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Spontaneous preoperative microembolic signals detected with transcranial Doppler are associated with vulnerable carotid plaque characteristics.
Conclusion: Spontaneous MES were detected in 26% of symptomatic patients scheduled for CEA and were associated with unstable carotid plaque characteristics. TCD might be a useful tool to help identify patients with vulnerable plaques. PMID: 23817452 [PubMed - as supplied by publisher]
Source: The Journal of Cardiovascular Surgery - July 1, 2013 Category: Cardiovascular & Thoracic Surgery Authors: Van Lammeren GW, Van De Mortel RH, Visscher M, Pasterkamp G, De Borst GJ, Moll FL, Vink A, Tromp SC, De Vries JP Tags: J Cardiovasc Surg (Torino) 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

Patching plus extended exposure and tacking of the common carotid cuff may reduce the late incidence of recurrent stenosis after carotid endarterectomy
The objective of this study was to determine whether routine patch angioplasty and precautions related to the common carotid cuff could reduce the risks for perioperative stroke, internal carotid artery (ICA) thrombosis, or recurrent carotid stenosis.Methods: The senior author (N.H.) performed 1959 consecutive isolated CEAs at the Cleveland Clinic from 1976 to 2004. This series can be divided into three distinct eras with respect to patching and management of the proximal common carotid cuff: (1) primary arteriotomy closure with selective patching in only 38 of 653 CEAs (5.8%) from 1976 to 1983 (group 1); (2) routine patch...
Source: Journal of Vascular Surgery - June 3, 2013 Category: Surgery Authors: Norman R. Hertzer, James F. Bena Tags: Clinical research studies 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

Serum levels of anti-apolipoprotein A-1 auto-antibodies and myeloperoxidase as predictors of major adverse cardiovascular events after carotid endarterectomy.
In conclusion, combining the assessment of anti-apoA-1 IgG and MPO appears as a promising risk stratification tool in patients with severe carotid stenosis. PMID: 23364307 [PubMed - as supplied by publisher]
Source: Thrombosis and Haemostasis - January 31, 2013 Category: Hematology Authors: Vuilleumier N, Montecucco F, Spinella G, Pagano S, Bertolotto M, Pane B, Pende A, Galan K, Roux-Lombard P, Combescure C, Dallegri F, Mach F, Palombo D Tags: Thromb Haemost Source Type: research

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