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IF03. Preoperative Hypertension Is Associated With Atherosclerotic Plaque Vulnerability in Patients Undergoing Carotid Endarterectomy
Elevated blood pressure is associated with primary manifestations of cerebrovascular disease, such as stroke and myocardial infarction. Moreover, untreated hypertension contributes to atherosclerotic disease progression and is a risk factor for periprocedural complications in patients undergoing carotid endarterectomy (CEA). It is currently unknown how hypertension influences this underlying culprit of cerebrovascular disease, namely, the atherosclerotic plaque. Therefore, the aim of this study was to determine whether blood pressure influences vulnerable plaque characteristics in patients undergoing CEA.
Source: Journal of Vascular Surgery - May 22, 2018 Category: Surgery Authors: Leonie Fassaert, Ian van Koeverden, Gerard Pasterkamp, Gert J. de Borst Source Type: research

Balancing Blood Pressure after Carotid Revascularization
Cardiovascular instability is more common in patients with cardiovascular disease, those receiving vasoactive medications and in those undergoing cardiovascular procedures such as carotid endarterectomy (CEA) or carotid artery stenting (CAS). The aim of carotid revascularization is to decrease the subsequent risk of fatal or disabling stroke in patients with significant carotid stenosis, but the benefits are apparent only if perioperative morbidity and mortality are low. Hypertension is common in patients undergoing carotid revascularization, with a prevalence of about 65%.
Source: Journal of Vascular Nursing - May 9, 2018 Category: Nursing Authors: Debra Kohlman-Trigoboff Source Type: research

Commentary on “Post-carotid Endarterectomy Hypertension. Part 2: Association with Peri-operative Clinical, Anaesthetic, and Transcranial Doppler Derived Parameters”
Guidance on peri-operative haemodynamics is crucial to prevent procedural stroke in carotid endarterectomy (CEA) by preserving cerebral perfusion.1,2 Newman et  al. suggest a one size fits all post-operative systolic blood pressure (BP) policy treating > 170 mmHg or > 160 mmHg in patients with symptoms.3 This policy causes significant overtreatment, as two in five CEA patients will undergo in hospital BP lowering treatment for several days, leading to a high workload, increased in hospital costs, and bed occupancy.
Source: European Journal of Vascular and Endovascular Surgery - February 28, 2018 Category: Surgery Authors: Leonie M.M. Fassaert, Gert J. de Borst Tags: Correspondence Source Type: research

Intra-operative Video Characterization of Carotid Artery Pulsation Patterns in Case Series with Post-endarterectomy Hypertension and Hyperperfusion Syndrome
AbstractCerebral hyperperfusion syndrome (CHS) is a complication that can occur after carotid endarterectomy (CEA), the treatment of choice to decrease the subsequent risk of fatal or disabling stroke for patients with symptomatic severe stenosis of the carotid artery. Because of its rarity and complexity, the mechanism of the condition is still unclear, making its prevention via prediction and monitoring challenging. This is especially true during surgery, when multiple factors can induce physiological changes, including blood pressure and baroreceptor functions, which are crucial factors for post-CEA hypertension and CHS...
Source: Translational Stroke Research - January 10, 2018 Category: Neurology Source Type: research

Primary Prevention of Stroke in Chronic Kidney Disease Patients: A Scientific Update
Background: Although chronic kidney disease (CKD) is an independent risk factor for stroke, official recommendations for the primary prevention of stroke in CKD are generally lacking.Summary: We searched PubMed and ISI Web of Science for randomised controlled trials, observational studies, reviews, meta-analyses and guidelines referring to measures of stroke prevention or to the treatment of stroke-associated risk factors (cardiovascular disease in general and atrial fibrillation (AF), arterial hypertension or carotid artery disease in particular) among the CKD population. The use of oral anticoagulation in AF appears safe...
Source: Cerebrovascular Diseases - January 9, 2018 Category: Neurology Source Type: research

Effect of an intensified multifactorial intervention on cardiovascular outcomes and mortality in type 2 diabetes (J-DOIT3): an open-label, randomised controlled trial
This study is registered with ClinicalTrials.gov, number NCT00300976. Findings Between June 16, 2006, and March 31, 2009, 2542 eligible patients were randomly assigned to intensive therapy or conventional therapy (1271 in each group) and followed up for a median of 8·5 years (IQR 7·3–9·0). Two patients in the intensive therapy group were found to be ineligible after randomisation and were excluded from the analyses. During the intervention period, mean HbA1c, systolic blood pressure, diastolic blood pressure, and LDL cholesterol concentrations were significantly lower in the intensive therapy group than in the convent...
Source: The Lancet Diabetes and Endocrinology - October 25, 2017 Category: Endocrinology Source Type: research

Can We Predict Who Will Develop Hypertension After Carotid Endarterectomy?
Haemorrhagic stroke is a rare and vexing complication of carotid endarterectomy (CEA). It occurs some days after a successful operation to prevent further ischaemic strokes, usually in the setting of post-operative hypertension, headache, or the full clinical picture of hyperperfusion syndrome, which features seizures, and cognitive and vigilance disturbances. The major risk factor associated with the hyperperfusion syndrome and intracerebral haemorrhage after CEA is post-operative hypertension and blood pressure lability.
Source: European Journal of Vascular and Endovascular Surgery - September 29, 2017 Category: Surgery Authors: Jos é M. Ferro Tags: Editorial Source Type: research

Comparison of Early Outcomes and Restenosis Rate Between Carotid Endarterectomy and Carotid Artery Stenting Using Propensity Score Matching Analysis.
CONCLUSION: This PSM based observation reconfirmed previous trial results in both asymptomatic and symptomatic patients with carotid artery stenosis in routine clinical practice: CEA showed lower 30 day MACE and mid-term restenosis rates than CAS. PMID: 28893482 [PubMed - as supplied by publisher]
Source: PubMed: Eur J Vasc Endovasc ... - September 8, 2017 Category: Surgery Authors: Heo SH, Yoon KW, Woo SY, Park YJ, Kim YW, Kim KH, Chung CS, Bang OY, Kim DI Tags: Eur J Vasc Endovasc Surg Source Type: research

Oleacein may inhibit destabilization of carotid plaques from hypertensive patients. Impact on high mobility group protein-1
Conclusion : Our results indicate that oleacein possess ability to attenuate the destabilization of carotid plaque and could be potentially useful in the reduction of ischemic stroke risk. Graphical abstract
Source: Phytomedicine - June 13, 2017 Category: Drugs & Pharmacology Source Type: research

Early Carotid Revascularization Reduces Readmission for Recurrent Ischemic Stroke in Acute Ischemic Stroke Patients: Analysis of United States Nationwide Readmissions Database (P4.294)
Conclusions:Patients with ischemic stroke undergoing carotid revascularization during the initial hospitalization have significantly lower risk of readmission related to another ischemic strokeDisclosure: Dr. Chaudhry has nothing to disclose. Dr. Gheith has nothing to disclose. Dr. Gu has nothing to disclose. Dr. Afzal has nothing to disclose. Dr. Rahman has nothing to disclose. Dr. Riaz has nothing to disclose. Dr. Sachdeva has nothing to disclose. Dr. Sattar has nothing to disclose. Dr. Razak has nothing to disclose. Dr. Qureshi has nothing to disclose.
Source: Neurology - April 17, 2017 Category: Neurology Authors: Chaudhry, S., Gheith, T., Gu, S., Afzal, M.-R., Rahman, H., Riaz, A., Sachdeva, G., Sattar, A., Razak, A., Qureshi, A. Tags: In-Hospital Stroke Care Source Type: research

Utilization of Carotid Revascularization for Ischemic Stroke/TIA: A Canadian Perspective (P5.276)
Conclusions:Use of CEA/CAS in patients with acute ischemic stroke/TIA admitted to hospitals in Canada has doubled over the last decade. Differences in utilization by age, sex and across provinces are seen.Disclosure: Dr. Najm has nothing to disclose. Dr. Lindsay has nothing to disclose. Dr. Hill has nothing to disclose. Dr. Demchuk has nothing to disclose. Dr. Menon has nothing to disclose.
Source: Neurology - April 17, 2017 Category: Neurology Authors: Najm, M., Lindsay, P., Hill, M. D., Demchuk, A., Menon, B. Tags: SubAcute Interventional Therapies in Cerebrovascular Disease Source Type: research

Carotid Endarterectomy in Octogenarians and Nonagenarians: Is it Worth the Effort ?
CONCLUSIONS: Carotid endarterectomy can be performed in the elderly as safely and cost effectively as in the younger population. PMID: 28398188 [PubMed]
Source: Acta Chirurgica Belgica - April 13, 2017 Category: Surgery Tags: Acta Chir Belg Source Type: research

Diastolic Blood Pressure is a Risk Factor for Peri-procedural Stroke Following Carotid Endarterectomy in Asymptomatic Patients
Carotid endarterectomy (CEA) prevents future stroke, but this benefit depends on detection and control of high peri-operative risk factors. In symptomatic patients, diastolic hypertension has been causally related to procedural stroke following CEA. The aim was to identify risk factors causing peri-procedural stroke in asymptomatic patients and to relate these to timing of surgery and mechanism of stroke.
Source: European Journal of Vascular and Endovascular Surgery - March 17, 2017 Category: Surgery Authors: D.D. de Waard, G.J. de Borst, R. Bulbulia, A. Huibers, A. Halliday, the Asymptomatic Carotid Surgery Trial-1 Collaborative Group Source Type: research

Diastolic Blood Pressure is a Risk Factor for Peri-procedural Stroke Following Carotid Endarterectomy in Asymptomatic Patients.
CONCLUSION: In ACST-1, diastolic blood pressure was the only independent risk factor associated with peri-procedural stroke or death. While the underlying mechanisms of the association between lower diastolic blood pressure and peri-procedural risk remain unclear, good pre-operative control of blood pressure may improve procedural outcome of carotid surgery in asymptomatic patients. PMID: 28318997 [PubMed - as supplied by publisher]
Source: PubMed: Eur J Vasc Endovasc ... - March 15, 2017 Category: Surgery Authors: de Waard DD, de Borst GJ, Bulbulia R, Huibers A, Halliday A, Asymptomatic Carotid Surgery Trial-1 Collaborative Group Tags: Eur J Vasc Endovasc Surg Source Type: research

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