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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: PubMed: Eur J Vasc Endovasc ... - June 13, 2013 Category: Surgery Authors: Naylor AR, Sayers RD, McCarthy MJ, Bown MJ, Nasim A, Dennis MJ, London NJ, Bell PR Tags: Eur J Vasc Endovasc Surg Source Type: research

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

Mechanism of Procedural Stroke Following Carotid Endarterectomy or Carotid Artery Stenting Within the International Carotid Stenting Study (ICSS) Randomised Trial.
CONCLUSION: Although the mechanism of procedural stroke in both CAS and CEA is diverse, haemodynamic disturbance is an important mechanism. Careful attention to blood pressure control could lower the incidence of procedural stroke. PMID: 26160210 [PubMed - as supplied by publisher]
Source: PubMed: Eur J Vasc Endovasc ... - July 6, 2015 Category: Surgery Authors: Huibers A, Calvet D, Kennedy F, Czuriga-Kovács KR, Featherstone RL, Moll FL, Brown MM, Richards T, de Borst GJ Tags: Eur J Vasc Endovasc Surg Source Type: research

CT 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, R. Kent Hutson, Mark W. Fugate, G. Ralston Major, Gregory W. Albers, Abdelazim A. Sirelkhatim, Biggya L. Sapkota, Steven D. Quartfordt, Blaise W. Baxter Source Type: research

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

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

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

A Systematic Review and Meta-analysis of Peri-Procedural Outcomes in Patients Undergoing Carotid Interventions Following Thrombolysis
CONCLUSION: Peri-procedural ICH and local haematoma were significantly more frequent in patients undergoing CEA after TT (vs. no TT), although there were no randomised comparisons. Peri-procedural hazards were also significantly higher for CAS after TT. The inverse relationship between timing to CEA and peri-procedural stroke/death mandates careful patient selection and suggests that it may be safer to defer CEA for six-seven days after TT.PMID:34266765 | DOI:10.1016/j.ejvs.2021.06.003
Source: PubMed: Eur J Vasc Endovasc ... - July 16, 2021 Category: Surgery Authors: Stavros K Kakkos Melina Vega de Ceniga Ross Naylor Source Type: research

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