Immune cells in carotid artery plaques: what can we learn from endarterectomy specimens?
CONCLUSIONS: Since the destabilization of the atherosclerotic plaque is a multifactorial process, a combination of various methods should be used to characterize the unstable plaques more accurately. In this context, studies characterizing plaque content from a cellular point ofview could elucidate some processes underlying the plaque progression. Together with morphological evaluation, these analyses could enable more precise assessment of plaque stability. PMID: 31782285 [PubMed - as supplied by publisher]
Carotid endarterectomy (CEA) is a proven intervention for stroke risk reduction in symptomatic and asymptomatic patients. High-risk patients are often offered carotid stenting to minimize risk and optimize outcomes. As a referral center for high-risk patients, we sought to evaluate and analyze our experience with high-risk CEA patients.
Across stroke subtypes, carotid artery stroke carries the highest risk of recurrence. Despite initiation of best medical therapy (BMT), some patients suffer recurrent neurological events before undergoing carotid endarterectomy (CEA). The aim was to identify clinical predictors of early recurrent events in patients with symptomatic carotid stenosis (sCS) awaiting CEA on modern BMT.
Carotid artery stenting (CAS) with distal or proximal cerebral protection devices is an extensively developed method of endovascular treatment for atherosclerotic carotid stenosis, especially in high risk surgical candidates. Immediate and long term outcomes of CAS and carotid endarterectomy (CEA) have already been compared in CREST (Carotid Revascularization Endarterectomy vs. Stenting Trial), which included average risk patients. It should also be noted that CAS and CEA were only comparable regarding the composite end point; CEA proved to be superior to CAS regarding the incidence of ipsilateral stroke.
Current recommendations are to perform carotid endarterectomy (CEA) within two weeks of symptoms due to superior long-term stroke prevention, although urgent CEA within 48-hours has been associated with increased perioperative stroke. With the development and rapid adoption of TransCarotid Artery Revascularization (TCAR), we aim to study the impact of timing on outcomes after TCAR.
Conclusions: Carotid endarterectomy continues to prove its safety in carotid artery stenosis patients. Continuous cerebral oxygenation monitoring is indispensable for carotid surgery. Despite discrepancies in surgical techniques, we believe that "one fits all strategy: general anesthesia, conventional endarterectomy without patch plasty, never shunter and always NIRS monitorization" may be used safely in patients undergoing carotid endarterectomy. PMID: 33014089 [PubMed]
We report changing patterns with multiple specialties participating in the delivery of carotid revascularization.
This study compares the FDA required 1-year outcomes of TCAR and CEA in the Vascular Quality Initiative (VQI) TCAR Surveillance Project (TSP) using a large cohort of patients matched on over 24 baseline variables.
ConclusionThe use of CEA is a feasible alternative to CAS in acute stroke and has the advantage that DAPT/GpIIb/IIIa inhibitors are not needed. All PH2 in CEA patients occurred during the intervention, implying that hemorrhage in this group is likely to be caused by reperfusion injury, whereas delayed hemorrhage is likely to b e caused by DAPT/GpIIb/IIIa inhibitors.
CONCLUSIONS: Carotid endarterectomy reduced the risk of recurrent stroke for people with significant stenosis. Endarterectomy might be of some benefit for participants with 50% to 69% symptomatic stenosis (moderate-quality evidence) and highly beneficial for those with 70% to 99% stenosis (moderate-quality evidence). PMID: 32918282 [PubMed - as supplied by publisher]
AbstractBackgroundMeasurement of luminal stenosis and determination of plaque instability using MR plaque imaging are effective strategies for evaluating high-risk carotid stenosis. Nevertheless, new methods are required to identify patients with carotid stenosis at risk of future stroke. We aimed to clarify the mechanisms and clinical implications of the hyperintense vessel sign (HVS) as a marker of high-risk carotid stenosis.MethodsWe included 148 patients who underwent carotid stent (CAS) or carotid endarterectomy (CEA). MRI FLAIR was performed to detect HVS prior to and within 7 days after CAS/CEA. MR plaque imaging an...