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26. Microembolic Risk of Carotid Artery Plaque Composition By MRI at the Time of Elective Revascularization
Current guidelines for management of carotid atherosclerosis, the predisposing factor for ischemic stroke, are based on degree of stenosis and presence of symptoms. Both carotid endarterectomy (CEA) and minimally invasive (CAS) procedures pose risks to the patient, including peri/post-operative stroke. Intracerebral microembolization is a major factor leading to stroke after surgical or percutaneous revascularization. The ability of transcranial Doppler (TCD) to detect intraoperative microembolization, diffusion-weighted brain MRI to detect microinfarct lesions, and carotid MRI to provide detailed information on plaque mor...
Source: Annals of Vascular Surgery - May 1, 2015 Category: Surgery Authors: Jennifer R. Li, Chiara Giannarelli, Venkatesh Mani, Errol Gordon, Prakash Krishnan, Jason Kovacic, George Dangas, Ziad Ali, Zahi Fayad, Juan Badimon, Peter Faries, Jose Wiley Source Type: research

The Indications of Carotid Artery Stenting in Symptomatic Patients May Need to Be Reconsidered
According to the 2011 and the 2014 updated American Heart Association/American Stroke Association Guidelines, carotid artery stenting (CAS) is indicated as an alternative to carotid endarterectomy (CEA) for the management of symptomatic carotid patients. According to these recommendations, CAS is preferred to CEA in symptomatic patients with specific technical, anatomic, or physiological characteristics that render these individuals at “high risk” for surgery (e.g., contralateral carotid occlusion, previous neck irradiation, recurrent carotid stenosis, and so forth).
Source: Annals of Vascular Surgery - October 8, 2014 Category: Surgery Authors: Kosmas I. Paraskevas, Frank J. Veith Tags: General Review Source Type: research

The Indications of Carotid Artery Stenting in Symptomatic Patients May Need To Be Reconsidered
According to the 2011, as well as the 2014 updated American Heart Association/American Stroke Association Guidelines, carotid artery stenting (CAS) is indicated as an alternative to carotid endarterectomy (CEA) for the management of symptomatic carotid patients. According to these recommendations, CAS is preferred over CEA in symptomatic patients with specific technical, anatomic or physiologic characteristics that render these individuals at “high risk” for surgery (e.g. contralateral carotid occlusion, previous neck irradiation, recurrent carotid stenosis, etc.).
Source: Annals of Vascular Surgery - October 8, 2014 Category: Surgery Authors: Kosmas I. Paraskevas, Frank J. Veith 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

Early Carotid Endarterectomy after Thrombolysis for Acute Ischemic Stroke
Source: Annals of Vascular Surgery - August 1, 2014 Category: Surgery Authors: Guy Lesèche, Mathieu Glorion, Quentin Pellenc, Mikael Mazighi, Pierre Amarenco Tags: 29th Annual Meeting, French Society for Vascular Surgery (SCV) Source Type: research

Carotid Endarterectomy in Octogenarian: Short- and Midterm Results
Conclusion: The good immediate results and good probability of survival at 3 years after surgery conveys a real benefit of this surgery in this age group, but patients should be selected on a case by case basis. In our experience, the presence of bilateral lesions should be a significant influence criterion in the preoperative risk assessment. Other evaluation criteria, such as cardiac status, are needed to optimize the selection of asymptomatic patients in particular.
Source: Annals of Vascular Surgery - May 1, 2014 Category: Surgery Authors: Lucie Salomon du Mont, Mihary Ravelojaona, Marc Puyraveau, Mazen Al Sayed, Enzo Ritucci, Simon Rinckenbach Tags: Clinical Research 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

Managing Recurrent Carotid Artery Disease with Redo Carotid Endarterectomy: A 10-year Retrospective Case Series
Conclusions: In our retrospective study, the stroke and restenosis rates after RCEAs were similar to those after primary CEA. Therefore, we consider RCEA to be a viable therapeutic option in patients with carotid disease that recurs after a primary CEA.
Source: Annals of Vascular Surgery - February 14, 2014 Category: Surgery Authors: A. George Akingba, Michael Bojalian, Changyu Shen, Jeffrey Rubin Tags: Clinical Research Source Type: research

Is Early Surgical Revascularization of Symptomatic Carotid Stenoses Safe?
Conclusions: This study confirms the interest of an early surgery for symptomatic carotid stenoses with a Rankin score of ≤3. The risk of recurrence of a cerebral ischemic accident during the preoperative period remains high.
Source: Annals of Vascular Surgery - February 13, 2014 Category: Surgery Authors: Thierry Merlini, Matthieu Péret, Pierre Lhommet, Séverine Debiais, Guillaume Marc, Sophie Godard, Robert Martinez, Bernard Enon, Jean Picquet Tags: Clinical Research Source Type: research

Regarding ‘Carotid Endarterectomy National Trends over a Decade: Does Gender Matter?’
We read with interest the results by Kuy et al. concluding that women show lower perioperative cardiac morbidity and mortality rates than men after carotid endarterectomy (CEA). These results seem to be opposing to other retrospective studies. According to Guzman et al., female gender does not influence 30-day stroke and mortality rates after CEA, regardless of preoperative symptom status. Likewise, Jim et al. conclude that women and men demonstrated similar results—including myocardial infarction (MI) and death—after carotid revascularization procedures. However, Bisdas et al. have found that asymptomatic women we...
Source: Annals of Vascular Surgery - February 13, 2014 Category: Surgery Authors: George Galyfos, Manolis Vavouranakis, Konstantinos Filis Tags: Letters to the Editor Source Type: research

Use of the Vascu-Guard Bovine Pericardium Patch for Arteriotomy Closure in Carotid Endarterectomy. Early and Long-Term Results
Conclusions: This series shows the efficacy, safety, and durability of CEA with BP patch closure, in both the short and long term. BP combines the advantages of vein and synthetic patches, representing a suitable option when performing CEA.
Source: Annals of Vascular Surgery - December 24, 2013 Category: Surgery Authors: John C. Papakostas, Stavros Avgos, Eleni Arnaoutoglou, Christos Nassis, Michalis Peroulis, Christina Bali, George Papadopoulos, Miltiadis I. Matsagkas Tags: Clinical Research Source Type: research

Discharge on the First Postoperative Day after Elective Carotid Endarterectomy
Conclusion: In this study, the majority of patients undergoing elective CEA were discharged safely on the first postoperative day. Social reasons, rather than medical reasons, underlied most cases of later discharge. There were no unplanned readmissions for complications of CEA.
Source: Annals of Vascular Surgery - December 23, 2013 Category: Surgery Authors: Pierre Van den Brande, Isolde Van Heymbeeck, Erik Debing, Dimitri Aerden, Karl von Kemp, Leslie Moerman, Chris Verborgh, Patrick Haentjens Tags: Clinical Research Source Type: research

Relation between B-mode Gray-scale Median and Clinical Features of Carotid Stenosis Vulnerability
Conclusions: No relation was found between the GSM and any clinical, radiologic, or intra- and postoperative neurologic phenomena. These data showed no additional value of the use of GSM in evaluating plaque vulnerability.
Source: Annals of Vascular Surgery - December 18, 2013 Category: Surgery Authors: Joé L. Kolkert, Robbert Meerwaldt, Jan Loonstra, Miranda Schenk, Job van der Palen, Jan J. van den Dungen, Clark J. Zeebregts Tags: Clinical Research Source Type: research

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