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Sex Is Associated With the Presence of Atherosclerotic Plaque Hemorrhage and Modifies the Relation Between Plaque Hemorrhage and Cardiovascular Outcome Clinical Sciences
Conclusions— Atherosclerotic carotid plaques obtained from men reveal a higher prevalence of PH compared with women. Local PH is strongly related to secondary manifestations of cardiovascular disease in men but not in women.
Source: Stroke - November 25, 2013 Category: Neurology Authors: Vrijenhoek, J. E. P., Den Ruijter, H. M., De Borst, G. J., de Kleijn, D. P. V., De Vries, J.-P. P. M., Bots, M. L., Van de Weg, S. M., Vink, A., Moll, F. L., Pasterkamp, G. Tags: Pathophysiology, Carotid Stenosis, Carotid endarterectomy, Epidemiology Clinical Sciences Source Type: research

Outcomes of urgent carotid endarterectomy for stable and unstable acute neurologic deficits
Conclusions: Our results with U-CEA confirm that this population has a higher risk profile compared with elective surgery. The type of acute presentation is correlated with perioperative risk. U-CEA was safe when performed on patients presenting with transient ischemic attack. An acceptable complication rate was achieved for patients with minor to moderate strokes. The poorest outcomes occurred in patients presenting with stroke in evolution: U-CEA in these patients should be offered with extreme caution, although we are aware that a conservative treatment may not grant a better prognosis.
Source: Journal of Vascular Surgery - November 18, 2013 Category: Surgery Authors: Iacopo Barbetta, Michele Carmo, Giulio Mercandalli, Patrizia Lattuada, Daniela Mazzaccaro, Alberto M. Settembrini, Raffaello Dallatana, Piergiorgio G. Settembrini Tags: Clinical research studies Source Type: research

11. “Two is better than one”? Simultaneous monitoring of multichannel somatosensory evoked potentials and electroencephalogram during carotid endarterectomy
In carotid endarterectomy (CEA), EEG and somatosensory evoked potentials (SEPs) are the most commonly used monitoring techniques to prevent perioperative stroke. However, which of these methods is the most appropriate is not definitely established. Here we evaluated retrospectively simultaneous EEG and SEP recordings. Our CEA series was analyzed backward to identify 30 patients requiring carotid shunt. Shunting was performed in 7.1% of 420 consecutive CEA over a 20-month period. All CEAs were continuously monitored by multi-channel EEG and SEPs before, during and 20min following carotid cross-clamping. The most reliable SE...
Source: Clinical Neurophysiology - October 21, 2013 Category: Neuroscience Authors: C. Cardinali, D. Battista, E. Del Sordo, S. Colon, N. Cellai, R. Mazzeo, E. Sirabella, S. Michelagnoli, F. Passuello, L. Ercolini, E. Barbanti, E. Chisci, P. Frosini, A. Lenzi, A. Molisso, L. Tramacere, A. Borgheresi, P. Vanni, M. Piccininni, G. Zaccara, Tags: Society Proceedings Source Type: research

A Retrospective Study on Early Carotid Endarterectomy within 48 Hours after Transient Ischemic Attack and Stroke in Evolution
Conclusions: CEA can be performed with an acceptable risk in properly selected symptomatic patients within 48 hours after TIA or SIE. The benefits of early CEA in symptomatic patients include the prevention of recurrent stroke.
Source: Annals of Vascular Surgery - September 5, 2013 Category: Surgery Authors: Emanuele Ferrero, Michelangelo Ferri, Andrea Viazzo, Carmelo Labate, Giuseppe Berardi, Alberto Pecchio, Salvatore Piazza, Matteo Ripepi, Franco Nessi Tags: Clinical Research Source Type: research

The impact of the present on admission indicator on the accuracy of administrative data for carotid endarterectomy and stenting
Conclusions: Administrative data has known limitations for assignment of symptom status and nonfatal perioperative outcomes. Given the uncertain timing of POA events as preoperative vs intraoperative and its apparent underestimation of the perioperative stroke rate, the use of administrative data even with the POA indicator for symptom status and non-fatal outcomes after CEA and CAS is hazardous.
Source: Journal of Vascular Surgery - August 29, 2013 Category: Surgery Authors: Margriet Fokkema, Rob Hurks, Thomas Curran, Rodney P. Bensley, Allen D. Hamdan, Mark C. Wyers, Frans L. Moll, Marc L. Schermerhorn Tags: Clinical research studies Source Type: research

Carotid endarterectomy for symptomatic low-grade carotid stenosis
Conclusions: This study shows that CEA is a safe, effective, and durable treatment for patients with symptomatic low-grade carotid stenosis associated with unstable plaque. Patients had excellent protection against further ischemic events and survived long enough to justify the initial surgical risk. Plaque instability seems to play a major part in the onset of ischemic events, regardless the entity of lumen narrowing.
Source: Journal of Vascular Surgery - August 19, 2013 Category: Surgery Authors: Enzo Ballotta, Annalisa Angelini, Franco Mazzalai, Giacomo Piatto, Antonio Toniato, Claudio Baracchini Tags: Clinical research studies Source Type: research

Safety of carotid endarterectomy following thrombolysis for acute ischemic stroke
Conclusions: Despite slightly higher rates of postoperative hemorrhagic strokes than those in randomized trials, CEA appears safe following thrombolysis for acute ischemic stroke. However, more data on the timing of surgery is needed.
Source: Journal of Vascular Surgery - July 29, 2013 Category: Surgery Authors: Yao Pey Yong, John Saunders, Said Abisi, Nikola Sprigg, Krishna Varadhan, Shane MacSweeney, Nishath Altaf Tags: Review articles Source Type: research

Teaching NeuroImages: Perfusion imaging of cerebral hyperperfusion syndrome following revascularization
A 69-year-old man developed acute-onset confusion and hypertension with systolic pressures in the 160s 1 day after carotid endarterectomy for right facial droop from left hemispheric lacunar infarcts. CT perfusion (figure, A–D) demonstrated findings consistent with cerebral hyperperfusion syndrome (CHS) following revascularization. CHS is caused by loss of autoregulation, hypertension, and ischemia-reperfusion injury resulting in increased regional blood flow and vascular congestion.1 CHS following revascularization may present as ipsilateral headache, focal seizure, or neurologic deficit. Nonperfusion imaging may sh...
Source: Neurology - July 22, 2013 Category: Neurology Authors: Kalra, V. B., Rao, B., Malhotra, A. Tags: CT, All Cerebrovascular disease/Stroke RESIDENT AND FELLOW SECTION 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

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

Carotid plaque hemorrhage on magnetic resonance imaging strongly predicts recurrent ischemia and stroke
ObjectiveThere is a recognized need to improve selection of patients with carotid artery stenosis for carotid endarterectomy (CEA). We assessed the value of magnetic resonance imaging (MRI)‐defined carotid plaque hemorrhage (MRIPH) to predict recurrent ipsilateral cerebral ischemic events, and stroke in symptomatic carotid stenosis. MethodsOne hundred seventy‐nine symptomatic patients with ≥50% stenosis were prospectively recruited, underwent carotid MRI, and were clinically followed up until CEA, death, or ischemic event. MRIPH was diagnosed if the plaque signal intensity was >150% that of the adjacent muscle. Ev...
Source: Annals of Neurology - June 4, 2013 Category: Neurology Authors: Akram A. Hosseini, Neghal Kandiyil, Shane T. S. MacSweeney, Nishath Altaf, Dorothee P. Auer Tags: Original Article Source Type: research

The role of completion imaging following carotid artery endarterectomy
A variety of completion imaging methods can be used during carotid endarterectomy to recognize technical errors or intrinsic abnormalities such as mural thrombus or platelet aggregation, but none of these methods has achieved wide acceptance, and their ability to improve the outcome of the operation remains a matter of controversy.It is unclear if completion imaging is routinely necessary and which abnormalities require re-exploration. Proponents of routine completion imaging argue that identification of these abnormalities will allow their immediate correction and avoid a perioperative stroke. However, much of the evidenc...
Source: Journal of Vascular Surgery - April 23, 2013 Category: Surgery Authors: Jean-Baptiste Ricco, Fabrice Schneider, Giulio Illuminati, Russell H. Samson Tags: Trans-Atlantic debate Source Type: research

Does Standardised Post-CEA Blood Pressure Control Make Cerebral Monitoring for Hyperperfusion Irrelevant?
Identification of patients at risk for developing cerebral hyperperfusion syndrome (HS) following carotid endarterectomy (CEA) is essential, as treatment in the early phase can potentially prevent life-threatening symptoms. Previous studies have shown the ability of perioperative transcranial Doppler (TCD) to more accurately predict occurrence of HS and associated intracranial haemorrhage (ICH) or stroke. Based on these studies, Newman et al. retrospectively analysed 1450 CEA patients with accessible TCD window. The authors were unable to demonstrate that increases in middle cerebral artery velocity predicted risk of suff...
Source: European Journal of Vascular and Endovascular Surgery - April 22, 2013 Category: Surgery Authors: G.J. de Borst, F.L. Moll Tags: Invited Commentary Source Type: research

Clinical risk predictors for cerebral hyperperfusion syndrome after carotid endarterectomy
Conclusions Independent, prospective monitoring of a large cohort of CEA cases identified a brief time interval between ischaemic symptoms and endarterectomy as the clearest risk factor for CHS.
Source: Journal of Neurology, Neurosurgery and Psychiatry - April 8, 2013 Category: Neurosurgery Authors: Maas, M. B., Kwolek, C. J., Hirsch, J. A., Jaff, M. R., Rordorf, G. A. Tags: Epilepsy and seizures, Headache (including migraine), Pain (neurology), Stroke, Hypertension, Ophthalmology, Ischaemic heart disease, Disability Neurosurgery Source Type: research

Changes in Middle Cerebral Artery Velocity after Carotid Endarterectomy do not Identify Patients at High-risk of Suffering Intracranial Haemorrhage or Stroke due to Hyperperfusion Syndrome
Conclusion: We were unable to demonstrate that significant increases in MCAV and PI were able to predict patients at increased risk of suffering a post-operative stroke due to HS or ICH. The provision of written guidance for managing PEH in Group 2 patients was associated with virtual abolition of ICH/HS.
Source: European Journal of Vascular and Endovascular Surgery - March 29, 2013 Category: Surgery Authors: J.E. Newman, M. Ali, R. Sharpe, M.J. Bown, R.D. Sayers, A.R. Naylor Tags: Carotid Disease Source Type: research

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