Diagnostic Value of Somatosensory Evoked Potential Changes During Carotid Endarterectomy A Systematic Review and Meta-analysis
Conclusions and RelevanceIntraoperative SSEP is a highly specific test in predicting neurological outcome following CEA. Patients with perioperative neurological deficits are 14 times more likely to have had changes in SSEPs during the procedure. The use of SSEPs to design prevention strategies is valuable in reducing perioperative cerebral infarctions during CEA.
Prior research shows that subclinical, micro-embolic infarcts result in long term cognitive changes. While both carotid endarterectomy (CEA) and carotid artery stenting (CAS) have potential for micro-embolic events, carotid artery stenting has shown to have larger volume of infarct. We have previously shown that large volume infarction is associated with long-term memory deterioration. The purpose of this study is to identify independent risk factors that trend towards higher embolic volumes in both procedures.
CONCLUSIONS: In this small group of patients, the hybrid procedure was proved to be a safe and efficient way of treatment for patients with concomitant carotid and cardiac diseases. The low rate of perioperative complications and good midterm results are encouraging. PMID: 32247782 [PubMed - as supplied by publisher]
This article examines the evidence for using the available options. RECENT FINDINGS Carotid endarterectomy is an effective treatment option for reducing the risk of stroke in appropriately selected patients. Patients should be stratified for future stroke risk based on both the degree of stenosis and the presence of symptoms referable to the culprit lesion. Carotid stenting is also useful in reducing stroke risk, again in carefully selected patients. Because of the publication of significant data regarding both carotid endarterectomy and carotid artery stenting in the last several years, selection can be far more person...
CONCLUSIONS: Given the trend toward expedited treatment of acute ischemic stroke with subsequent transfer to regional referral centers, vascular specialists will be confronted with an increasing number of patients who may require urgent CEA after antecedent IVT. Further study is warranted to clearly delineate the appropriate interval from IVT to CEA and, specifically, to establish the safety of CEA with 72 hours of tPA administration. PMID: 32225134 [PubMed - in process]
Conditions: Carotid Stenosis; Carotid Endarterectomy Intervention: Diagnostic Test: Biomarker - FGF 23; troponin I; PCR - high sensitivity; BNP Sponsor: Universidade do Porto Not yet recruiting
Lesion manipulation during internal carotid artery (ICA) surgical dissection is the most crucial stage of carotid endarterectomy (CEA); a friable part of the carotid plaque or a thrombus may detach from the arterial wall leading to cerebral embolism. Proximal protection devices used in carotid stenting (CAS) reverse the blood flow to the brain eliminating, at least after their deployment, the chance of cerebral embolism. Based on the working principle of these devices, we propose a new approach to CEA making use of a flow-reversal technique and we report its successful application in 2 high risk patient with a soft and fri...
CONCLUSIONS: The results suggest different DNAm status of MMP24 between stable and unstable atherothrombotic carotid plaques, and between atherothrombotic stroke and controls in blood samples. PMID: 32206187 [PubMed]
We present a case of ocular ischemic syndrome successfully treated with carotid endarterectomy, and summarize the current literature regarding management of ocular ischemic syndrome.
In June of 1986, I arrived at the University of Cincinnati, eager to begin my vascular fellowship with Dick Kempczinski, a rising star in the academic vascular community. My arrival coincided with the publication of a groundbreaking, and somewhat sobering, review of the outcomes of carotid endarterectomy in the Cincinnati community, authored by Dick and Tom Brott.1 They found a disturbing stroke rate of 5.1% and mortality of 2.3%, with no statistically significant difference based on the specialty of the operating surgeon —by implication, all specialties were performing the procedure equally poorly.
CONCLUSION: At least half of the procedural strokes in this study were ischaemic and ipsilateral to the treated artery. Half of all procedural complications occurred on the day of surgery, but one-third after day 3 when many patients had been discharged. PMID: 32162310 [PubMed - as supplied by publisher]