15,585 results match your criteria carotid endarterectomy


Warfarin Treatment Is Associated to Increased Internal Carotid Artery Calcification.

Front Neurol 2021 12;12:696244. Epub 2021 Jul 12.

Neurology, Neurocenter, Helsinki University Hospital, Helsinki, Finland.

Long-term treatment with the vitamin K antagonist warfarin is widely used for the prevention of venous thrombosis and thromboembolism. However, vitamin K antagonists may promote arterial calcification, a phenomenon that has been previously studied in coronary and peripheral arteries, but not in extracranial carotid arteries. In this observational cohort study, we investigated whether warfarin treatment is associated with calcification of atherosclerotic carotid arteries. Read More

View Article and Full-Text PDF

Processed Multiparameter Electroencephalogram-Guided General Anesthesia Management Can Reduce Postoperative Delirium Following Carotid Endarterectomy: A Randomized Clinical Trial.

Front Neurol 2021 12;12:666814. Epub 2021 Jul 12.

Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China.

Patients undergoing carotid endarterectomy (CEA) for severe carotid stenosis are vulnerable to postoperative delirium, a complication frequently associated with poor outcome. This study investigated the impact of processed electroencephalogram (EEG)-guided anesthesia management on the incidence of postoperative delirium in patients undergoing CEA. This single-center, prospective, randomized clinical trial on 255 patients receiving CEA under general anesthesia compared the outcomes of patient state index (PSI) monitoring [SEDLine Brain Function Monitor (Masimo, Inc, Irvine, CA)] (standard group, = 128) with PSI combined with density spectral array(DSA) -guided monitoring (intervention group, = 127) to reduce the risk of intraoperative EEG burst suppression. Read More

View Article and Full-Text PDF

Early Outcomes After Carotid Endarterectomy and Carotid Artery Stenting: A Propensity-Matched Cohort Analysis.

Neurosurgery 2021 Jul 28. Epub 2021 Jul 28.

Department of Neurosurgery, Rhode Island Hospital, Lifespan Health System, Providence, Rhode Island, USA.

Background: Carotid endarterectomy (CEA) and carotid artery stenting (CAS) represent options to treat many patients with carotid stenosis. Although randomized trial data are plentiful, estimated rates of morbidity and mortality for both CEA and CAS have varied substantially.

Objective: To evaluate rates of adverse outcomes after CAS and CEA in a large national database. Read More

View Article and Full-Text PDF

SPECT/CT imaging of inflammation and calcification in human carotid atherosclerosis to identify the plaque at risk of rupture.

J Nucl Cardiol 2021 Jul 27. Epub 2021 Jul 27.

Department of Biomedical Engineering, Thorax Center, Erasmus MC, Rotterdam, The Netherlands.

Background: Calcification and inflammation are atherosclerotic plaque compositional biomarkers that have both been linked to stroke risk. The aim of this study was to evaluate their co-existing prevalence in human carotid plaques with respect to plaque phenotype to determine the value of hybrid imaging for the detection of these biomarkers.

Methods: Human carotid plaque segments, obtained from endarterectomy, were incubated in [111In]In-DOTA-butylamino-NorBIRT ([111In]In-Danbirt), targeting Leukocyte Function-associated Antigen-1 (LFA-1) on leukocytes. Read More

View Article and Full-Text PDF

Management of patients with asymptomatic carotid stenosis may need to be individualized: a multidisciplinary call for action.

Int Angiol 2021 Jul 27. Epub 2021 Jul 27.

Department of Neurology & Stroke Program, University of Maryland School of Medicine, Baltimore, MD, USA.

The optimal management of patients with asymptomatic carotid stenosis (ACS) is the subject of extensive debate. According to the 2017 European Society for Vascular Surgery guidelines, carotid endarterectomy should (Class IIa; Level of Evidence: B) or carotid artery stenting may be considered (Class IIb; Level of Evidence: B) in the presence of one or more clinical/imaging characteristics that may be associated with an increased risk of late ipsilateral stroke (e.g. Read More

View Article and Full-Text PDF

Slow Medicine.

Authors:
Elena Hill

J Am Board Fam Med 2021 Jul-Aug;34(4):871-873

From the Family Medicine Attending Physician, Bronxcare Health Systems, Bronx, NY (EH).

This is an opinion piece that examines the dichotomy of "fast medicine" (which involves high medical use and spending) and what I refer to as "slow medicine". It discusses ethical questions around which of these two frameworks really confers better "health" to patients - using examples from a real patient scenario of mine who was considering undergoing a relatively high-risk carotid endarterectomy. It then re-affirms the importance of primary care to conferring health and the ultimate value of primary care, or "slow medicine". Read More

View Article and Full-Text PDF
September 2020

Clinical Response to Procedural Stroke Following Carotid Endarterectomy: A Delphi Consensus Study.

Eur J Vasc Endovasc Surg 2021 Jul 23. Epub 2021 Jul 23.

Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht University, the Netherlands. Electronic address:

Objective: No dedicated studies have been performed on the optimal management of patients with an acute stroke related to carotid intervention nor is there a solid recommendation given in the European Society for Vascular Surgery guideline. By implementation of an international expert Delphi panel, this study aimed to obtain expert consensus on the optimal management of in hospital stroke occurring during or following CEA and to provide a practical treatment decision tree.

Methods: A four round Delphi consensus study was performed including 31 experts. Read More

View Article and Full-Text PDF

Contralateral Stenosis and Echolucent Plaque Morphology are Associated with Elevated Stroke Risk in Patients Treated with Asymptomatic Carotid Artery Stenosis within a Controlled Clinical Trial (SPACE-2).

J Stroke Cerebrovasc Dis 2021 Jul 23;30(9):105940. Epub 2021 Jul 23.

Department of Neurology, University Hospital of Heidelberg, Heidelberg, Germany. Electronic address:

Background: Asymptomatic carotid artery stenosis (ACS) has a low risk of stroke. To achieve an advantage over noninterventional best medical treatment (BMT), carotid endarterectomy (CEA) or carotid artery stenting (CAS) must be performed with the lowest possible risk of stroke. Therefore, an analysis of risk-elevating factors is essential. Read More

View Article and Full-Text PDF

Early outcomes of routine delayed shunting in carotid endarterectomy for symptomatic patients.

J Cardiovasc Surg (Torino) 2021 Jul 26. Epub 2021 Jul 26.

Vascular and Endovascular Surgery Division, Department Of Cardiac, Thoracic Vascular Sciences and Public Health, School of Medicine, Padova University, Padua, Italy -

Background: The role of shunting during carotid endarterectomy (CEA) in symptomatic patients is unclear. The aim was to evaluate early outcomes of CEA with routine "delayed" shunt insertion, for patients with symptomatic carotid stenosis.

Methods: we conducted a single-center retrospective review of symptomatic patients undergoing CEA (2009-2020). Read More

View Article and Full-Text PDF

Reallocation of Carotid Surgery Activity with the Support of Telemedicine in a COVID-Free Clinic during COVID-19 Pandemic.

Eur Neurol 2021 Jul 23:1-5. Epub 2021 Jul 23.

Department of Surgery, Vascular and Endovascular Surgery Unit, San Giovanni di Dio Hospital, USL Toscana Centro, Florence, Italy.

The aim of this study is to report the reallocation of carotid surgery activity with the support of telemedicine in a COVID-free clinic during COVID-19 pandemic. Patients with symptomatic carotid stenosis or asymptomatic vulnerable plaques were reallocated to a COVID-free private clinic which began to cooperate with the National Health System during the emergency. Quick training of staff nurses was performed. Read More

View Article and Full-Text PDF

Healthcare disparities in vascular surgery: A critical review.

J Vasc Surg 2021 Aug;74(2S):6S-14S.e1

Division of Vascular Surgery and Endovascular Therapy, Department of Cardiovascular and Thoracic Surgery, School of Medicine, West Virginia University, Morgantown, WV; Department of Occupational and Environmental Health Sciences, School of Public Health, West Virginia University, Morgantown, WV.

Health disparities in vascular surgical care have existed for decades. Persons categorized as Black undergo a nearly twofold greater risk-adjusted rate of leg amputations. Persons categorized as Black, Latinx, and women have hemodialysis initiated via autogenous fistula less often than male persons categorized as White. Read More

View Article and Full-Text PDF

Impact of a Regional Smoking Cessation Intervention for Vascular Surgery Patients.

J Vasc Surg 2021 Jul 20. Epub 2021 Jul 20.

Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan. Electronic address:

Objective: Tobacco use is common among vascular surgery patients and negatively impacts outcomes and longevity. In the second quarter of 2018, a statewide vascular quality collaborative launched an initiative across its 35 participating hospitals to promote smoking cessation at the time of surgery. This intervention was based on the Vascular Physician Offer and Report (VAPOR) trial and consisted of 3 components: brief physician-delivered advice, referral to telephone-based counseling, and nicotine replacement therapy (NRT). Read More

View Article and Full-Text PDF

[Atherosclerosis of the intracranial arteries and of the extracranial carotid artery.]

Ther Umsch 2021 Aug;78(6):277-289

Department für Neurologie, Inselspital, Universitätsspital und Universität Bern.

Atherosclerosis of the intracranial arteries and of the extracranial carotid artery. Intracranial atherosclerotic stenoses are the most common cause of ischemic stroke worldwide. Nowadays, three therapeutic approaches are available for consideration for patients with intracranial atherosclerotic stenoses: A conservative therapy (best medical treatment, management of vascular risk factors and healthy lifestyle), endovascular and surgical therapy. Read More

View Article and Full-Text PDF

The Diagnostic Accuracy of Intra-Operative Near Infrared Spectroscopy in Carotid Artery Endarterectomy Under Regional Anaesthesia: Systematic Review and Meta-Analysis.

Eur J Vasc Endovasc Surg 2021 Jul 17. Epub 2021 Jul 17.

Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Department of Biomedicine - Unity of Anatomy, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.

Objective: Intra-operative near infrared spectroscopy (NIRS) is a non-invasive tool used to monitor regional cerebral oxygen saturation during carotid endarterectomy (CEA), for which accuracy remains unclear. Therefore, this systematic review and meta-analysis aimed to determine the diagnostic accuracy of NIRS in patients undergoing CEA under regional anaesthesia (RA).

Data Sources: MEDLINE, Scopus, and Web of Science were searched for studies that compared NIRS with the "awake test" in patients undergoing CEA under RA. Read More

View Article and Full-Text PDF

Outcomes of Carotid Revascularization in the Treatment of Restenosis After Prior Carotid Endarterectomy.

Stroke 2021 Jul 20:STROKEAHA120033667. Epub 2021 Jul 20.

Division of Vascular and Endovascular Surgery, University of California San Diego, La Jolla (N.E., I.N., M.B.M.).

Background And Purpose: Restenosis after carotid endarterectomy (CEA) is associated with an increased risk of ipsilateral stroke. The optimal procedural modality for this indication has yet to be determined. Here, we evaluate the in-hospital outcomes of transcarotid artery revascularization (TCAR), redo-CEA, and transfemoral carotid artery stenting (TFCAS) in a large contemporary cohort of patients who underwent treatment for restenosis after CEA. Read More

View Article and Full-Text PDF

Intraoperative Neurophysiology and Transcranial Doppler for Detection of Cerebral Ischemia and Hyperperfusion during Carotid Endarterectomy.

World Neurosurg 2021 Jul 13. Epub 2021 Jul 13.

Department of Neurosurgery, Cangzhou Central Hospital, Hebei province, China.

Objective: To evaluate and compare the efficacy of intraoperative neurophysiological monitoring (IONM) and intraoperative transcranial Doppler (TCD) techniques for identification of hypoperfusion during carotid artery (CA) clamp and hyperperfusion after release of occlusion during carotid endarterectomy (CEA).

Methods: A retrospective, consecutive case series of 152 patients undergoing CEA between June 2018 and March 2020 were reviewed. Monitoring of somatosensory evoked potentials (SEPs), motor evoked potentials (MEPs), electroencephalogram (EEG) and TCD were investigated. Read More

View Article and Full-Text PDF

Conventional Carotid Endarterectomy with Shunt versus Eversion Carotid Endarterectomy without Shunt does the Technique Influence the Outcome in Symptomatic Critical Carotid Stenosis.

Asian J Neurosurg 2021 Apr-Jun;16(2):321-325. Epub 2021 May 28.

Department of Cardio Vascular and Thoracic Surgery, Division of Vascular Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India.

Introduction: Carotid endarterectomy (CEA) is a surgical procedure done to prevent future embolic stroke in patients with internal carotid artery (ICA) stenosis. Conventional CEA (c-CEA) and eversion CEA (e-CEA) are two surgical techniques used for the above. As carotid shunt is rarely used in e-CEA, a certain amount of cerebral ischemia occurs in patients who were already having carotid stenosis. Read More

View Article and Full-Text PDF

A Systematic Review and Meta-analysis of Peri-Procedural Outcomes in Patients Undergoing Carotid Interventions Following Thrombolysis.

Eur J Vasc Endovasc Surg 2021 Jul 12. Epub 2021 Jul 12.

Leicester Vascular Institute, Glenfield Hospital, Leicester, UK.

Objective: To evaluate the safety of carotid artery stenting (CAS) and carotid endarterectomy (CEA) after thrombolytic therapy (TT).

Data Sources: Medline, Scopus, and Cochrane databases.

Review Methods: Systematic review and meta-analysis of studies involving patients who underwent CEA/CAS after TT. Read More

View Article and Full-Text PDF

Plaque Elasticity and Intraplaque Neovascularisation on Carotid Artery Ultrasound: A Comparative Histological Study.

Eur J Vasc Endovasc Surg 2021 Jul 12. Epub 2021 Jul 12.

Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, China. Electronic address:

Objective: Plaque elasticity and intraplaque neovascularisation are strongly suggestive of vulnerable plaque. This study aimed to investigate the relationship between intraplaque neovascularisation and plaque elasticity, and to compare the ultrasound findings with histopathological changes.

Methods: Patients enrolled in this study presented with symptomatic carotid stenosis (> 70%) and later underwent both pre-operative ultrasonography and endarterectomy. Read More

View Article and Full-Text PDF

Cervical plexus block and carotid endarterectomy in the COVID-19 pandemic: regional anesthesia is the key.

Minerva Anestesiol 2021 Jul 14. Epub 2021 Jul 14.

Department of Anesthesia and Cardiac Surgery Intensive Care Unit, San Michele Hospital, Maddaloni, Caserta, Italy.

View Article and Full-Text PDF

Experimental comparative assay of tensile resistance of greater saphenous vein from ankle and groin.

J Vasc Bras 2021 25;20:e20190117. Epub 2021 Jun 25.

Universidade Federal do Paraná - UFPR, Hospital de Clínicas, Unidade de Cardiologia e Pneumologia, Curitiba, PR, Brasil.

Background: The great saphenous vein is used as patch material in several types of arterial reconstruction, including trauma and carotid and femoral endarterectomy. There have been reports of saphenous patch blowout, particularly of patches constructed with veins harvested from the ankle. There is a need for objective measurement of the resistance of saphenous vein tissues. Read More

View Article and Full-Text PDF

Endarterectomy for symptomatic non-stenotic carotids: a systematic review and descriptive analysis.

Stroke Vasc Neurol 2021 Jul 8. Epub 2021 Jul 8.

Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA

Objective: To systematically analyse prior reports of carotid endarterectomy (CEA) performed in cases of ≤50% carotid stenosis in order to understand patient tolerance and potential benefit.

Methods: A systematic review and descriptive analysis was performed in concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. An English-language search was performed of online databases using librarian-selected search terms. Read More

View Article and Full-Text PDF

The Effect of Hemodynamic Parameters on Cerebral Oxygenization During Carotid Endarterectomy.

Braz J Cardiovasc Surg 2021 Jul 7. Epub 2021 Jul 7.

Department of Cardiovascular Surgery, Okmeydanı Training and Research Hospital, Istanbul, Turkey.

Introduction: Near-infrared spectroscopy (NIRS) is a non-invasive technique to detect cerebral ischemia by monitoring changes in regional cerebral oxygenation (rSO) in the frontal lobes. However, there are no studies showing the changes in NIRS values in response to hemodynamic variations during stages of carotid endarterectomy (CEA) procedure and clinical implications of these changes. The aim of this study was to determine if hemodynamic changes affect NIRS values during carotid endarterectomy and if our results may help to provide strategies for hemodynamic management in these patients. Read More

View Article and Full-Text PDF

Correlation Between Calcification Characteristics of Carotid Atherosclerotic Plaque and Plaque Vulnerability.

Ther Clin Risk Manag 2021 1;17:679-690. Epub 2021 Jul 1.

Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China.

Purpose: To investigate the relationship between calcification characteristics of carotid atherosclerotic plaque and lipid rich necrotic core (LRNC) and intraplaque hemorrhage (IPH).

Methods: Patients with severe carotid stenosis undergoing carotid endarterectomy (CEA) were selected. Ultrasound and CT angiography (CTA) were performed to evaluate the calcification characteristics of the plaque before the surgery. Read More

View Article and Full-Text PDF

Management of a Mobile Floating Carotid Plaque Responsible for Calcified Cerebral Emboli: A Double Sword of Damocles.

EJVES Vasc Forum 2020 21;47:69-72. Epub 2021 Apr 21.

Department of Vascular Surgery, Henri Mondor University Hospital, Créteil, France.

Introduction: The management of a rare case of calcified cerebral emboli associated with a mobile carotid plaque (MCP) is reported and discussed.

Report: A 76 year old patient presented with sudden weakness of the left lower limb one month ago, which resolved spontaneously. A cerebral magnetic resonance imaging showed recent multiple infarcts in the right middle cerebral artery (MCA) territory. Read More

View Article and Full-Text PDF

Identification of Periopathogens in Atheromatous Plaques Obtained from Carotid and Coronary Arteries.

Biomed Res Int 2021 17;2021:9986375. Epub 2021 Jun 17.

Clinic for Dentistry, Faculty of Medicine, University of Priština Kosovska Mitrovica, Kosovska Mitrovica, Serbia.

Increasing attention has been paid to the possible link between periodontal disease and atherosclerosis over the past decade. The aim of this study is to investigate the presence of five periopathogens: (), (), (), (), and () in atheromatous plaques obtained from the carotid and coronary arteries in patients who underwent coronary artery bypass graft surgery and carotid endarterectomy. Group I (carotid arteries) consisted of 30 patients (mean age: 54. Read More

View Article and Full-Text PDF

Unusual course of the vagus nerve passing anterior to the internal carotid artery during carotid endarterectomy.

Surg Neurol Int 2021 14;12:278. Epub 2021 Jun 14.

Departments of Neurosurgery, Nagasaki Medical Center, Omura, Nagasaki, Japan.

Background: Carotid endarterectomy (CEA) is a conventional surgical technique to prevent ischemic stroke and the effectiveness for advanced lesions is established in many large studies. The vagus nerve is one of the cranial nerves that we usually encounter during CEA manipulation, which is identified as located posterior to the vessels in a position posterolateral to the carotid artery and posteromedial to the internal jugular vein.

Case Description: We experienced an extremely rare case of the vagus nerve passing anterior to the internal carotid artery during CEA. Read More

View Article and Full-Text PDF

Plasma Testosterone Levels and Atherosclerotic Plaque Gene Expression in Men With Advanced Atherosclerosis.

Front Cardiovasc Med 2021 14;8:693351. Epub 2021 Jun 14.

Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.

Low plasma testosterone levels have been shown to predict worse outcome in men with severe atherosclerotic disease. We hypothesized that a low plasma testosterone level affects disease risk through changes in gene expression in atherosclerotic plaques. Therefore, we studied plasma testosterone levels in relation to gene expression levels in atherosclerotic plaque tissue of men with advanced atherosclerotic disease. Read More

View Article and Full-Text PDF

Integrative multiomics analysis of human atherosclerosis reveals a serum response factor-driven network associated with intraplaque hemorrhage.

Clin Transl Med 2021 Jun;11(6):e458

Department of Pathology, School for Cardiovascular Diseases (CARIM), Maastricht UMC+, Maastricht, The Netherlands.

Background: While single-omics analyses on human atherosclerotic plaque have been very useful to map stage- or disease-related differences in expression, they only partly capture the array of changes in this tissue and suffer from scale-intrinsic limitations. In order to better identify processes associated with intraplaque hemorrhage and plaque instability, we therefore combined multiple omics into an integrated model.

Methods: In this study, we compared protein and gene makeup of low- versus high-risk atherosclerotic lesion segments from carotid endarterectomy patients, as judged from the absence or presence of intraplaque hemorrhage, respectively. Read More

View Article and Full-Text PDF