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The need for treatment of hemodynamic instability following carotid endarterectomy is associated with increased perioperative and 1-year morbidity and mortality
The objective of this study was to evaluate the outcomes of patients after carotid endarterectomy (CEA) who developed postoperative hypertension or hypotension requiring the administration of intravenous vasoactive medication (IVMED).Methods: We examined consecutive, primary elective CEA performed by 128 surgeons within the Vascular Study Group of New England (VSGNE) database (2003-2010) and compared outcomes of patients who required postoperative IVMED to treat hyper- or hypotension with those who did not. Outcomes included perioperative death, stroke, myocardial infarction (MI), congestive heart failure (CHF), hospital l...
Source: Journal of Vascular Surgery - September 3, 2013 Category: Surgery Authors: Tze-Woei Tan, Mohammad H. Eslami, Jeffrey A. Kalish, Robert T. Eberhardt, Gheorghe Doros, Philip P. Goodney, Jack L. Cronenwett, Alik Farber, Vascular Study Group of New England Tags: Clinical research studies Source Type: research

Early-Term Complications after Carotid Endarterectomy and Their Risk Factors: Eight-Year Employment of Local Treatment Protocol of a Russian High-Volume Center
Conclusions: The present retrospective analysis of the local carotid surgery register showed appropriate outcomes after CEA regarding the cumulative incidence of MACE, which is comparable to previously published international register data. A previous history of stroke, myocardial infarction, COPD, a prolonged clamping time during CEA, and diabetes mellitus were found to be factors of high-risk for cardiovascular mortality. A prolonged clamping was identified as an independent predictor of any stroke.Eur Surg Res
Source: European Surgical Research - December 17, 2020 Category: Surgery Source Type: research

Patients at elevated risk of major adverse events following endarterectomy for asymptomatic carotid stenosis
Conclusions A high-risk subset of patients undergoing CEA for asymptomatic carotid stenosis can be identified. If patient selection is optimized and perioperative morbidity and mortality are minimized, CEA will continue to play an important role in stroke prevention for those with significant asymptomatic carotid stenosis.
Source: The American Journal of Surgery - May 23, 2015 Category: Surgery Source Type: research

The impact of Centers for Medicare and Medicaid Services high-risk criteria on outcome after carotid endarterectomy and carotid artery stenting in the SVS Vascular Registry
Objective: The Centers for Medicare and Medicaid Services (CMS) require high-risk (HR) criteria for carotid artery stenting (CAS) reimbursement. The impact of these criteria on outcomes after carotid endarterectomy (CEA) and CAS remains uncertain. Additionally, if these HR criteria are associated with more adverse events after CAS, then existing comparative effectiveness analysis of CEA vs CAS may be biased. We sought to elucidate this using data from the SVS Vascular Registry.Methods: We analyzed 10,107 patients undergoing CEA (6370) and CAS (3737), stratified by CMS HR criteria. The primary endpoint was composite death,...
Source: Journal of Vascular Surgery - February 13, 2013 Category: Surgery Authors: Marc L. Schermerhorn, Margriet Fokkema, Philip Goodney, Ellen D. Dillavou, Jeffrey Jim, Christopher T. Kenwood, Flora S. Siami, Rodney A. White, SVS Outcomes Committee Tags: Clinical research studies Source Type: research

Prospective Randomized Trial of ACUSEAL Versus Vascu-Guard Patching in Carotid Endarterectomy
Conclusions: Although CEA patching with ACUSEAL versus Vascu-Guard differed in hemostasis time, the frequency of reexploration for neck hematomas was more frequent in the pericardial patch group; however, only 1 patient had documented suture line bleeding and the surgical reexploration rate is not likely to be patch related. There were not any significant differences in perioperative/late neurologic events and late restenosis in the 2 groups.
Source: Annals of Vascular Surgery - February 20, 2014 Category: Surgery Authors: Patrick A. Stone, Ali F. AbuRahma, Albeir Y. Mousa, David Phang, Stephen M. Hass, Asmita Modak, David Dearing Tags: Clinical Research Source Type: research

Optimal selection of asymptomatic patients for carotid endarterectomy based on predicted 5-year survival
We examined factors associated with 5-year survival following CEA in patients with asymptomatic internal carotid artery (ICA) stenosis.Methods: Prospectively collected data from 4114 isolated CEAs performed for asymptomatic stenosis across 24 centers in the Vascular Study Group of New England between 2003 and 2011 were used for this analysis. Late survival was determined with the Social Security Death Index. Cox proportional hazard models were used to identify risk factors for mortality within the first 5 years after CEA and to calculate a risk score for predicting 5-year survival.Results: Overall 3- and 5-year survival af...
Source: Journal of Vascular Surgery - March 13, 2013 Category: Surgery Authors: Jessica B. Wallaert, Jack L. Cronenwett, Daniel J. Bertges, Andres Schanzer, Brian W. Nolan, Randall De Martino, Jens Eldrup-Jorgensen, Philip P. Goodney, Vascular Study Group of New England Tags: Clinical research studies Source Type: research

Reply
Multiple studies have demonstrated the efficacy of transcranial Doppler (TCD)-directed dextran therapy during carotid endarterectomy (CEA). In our recent review of 6641 CEAs performed within the auspices of the Vascular Study Group of New England, we found perioperative infusion of dextran was not correlated with lower stroke rates but rather was associated with increased postoperative cardiac complications, including myocardial infarction and congestive heart failure. We concluded that there was limited clinical utility for the routine use of dextran during CEA.
Source: Journal of Vascular Surgery - October 1, 2013 Category: Surgery Authors: Tze-Woei Tan, Alik Farber Tags: Letters to the Editor Source Type: research

Clinical Impact of Routine Cardiology Consultation Prior to Elective Carotid Endarterectomy in Neurologically Asymptomatic Patients.
CONCLUSION: Routine cardiology consultation before elective CEA in patients with asymptomatic carotid stenosis reduced peri-operative cardiac complications and long term fatal cardiovascular events. This approach may be considered to maximise the risk/benefit ratio of CEA in asymptomatic patients. PMID: 31866235 [PubMed - as supplied by publisher]
Source: PubMed: Eur J Vasc Endovasc ... - December 18, 2019 Category: Surgery Authors: Squizzato F, Antonello M, Taglialavoro J, Prosdocimi L, Grego F, Lupia M, Piazza M Tags: Eur J Vasc Endovasc Surg Source Type: research

Revised cardiac score index is a predictor of long-term outcomes after carotid endarterectomy
Conclusion: RCRI and CtRCRI did not predict MACE in the perioperative period but are good predictors of 30-day complications (Clavien-Dindo ≥2). Both RCRI and CtRCRI have good prognostic value as predictors of long-term cardiovascular events.PMID:35171024 | DOI:10.1024/0301-1526/a000988
Source: VASA. Zeitschrift fur Gefasskrankheiten. Journal for Vascular Diseases - February 16, 2022 Category: Surgery Authors: Filipa J ácome Leandro N óbrega Ant ónio Pereira-Neves Lu ís Duarte-Gamas Joana Mour ão Pedro Videira-Reis Marina Dias-Neto Jo ão Rocha-Neves Source Type: research

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