Risk of perioperative neck hematoma in TIA and non-disabling stroke patients with symptomatic carotid artery stenosis undergoing endarterectomy within 14 days from cerebrovascular event
Perioperative neck hematoma (PNH) requiring re-intervention is an important complication after carotid endarterectomy (CEA). There are limited data regarding the potential risk factors associated with PNH. The aim of this prospective, multicenter study was to document the rate of PNH in symptomatic carotid artery stenosis (sCAS) patients treated with CEA within the first 14 days of cerebrovascular symptom onset and to identify possible predictors of this complication.
Conclusion In this retrospective series of simultaneous TCD and SEP monitoring during CEA surgery of predominantly symptomatic ICA stenosis patients, the stroke and death rate was 1.4%. SEP seemed to be superior to TCD in predicting the need for an intraoperative shunt and for predicting temporary postoperative deficits. Further prospective studies are needed. [...] Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals: Table of contents | Abstract | Full text
The objective of the present study was to examine the intersectionality between race/ethnicity, insurance status, and postoperative outcomes in carotid procedures.
The selection of patients for carotid endarterectomy (CEA) is one of the vascular surgeon's most delicate tasks. Although one knows that some patients will suffer a disabling stroke or die in the attempt to prevent these events, it is equally devastating when it happens. Thus, the solid evidence of the 1990s on the benefit of the procedure in patients with a significant symptomatic stenosis was welcomed.1,2 Even more welcomed were (and are) those studies further increasing the subgroups of patients who benefit the most, leading to well established evidence based guidelines.
CONCLUSIONS: Limb shaking TIA point to carotid artery disease in the majority of patients and vertebrobasilar artery disease in one third. Fast and timely treatment with either surgical or CAS eliminates the attacks and also reduce their risk of stroke. PMID: 31916976 [PubMed - as supplied by publisher]
Carotid endarterectomy (CEA) represents a standard procedure in case of symptomatic carotid stenosis of 50-99% within 2 weeks from onset of stroke or transient ischemic symptoms (TIA). The optimal time to perform CEA after Intravenous Thrombolysis (IVT) is still unclear. The aim of this study was to analyze the safety of CEA performed within 2 weeks from IVT.
Conclusions: Perioperative stroke drastically increases the risk of 30-day mortality. The occurrence of perioperative stroke exhibited high specificity but modest sensitivity in predicting 30-day mortality following CAS. This highlights the importance of neurophysiologic monitoring to detect intraoperative cerebral ischemia and perform timely interventions.
Abstract OBJECTIVE: The aim was to determine the clinical impact of routine cardiology consultation before carotid endarterectomy (CEA) in neurologically asymptomatic patients, in terms of early and long term cardiovascular events. METHODS: A single centre retrospective review of consecutive patients receiving CEA from 2007 to 2017 for asymptomatic carotid stenosis was performed. Two groups were compared: patients operated on from 2007 to 2012 received a pre-operative cardiology consultation only in selected cases (group A); from 2012 to 2017 patients received a routine pre-operative cardiology consultation (...
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.
Review of English-language articles published from PubMed (MEDLINE) and Google Scholar between January 1, 1985, and January 1, 2019.
In his landmark 1951 publication entitled “Occlusion of the Internal Carotid Artery,” C. Miller Fisher both described the pathogenesis of hemispheric stroke related to carotid bifurcation atherosclerosis and went on to speculate that “one day surgeons may even devise a way to remove the offending plaque and thereby prevent stroke.” His prophecy was soon realized when prophylactic carotid endarterectomy (CEA) was launched more or less simultaneously on three different continents in 1953. The fundamentals of this stroke preventive strategy remain clinically valid today, being supported by virtual...