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P-020 Emergent Carotid Artery Stenting with or without Intracranial Tandem Occlusion Lesions Following Carotid Endarterectomy
Conclusion Emergent endovascular evaluation in the setting of acute post CEA thrombosis is a safe and timely treatment option, with the benefit of detecting and treating embolic intracranial lesions. More investigation is necessary to define the role of immediate angiography and intervention in this rare surgical complication. Abstract P-020 Table 1Patient demographics AgeGender% Carotid stenosisSymptomaticCase 166M90NCase 273M80–99YCase 378M70YCase 459F80–99YCase 555M80–99NCase 680MUnknownUnknown Abstract P-020 Table 2Pre procedural metrics Time from CEA to symptoms (hrs)Time from last normal to throm...
Source: Journal of NeuroInterventional Surgery - July 26, 2014 Category: Neurosurgery Authors: Vargas, J., Zuckerman, S., Chaudry, I., Turner, R., Turk, A., Spiotta, A. Tags: Oral poster abstracts Source Type: research

Emergent intracranial surgical embolectomy in conjunction with carotid endarterectomy for acute internal carotid artery terminus embolic occlusion and tandem occlusion of the cervical carotid artery due to plaque rupture.
Abstract Acute internal carotid artery (ICA) terminus occlusion is associated with extremely poor functional outcomes or mortality, especially when it is caused by plaque rupture of the cervical ICA with engrafted thrombus that elongates and extends into the ICA terminus. The goal of this study was to evaluate the efficacy and safety of surgical embolectomy in conjunction with carotid endarterectomy (CEA) for acute ICA terminus occlusion associated with cervical plaque rupture resulting in tandem occlusion. A retrospective review of medical records was performed. Clinical and radiographic characteristics were eval...
Source: Journal of Neurosurgery - January 9, 2015 Category: Neurosurgery Authors: Hasegawa H, Inoue T, Tamura A, Saito I Tags: J Neurosurg Source Type: research

64Cu-DOTATATE PET/MRI for Detection of Activated Macrophages in Carotid Atherosclerotic Plaques: Studies in Patients Undergoing Endarterectomy.
CONCLUSIONS: The novel PET tracer (64)Cu-DOTATATE accumulates in atherosclerotic plaques of the carotid artery. CD163 gene expression correlated independently with (64)Cu-DOTATATE uptake measured by real-time quantitative polymerase chain reaction in the final multivariate model, indicating that (64)Cu-DOTATATE PET is detecting alternatively activated macrophages. This association could potentially improve noninvasive identification and characterization of vulnerable plaques. PMID: 25977567 [PubMed - as supplied by publisher]
Source: Arteriosclerosis, Thrombosis and Vascular Biology - May 14, 2015 Category: Cardiology Authors: Folke Pedersen S, Vikjær Sandholt B, Høgild Keller S, Espe Hansen A, Ettrup Clemmensen A, Sillesen H, Højgaard L, Sejersten Ripa R, Kjær A Tags: Arterioscler Thromb Vasc Biol Source Type: research

Decreased 13N‑labeled ammonia uptake in the ipsilateral and contralateral hemispheres following carotid endarterectomy.
Authors: Wang T, Wang X, He Y, Zhang T, Song J, Bai X, Han C Abstract Carotid artery plaques are a leading cause of ischemic stroke, and carotid endarterectomy (CEA) is one of the major treatment approaches for this disease. Changes in cerebral metabolism following CEA remain unclear. The present study aimed to evaluate the effect of cerebral ammonia metabolism following CEA using 13N‑labeled ammonia positron emission tomography (PET) in humans. A total of 20 patients were enrolled in the present study, with a mean age of 59.5 years, comprising 16 males and four females. Of these patients, eight underwent rig...
Source: Molecular Medicine Reports - September 10, 2015 Category: Molecular Biology Tags: Mol Med Rep Source Type: research

Long-term Outcome After EndoVAC Hybrid Repair of Infected Vascular Reconstructions.
CONCLUSION: The EndoVAC technique is an alternative, less invasive, option for treatment of infected vascular reconstructions in selected cases, when neither traditional radical surgery, nor conservative simple negative pressure wound therapy are considered feasible or safe. The exact indications for this alternative hybrid treatment need to be established. PMID: 26944600 [PubMed - as supplied by publisher]
Source: PubMed: Eur J Vasc Endovasc ... - March 1, 2016 Category: Surgery Authors: Thorbjørnsen K, Djavani Gidlund K, Björck M, Kragsterman B, Wanhainen A Tags: Eur J Vasc Endovasc Surg Source Type: research

The Influence of Collagen Impregnation of a Knitted Dacron Patch Routinely Used in Carotid Endarterectomy
In selected populations, carotid endarterectomy (CEA) reduces long-term stroke risk. Studies have shown increased risk of restenosis with use of a collagen-impregnated Dacron patch compared to a PTFE patch. There is concern that collagen-impregnation may initiate thrombosis or increase restenosis due to platelet activation. We performed a retrospective analysis of our CEA experience with routine patching using knitted Dacron patches with (Hemashield) and without (Sauvage) collagen-impregnation.
Source: Annals of Vascular Surgery - June 29, 2016 Category: Surgery Authors: Daisy Chou, Allan Tulloch, David Cossman, J. Louis Cohen, Rajeev Rao, James Mirocha, Willis Wagner Source Type: research

The Influence of Collagen Impregnation of a Knitted Dacron Patch Used in Carotid Endarterectomy
In selected populations, carotid endarterectomy (CEA) reduces long-term stroke risk. Studies have shown increased risk of restenosis with use of a collagen-impregnated Dacron patch compared to a PTFE patch. There is concern that collagen-impregnation may initiate thrombosis or promote restenosis due to platelet activation. We performed a retrospective analysis of our CEA experience with routine patching using knitted Dacron patches with (Hemashield) and without (Sauvage) collagen-impregnation.
Source: Annals of Vascular Surgery - September 21, 2016 Category: Surgery Authors: Daisy Chou, Allan Tulloch, David Cossman, J. Louis Cohen, Rajeev Rao, Galinos Barmparas, James Mirocha, Willis Wagner Source Type: research

Medical Treatment Strategies To Reduce Peri-operative Morbidity and Mortality after Carotid Surgery
There is a paucity of high quality evidence regarding what constitutes ‘optimal medical therapy’ for the purposes of reducing morbidity/mortality following carotid endarterectomy (CEA). All patients should be prescribed antiplatelet therapy. Low dose aspirin (75-325mg) should be continued throughout the peri-operative period and there is no evidence that higher dos es confer additional benefit. There is emerging evidence that early implementation of dual antiplatelet therapy in recently symptomatic patients (aspirin 75mg plus clopidogrel 75mg) may reduce recurrent cerebral events prior to CEA and that dual antiplatelet...
Source: Seminars in Vascular Surgery - April 27, 2017 Category: Surgery Authors: Ross Naylor Source Type: research

Medical treatment strategies to reduce perioperative morbidity and mortality after carotid surgery
There is a paucity of high-quality evidence regarding what constitutes “optimal medical therapy” for the purposes of reducing morbidity/mortality after carotid endarterectomy (CEA). All patients should be prescribed antiplatelet therapy. Low-dose aspirin (75 to 325 mg) should be continued throughout the perioperative period and there is no evidence that higher dose s confer additional benefit. There is emerging evidence that early implementation of dual antiplatelet therapy in recently symptomatic patients (aspirin 75 mg plus clopidogrel 75 mg) can reduce recurrent cerebral events before CEA and that dual antiplatelet ...
Source: Seminars in Vascular Surgery - April 27, 2017 Category: Surgery Authors: A. Ross Naylor Source Type: research

Combined interventional and surgical treatment of tandem middle cerebral artery embolus and internal carotid artery occlusion: case report.
Abstract Tandem internal carotid artery (ICA) origin occlusion and middle cerebral artery (MCA) thromboembolism is a life-threatening condition with poor neurological outcome. The authors report on a patient presenting with acute ischemic stroke from a tandem ICA and MCA occlusion with penumbra. Emergency MCA mechanical thrombectomy was performed through percutaneous cervical ICA access due to the inability to cross the cervical carotid occlusion. Emergency carotid endarterectomy to reperfuse the poorly collateralized hemisphere and repair the ICA access site was performed 2 hours after completion of tissue plasmi...
Source: Journal of Neurosurgery - November 17, 2017 Category: Neurosurgery Authors: Frenkel MB, Renfrow JJ, Singh J, Garg N, Wolfe SQ Tags: J Neurosurg Source Type: research

Considerations Beyond Stenosis for Carotid Endarterectomy in Treating Free-Floating Thrombus of the Carotid Artery
Free-floating thrombus (FFT) of the carotid artery is an uncommon condition that can present with neurologic symptoms, often in the setting of ischemic stroke. The literature pertaining to the incidence and optimal treatment of this condition is limited. Herein we report our contemporary experience with FFT across a range of degrees of carotid stenosis.
Source: Annals of Vascular Surgery - May 7, 2019 Category: Surgery Authors: Besher Tolaymat, Karen Irizarry, Michaella Reif, Charles B. Drucker, Brittany O. Aicher, Rajabrata Sarkar, Shahab Toursavadkohi, Thomas S. Monahan Tags: Clinical Research, Basic Science Source Type: research

Carotid endarterectomy using a flow-reversal technique in the acute period: a novel approach that may reduce intraoperative cerebral events
Lesion manipulation during internal carotid artery (ICA) surgical dissection is the most crucial stage of carotid endarterectomy (CEA); a friable part of the carotid plaque or a thrombus may detach from the arterial wall leading to cerebral embolism. Proximal protection devices used in carotid stenting (CAS) reverse the blood flow to the brain eliminating, at least after their deployment, the chance of cerebral embolism. Based on the working principle of these devices, we propose a new approach to CEA making use of a flow-reversal technique and we report its successful application in 2 high risk patient with a soft and fri...
Source: Annals of Vascular Surgery - March 30, 2020 Category: Surgery Authors: Vangelis G. Alexiou, Dimitrios Chatzis, Andreas M. Lazaris, Konstantinos Kondylis, Stylianos Koutsias Tags: Selected Technique Source Type: research

Carotid Endarterectomy Using a Flow-Reversal Technique in the Acute Period: A  Novel Approach That May Reduce Intraoperative Cerebral Events
Lesion manipulation during internal carotid artery (ICA) surgical dissection is the most crucial stage of carotid endarterectomy (CEA); a friable part of the carotid plaque or a thrombus may detach from the arterial wall, leading to cerebral embolism. Proximal protection devices used in carotid artery stenting reverse the blood flow to the brain eliminating, at least after their deployment, the chance of cerebral embolism. Based on the working principle of these devices, we propose a new approach to CEA making use of a flow-reversal technique, and we report its successful application in 2 high-risk patients with a soft and...
Source: Annals of Vascular Surgery - March 30, 2020 Category: Surgery Authors: Vangelis G. Alexiou, Dimitrios Chatzis, Andreas M. Lazaris, Konstantinos Kondylis, Stylianos G. Koutsias Tags: Selected Technique Source Type: research

Use of Transcarotid Artery Revascularization to Treat Symptomatic Carotid Artery Stenosis Associated with Free Floating Thrombus
We describe a 67-year-old female who presented with a diagnosis of right hemispheric stroke in evolution and prior history of right CEA and a mechanical mitral valve.
Source: Annals of Vascular Surgery - August 11, 2020 Category: Surgery Authors: Ravi Mareedu, Jason Hwang, Sudhir Vyakaranam, Sashi Inkollu Tags: Case Report Source Type: research

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