A Simple Clinical Score Identifies Higher Risk of Stroke in Patients with Asymptomatic Carotid Artery Stenosis
Introduction - Three large randomised trials have assessed the efficacy and safety of carotid endarterectomy (CEA) in patients with tight carotid stenosis and no recent unilateral symptoms. Although absolute risk reductions changed over time, the trials (VA, ACAS, ACST-1; 5226 participants recruited from 1983-2003) found that stroke risk was halved by successful surgery.
In 2007, the UK Department of Health (DOH) published its National Stroke Strategy, which detailed 20 quality markers for delivering a high quality stroke service, one of which was that patients suffering a transient ischaemic attack (TIA) or minor stroke should be investigated and treated more quickly after symptom onset.1 Interestingly, the National Stroke Strategy also advised that carotid endarterectomy (CEA) should be performed within 48 h of symptom onset, although no evidence was provided to support this threshold.
Review of English-language articles published from PubMed (MEDLINE) and Google Scholar between January 1, 1985, and January 1, 2019.
Currently there is no definitive level I evidence regarding the appropriate management of asymptomatic moderate to severe carotid artery stenosis in the octogenarian patient. In this 5-year review of National Surgical Quality Improvement Program registry data, exceptional “real-world” results are reported with use of carotid endarterectomy (CEA) in this growing cohort.1 The combined stroke and death rate was 2% at 30-day follow-up (stroke rate 1%!), with the authors stating that “age alone should not interdict this modality.”
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 (...