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Protamine sulfate use during tibial bypass does not appear to increase thrombotic events or affect short-term graft patency.
CONCLUSIONS: Heparin reversal with protamine sulfate after tibial or peroneal bypass grafting is not associated with higher cardiovascular morbidity, bypass thrombosis, amputation, or mortality. Additionally, there was no statistically significant difference in post-operative bleeding or thrombosis complications for patients who did not receive protamine, although the findings are suggestive of a potential difference in a more adequately powered study. Our results suggest that protamine sulfate is safe for intraoperative use without increased risk of thrombotic complications or early tibial bypass graft failure. PMID:...
Source: Vascular - May 10, 2020 Category: Surgery Authors: Phair J, Futchko J, Trestman EB, Carnevale M, Friedmann P, Shukla H, Garg K, Koleilat I Tags: Vascular Source Type: research

Carotid endarterectomy using a flow-reversal technique in the acute period: a novel approach that may reduce intraoperative cerebral events
Lesion manipulation during internal carotid artery (ICA) surgical dissection is the most crucial stage of carotid endarterectomy (CEA); a friable part of the carotid plaque or a thrombus may detach from the arterial wall leading to cerebral embolism. Proximal protection devices used in carotid stenting (CAS) reverse the blood flow to the brain eliminating, at least after their deployment, the chance of cerebral embolism. Based on the working principle of these devices, we propose a new approach to CEA making use of a flow-reversal technique and we report its successful application in 2 high risk patient with a soft and fri...
Source: Annals of Vascular Surgery - March 30, 2020 Category: Surgery Authors: Vangelis G. Alexiou, Dimitrios Chatzis, Andreas M. Lazaris, Konstantinos Kondylis, Stylianos Koutsias Tags: Selected Technique Source Type: research

Carotid Endarterectomy Using a Flow-Reversal Technique in the Acute Period: A  Novel Approach That May Reduce Intraoperative Cerebral Events
Lesion manipulation during internal carotid artery (ICA) surgical dissection is the most crucial stage of carotid endarterectomy (CEA); a friable part of the carotid plaque or a thrombus may detach from the arterial wall, leading to cerebral embolism. Proximal protection devices used in carotid artery stenting reverse the blood flow to the brain eliminating, at least after their deployment, the chance of cerebral embolism. Based on the working principle of these devices, we propose a new approach to CEA making use of a flow-reversal technique, and we report its successful application in 2 high-risk patients with a soft and...
Source: Annals of Vascular Surgery - March 30, 2020 Category: Surgery Authors: Vangelis G. Alexiou, Dimitrios Chatzis, Andreas M. Lazaris, Konstantinos Kondylis, Stylianos G. Koutsias Tags: Selected Technique Source Type: research

Carotid web leads to new thrombus formation: computational fluid dynamic analysis coupled with histological evidence
We describe a 48-year-old woman with carotid web who developed embolic stroke. We obtained a fresh thrombus from the internal carotid artery when carotid endarterectomy was performed. A preoperative computational fluid dynamics (CFD) study showed stagnation of blood around the web structure as well as the low wall shear stress. The rheological analysis newly disclosed mechanisms of thrombus formation related to the carotid web. CFD study in the carotid web may determine indication and timing of surgical interventions with further accumulation of clinical evidence.
Source: Acta Neurochirurgica - March 9, 2020 Category: Neurosurgery Source Type: research

Optical Coherence Tomography as an Adjunct During Carotid Artery Stenting for Carotid Atherosclerotic Disease
ConclusionOptical coherence tomography image acquisition was found to be safe, effective, and to provide valuable information about plaque morphology and stent-vessel interactions. The role of perioperative anticoagulation after stenting should be re-evaluated given the new findings. A  study comparing CAS with and without OCT with a clinical primary outcome such as ipsilateral stroke could help determine if OCT is an innovative tool to guide stenting and antithrombotic management.
Source: Clinical Neuroradiology - May 30, 2019 Category: Neurology Source Type: research

Considerations Beyond Stenosis for Carotid Endarterectomy in Treating Free-Floating Thrombus of the Carotid Artery
Free-floating thrombus (FFT) of the carotid artery is an uncommon condition that can present with neurologic symptoms, often in the setting of ischemic stroke. The literature pertaining to the incidence and optimal treatment of this condition is limited. Herein we report our contemporary experience with FFT across a range of degrees of carotid stenosis.
Source: Annals of Vascular Surgery - May 7, 2019 Category: Surgery Authors: Besher Tolaymat, Karen Irizarry, Michaella Reif, Charles B. Drucker, Brittany O. Aicher, Rajabrata Sarkar, Shahab Toursavadkohi, Thomas S. Monahan Tags: Clinical Research, Basic Science Source Type: research

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

Hemoglobin A1c-related histologic characteristics of symptomatic carotid plaques
Conclusions: Increased HbA1c values seem to contribute to plaque instability through the formation of a thin fibrous cup. Thus, of the carotid artery plaque parameters including fibrous cup thickness, plaque rupture, lipid core, inflammation, intraplaque hemorrhage, thrombus, calcification, necrotic core, and neovascularization, fibrous cup thickness is the only histomorphological feature that affected by HbA1c.
Source: Nigerian Journal of Clinical Practice - March 5, 2019 Category: Rural Health Authors: M Tecellioglu S Alan S Kamisli FS Tecellioglu O Kamisli C Ozcan 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

Invited commentary
Since current guidelines based on randomized clinical trials1-6 have established degree of carotid stenosis as the primary surrogate for stroke risk and indication for carotid endarterectomy or stenting, accurate assessment of the degree of carotid stenosis has been the traditional focus of carotid imaging.7 However, the degree of carotid stenosis is an inadequate assessment of stroke risk, and other key factors for determining carotid plaque vulnerability include intraplaque hemorrhage, plaque rupture, and luminal thrombus.
Source: Journal of Vascular Surgery - November 20, 2018 Category: Surgery Authors: Karen J. Ho Tags: From bench to bedside Source Type: research

Morphology and histology of silent and symptom-causing atherosclerotic carotid plaques - Rationale and design of the Helsinki Carotid Endarterectomy Study 2 (the HeCES2).
This article provides a detailed study design and protocol of HeCES2, an observational prospective cohort study with the objective to investigate the pathophysiology of carotid atherosclerosis. MATERIALS AND METHODS: Recruitment and carotid endarterectomies of the study patients with carotid atherosclerosis were performed from October 2012 to September 2015. After brain and carotid artery imaging, endarterectomised carotid plaques (CPs) and blood samples were collected from 500 patients for detailed biochemical and molecular analyses. Findings to date: We developed a morphological grading for macroscopic characteristic...
Source: Annals of Medicine - July 18, 2018 Category: Internal Medicine Tags: Ann Med Source Type: research

Carotid artery disease: clinical features and management
Publication date: June 2018Source: Surgery (Oxford), Volume 36, Issue 6Author(s): A. Ross NaylorAbstractThe most common single cause of ischaemic carotid territory stroke is thromboembolism from stenoses in the extracranial internal carotid artery (ICA). In the majority, embolism is preceded by an acute change in plaque morphology predisposing the patient to overlying thrombus formation and embolization. The management of patients with carotid artery disease mandates risk factor modification, antiplatelet and statin therapy in everyone. There is grade A, level I evidence that recently symptomatic patients with 50–99% NAS...
Source: Surgery (Oxford) - July 11, 2018 Category: Surgery Source Type: research

Low carotid stump pressure as a predictor for ischemic symptoms and as a marker for compromised cerebral reserve in octogenarians undergoing carotid endarterectomy
Carotid artery occlusive disease can cause stroke by embolization, thrombosis, and hypoperfusion. The majority of strokes secondary to cervical carotid atherosclerosis are believed to be of embolic etiology. However, cerebral hypoperfusion could be an important factor in perioperative stroke. We retrospectively reviewed the stump pressure (SP) of carotid endarterectomy (CEA) of patients at Pennsylvania Hospital to identify whether physiologic perfusion differences account for differences in perioperative stroke rates, particularly in octogenarians.
Source: Journal of Vascular Surgery - February 23, 2018 Category: Surgery Authors: Sam C. Tyagi, Matthew J. Dougherty, Shinichi Fukuhara, Douglas A. Troutman, Danielle M. Pineda, Hong Zheng, Keith D. Calligaro Tags: Clinical paper Source Type: research

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