Carotid Intervention (carotid + intervention)

Distribution by Scientific Domains
Medical Sciences100%

Selected Abstracts

Carotid intervention: and so it goes, guidelines and timing

ANZ JOURNAL OF SURGERY, Issue 6 2010
John P. Harris AM
No abstract is available for this article. [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]

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]

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]

Mechanical embolectomy for large vessel ischemic strokes: A cardiologist's experience,

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 3 2010
Dr. Mark Abelson FCP (Cardiology)
Abstract Introduction: Large vessel acute ischemic stroke has a poor outcome. Intravenous (IV) thrombolysis is often contra-indicated and if given, usually ineffective. Mechanical embolectomy is an option in these patients and may be performed by an interventional cardiologist experienced in carotid interventions. Method: Consecutive stroke patients were assessed by the stroke physician and, if eligible, referred for possible mechanical embolectomy using the Merci retriever. All procedures were done by a single cardiologist. Patient information, procedural characteristics and clinical outcomes at 90 days were collected by retrospective chart review. Results: A total of 22 patients were referred for emergency cerebral angiography with 17 undergoing mechanical embolectomy. The mean National Institute of Health Stroke Scale (NIHSS) score was 20.1 and the mean stroke duration was 284 min. Recanalization was successful in 15 (88%) patients. Ten patients (59%) had a good outcome (modified Rankin Score ,2 at 90 days) and four died (mortality 23%). Three patients had significant intra-cerebral hemorrhage. There were no other major adverse events. Conclusions: For patients with large vessel occlusion strokes where IV thrombolysis was either contra-indicated or had failed, mechanical embolectomy performed by an interventional cardiologist had a high recanalization rate with an acceptable clinical outcome and safety profile. © 2010 Wiley-Liss, Inc. [source]