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Postoperative disability and one-year outcomes for patients suffering a stroke after carotid endarterectomy
Objective: Although post-carotid endarterectomy (CEA) strokes are rare, they can be devastating. The degree of disability that patients develop after such events and its effects on long-term outcomes are unclear. Our goal was to assess the extent of postoperative disability in patients suffering strokes after CEA and evaluate its association with long-term outcomes.
Source: European Journal of Vascular and Endovascular Surgery - August 1, 2023 Category: Surgery Authors: Scott R. Levin, Alik Farber, Anna Kobzeva-Herzog, Elizabeth G. King, Mohammad H. Eslami, Karan Garg, Virendra I. Patel, Caron B. Rockman, Denis Rybin, Jeffrey J. Siracuse Tags: Clinical research study Source Type: research

Optimising Secondary Prevention: a One Year Review of Lipid Lowering Therapy (LLT) and Cholesterol Monitoring in Patients Undergoing Carotid Surgery
Objective: Stroke is common (100 000 new cases annually in the UK), with carotid atherosclerotic disease a recognised cause.1 In such cases patients may require either surgical or endovascular carotid intervention but they should also receive optimal medical therapy including lipid lowering therapy (LLT).2 Statins have been shown to reduce the 10 year risk of stroke/death (17.9% vs. 7.6%) after carotid endarterectomy.3 Current European Society for Vascular Surgery (ESVS) Guidelines advise high intensity statin (HIS) treatment with a target LDL C level of
Source: European Journal of Vascular and Endovascular Surgery - May 1, 2023 Category: Surgery Authors: J.Y. Kwan, M. Sood, F. Stocco, N. Orozov, K. Spencer-jones, M. Bailey, P. Coughlin, J. Scott Source Type: research

Effect of the Pre-Operative Systemic Inflammatory Response on Outcomes Following Carotid Endarterectomy for Symptomatic Carotid Stenosis
Objective: Stroke accounts for over 100 000 acute hospital presentations per year in the UK, and approximately 4 500 carotid endarterectomies are performed annually in the UK.1 This is despite a relative paucity of cases performed for asymptomatic carotid stenosis, in comparison with other countries.1 Periprocedural stroke and death rates have fallen in recent years,2 although these remain notable risks necessitating careful patient selection and counselling. Chronic activation of the systemic inflammatory response (SIR) is prevalent in patients with atherosclerotic disease and influences both the pathogenesis and prognosis.
Source: European Journal of Vascular and Endovascular Surgery - May 1, 2023 Category: Surgery Authors: K. Dosanj, N. Bradley, C. Roxburgh, D. Mcmillan, G. Guthrie Source Type: research

Endarterectomy Achieves Lower Stroke and Death Rates Compared With Stenting in Patients With Asymptomatic Carotid Stenosis: a Systematic Review and Meta-Analysis of the Literature
Objective: It is currently unclear whether carotid artery stenting (CAS) is as safe as carotid endarterectomy (CEA) for patients with notable asymptomatic stenosis. The aim of this study was to update a systematic review and meta-analysis of trials comparing CAS with CEA previously performed, showing a moderate certainty of evidence in favour of CEA regarding 30 day stroke or death rates.1
Source: European Journal of Vascular and Endovascular Surgery - May 1, 2023 Category: Surgery Authors: L. Alexopoulou-Prounia, S.K. Kakkos, I. Kakisis, G. Geroulakos Source Type: research

Similar 30 Day Clinical Outcomes After Carotid Artery Stenting By Different Medical Specialities: Analysis From a Large, Multicentre, European Roadsaver Study
Objective: Carotid artery disease treatment options include optimal medical therapy, surgical carotid endarterectomy (CEA), and endovascular carotid artery stenting (CAS). Clinical trials from the past two decades, comparing CEA with CAS reveal higher periprocedural (up to 30 days) risk of stroke or death with CAS. The higher risk is primarily noted in symptomatic patients (> 70 years old), while in younger and/or asymptomatic patients CEA and CAS outcomes are more comparable.1 Contemporary CAS is carried out by operators of different specialties, including angiologists, (neuro)radiologists, cardiologists, and vascular sur...
Source: European Journal of Vascular and Endovascular Surgery - May 1, 2023 Category: Surgery Authors: A. Schwindt, The Roadsaver Investigators O.B.O. Source Type: research

The Impact of Full Collapse on the Risk of Ischaemic Stroke in Patients with Carotid Near Occlusion
Carotid near occlusion (CNO) is a severe carotid stenosis associated with a reduction in the calibre of the extracranial internal carotid artery distal to the stenosis.1 The risk of ipsilateral stroke in patients with CNO is a controversial issue. While a post hoc analysis of the North American Symptomatic Carotid Endarterectomy Trial (NASCET) and the European Carotid Surgery Trial (ECST) reported a lower risk of ipsilateral stroke for medically treated patients with CNO compared with patients with severe (70 –99%) carotid stenosis2, more recent studies have shown that the CNO recurrence rate may be higher.
Source: European Journal of Vascular and Endovascular Surgery - April 20, 2023 Category: Surgery Authors: Andr és García-Pastor, Ana Iglesias-Mohedano, Antonio Gil-Núñez Tags: Editorial Source Type: research

Long Term Mortality in Patients Treated with Carotid Endarterectomy
Carotid endarterectomy (CEA) is an effective surgical method for stroke prevention in selected patients with carotid stenosis. Few contemporary studies report on long term mortality in CEA treated patients, despite continuous changes in medication, diagnostics, and patient selection. Here, the long term mortality is described in a well characterised cohort of asymptomatic and symptomatic CEA patients, sex differences evaluated, and mortality ratio compared with the general population.
Source: European Journal of Vascular and Endovascular Surgery - March 3, 2023 Category: Surgery Authors: Katarina Wad én, Rebecka Hultgren, Maria Ioanna Kotopouli, Peter Gillgren, Joy Roy, Ulf Hedin, Ljubica Matic Source Type: research

Long Term Mortality Rate in Patients Treated with Carotid Endarterectomy
Carotid endarterectomy (CEA) is an effective surgical method for stroke prevention in selected patients with carotid stenosis. Few contemporary studies report on the long term mortality rate in CEA treated patients, despite continuous changes in medication, diagnostics, and patient selection. Here, the long term mortality rate is described in a well characterised cohort of asymptomatic and symptomatic CEA patients, sex differences evaluated, and mortality ratio compared with the general population.
Source: European Journal of Vascular and Endovascular Surgery - March 3, 2023 Category: Surgery Authors: Katarina Wad én, Rebecka Hultgren, Maria Ioanna Kotopouli, Peter Gillgren, Joy Roy, Ulf Hedin, Ljubica Matic Source Type: research

Carotid endarterectomy is safe for octogenarians
Background: Carotid endarterectomy (CEA) has demonstrated superior results in stroke risk reduction for patients with symptomatic and asymptomatic high-grade carotid stenosis. However, this benefit has long been questioned for the elderly and high-risk populations. In the present study, we aimed to provide high-volume, single-institution data with long-term follow-up examining the risk factors for postoperative stroke and stroke-free survival stratified by age for asymptomatic and symptomatic patients undergoing CEA.
Source: European Journal of Vascular and Endovascular Surgery - January 1, 2023 Category: Surgery Authors: Yazen Qumsiyeh, Sammy Siada, Yueqi Yan, Rachel Dirks, Amna Ali, Meelod Daneshvar, Leigh Ann O ’Banion Source Type: research

Measurement of the Brain Atrophy Index To Predict Mortality: a ‘No-Brainer’?
In this issue of the European Journal of Vascular and Endovascular Surgery, Lauksia et  al. present a multivariable analysis of pre-operative brain atrophy as a predictor of long term mortality after carotid endarterectomy (CEA).1 In the field of carotid revascularisation, various prediction models have been developed in the past to assist stratifying patients into groups at high and low risk of peri-procedural complications or long term stroke risk. An evaluation of the external performance of 23 short and seven long term outcome models showed that these models do not reliably predict outcome after carotid revascularisat...
Source: European Journal of Vascular and Endovascular Surgery - December 22, 2022 Category: Surgery Authors: Jos C. van den Berg Tags: Invited Commentary Source Type: research

Locoregional anaesthesia and intraoperative angiography in carotid endarterectomy - 16-year results of a consecutive single-centre series
This study analyses the associations between patient characteristics, LA and intraoperative imaging strategies and the in-hospital stroke and death rates in elective CEA over a 16-years period.
Source: European Journal of Vascular and Endovascular Surgery - October 10, 2022 Category: Surgery Authors: Felix Kirchhoff, Hans-Henning Eckstein, Munich carotid investigation group Source Type: research

Locoregional Anaesthesia and Intra-Operative Angiography in Carotid Endarterectomy: 16 Year Results of a Consecutive Single Centre Series
This study analysed the associations between patient characteristics, LA, and intra-operative imaging strategies and the in hospital stroke and death rates in elective CEA over a 16 year period.
Source: European Journal of Vascular and Endovascular Surgery - October 10, 2022 Category: Surgery Authors: Felix Kirchhoff, Hans-Henning Eckstein, for the Munich carotid investigation group Source Type: research

Multivariable Analysis of Pre-operative Brain Atrophy as a Predictor of Long Term Mortality After Carotid Endarterectomy
Brain atrophy is associated with an increased mortality rate in elderly trauma patients and in patients treated with mechanical thrombectomy for acute ischaemic stroke. In the setting of ischaemic stroke, the association between brain atrophy and death is stronger than that of sarcopenia. It has previously been shown that lower masseter area, as a marker of sarcopenia, is linked to lower survival after carotid endarterectomy (CEA). The aim of this study was to investigate whether brain atrophy is also associated with long term mortality in patients undergoing CEA.
Source: European Journal of Vascular and Endovascular Surgery - October 6, 2022 Category: Surgery Authors: Iisa Lauksio, Linda Wallenius, Iisa Lindstr öm, Jussi M. Kärkkäinen, Niina Khan, Jussi Hernesniemi, Sara Protto, Niku K.J. Oksala Source Type: research

Multivariable analysis of preoperative brain atrophy as a predictor of long-term mortality after carotid endarterectomy
Brain atrophy is associated with increased mortality in elderly trauma patients and in patients treated with mechanical thrombectomy for acute ischemic stroke. In the setting of ischemic stroke, the association of brain atrophy with mortality is stronger than that of sarcopenia. We have previously shown that lower masseter area, as a marker of sarcopenia, is linked to lower survival after carotid endarterectomy (CEA) and hypothesized that brain atrophy would also be associated with long-term mortality in patients undergoing CEA.
Source: European Journal of Vascular and Endovascular Surgery - October 6, 2022 Category: Surgery Authors: Lauksio Iisa, Wallenius Linda, Lindstr öm Iisa, Kärkkäinen Jussi Mikael, Khan Niina, Hernesniemi Jussi, Protto Sara, Oksala Niku Kalle Jalmari Source Type: research

Comparison of methods for monitoring of intraoperative cerebral perfusion in patients undergoing carotid endarterectomy with selective shunting – a systematic review and network meta-analysis of randomized controlled trials and cohort studies
The objective of our study was to analyze the influence of different methods of monitoring of cerebral perfusion (MCP) on stroke, death, and usage of intraluminal shunt during carotid endarterectomy (CEA).
Source: European Journal of Vascular and Endovascular Surgery - September 19, 2022 Category: Surgery Authors: Aleksa Jovanovic, Magnus Jonsson, Joy Roy, Julia Eriksson, Perica Mutavdzic, Ranko Trailovic, Igor Koncar Tags: Systematic Review Source Type: research

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