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Why is the management of asymptomatic carotid disease so controversial?
Conclusions The inescapable conclusion is that only a relatively small proportion of asymptomatic patients benefit from prophylactic CEA/CAS. The key question, therefore, remains; is society prepared to invest sufficient resources in identifying these ‘high risk for stroke’ patients so that they can benefit from aggressive BMT and CEA or CAS, leaving the majority of lower risk patients to be treated medically?
Source: The Surgeon - December 6, 2014 Category: Surgery Source Type: research

CT Perfusion Imaging in the Selection of Acute Stroke Patients to Undergo Emergent Carotid Endarterectomy
Severe acute stroke patients with critical carotid stenosis or occlusion without intracranial thrombus typically do not undergo emergent carotid thromboendarterectomy (CEA) because of the risk of reperfusion-related intracranial hemorrhage. Past studies have not consistently demonstrated benefit of early operative intervention. Cerebral computed tomography (CT), cervical and cerebral CT angiography (CTA), and cerebral CT perfusion (CTP) imaging may identify a subset of acute stroke patients without intracranial thrombus who may benefit from emergent CEA.
Source: Annals of Vascular Surgery - September 3, 2014 Category: Surgery Authors: Thomas G. Devlin, Sachin V. Phade, R. Kent Hutson, Mark W. Fugate, G. Ralston Major, Gregory W. Albers, Abdelazim A. Sirelkhatim, Biggya L. Sapkota, Steven D. Quartfordt, Blaise W. Baxter Source Type: research

Computed Tomography Perfusion Imaging in the Selection of Acute Stroke Patients to Undergo Emergent Carotid Endarterectomy
Severe acute stroke patients with critical carotid stenosis or occlusion without intracranial thrombus typically do not undergo emergent carotid thromboendarterectomy (CEA) because of the risk of reperfusion-related intracranial hemorrhage. Past studies have not consistently demonstrated benefit of early operative intervention. Cerebral computed tomography (CT), cervical and cerebral CT angiography (CTA), and cerebral CT perfusion (CTP) imaging may identify a subset of acute stroke patients without intracranial thrombus who may benefit from emergent CEA.
Source: Annals of Vascular Surgery - September 3, 2014 Category: Surgery Authors: Thomas G. Devlin, Sachin V. Phade, Rodney K. Hutson, Mark W. Fugate, Grant R. Major, Gregory W. Albers, Abdelazim A. Sirelkhatim, Biggya L. Sapkota, Steven D. Quartfordt, Blaise W. Baxter Tags: Case Report Source Type: research

P-020 Emergent Carotid Artery Stenting with or without Intracranial Tandem Occlusion Lesions Following Carotid Endarterectomy
Conclusion Emergent endovascular evaluation in the setting of acute post CEA thrombosis is a safe and timely treatment option, with the benefit of detecting and treating embolic intracranial lesions. More investigation is necessary to define the role of immediate angiography and intervention in this rare surgical complication. Abstract P-020 Table 1Patient demographics AgeGender% Carotid stenosisSymptomaticCase 166M90NCase 273M80–99YCase 378M70YCase 459F80–99YCase 555M80–99NCase 680MUnknownUnknown Abstract P-020 Table 2Pre procedural metrics Time from CEA to symptoms (hrs)Time from last normal to throm...
Source: Journal of NeuroInterventional Surgery - July 26, 2014 Category: Neurosurgery Authors: Vargas, J., Zuckerman, S., Chaudry, I., Turner, R., Turk, A., Spiotta, A. Tags: Oral poster abstracts Source Type: research

Identification of Patients with a Histologically Unstable Carotid Plaque Using Ultrasonic Plaque Image Analysis
Objectives: In patients with carotid stenosis the risk of stroke is highest in the first few days after onset of symptoms and it is low in asymptomatic patients. The ability to identify patients with a high (or low) probability of having a histologically unstable plaque might become a complimentary method that can refine the indications for surgical intervention.Methods: Two histopathologists, using validated American Heart Association criteria, independently graded plaques harvested during carotid endarterectomy. Preoperative Duplex images were independently assessed for juxtaluminal black area, plaque type, plaque area, ...
Source: European Journal of Vascular and Endovascular Surgery - June 18, 2014 Category: Surgery Authors: M.K. Salem, M.J. Bown, R.D. Sayers, K. West, D. Moore, A. Nicolaides, T.G. Robinson, A.R. Naylor Tags: Carotid Disease Source Type: research

Identification of Patients with a Histologically Unstable Carotid Plaque Using Ultrasonic Plaque Image Analysis.
CONCLUSIONS: Computerized plaque analysis has the potential to identify patients with histologically unstable carotid plaques. This model requires validation, but offers the potential to influence patient selection for emergency interventions and the monitoring of medical therapy. PMID: 24947079 [PubMed - as supplied by publisher]
Source: PubMed: Eur J Vasc Endovasc ... - June 16, 2014 Category: Surgery Authors: Salem MK, Bown MJ, Sayers RD, West K, Moore D, Nicolaides A, Robinson TG, Naylor AR Tags: Eur J Vasc Endovasc Surg Source Type: research

Ischemic Stroke Predicts Myocardial Injury After Carotid Endarterectomy for Symptomatic Severe Carotid Artery Stenosis
Myocardial injury following carotid endarterectomy (CEA) is a common cause of morbidity and mortality, and its risk varies depending on the severity and extent of disease. However, when patients with sympotomatic severe carotid stenosis undergo CEA, the frequency and potential predictors of myocardial injury remain unknown. A total of 40 patients (32 men and 8 women) who underwent successful standard CEA were observed. Cardiac troponin I (cTnI) concentrations were assessed before surgery and on postoperative days 1, 2, and 3 in all patients. Myocardial injury was defined as the peak cTnI concentration > 0.04 ng/mL. In a...
Source: Clinical and Applied Thrombosis/Hemostasis - April 2, 2014 Category: Hematology Authors: Feng, H., Wang, T.-L., Cai, B. Tags: Original Articles Source Type: research

Time Dependent Changes in Atherosclerotic Plaque Composition in Patients Undergoing Carotid Surgery.
CONCLUSIONS: In conclusion, over the past decade, atherosclerotic plaques harvested during carotid endarterectomy show a time dependent change in plaque composition characterized by a decrease in features currently believed to be causal for plaque instability. This seems to go hand in hand with improvements in risk factor management. PMID: 24637558 [PubMed - as supplied by publisher]
Source: Circulation - March 17, 2014 Category: Cardiology Authors: van Lammeren GW, den Ruijter HM, Vrijenhoek JE, van der Laan S, Velema E, de Vries JP, de Kleijn DP, Vink A, de Borst GJ, Moll FL, Bots ML, Pasterkamp G Tags: Circulation Source Type: research

Stroke Rounds: Early Surgery Looks Safe After tPA
(MedPage Today) -- Performing carotid endarterectomy or stenting in patients who were recently treated with thrombolytic therapy for an acute stroke appeared to be safe, an observational study showed.
Source: MedPage Today Cardiovascular - March 11, 2014 Category: Cardiology Source Type: news

Urgent Carotid Surgery and Stenting May Be Safe After Systemic Thrombolysis for Stroke Clinical Sciences
Conclusions— Urgent carotid endarterectomy or carotid artery stenting after thrombolysis for stroke may be safe without increased risk of serious complications.
Source: Stroke - February 24, 2014 Category: Neurology Authors: Koraen-Smith, L., Troeng, T., Bjorck, M., Kragsterman, B., Wahlgren, C.-M., on behalf of the Swedish Vascular Registry and the Riks-Stroke Collaboration, This work was supported by the Steering Committee of the Swedish Vascular Registry (Swedvasc):, Krags Tags: Acute Cerebral Infarction, Carotid Stenosis, Emergency treatment of Stroke, Carotid endarterectomy, Angioplasty and Stenting Clinical Sciences Source Type: research

The collagen cross‐linking enzyme lysyl oxidase is associated with the healing of human atherosclerotic lesions
ConclusionsLOX may contribute to the healing of atherosclerotic lesions and to prevention of its lethal complications. Mediators of inflammation may control LOX expression in plaques and hence plaque stability.This article is protected by copyright. All rights reserved.
Source: Journal of Internal Medicine - February 1, 2014 Category: Internal Medicine Authors: Olga A. Ovchinnikova, Lasse Folkersen, Jonas Persson, Jan H. N. Lindeman, Thor Ueland, Pål Aukrust, Natalya Gavrisheva, Eugene Shlyakhto, Gabrielle Paulsson‐Berne, Ulf Hedin, Peder S. Olofsson, Göran K. Hansson Tags: Original Source Type: research

Posterior transverse plication of the internal carotid artery to correct for kinking
Conclusions: Although the indications for additional shortening procedures following CEA need to be defined, in this small series, PTP as an additional shortening procedure of the ICA following CEA seems feasible and safe with no additional periprocedural risk for narrowing at the plicature or thrombosis of the endarterectomy plane. However, restenosis at the plicature may hamper the long term benefit of carotid reconstruction.
Source: Journal of Vascular Surgery - January 21, 2014 Category: Surgery Authors: Michiel H.F. Poorthuis, Eelco C. Brand, Raechel J. Toorop, Frans L. Moll, Gert Jan de Borst Tags: Clinical research studies 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

Results of carotid artery stenting with transcervical access
Conclusions: CAS with the transcervical approach is a safe procedure with low incidence of stroke and complications. It can be used as an alternative to femoral access in patients with unfavorable aortoiliac or aortic arch anatomy.
Source: Journal of Vascular Surgery - September 26, 2013 Category: Surgery Authors: George S. Sfyroeras, Konstantinos G. Moulakakis, Fotis Markatis, Constantinos N. Antonopoulos, George A. Antoniou, John D. Kakisis, Elias N. Brountzos, Christos D. Liapis Tags: Review article 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

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