Examination of the interaction between method of anesthesia and shunting with carotid endarterectomy

This study aims to evaluate whether the choice of anesthesia modifies the association between shunting and in-hospital stroke/death after CEA.
Source: Journal of Vascular Surgery - Category: Surgery Authors: Source Type: research

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The objective of the present study was to examine the intersectionality between race/ethnicity, insurance status, and postoperative outcomes in carotid procedures.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Original Article Source Type: research
Authors: Kim JW, Huh U, Song S, Sung SM, Hong JM, Cho A Abstract Background: The surgical strategies for carotid endarterectomy (CEA) vary in terms of the anesthesia method, neurological monitoring, shunt usage, and closure technique, and no gold-standard procedure has been established yet. We aimed to analyze the feasibility and benefits of CEA under regional anesthesia (RA) and CEA under general anesthesia (GA). Methods: Between June 2012 and December 2017, 65 patients who had undergone CEA were enrolled, and their medical records were prospectively collected and retrospectively reviewed. A total of 35 patien...
Source: Korean Journal of Thoracic and Cardiovascular Surgery - Category: Cardiovascular & Thoracic Surgery Tags: Korean J Thorac Cardiovasc Surg Source Type: research
Introduction: To assess the differences of completion angiography after carotid endarterectomy between local and general anesthetic approach. Our secondary outcomes were to evaluate the relationship between intraoperative reparations and postoperative strokes; and to assess the usefulness of external carotid reparation when it was occluded during the procedure.
Source: European Journal of Vascular and Endovascular Surgery - Category: Surgery Authors: Source Type: research
Introduction: Cerebral border zone infarctions (Watershed infarctions) on the early postoperative outcomes of patient undergoing carotid endarterectomy (CEA) were associated, in several studies, with a higher neurological complication rate. The current hypothesis is that hemodynamic phenomenon is involved. CEA performed under locoregional anesthesia enable to instantly reveal any hemodynamic phenomenon.
Source: European Journal of Vascular and Endovascular Surgery - Category: Surgery Authors: 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
A number of awake patients undergoing carotid endarterectomy (CEA) present from test clamp neurological deficits (NDs) during the procedure. Current guidelines advocate tighter Doppler ultrasound (DUS) surveillance in these patients because of probable higher likelihood of hemodynamic stroke (class 1 grade C), although evidence is lacking regarding benefit. The aim for the study is the assumption that patients who present ND have a higher risk of developing a complete stroke if the ipsilateral carotid artery becomes occluded, and for this reason, surveillance over restenosis of endarterectomy in this group is justifiable; ...
Source: Annals of Vascular Surgery - Category: Surgery Authors: Tags: Clinical Research Source Type: research
A number of awake patients undergoing carotid endarterectomy (CEA) present from test clamp neurological deficits (ND) during the procedure. Current guidelines advocate tighter doppler ultrasound (DUS) surveillance in these patients due to probable higher likelihood of hemodynamic stroke (class 1 grade C), although evidence is lacking regarding benefit. the reasoning for the study is: the assumption that patients who present ND have a higher risk of developing a complete stroke if the ipsilateral carotid artery becomes occluded, and for this reason surveillance over restenosis of endarterectomy in this group is justifiable,...
Source: Annals of Vascular Surgery - Category: Surgery Authors: Tags: Clinical Research, Basic Science Source Type: research
AbstractBackgroundShort-acting vasopressor agents like phenylephrine or ephedrine can be used during carotid endarterectomy (CEA) to achieve adequate blood pressure (BP) to prevent periprocedural stroke by preserving the cerebral perfusion. Previous studies in healthy subjects showed that these vasopressors also affected the frontal lobe cerebral tissue oxygenation (rSO2) with a decrease after administration of phenylephrine. This decrease is unwarranted in patients with jeopardized cerebral perfusion, like CEA patients. The study aimed to evaluate the impact of both phenylephrine and ephedrine on the rSO2 during CEA.Metho...
Source: Neurocritical Care - Category: Neurology Source Type: research
ConclusionWe thought that CEA remains the most efficient treatment modality among symptomatic and asymptomatic octogenarians with severe carotid artery stenosis and no difference was found compared to non-octogenarians. Advanced age should not be considered as a  high-risk group and selected octogenarians are good candidates for CEA.
Source: European Surgery - Category: Surgery Source Type: research
Ahmed Mohamed Elhfnawy1*, Peter U. Heuschmann2, Mirko Pham3†, Jens Volkmann1† and Felix Fluri1,4 1Department of Neurology, University Hospital Würzburg, Würzburg, Germany 2Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany 3Institute of Diagnostic and Interventional Neuroradiology, University Hospital of Würzburg, Würzburg, Germany 4Department of Neurology, Kantonssptial St. Gallen, St. Gallen, Switzerland Background and Purpose: Internal carotid artery stenosis (ICAS)≥70% is a leading cause of ischemic cerebrovascular event...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
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