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Patches of different types for carotid patch angioplasty.
CONCLUSIONS: The number of outcome events is too small to allow conclusions, and more trial data are required to establish whether any differences do exist. Nevertheless, there is little to no difference in effect on perioperative and long-term ipsilateral stroke between vein and any synthetic patch material. Some evidence indicates that other synthetic patches (e.g. PTFE) may be superior to Dacron grafts in terms of perioperative stroke and TIA rates, and both early and late arterial re-stenosis and occlusion. Pseudoaneurysm formation may be more common after use of a vein patch than after use of a synthetic patch. Bovin...
Source: Cochrane Database of Systematic Reviews - February 18, 2021 Category: General Medicine Authors: Orrapin S, Benyakorn T, Howard DP, Siribumrungwong B, Rerkasem K Tags: Cochrane Database Syst Rev Source Type: research

Carotid artery stenting versus endarterectomy for treatment of carotid artery stenosis.
CONCLUSIONS: Stenting for symptomatic carotid stenosis is associated with a higher risk of periprocedural stroke or death than endarterectomy. This extra risk is mostly attributed to an increase in minor, non-disabling strokes occurring in people older than 70 years. Beyond the periprocedural period, carotid stenting is as effective in preventing recurrent stroke as endarterectomy. However, combining procedural safety and long-term efficacy in preventing recurrent stroke still favours endarterectomy. In people with asymptomatic carotid stenosis, there may be a small increase in the risk of periprocedural stroke or death wi...
Source: Cochrane Database of Systematic Reviews - February 24, 2020 Category: General Medicine Authors: Müller MD, Lyrer P, Brown MM, Bonati LH Tags: Cochrane Database Syst Rev Source Type: research

Local versus general anaesthesia for carotid endarterectomy
CONCLUSIONS: The incidence of stroke and death were not convincingly different between local and general anaesthesia for people undergoing carotid endarterectomy. The current evidence supports the choice of either approach. Further high-quality studies are still needed as the evidence is of limited reliability.PMID:34642940 | DOI:10.1002/14651858.CD000126.pub5
Source: Cochrane Database of Systematic Reviews - October 13, 2021 Category: General Medicine Authors: Amaraporn Rerkasem Saritphat Orrapin Dominic Pj Howard Sothida Nantakool Kittipan Rerkasem Source Type: research

Patch angioplasty versus primary closure for carotid endarterectomy
CONCLUSIONS: Compared with primary closure, carotid patch angioplasty may reduce the risk of perioperative arterial occlusion and long-term restenosis of the operated artery. It would appear to reduce the risk of ipsilateral stroke during the perioperative and long-term period and reduce the risk of any stroke in the long-term when compared with primary closure. However, the evidence is uncertain due to the limited quality of included trials.PMID:35920689 | DOI:10.1002/14651858.CD000160.pub4
Source: Cochrane Database of Systematic Reviews - August 3, 2022 Category: General Medicine Authors: Saritphat Orrapin Thoetphum Benyakorn Boonying Siribumrungwong Kittipan Rerkasem Source Type: research

Local versus general anaesthesia for carotid endarterectomy.
CONCLUSIONS: The proportion of patients who had a stroke or died within 30 days of surgery did not differ significantly between the two types of anaesthetic techniques used during carotid endarterectomy. This systematic review provides evidence to suggest that patients and surgeons can choose either anaesthetic technique, depending on the clinical situation and their own preferences. PMID: 24353155 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - December 19, 2013 Category: Journals (General) Authors: Vaniyapong T, Chongruksut W, Rerkasem K Tags: Cochrane Database Syst Rev Source Type: research

Carotid endarterectomy for symptomatic carotid stenosis.
CONCLUSIONS: Carotid endarterectomy reduced the risk of recurrent stroke for people with significant stenosis. Endarterectomy might be of some benefit for participants with 50% to 69% symptomatic stenosis (moderate-quality evidence) and highly beneficial for those with 70% to 99% stenosis (moderate-quality evidence). PMID: 32918282 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - September 11, 2020 Category: General Medicine Authors: Rerkasem A, Orrapin S, Howard DP, Rerkasem K Tags: Cochrane Database Syst Rev Source Type: research

Routine or selective carotid artery shunting for carotid endarterectomy (and different methods of monitoring in selective shunting)
CONCLUSIONS: This review concluded that the data available were too limited to either support or refute the use of routine or selective shunting in carotid endarterectomy when performed under general anaesthesia. Large-scale randomised trials of routine shunting versus selective shunting are required. No method of monitoring in selective shunting has been shown to produce better outcomes.PMID:35731671 | DOI:10.1002/14651858.CD000190.pub4
Source: Cochrane Database of Systematic Reviews - June 22, 2022 Category: General Medicine Authors: Busaba Chuatrakoon Sothida Nantakool Amaraporn Rerkasem Saritphat Orrapin Dominic Pj Howard Kittipan Rerkasem Source Type: research

Routine or selective carotid artery shunting for carotid endarterectomy (and different methods of monitoring in selective shunting).
CONCLUSIONS: This review concluded that the data available were too limited to either support or refute the use of routine or selective shunting in carotid endarterectomy. Large scale randomised trials of routine shunting versus selective shunting are required. No method of monitoring in selective shunting has been shown to produce better outcomes. PMID: 24956204 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - June 23, 2014 Category: Journals (General) Authors: Chongruksut W, Vaniyapong T, Rerkasem K Tags: Cochrane Database Syst Rev Source Type: research

Cerebral near-infrared spectroscopy (NIRS) for perioperative monitoring of brain oxygenation in children and adults.
CONCLUSIONS: The effects of perioperative active cerebral NIRS monitoring of brain oxygenation in adults for reducing the occurrence of short-term, mild POCD are uncertain due to the low quality of the evidence. There is uncertainty as to whether active cerebral NIRS monitoring has an important effect on postoperative stroke, delirium or death because of the low number of events and wide confidence intervals. The conclusions of this review may change when the eight ongoing studies are published and the 12 studies awaiting assessment are classified. More RCTs performed in the paediatric population and high-risk patients und...
Source: Cochrane Database of Systematic Reviews - January 17, 2018 Category: General Medicine Authors: Yu Y, Zhang K, Zhang L, Zong H, Meng L, Han R Tags: Cochrane Database Syst Rev Source Type: research