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Closing the Loop: A 21-year Audit of Strategies for Preventing Stroke and Death Following Carotid Endarterectomy
The objective of this review was to identify causes of stroke/death after carotid endarterectomy (CEA) and to develop transferable strategies for preventing stroke/death after CEA, via an overview of a 21-year series of themed research and audit projects. Three preventive strategies were identified: (i) intra-operative transcranial Doppler (TCD) ultrasound and completion angioscopy which virtually abolished intra-operative stroke, primarily through the removal of residual luminal thrombus prior to restoration of flow; (ii) dual antiplatelet therapy with a single 75-mg dose of clopidogrel the night before surgery in additio...
Source: European Journal of Vascular and Endovascular Surgery - June 17, 2013 Category: Surgery Authors: A.R. Naylor, R.D. Sayers, M.J. McCarthy, M.J. Bown, A. Nasim, M.J. Dennis, N.J.M. London, P.R.F. Bell Tags: Carotid Disease Source Type: research

Commentary on ‘Protamine Reduces Bleeding Complications Without Increasing the Risk of Stroke After Carotid Endarterectomy: A Meta-analysis’
Kakisis et al. demonstrate in their meta-analysis that reversing the effect of heparin with protamine seems to reduce the number of major neck hematomas associated with CEA. One might fear that this would be at the cost of an increased level of cerebral thromboembolism. However, Kakisis et al. showed that administration of protamine does not seem to influence the rate of stroke.1
Source: European Journal of Vascular and Endovascular Surgery - July 13, 2016 Category: Surgery Authors: L.K. Rathenborg Tags: Invited Commentary Source Type: research

Nationwide Experience of Cardio- and Cerebrovascular Complications During Infrainguinal Endovascular Intervention for Peripheral Arterial Disease and Acute Limb Ischaemia
Conclusions: In this population-based study we found a low risk of cardiac complications, but catheter-administered thrombolytic therapy entailed a non-negligible risk of major stroke.
Source: European Journal of Vascular and Endovascular Surgery - January 21, 2013 Category: Surgery Authors: J. Nordanstig, K. Smidfelt, M. Langenskiöld, B. Kragsterman Tags: Peripheral Arterial Disease Source Type: research

Virtual Patient-Specific Thrombectomies: The Impact of the Vessel Morphology
Objective: The endovascular thrombectomy (EVT) procedure is the most effective treatment for large vessel occlusions (LVO) in acute ischaemic stroke. EVT is a minimally invasive procedure aiming at mechanically removing the thrombus obstructing the cerebral artery by means of a stent retriever. The cerebral arteries mostly affected by stroke are the internal carotid artery (ICA), the middle cerebral artery (MCA), and the anterior cerebral artery (ACA), which form the T-junction (Fig. 1A). The ICA is characterised by a tortuous morphology, referred to as carotid siphon, which can complicate the thrombectomy procedure during...
Source: European Journal of Vascular and Endovascular Surgery - February 1, 2022 Category: Surgery Authors: Sara Bridio, Giulia Luraghi, Jose F. Rodriguez Matas, Julia N. Kawamoto, Kevin M. Moerman, Patrick McGarry, Praneeta R. Konduri, Nerea Arrarte Terreros, Henk M. Marquering, Ed van Bavel, Charles B.L.M. Majoie, Francesco Migliavacca Source Type: research

Identification of Patients with a Histologically Unstable Carotid Plaque Using Ultrasonic Plaque Image Analysis
Objectives: In patients with carotid stenosis the risk of stroke is highest in the first few days after onset of symptoms and it is low in asymptomatic patients. The ability to identify patients with a high (or low) probability of having a histologically unstable plaque might become a complimentary method that can refine the indications for surgical intervention.Methods: Two histopathologists, using validated American Heart Association criteria, independently graded plaques harvested during carotid endarterectomy. Preoperative Duplex images were independently assessed for juxtaluminal black area, plaque type, plaque area, ...
Source: European Journal of Vascular and Endovascular Surgery - June 18, 2014 Category: Surgery Authors: M.K. Salem, M.J. Bown, R.D. Sayers, K. West, D. Moore, A. Nicolaides, T.G. Robinson, A.R. Naylor Tags: Carotid Disease Source Type: research

Upper Extremity Ischemia as a “Warning Shot” of Cerebellar Infarction
A 44-year-old woman without cardiovascular risk factors complained of pain and coldness in the digits of her left hand. Radial and ulnar pulses were palpable, with equal brachial pressures on both sides. After a 2-hour stay in the outpatient department she developed acute headache, nausea, and vomiting. Computed tomographic scan with contrast medium revealed a floating thrombus in the left subclavian artery extending towards the origin of the vertebral artery (A). Brain magnetic resonance imaging demonstrated an infarction of the left cerebellum (B), whereupon the patient was immediately referred to the stroke unit.
Source: European Journal of Vascular and Endovascular Surgery - February 29, 2016 Category: Surgery Authors: S. Regus, W. Lang Tags: Coup D'Oeil Source Type: research

Overview of Evidence on Emergency Carotid Stenting in Acute Ischemic Stroke due to Tandem Occlusions: A Systematic Review and Meta-Analysis
Introduction - The combination of cervical internal carotid artery (ICA) occlusion with synchronous intracranial thrombus represents 10-20% of all acute ischemic strokes (AIS), and such tandem occlusions are strongly associated with poor outcome.
Source: European Journal of Vascular and Endovascular Surgery - November 30, 2019 Category: Surgery Authors: Andreia P. Coelho, Miguel Lobo, Ricardo Gouveia, Rita Augusto, Nuno Coelho, Ana C. Semi ão, Diogo Silveira, Alexandra Canedo Source Type: research

Symptomatic Carotid Plaques Show Decreased (18)F-Fluorodeoxyglucose (FDG) Uptake on Positron Emission Tomography (PET) After 3 Months Follow-up from Last Symptom
Introduction: The risk of stroke is high shortly after the index symptoms in patients with carotid disease. This indicates that unstable carotid plaques stabilizes over time, which may be due to changes in composition and inflammatory activity. Inflammation is thought to be one of the leading causes in atherosclerotic plaques destabilizing leading to thrombosis. With positron emission tomography (PET) previous studies have shown increased uptake of the glucose analogue tracer [18F]-fluorodeoxyglucose (FDG) in symptomatic compared to asymptomatic carotid plaques.
Source: European Journal of Vascular and Endovascular Surgery - November 30, 2019 Category: Surgery Authors: L ærke Urbak, Rasmus Sejersten Ripa, Benjamin Sandholt, Andreas Kjaer, Henrik Sillesen, Martin Graebe Source Type: research

Carotid Endarterectomy Following Intravenous Thrombolysis in the UK
The aim of this study was to evaluate the effect of pre-operative intravenous thrombolytic therapy (ivTT) on short term outcomes after carotid endarterectomy (CEA) among patients who presented with ischaemic stroke.
Source: European Journal of Vascular and Endovascular Surgery - June 2, 2021 Category: Surgery Authors: Amundeep S. Johal, A. Ross Naylor, Arun D. Pherwani, Qiuju Li, Panagiota Birmpili, Sam Waton, Richard O ’Neill, Jonathan R. Boyle, David A. Cromwell Source Type: research

Endovascular Thrombectomy for Acute Arterial Mesenteric Ischaemia: No Benefit of Mechanical Over Manual Thrombus Aspiration
Early vessel recanalisation is the cornerstone of treatment of acute arterial mesenteric ischaemia (AMI) and can be achieved by either percutaneous endovascular techniques or open repair. Depending on the mechanism of superior mesenteric artery (SMA) occlusion, endovascular techniques include intra-arterial thrombolysis, thrombus aspiration, or stenting. Endovascular thrombus aspiration has been shown to be beneficial for cerebral stroke, lower limb ischaemia, and myocardial infarction. Regarding AMI, endovascular thrombus aspiration has only been evaluated in small series,1 and SMA thrombus aspiration methods (manual or m...
Source: European Journal of Vascular and Endovascular Surgery - May 11, 2022 Category: Surgery Authors: Lorenzo Garzelli, Iannis B. Abdallah, Alexandre Nuzzo, Olivier Corcos, Yves Castier, Maxime Ronot Tags: Research Letter Source Type: research

Bleeding Issues During Thrombolysis for Acute Leg Ischaemia
When we started testing catheter directed low dose thrombolysis (CDT) for acute leg ischaemia (ALI) in the 1980s, it was the first time endovascular intervention advanced beyond simple balloon angioplasty. In many respects, CDT kick started the endovascular revolution. Clots could be removed without surgery, and from arteries too small for embolectomy catheters to reach. But there was a price to pay: thrombolytic drugs caused bleeding, mainly from catheter puncture sites, but also from distant areas, such as haemorrhagic stroke.
Source: European Journal of Vascular and Endovascular Surgery - January 6, 2023 Category: Surgery Authors: Jonothan Earnshaw Tags: Invited Commentary Source Type: research

Activated Clotting Time Guided Heparinisation During Open Abdominal Aortic Aneurysm Repair (ACTION-1) - Rationale and Design of a Randomised Trial
Unfractionated heparin has been used by vascular surgeons worldwide for more than 70 years during non-cardiac arterial procedures (NCAP) to prevent clot formation and reduce thromboembolic complications (TEC), for example, arterial thrombosis, peripheral emboli, myocardial infarction, colonic ischaemia, deep venous thrombosis, and stroke.1,2 In this Research Letter, shortcomings and high variation in current intra-operative heparin use, the need for scientific evidence, and the design of a randomised controlled trial (RCT) are discussed.
Source: European Journal of Vascular and Endovascular Surgery - January 12, 2023 Category: Surgery Authors: Max Hoebink, Liliane C. Roosendaal, Arno M. Wiersema, Vincent Jongkind, the ACTION-1 research collaborative Tags: Research Letter Source Type: research