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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

The Role of Neurosonology in the Diagnosis and Management of Patients with Carotid Artery Disease: A Review
ABSTRACT Carotid artery disease (CAD) is a common cause of ischemic stroke with high rates of recurrence. Carotid endarterectomy (CEA) or carotid artery stenting (CAS) are highly recommended for the secondary prevention of symptomatic CAD during the first 14 days following the index event of transient ischemic attack or minor stroke. CEA or CAS may also be offered in selected cases with severe asymptomatic stenosis. Herein, we review the utility of neurosonology in the diagnosis and pre‐/peri‐interventional assessment of CAD patients who undergo carotid revascularization procedures. Carotid ultrasound may provide inval...
Source: Journal of Neuroimaging - January 1, 2018 Category: Radiology Authors: Odysseas Kargiotis, Apostolos Safouris, Georgios Magoufis, Maria Georgala, Andromachi Roussopoulou, Eleftherios Stamboulis, Konstantinos G. Moulakakis, Andreas Lazaris, George Geroulakos, Spyros Vasdekis, Georgios Tsivgoulis Tags: Views and Reviews Source Type: research

Combined interventional and surgical treatment of tandem middle cerebral artery embolus and internal carotid artery occlusion: case report.
Abstract Tandem internal carotid artery (ICA) origin occlusion and middle cerebral artery (MCA) thromboembolism is a life-threatening condition with poor neurological outcome. The authors report on a patient presenting with acute ischemic stroke from a tandem ICA and MCA occlusion with penumbra. Emergency MCA mechanical thrombectomy was performed through percutaneous cervical ICA access due to the inability to cross the cervical carotid occlusion. Emergency carotid endarterectomy to reperfuse the poorly collateralized hemisphere and repair the ICA access site was performed 2 hours after completion of tissue plasmi...
Source: Journal of Neurosurgery - November 17, 2017 Category: Neurosurgery Authors: Frenkel MB, Renfrow JJ, Singh J, Garg N, Wolfe SQ Tags: J Neurosurg 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

Pattern of Utilization of Carotid Endarterectomy in Acute Ischemic Stroke Patients Undergoing Early Carotid Endarterectomy According to Severity of Neurological Deficits and Infarct Size (P5.277)
Conclusions:CEA was performed in ischemic stroke patients with minor or moderate infarction on CT scan with an acceptable rate of recurrent stroke and death and without any adverse functional outcome.Disclosure: Dr. Ahrar has nothing to disclose. Dr. Qureshi has nothing to disclose. Dr. Saleem has nothing to disclose.
Source: Neurology - April 17, 2017 Category: Neurology Authors: Ahrar, A., Qureshi, A., Saleem, M. Tags: SubAcute Interventional Therapies in Cerebrovascular Disease Source Type: research

Evidence-Based Carotid Interventions for Stroke Prevention: State-of-the-art Review.
Authors: Morris DR, Ayabe K, Inoue T, Sakai N, Bulbulia R, Halliday A, Goto S Abstract Carotid artery stenosis is responsible for between 10-20% of all ischaemic strokes. Interventions, such as carotid endarterectomy and carotid stenting, effectively reduce the risk of stroke in selected individuals. This review describes the history of carotid interventions, and summarises reliable evidence on the safety and efficacy of these interventions gained from large randomised clinical trials.Early trials comparing carotid endarterectomy to medical therapy alone in symptomatic patients, and asymptomatic patients, demonstra...
Source: Journal of Atherosclerosis and Thrombosis - March 8, 2017 Category: Cardiology Tags: J Atheroscler Thromb Source Type: research

The Influence of Collagen Impregnation of a Knitted Dacron Patch Used in Carotid Endarterectomy
In selected populations, carotid endarterectomy (CEA) reduces long-term stroke risk. Studies have shown increased risk of restenosis with use of a collagen-impregnated Dacron patch compared to a PTFE patch. There is concern that collagen-impregnation may initiate thrombosis or promote restenosis due to platelet activation. We performed a retrospective analysis of our CEA experience with routine patching using knitted Dacron patches with (Hemashield) and without (Sauvage) collagen-impregnation.
Source: Annals of Vascular Surgery - September 21, 2016 Category: Surgery Authors: Daisy Chou, Allan Tulloch, David Cossman, J. Louis Cohen, Rajeev Rao, Galinos Barmparas, James Mirocha, Willis Wagner Source Type: research

Deaths prompt FDA warning on Baxter ’ s Vascu-Guard patch
The FDA today released a notice warning of issues with Baxter‘s (NYSE:BAX) Vascu-Guard peripheral vascular patch after receiving multiple adverse event reports including 3 patient deaths potentially related to the issue. The Vascu-Guard patch is designed for use in vascular reconstruction surgeries including carotid, renal, iliac, femoral, profund and tibial blood vessels and arteriovenous access revisions, the FDA said. The federal watchdog said it has received reports of issues with intraoperative or postoperative bleeding and hematomas, some of which required clinical interventions and 3 patient deaths which occur...
Source: Mass Device - September 1, 2016 Category: Medical Equipment Authors: Fink Densford Tags: Food & Drug Administration (FDA) Recalls Vascular Baxter International Source Type: news

Commentary on ‘Protamine Reduces Bleeding Complications Without Increasing the Risk of Stroke After Carotid Endarterectomy: A Meta-analysis’
Kakisis et  al. demonstrate in their meta-analysis that reversing the effect of heparin with protamine seems to reduce the number of major neck hematomas associated with CEA. One might fear that this would be at the cost of an increased level of cerebral thromboembolism. However, Kakisis et al. showed that a dministration of protamine does not seem to influence the rate of stroke.1
Source: European Journal of Vascular and Endovascular Surgery - July 13, 2016 Category: Surgery Authors: L.K. Rathenborg Tags: Invited Commentary Source Type: research

The Influence of Collagen Impregnation of a Knitted Dacron Patch Routinely Used in Carotid Endarterectomy
In selected populations, carotid endarterectomy (CEA) reduces long-term stroke risk. Studies have shown increased risk of restenosis with use of a collagen-impregnated Dacron patch compared to a PTFE patch. There is concern that collagen-impregnation may initiate thrombosis or increase restenosis due to platelet activation. We performed a retrospective analysis of our CEA experience with routine patching using knitted Dacron patches with (Hemashield) and without (Sauvage) collagen-impregnation.
Source: Annals of Vascular Surgery - June 30, 2016 Category: Surgery Authors: Daisy Chou, Allan Tulloch, David Cossman, J. Louis Cohen, Rajeev Rao, James Mirocha, Willis Wagner Source Type: research

Circulating Chemerin Is Associated With Carotid Plaque Instability, Whereas Resistin Is Related to Cerebrovascular Symptomatology.
CONCLUSIONS: Low chemerin and high resistin levels were associated with carotid disease severity, suggesting that these adipokines may act as potential markers for plaque instability and stroke risk. Future studies are needed to assess causation between circulating adipokines and plaque instability. PMID: 27312219 [PubMed - as supplied by publisher]
Source: Arteriosclerosis, Thrombosis and Vascular Biology - June 15, 2016 Category: Cardiology Authors: Gasbarrino K, Mantzoros C, Gorgui J, Veinot JP, Lai C, Daskalopoulou SS Tags: Arterioscler Thromb Vasc Biol Source Type: research

The Mechanism of Procedural Stroke Following Carotid Endarterectomy within the Asymptomatic Carotid Surgery Trial 1
Conclusion: In ACST-1, the risk of procedural stroke was low. Most strokes (60%) occurred on the day of the procedure and were caused by thrombosis or thrombotic occlusion of the ipsilateral carotid artery. These findings emphasize the importance of immediate assessment of the treated carotid artery when a stroke occurs after CEA.Cerebrovasc Dis 2016;42:178-185
Source: Cerebrovascular Diseases - April 26, 2016 Category: Neurology Source Type: research

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