential cardiac sources of embolism. Results. In 20% (40/197) of patients, a severe symptomatic ICA stenosis and/or a major risk factor for a cardiac source of embolism were found. In 56% (110/197) of patients, a moderate or severe symptomatic ICA stenosis and/or a potential cardiac source of embolism were found, whereas 11% (21/197) of patients had both a moderate or severe symptomatic ICA stenosis and a potential cardiac source of embolism. Conclusions. This study suggests that the presence of a moderate or severe symptomatic ICA stenosis does not exclude the presence of a potential cardiac source of embolism and vice versa. Carotid sonography and TEE complement each other and are valuable diagnostic tools that should be recommended in patients with ischemic stroke or TIA in the territory of the carotid artery when they are candidates for carotid endarterectomy and for oral anticoagulation. © 2006 Wiley Periodicals, Inc. J Clin Ultrasound 34:374,379, 2006 [source]

Protected Carotid Stenting in High-Risk Patients: Results of the SpideRX Arm of the Carotid Revascularization with ev3 Arterial Technology Evolution Trial

JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 5 2010
ROBERT D. SAFIAN M.D.
Purpose:,A prospective nonrandomized multicenter registry of 160 patients with severe carotid stenosis and high-risk features for carotid endarterectomy was conducted during the 3-month period from March to May 2005. Methods:,Carotid artery stenting (CAS) was performed with the SpideRXÔ Embolic Protection System (ev3, Inc., Plymouth, MN, USA) as part of an investigational device exemption from the Food and Drug Administration. Results:,The primary end-point of major adverse cardiac and cerebrovascular events at 30 days after CAS was observed in nine patients (5.6%), including death in four patients (2.5%), nonfatal stroke in five patients (3.1%), and nonfatal myocardial infarction in one patient (0.6%). A secondary end-point of technical success (defined as successful deployment of all devices, filter retrieval, and final diameter stenosis <50%) was achieved in 156 of 160 patients (97.5%). The only independent predictor of death or stroke at 30 days was baseline stenosis severity (P < 0.05). Conclusion:,CAS with distal embolic protection using the SpideRXÔ Embolic Protection System is a reasonable alternative for revascularization of some high-risk patients with severe carotid stenosis. (J Interven Cardiol 2010;23:491,498) [source]

European Carotid PROCAR Trial: Prospective Multicenter Trial to Evaluate the Safety and Performance of the ev3 ProtégéÔ Stent in the Treatment of Carotid Artery Stenosis,1- and 6-Month Follow-Up

JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 3 2006
JENNIFER SUGITA
Background: The purpose of the European PROCAR Trial was to evaluate the safety and performance of the Protégé stent in the treatment of common and/or internal carotid artery stenoses with adjunctive use of a filter embolic protection device. Method: The Protégé® GPS stent is a self-expanding Nitinol stent system mounted on a 6 Fr 0.018, (6,9 mm stent) or 7 Fr 0.035, (10 mm stent) over-the-wire delivery system. Study patient assessments were conducted at baseline, periprocedure, discharge, and 1 and 6 months postprocedure. A total of 77 patients have been enrolled in the trial. Results: In the 77 lesions treated (31 symptomatic, 46 asymptomatic), the procedure was technically successful in 76 (99%), with an average residual stenosis of less than 30%. One procedure failed because the embolic protection device could not be retrieved and the patient was sent to surgery. Within 30 days, there were four (5.2%) major adverse neurological events (MANEs). Three of the MANEs were major strokes (3.9%), one a minor stroke. The fifth MANE occurred prior to the 6-month follow-up visit; this patient had a major stroke 75 days after the procedure and died 36 days later. One additional death occurred because of urosepsis. Conclusions: The PROCAR trial shows that the Protégé stent with adjuvant use of a filter embolic protection device satisfies safety and performance criteria for the treatment of carotid artery stenosis. The incidence of MANEs for the Protégé stent is comparable to the incidence of these events in other recent carotid stent studies and standard carotid endarterectomy (CEA). [source]

In vivo detection of hemorrhage in human atherosclerotic plaques with magnetic resonance imaging,

JOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 1 2004
Vincent C. Cappendijk MD
Abstract Purpose To investigate the performance of high-resolution T1-weighted (T1w) turbo field echo (TFE) magnetic resonance imaging (MRI) for the identification of the high-risk component intraplaque hemorrhage, which is described in the literature as a troublesome component to detect. Materials and Methods An MRI scan was performed preoperatively on 11 patients who underwent carotid endarterectomy because of symptomatic carotid disease with a stenosis larger than 70%. A commonly used double inversion recovery (DIR) T1w turbo spin echo (TSE) served as the T1w control for the T1w TFE pulse sequence. The MR images were matched slice by slice with histology, and the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the MR images were calculated. Additionally, two readers, who were blinded for the histological results, independently assessed the MR slices concerning the presence of intraplaque hemorrhage. Results More than 80% of the histological proven intraplaque hemorrhage could be detected using the TFE sequence with a high interobserver agreement (Kappa = 0.73). The TFE sequence proved to be superior to the TSE sequence concerning SNR and CNR, but also in the qualitative detection of intraplaque hemorrhage. The false positive TFE results contained fibrous tissue and were all located outside the main plaque area. Conclusion The present study shows that in vivo high-resolution T1w TFE MRI can identify the high-risk component intraplaque hemorrhage with a high detection rate in patients with symptomatic carotid disease. Larger clinical trials are warranted to investigate whether this technique can identify patients at risk for an ischemic attack. J. Magn. Reson. Imaging 2004;20:105,110. © 2004 Wiley-Liss, Inc. [source]

Who Should Be Screened for Asymptomatic Carotid Artery Stenosis?

JOURNAL OF NEUROIMAGING, Issue 2 2001
Experience From the Western New York Stroke Screening Program
ABSTRACT Objective. Identification of significant asymptomatic carotid artery stenosis (ACAS) is important because of the stroke-risk reduction observed with carotid endarterectomy. The authors developed and validated a simple scoring system based on routinely available information to identify persons at high risk for ACAS using data collected during a community health screening program at various sites in western New York. A total of 1331 unselected volunteers without previous stroke, transient ischemic attack, or carotid artery surgery were evaluated by personal interview and duplex ultrasound. The main outcome measure was carotid artery stenosis >60% by duplex ultrasound. In the derivation set (n= 887), 4 variables were significantly associated with ACAS >60%: age >65 years (odds ratio [OR] = 4.1, 95% confidence interval [CI] = 2.6,6.7), current smoking (OR = 2.0, 95% CI = 1.2,3.5), coronary artery disease (OR = 2.4, 95% CI = 1.5,3.9), and hypercholesterolemia (OR = 1.9, 95% CI = 1.2,2.9). Three risk groups (low, intermediate, and high) were defined on the basis of total risk score assigned on the basis of the strength of association. The scheme effectively stratified the validation set (n= 444); the likelihood ratio and posttest probability for ACAS in the high-risk group were 3.0 and 35%, respectively, and in the intermediate and low-risk groups were 1.4 and 20% and 0.4 and 7%, respectively. Routinely available information can be used to identify persons in the community at high risk for ACAS. Doppler ultrasound screening in this subgroup may prove to be cost-effective and have an effect on stroke-free survival. [source]

Postoperative epidural hematoma or cerebrovascular accident?

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2002
A dilemma in differential diagnosis
An elderly lady developed an epidural hematoma following combined spinal-epidural anesthesia with a local anesthetic,opioid mixture for a vaginal hysterectomy. This occurred in association with the use of prophylactic subcutaneously administered unfractionated heparin. She had diabetes, hypertension and had previously undergone coronary artery bypass surgery and right carotid endarterectomy. Warfarin and aspirin were discontinued 2 weeks before the surgery. Postoperatively, an atypical presentation of backache, bilateral sensory loss and left lower limb monoplegia ensued. The initial clinical impression was of a cerebrovascular accident. Magnetic resonance imaging, however, revealed an extensive epidural hematoma that necessitated decompression laminectomy. Progression to paraparesis occurred but the patient gradually regained much of her functionality over the next 2 years. [source]

An added benefit of bilateral blood pressure monitoring during carotid endarterectomy

ANAESTHESIA, Issue 9 2007
O. O'Connell
No abstract is available for this article. [source]

Combined carotid endarterectomy and oesophagectomy

ANAESTHESIA, Issue 6 2003
S. Rassam
No abstract is available for this article. [source]

Guidelines for patient selection and performance of carotid artery stenting

Patient flow to carotid endarterectomy: hastening the patient journey

ANZ JOURNAL OF SURGERY, Issue 6 2010
Manar Khashram
Abstract Background:, Early carotid endarterectomy (CEA) after stroke or transient ischaemic attack is the proposed standard of care to prevent recurrent ischaemic events in selected patients. The aim of this study was to investigate if this standard is achieved in a tertiary vascular unit. Methods:, This was a clinical audit. CEAs performed from 1 January 2006 to 31 December 2008 at Christchurch hospital were identified. The value stream from initial presentation to surgery was mapped in two phases (phase 1; 2006,2007 and phase 2; 2008). Patients who had carotid intervention for asymptomatic carotid lesions were excluded. Results:, The relevant patient journey was documented in 81 patients (55 phase 1; 26 phase 2). Median time from initial presentation to carotid ultrasound was 5 days in phase 1 and 6 days in phase 2. Time from presentation to vascular surgery review was 22 days in phase 1 and 13 days in phase 2. Time from presentation to CEA significantly reduced from 83 to 32 days between phases (P < 0.005). Conclusions:, There has been a significant decrease in time from presentation to operation between phase 1 and 2. The most significant change is reduced delay between vascular surgery review and CEA. There has been no improvement in urgency of referral for imaging or surgical review. This part of the patient journey is a target for improvement. [source]

Association of carotid artery atheromatous plaque types with cerebral perfusion

ANZ JOURNAL OF SURGERY, Issue 11 2009
Dong Yan Gao
Abstract Background:, In an attempt to define the association of internal carotid artery atheromatous plaque morphology with potential cerebral ischaemia, we have investigated the relationship of different carotid plaque types with defects in cerebral perfusion. Methods:, In 130 patients requiring surgical correction of internal carotid artery stenoses greater than 70%, defects in cerebral perfusion due to both haemodynamic insufficiency and intracerebral vessel occlusion were identified using single photon emission computed tomography scans (SPECT). Carotid artery plaques in these patients were classified as homogeneous or heterogeneous based on preoperative Doppler Duplex Scanning and on the macroscopic characteristics of the plaques recorded by the surgeon during carotid endarterectomy, with sub-classification into potentially embolus-generating and non- embolus-generating plaques. In individual patients, plaque types were then correlated with the perfusion defects found in the SPECT scans. Results:, Of 130 patients, 112 (86%) had cerebral perfusion defects. In 56 asymptomatic patients in the study, 48 (85.7%) had perfusion defects as did 64 (86.5%) of 74 symptomatic patients. Cerebral infarcts were seen in 41 (31.5%). Occlusive infarcts (66%) were twice as frequent as haemodynamic insufficiency infarcts (34%). Eighteen patients with small cerebral infarcts on SPECT scanning gave no medical history of cerebral symptoms. Statistical analysis of the results revealed that there was no statistically identifiable association between carotid plaque type and the generation of cerebral symptoms or infarction. Conclusion:, This study found that internal carotid plaque morphology has no statistically significant association with perfusion defects, symptoms or cerebral infarction in patients with significant internal carotid artery stenosis. Also, it is suggested that haemodynamic cerebral infarction may be more common that previously believed (34% of infarcts identified in the study). Further, it is suggested that plaque morphology alone is not an indication for carotid endarterectomy. [source]

Statin therapy and carotid endarterectomy: a review of trends in New South Wales, 1990,2004

ANZ JOURNAL OF SURGERY, Issue 6 2009
David A. Robinson
Abstract Background:, The number of patients requiring carotid endarterectomy in our hospitals had been noted to be declining. Hence, our aim was to look at the numbers of carotid interventions in our State to see whether this trend was more pervasive and to look at trends in statin prescriptions over the same time-course. Methods:, We queried the New South Wales Department of Health Inpatients Statistics Collection database to determine the number of carotid interventions between 1 July 1990 and 30 June 2004. We also collected data on statin prescriptions from the Health Insurance Commission of the Australian Department of Health and Ageing. The trends in carotid interventions were examined using negative binomial regression. Results:, The rate of carotid interventions increased by 9.8% between 1990 and 1991 and 1997 and 1998 and then declined from 1998 to 1999 through 2003 to 2004 by 6.8%. We noted a similar trend in octogenarians, although the peak was somewhat earlier. The prescription of statins was found to have increased eightfold between 1992 and 2003. Conclusion:, The rate of carotid intervention has declined significantly from a peak in the late 1990s. This peak was at least partly accounted for by North American Symptomatic Carotid Endarterectomy Trial and Advances in Computer Sciences and Technology, studies that were conducted largely before the advent of statins. The number of persons in the community on statins has increased enormously since that time. We ponder over the influence of statins on the natural history of carotid artery disease and the implication this has for future trials of carotid intervention in asymptomatic patients. [source]

COMMON FACIAL VEIN: AN ALTERNATIVE PATCH MATERIAL IN CAROTID ANGIOPLASTY

ANZ JOURNAL OF SURGERY, Issue 3 2008
Abeywardana M. S. Abeysekara
Patch angioplasty is a popular adjunct to carotid endarterectomy to facilitate arteriotomy closure. The long saphenous vein is the common autogenous patch in use. We tested the feasibility of using the ipsilateral common facial vein (CFV), which is usually sacrificed during exposure of the carotid bifurcation. A consecutive series of 17 patients undergoing carotid endarterectomy was examined to show the use of CFV patch in arteriotomy closure in 18 procedures. During exposure of the carotid bifurcation, the facial vein was harvested and distended with heparinized saline to assess the size of the vein. If the vein had an adequate diameter, it was everted and used as a double-layered patch. Patients were followed up postoperatively with serial duplex scanning at 3, 6 and 12 months, and yearly thereafter. The median (range) age of the patients in the series was 66 years (52,72 years). Of the 18 CFV harvested, 2 were rejected because of small calibre. The median (range) length of the vein harvested was 5 cm (4,6 cm). The average diameter of harvested vein was 5 mm. The median (range) time taken for harvesting, distending and everting the vein was 10 min (8,12 min). There were no perioperative deaths or strokes. There was no significant re-stenosis during the follow up of 24 months (18,36 months), with a mean peak velocity of 0.86 m/s (0.58,1.29 ). The use of everted CFV patch in carotid angioplasty is safe, quick, convenient and durable, whereas saphenous veins are spared and lower limb incisions avoided. [source]