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Computed Tomography Perfusion Imaging in the Selection of Acute Stroke Patients to Undergo Emergent Carotid Endarterectomy
Severe acute stroke patients with critical carotid stenosis or occlusion without intracranial thrombus typically do not undergo emergent carotid thromboendarterectomy (CEA) because of the risk of reperfusion-related intracranial hemorrhage. Past studies have not consistently demonstrated benefit of early operative intervention. Cerebral computed tomography (CT), cervical and cerebral CT angiography (CTA), and cerebral CT perfusion (CTP) imaging may identify a subset of acute stroke patients without intracranial thrombus who may benefit from emergent CEA.
Source: Annals of Vascular Surgery - September 3, 2014 Category: Surgery Authors: Thomas G. Devlin, Sachin V. Phade, Rodney K. Hutson, Mark W. Fugate, Grant R. Major, Gregory W. Albers, Abdelazim A. Sirelkhatim, Biggya L. Sapkota, Steven D. Quartfordt, Blaise W. Baxter Tags: Case Report Source Type: research

An ischemic stroke patient with free floating thrombus in carotid artery, successfully treated by open carotid thrombectomy: a first case report in Nepal.
We present a case in which we performed open surgery and achieved successful retrieval of the thrombus. A 40 year-old male patient presented with ischemic stroke and mild left hemiparesis. Computerized tomography and magnetic resonance imaging showed infarction in the right parieto-occipital area. Carotid Doppler study showed carotid stenosis on the right side. Further investigation with CT angiography of the neck vessels confirmed significant carotid artery occlusion with a free-floating thrombus in the internal carotid artery. Carotid endarterectomy was planned under EEG monitoring. The right carotid artery was exposed w...
Source: Hiroshima Journal of Medical Sciences - December 12, 2015 Category: Journals (General) Tags: Hiroshima J Med Sci Source Type: research

Stroke Rounds: Early Surgery Looks Safe After tPA
(MedPage Today) -- Performing carotid endarterectomy or stenting in patients who were recently treated with thrombolytic therapy for an acute stroke appeared to be safe, an observational study showed.
Source: MedPage Today Cardiovascular - March 11, 2014 Category: Cardiology Source Type: news

Ischemic Stroke Predicts Myocardial Injury After Carotid Endarterectomy for Symptomatic Severe Carotid Artery Stenosis
Myocardial injury following carotid endarterectomy (CEA) is a common cause of morbidity and mortality, and its risk varies depending on the severity and extent of disease. However, when patients with sympotomatic severe carotid stenosis undergo CEA, the frequency and potential predictors of myocardial injury remain unknown. A total of 40 patients (32 men and 8 women) who underwent successful standard CEA were observed. Cardiac troponin I (cTnI) concentrations were assessed before surgery and on postoperative days 1, 2, and 3 in all patients. Myocardial injury was defined as the peak cTnI concentration > 0.04 ng/mL. In a...
Source: Clinical and Applied Thrombosis/Hemostasis - April 2, 2014 Category: Hematology Authors: Feng, H., Wang, T.-L., Cai, B. Tags: Original Articles Source Type: research

Acute Stroke After Carotid Endarterectomy: Time for a Paradigm Shift? Multicenter Experience With Emergent Carotid Artery Stenting With or Without Intracranial Tandem Occlusion Thrombectomy
CONCLUSION: Emergent endovascular evaluation in the setting of acute post--carotid endarterectomy thrombosis is a safe and timely treatment option, with the benefit of detecting and treating embolic intracranial lesions. Immediate angiography and intervention in this rare surgical complication show promising initial results. ABBREVIATIONS: CAS, carotid artery stenting CEA, carotid endarterectomy ICA, internal carotid artery NASCET, North American Symptomatic Carotid Endarterectomy Trial
Source: Neurosurgery - March 19, 2015 Category: Neurosurgery Tags: Research-Human-Clinical Studies 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

Posterior Cerebral Circulation Stroke Secondary to Foetal Origin of Posterior Communicating Artery: an Indication for Carotid Endarterectomy
Posterior cerebral circulation strokes are most commonly caused by posterior vasculature in situ thrombosis, cardiac emboli, or arterial dissection. However, the foetal origin of the posterior communicating artery is an anatomical variant of the cerebral circulation that results in communication between the internal carotid and posterior cerebral circulation. This can, therefore, rarely result in posterior cerebral territory infarction from internal carotid artery thromboembolism. This is a report of a case in which a patient suffered posterior circulatory stroke secondary to this anatomical variation of the circle of Willis.
Source: EJVES Extra - December 15, 2020 Category: Surgery Authors: Lydia Mann, Ryan Preece, Liz Haslam, Sharath Paravastu, Richard A. Bulbulia, Sachin R. Kulkarni Tags: Case Report Source Type: research

Acute ischemic stroke: The role of emergency carotid endarterectomy in isolated extracranial internal carotid artery occlusion
CONCLUSIONS: Emergency CEA in isolated eICA occlusion has proved to be a safe and effective treatment option in selected patients. CT perfusion, imaging the ischemic penumbra and quantifying the tissue suitable for reperfusion, offers a valid support in the diagnostic-therapeutic workup. Indeed, we can infer that the area of the ischemic penumbra is directly proportional to the margin of clinical improvement after revascularization, supposing that the appropriate intervention timing is respect.PMID:37594376 | DOI:10.1177/17085381231192712
Source: Vascular - August 18, 2023 Category: Surgery Authors: Pierfilippo Acciarri Alice Camagni Maddalena Bressan Gladiol Zenunaj Ilaria Casetta Andrea Bernardoni Vincenzo Gasbarro Luca Traina Source Type: research

Asymptomatic Carotid Stenosis Is Associated With Circadian and Other Variability in Embolus Detection
Conclusions: Embolism associated with asymptomatic carotid stenosis shows circadian variation with highest rates 4–6 h before midday. This corresponds with peak circadian incidence of stroke and other vascular complications. These and ASED Study results show that monitoring frequency, duration, and time of day are important in ES detection. Introduction Transcranial Doppler (TCD) detected microembolism in the ipsilateral middle cerebral artery (MCA) may help stratify the risk of stroke and other arterial disease complications in persons with advanced (≥60%) asymptomatic carotid stenosis. If so, this t...
Source: Frontiers in Neurology - April 15, 2019 Category: Neurology Source Type: research

Modern Treatment of Asymptomatic Carotid Stenosis —The Importance of Both Medical Therapy and Carotid Endarterectomy
Each year there are approximately 700  000 new ischemic strokes in the US, and 10% to 15% of them are caused by thromboembolism from a previously asymptomatic carotid stenosis (ACS). Three large randomized clinical trials, published in the 1990s and early 2000s, have demonstrated a significant benefit of carotid endarterectomy (CEA) i n preventing stroke in patients with severe ACS compared with medical therapy alone. They showed a 50% relative risk reduction in 5-year stroke rate and an approximately 1% per year absolute stroke risk reduction. Over the course of the past 2 decades, there has been significant improvement...
Source: JAMA Surgery - June 8, 2022 Category: Sports Medicine Source Type: research

Carotid Endarterectomy Following Intravenous Thrombolysis in the UK
CONCLUSION: The use of ivTT before CEA in stroke patients was not associated with an increased risk of 30 day stroke, but there was an increase in the risk of neck haematoma.PMID:34088616 | DOI:10.1016/j.ejvs.2021.03.033
Source: PubMed: Eur J Vasc Endovasc ... - June 5, 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

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