Prolonged Autonomic Fluctuation Derived from Parasympathetic Hypertonia after Carotid Endarterectomy but not Stenting

Carotid endarterectomy (CEA) is a standard treatment for carotid artery stenosis, but the incidence after periprocedural myocardial infarction (MI) is not negligible. The mechanism for the higher risk of MI following CEA compared with the carotid artery stenting (CAS) is unclear. We hypothesized that it may be explained by different autonomic nervous responses.
Source: Journal of Stroke and Cerebrovascular Diseases - Category: Neurology Authors: Source Type: research

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Introduction: Intraplaque hemorrhage (IPH) is an important feature of plaque vulnerability. Patients with a history of transient ischemic attack or stroke are treated with platelet aggregation inhibitors to prevent secondary myocardial infarction or ischemic stroke. Although antiplatelet medication is effective in reduction of clot formation, it also has adverse effects. It has therefore been hypothesized that platelet aggregation inhibitors could also initiate the onset or progression of IPH. A histopathological study on 154 carotid endarterectomy plaques found that preoperative antiplatelet therapy was associated with an...
Source: European Journal of Vascular and Endovascular Surgery - Category: Surgery Authors: Source Type: research
Previously, we described a Vascular Study Group of New England (VSGNE) risk predictive model to predict composite adverse outcomes (postoperative death, stroke, myocardial infarction, or discharge to extended care facilities) after carotid endarterectomy (CEA). The goal of this study was to externally validate this model using an independent database.
Source: Journal of Vascular Surgery - Category: Surgery Authors: Source Type: research
Authors: Jeong MJ, Kwon H, Kim MJ, Han Y, Kwon TW, Cho YP Abstract Purpose: We aimed to compare clinical outcomes after carotid endarterectomy (CEA) between Korean patients with and without severe contralateral extracranial carotid stenosis or occlusion (SCSO). Methods: Between January 2004 and December 2014, a total of 661 patients who underwent 731 CEAs were stratified by SCSO (non-SCSO and SCSO groups) and analyzed retrospectively. The study outcomes included the occurrence of major adverse cardiovascular events (MACE), defined as stroke or myocardial infarction, and all-cause mortality during the perioperat...
Source: Annals of Surgical Treatment and Research - Category: Surgery Tags: Ann Surg Treat Res Source Type: research
HISTORICALLY, carotid endarterectomy (CEA) surgery has generated several disputes regarding the choice of anesthesia provided and intraoperative neuromonitoring. The landmark General Anesthesia versus Local Anesthesia trial,1 which included 3,526 patients, showed no difference in the occurrence of stroke, myocardial infarction, or death at 30 days after surgery with respect to either local or general anesthesia. Harky et al.2 conducted a systematic review and meta-analysis of general versus local anesthesia in CEA surgery and concluded that each of the anesthetic techniques was noninferior to one another.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Editorial Source Type: research
AbstractAimsIdentifying factors associated with worse outcome following carotid endarterectomy (CEA) is important to improve prevention of major adverse cardiovascular and cerebrovascular events (MACCE), yet rarely used for registries. We intended to identify predictors of MACCE following CEA as recently analysed for stenting.Methods and resultsPatients undergoing CEA at 2 centers over 13  years were entered into a database. Baseline clinical characteristics, procedural factors and a panel of clinical and lesion-related high-risk features (SHR) and exclusion criteria (SE), empirically compiled for stratification in th...
Source: Clinical Research in Cardiology - Category: Cardiology Source Type: research
Abstract BACKGROUND: The aim of this study was to evaluate the frequency of postoperative complications in patients who underwent coronary artery bypass grafting (CABG) and simultaneous carotid endarterectomy (CEA) and find predictors of postoperative complications. METHODS: We retrospectively evaluated 86 patients after simultaneous CABG and CEA. Inclusion criteria were: patients with asymptomatic carotid stenosis with a reduction of the carotid lumen diameter of more than 70% detected with Doppler ultrasound and diagnosed with one, two, or three vessel coronary artery disease with coronary stenosis more tha...
Source: The Heart Surgery Forum - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Heart Surg Forum Source Type: research
AbstractObjective: To systematically compare outcomes between patients with asymptomatic carotid artery diseases (>80% stenosis) that had undergone staged carotid endarterectomy (CEA) before coronary artery bypass grafting (CABG) vs simultaneous CEA and CABG.Methods: A comprehensive electronic search of MEDLINE, Scopus, EMBASE, and Ovid from their inception up till August 2018 was performed to identify all studies comparing staged CEA followed by CABG to simultaneous CEA and CABG. Primary outcome measure was postoperative stroke, and secondary measures were myocardial infarction (MI) and 30 ‐day mortality rates.Result...
Source: Journal of Cardiac Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: ORIGINAL ARTICLE Source Type: research
Conclusion: carotid endarterectomy is the procedure of choice in carotid stenosis. The low rates of perioperative mortality, morbidity and complications have been demonstrated. PMID: 31448795 [PubMed - in process]
Source: Cirugia y Cirujanos - Category: Surgery Authors: Tags: Cir Cir Source Type: research
Contributors : Amira D Mahmoud ; Margaret D Ballantyne ; Vladislav Miscianinov ; Karine Pinel ; John Hung ; Jakub Kazynski ; Adriana S Tavares ; Angela C Bradshaw ; David E Newby ; Andrea Caporali ; Gwyn W Gould ; Sarah J George ; Igor Ulitsky ; Judith C Sluimer ; Julie Rodor ; Andrew H BakerSeries Type : Expression profiling by high throughput sequencingOrganism : Homo sapiensAtherosclerosis is a serious and very common condition where plaque builds up inside arteries and that can lead to heart attack or stroke. The development and rupture of the plaque is a complex process, involving the interplay of many cell types and ...
Source: GEO: Gene Expression Omnibus - Category: Genetics & Stem Cells Tags: Expression profiling by high throughput sequencing Homo sapiens Source Type: research
In this single-center, retrospective study, we aimed to compare early and late outcomes after carotid endarterectomy (CEA) between younger and elderly patients and to investigate the impact of patient age on the overall incidence of cardiovascular events after CEA. A total of 613 patients with 675 CEAs between January 2007 and December 2014 were stratified by patient age into 2 groups: younger (≤60 years, n = 103 CEAs, 15.3%) and elderly (>60 years, n = 572 CEAs, 84.7%) groups. The study outcomes were defined as the occurrence of major adverse events (MAEs), including fatal or nonfatal stroke or myocardial i...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research
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