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Asymptomatic Carotid Stenosis Is Associated With Circadian and Other Variability in Embolus Detection
Conclusions: Embolism associated with asymptomatic carotid stenosis shows circadian variation with highest rates 4–6 h before midday. This corresponds with peak circadian incidence of stroke and other vascular complications. These and ASED Study results show that monitoring frequency, duration, and time of day are important in ES detection. Introduction Transcranial Doppler (TCD) detected microembolism in the ipsilateral middle cerebral artery (MCA) may help stratify the risk of stroke and other arterial disease complications in persons with advanced (≥60%) asymptomatic carotid stenosis. If so, this t...
Source: Frontiers in Neurology - April 15, 2019 Category: Neurology Source Type: research

Technical improvements in carotid revascularization based on the mechanism of procedural stroke.
In conclusion, this review provides an overview of the pathophysiological mechanism of stroke following carotid revascularization (both CAS and CEA) and of the technical improvements that have contributed to reducing this stroke risk. PMID: 30827087 [PubMed - as supplied by publisher]
Source: The Journal of Cardiovascular Surgery - February 28, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Fassaert LM, de Borst GJ Tags: J Cardiovasc Surg (Torino) Source Type: research

Medical Treatment Strategies To Reduce Peri-operative Morbidity and Mortality after Carotid Surgery
There is a paucity of high quality evidence regarding what constitutes ‘optimal medical therapy’ for the purposes of reducing morbidity/mortality following carotid endarterectomy (CEA). All patients should be prescribed antiplatelet therapy. Low dose aspirin (75-325mg) should be continued throughout the peri-operative period and there is no evidence that higher dos es confer additional benefit. There is emerging evidence that early implementation of dual antiplatelet therapy in recently symptomatic patients (aspirin 75mg plus clopidogrel 75mg) may reduce recurrent cerebral events prior to CEA and that dual antiplatelet...
Source: Seminars in Vascular Surgery - April 27, 2017 Category: Surgery Authors: Ross Naylor Source Type: research

Medical treatment strategies to reduce perioperative morbidity and mortality after carotid surgery
There is a paucity of high-quality evidence regarding what constitutes “optimal medical therapy” for the purposes of reducing morbidity/mortality after carotid endarterectomy (CEA). All patients should be prescribed antiplatelet therapy. Low-dose aspirin (75 to 325 mg) should be continued throughout the perioperative period and there is no evidence that higher dose s confer additional benefit. There is emerging evidence that early implementation of dual antiplatelet therapy in recently symptomatic patients (aspirin 75 mg plus clopidogrel 75 mg) can reduce recurrent cerebral events before CEA and that dual antiplatelet ...
Source: Seminars in Vascular Surgery - April 27, 2017 Category: Surgery Authors: A. Ross Naylor Source Type: research

Predictors of Cervical Bleeding after Carotid Endarterectomy
Conclusions: Postoperative severe bleeding after carotid surgery in our institution is not an uncommon complication. Its incidence is within the range reported in the literature, but it is not associated with major complications or mortality. Antiplatelet treatment with clopidogrel is the main risk factor associated with reintervention. Other factors, such as coagulation control, postoperative hypertension management, and the use of an autologous patch, could help reduce its incidence.
Source: Annals of Vascular Surgery - September 30, 2013 Category: Surgery Authors: Sara Mercedes Morales Gisbert, Vicente Andrés Sala Almonacil, Jose Miguel Zaragozá García, Beatriz Genovés Gascó, Francisco Julián Gómez Palonés, Eduardo Ortiz Monzón Tags: Clinical Research 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