CAR 3. Neurologic Complication Rates of Intravenous Thrombolysis Combined With Early Carotid Endarterectomy for Treatment of Hyperacute Ischemic Stroke
Intravenous thrombolysis for treatment of acute carotid-associated stroke can be combined with carotid endarterectomy (CEA) either simultaneously or in a staged procedure. The aim of this single-center retrospective study was to analyze the short-term and long-term results of sequential lysis with CEA.
To report a single center experience with early surgical carotid revascularization in patients affected by transient ischemic attack and minor/moderate ischemic acute stroke.
Intraplaque haemorrhage (IPH) has been independently associated with a higher risk of future ipsilateral stroke in patients with carotid artery stenosis. Evaluation of plaque characteristics may contribute to risk assessment of recurrent (silent) cerebrovascular events in order to prioritise patients for timing of treatment. It is unknown if patients showing histologically apparent IPH also have increased risk of silent ischaemic brain lesions in the waiting period between index event and revascularisation.
CONCLUSION: Symptomatic patients with ipsilateral carotid stenosis and silent brain ischaemia on pre-operative MR-DWI, more often showed pathological evidence of IPH compared with those without ischaemic lesions. This identifies carotid IPH as a marker for patients at risk of silent brain ischaemia and possibly for future stroke and other arterial disease complications. Such patients may be more likely to benefit from CEA than those without evidence of ipsilateral carotid IPH. PMID: 31631008 [PubMed - as supplied by publisher]
In their systematic review and meta-analysis (n=5 studies; 16,712 patients), Giannopoulos et al.1 compared synchronous carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) vs. staged carotid artery stenting (CAS) followed by CABG. They demonstrated that perioperative stroke (3% [447/15,727] vs. 3% [33/985], for CEA/CABG vs. CAS/CABG, respectively; odds ratio [OR]: 0.84; 95% confidence interval [CI]: 0.43-1.64; I2=39.1%) and transient ischemic attack (TIA) rates (1% [2/193] vs 4% [4/95] for CEA/CABG vs.
CONCLUSIONS: Carotid endarterectomy continues to demonstrate effectiveness and safety for management of acute strokes, while carotid stenting has limitations. Carotid artery stenting has been shown to be non-inferior in some patient populations, but more recent and future technologic developments may expand the potential acceptable patient selection criteria. PMID: 31603298 [PubMed - as supplied by publisher]
ulo M Abstract INTRODUCTION: The best timing for carotid endarterectomy in patients with stroke is still matter of debate, particularly in case of significant cerebral ischemic lesion or neurological deterioration. The present review and meta-analysis aims to report the best evidence in the outcome of patients submitted to urgent (
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...
Abstract OBJECTIVES: The aim of this review was to carry out primary and secondary analyses of 20 randomised controlled trials (RCTs) comparing carotid endarterectomy (CEA) with carotid artery stenting (CAS). METHODS: A systematic review and meta-analysis of data from 20 RCTs (126 publications) was carried out. RESULTS: Compared with CEA, the 30 day death/stroke rate was significantly higher after CAS in seven RCTs involving 3467 asymptomatic patients (odds ratio [OR] 1.64, 95% confidence interval [CI] 1.02-2.64) and in 10 RCTs involving 5797 symptomatic patients (OR 1.71, 95% CI 1.38-2.11). Excluding pr...
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]
The objective of the study was to report the changes in serum CLU concentrations of patients undergoing CEA. Materials and methods: The study involved 25 patients with severe internal carotid artery stenosis. Serum samples were taken from patients at three different times: within 24 hours preoperatively to CEA, 12 hours postoperatively, and 48 hours postoperatively. Serum CLU concentrations were measured using a commercially available enzyme-linked immunosorbent assay. Results: When compared to concentrations preoperatively, the serum CLU concentration initially decreased during the 12 hours fol...