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PC164 Fast-Track Thrombolysis for Acute Lower Extremity In-Stent Occlusions: A Novel Approach to Minimize Complications of Standard Thrombolytic Therapy
The role of catheter-directed thrombolysis (CDT) in the treatment of acute lower extremity ischemia may require prolonged periods of time to achieve successful lysis. Prolonged thrombolysis infusion has demonstrated increased incidence of intracranial bleeding, stroke, and local complications. It is expensive and increases hospital length of stay. To minimize these potentially negative outcomes, we developed a fast track approach (FTA) that included the use of aggressive balloon angioplasty and stenting before the thrombus was completely lysed.
Source: Journal of Vascular Surgery - May 17, 2017 Category: Surgery Authors: Syed Ali Rizvi, Anil Hingorani, Enrico Ascher, Natalie Marks Tags: C10: Poster Competition Source Type: research

A critical note on protamine use in carotid endarterectomy
Two recent meta-analyses investigated the risks and benefits of heparin reversal by protamine after carotid endarterectomy (CEA).1,2 They found that heparin reversal with protamine reduces the risk for reoperation due to bleeding without an increased risk of stroke, myocardial infarction, or death. Yet, we would like to address the hemostatic and hemodynamic effects of protamine.
Source: Journal of Vascular Surgery - August 22, 2017 Category: Surgery Authors: Michael I. Meesters, Christa Boer Tags: Letter to the Editor Source Type: research

LEA 24. Synthetic Marijuana and Acute Lower Limb Thromboembolism and Ischemia —A Case Report
Synthetic marijuana use has been reported in the last years as a possible causative factor of different cardiovascular events, including myocardial infarction, ischemic stroke, intracranial bleeding, and cerebral vasospasm. One case of aortic thrombosis was also reported, but that was in a patient using cocaine and synthetic marijuana together. A case of lower limb thromboembolism and synthetic marijuana use has not been reported to date. Intoxication, material impurity, blood vessel reactivity, and chemical interaction with other drugs have been proposed as possible mechanisms of these events.
Source: Journal of Vascular Surgery - October 21, 2019 Category: Surgery Authors: Asaf Rabin Source Type: research

Protamine use in transcarotid artery revascularization is associated with lower risk of bleeding complications without higher risk of thromboembolic events
Recent studies have found that transcarotid artery revascularization (TCAR) is associated with lower risk of stroke or death compared with transfemoral carotid artery stenting but higher risk of bleeding complications, presumably associated with the need for an incision. Heparin anticoagulation is universally used during TCAR, so protamine use may reduce bleeding complications. However, the safety and effectiveness of protamine use in TCAR are unknown. We therefore evaluated the impact of protamine use on perioperative outcomes after TCAR in the Vascular Quality Initiative TCAR Surveillance Project.
Source: Journal of Vascular Surgery - April 5, 2020 Category: Surgery Authors: Patric Liang, Raghu L. Motaganahalli, Mahmoud B. Malas, Grace J. Wang, Jens Eldrup-Jorgensen, Jack L. Cronenwett, Brian W. Nolan, Vikram S. Kashyap, Marc L. Schermerhorn Source Type: research

Ticagrelor or clopidogrel for dual antiplatelet therapy after transcarotid and transfemoral stenting of the carotid artery: are we ready for a randomized controlled trial?
In the work by Marcaccio et  al,1 the efficacy and safety of perioperative dual antiplatelet therapy (DAPT) with aspirin/ticagrelor vs aspirin/clopidogrel in patients undergoing carotid artery stenting (CAS) or transcarotid artery revascularization (TCAR) was examined using data collected from the Vascular Quality Initiative. Compared with aspirin/clopidogrel, aspirin/ticagrelor was associated with a potentially lower risk of stroke/death and bleeding complications after CAS in cases in which protamine was used but a higher risk of these outcomes in the absence of protamine.
Source: Journal of Vascular Surgery - June 20, 2022 Category: Surgery Authors: Mario D'Oria, Sandro Lepidi Tags: Letter to the Editor Source Type: research

Risk of Bleeding Complications With Different Peri-Operative Antithrombotic Regimens During Carotid Endarterectomy: a National Registry Analysis
Antithrombotic therapy is one of the cornerstones of the prevention of (recurrent) ocular or cerebral ischaemic events in patients with carotid artery stenosis. Randomised controlled trials on antithrombotic therapy for patients with minor ischaemic stroke and transient ischaemic attack (TIA) have recommended dual antiplatelet therapy (DAPT) in the three weeks following the index event. However, these trials excluded patients undergoing carotid revascularisation. To date, the optimal antithrombotic therapy during the peri-operative period of carotid endarterectomy (CEA) remains unclear.
Source: Journal of Vascular Surgery - January 19, 2023 Category: Surgery Authors: S.J.A. Donners, J.M. Mekke, E.S. van Hattum, R.J. Toorop, G.J. de Borst, Dutch Audit for Carotid Interventions (DACI) Collaborators Source Type: research

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