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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: 27819579 [PubMed - in process]
Source: Acta Chirurgica Belgica - November 9, 2016 Category: Surgery Tags: Acta Chir Belg Source Type: research

Stroke prevention.
Abstract Patients who have had a stroke are at high risk for recurrent stroke, myocardial infarction, and vascular death. Prevention of these events should be initiated promptly after stroke, because many recurrent events occur early, and should be tailored to the precise cause of stroke, which may require specific treatment. Lifestyle advice including abstinence from smoking, regular exercise, Mediterranean-style diet, and reduction of salt intake and alcohol consumption are recommended for all patients with stroke. For most patients with ischemic stroke or TIA, control of risk factors, including lowering blood p...
Source: Presse Medicale - November 1, 2016 Category: Journals (General) Authors: Isabel C, Calvet D, Mas JL Tags: Presse Med Source Type: research

Pathophysiology and management of reperfusion injury and hyperperfusion syndrome after carotid endarterectomy and carotid artery stenting
AbstractCerebral hyperperfusion is a relatively rare syndrome with significant and potentially preventable clinical consequences. The pathophysiology of cerebral hyperperfusion syndrome (CHS) may involve dysregulation of the cerebral vascular system and hypertension, in the setting of increase in cerebral blood flow. The early recognition of CHS is important to prevent complications such as intracerebral hemorrhage. This review will focus on CHS following carotid endarterectomy and carotid artery stenting. We will discuss the typical clinical features of CHS, risk factors, pathophysiology, diagnostic modalities for detecti...
Source: Experimental and Translational Stroke Medicine - September 6, 2016 Category: Neurology Source Type: research

Diastolic Blood Pressure as an Independent Risk Factor for Periprocedural Events Following Carotid Endarterectomy in Asymptomatic Patients (On Behalf Of the Acst-1 Collaborative Group)
Introduction: Benefits of carotid endarterectomy (CEA) in stroke prevention partly depend on periprocedural risks. Although systolic hypertension is thought of as a risk factor for periprocedural events, effects of diastolic blood pressure (dBP) are often ignored. In a recent post-hoc analysis of ICSS, diastolic blood pressure was associated with adverse outcome after CEA in symptomatic patients. We aimed to identify whether this was also a risk factor for periprocedural stroke or death in asymptomatic patients in the Asymptomatic Carotid Surgery Trial (ACST-1).
Source: European Journal of Vascular and Endovascular Surgery - August 27, 2016 Category: Surgery Authors: D.D. De Waard, G.-J. de Borst, R. Bulbulia, A. Halliday Source Type: research

Regional Anesthesia is Associated With Decreased Postoperative Hypertension in Patients Undergoing Eversion Carotid Endarterectomy
Eversion carotid endarterectomy (eCEA) has been effective in reducing stroke risk in patients with carotid artery stenosis. Recent literature shows that patients who undergo eCEA are at risk for development of postoperative hypertension requiring intravenous (IV) antihypertensive medication. The purpose of this study was to assess whether the type of anesthesia (regional or general) has an impact on the incidence of postoperative hypertension requiring IV antihypertensive medication in the surgical intensive care unit (SICU) in patients undergoing eCEA.
Source: Journal of Vascular Surgery - August 23, 2016 Category: Surgery Authors: Felecia Jinwala, Justin Oh, Viktor Dombrovskiy, Khanjan Nagarsheth, Saum Rahimi Tags: Abstract from the 2016 Eastern Vascular Society Annual Meeting Source Type: research

O-042 Functional Outcome Prediction Model for Carotid Stenting Patients Using Admission Profiles: 29,453 patients using NIS data 2005 to 2013
ConclusionsAge (greater than 80), presence of symptoms including TIA, DM, CHF, COPD and CRF were identified to predict worse functional outcome after CAS.DisclosuresS. Park: None. M. Alexander: 1; C; : Investigator in CREST2 Trial. A. Rosengart: None.
Source: Journal of NeuroInterventional Surgery - July 28, 2016 Category: Neurosurgery Authors: Park, S., Alexander, M., Rosengart, A. Tags: Oral abstracts Source Type: research

Barostim implantation with ipsilateral carotid endarterectomy as a one-stage procedure
Hypertension (HTN) remains a significant public health problem with substantial patient morbidity, mortality, and cost to the health care system despite advances in treatment (1). Clinical trials have demonstrated significant and lasting reductions in arterial pressure from baroreflex activation therapy (BAT), which functions by electrical stimulation of the carotid sinus using the Barostim neo™ system in patients with resistant HTN (2, 3). Significant carotid atherosclerosis, however, has been a contraindication for ipsilateral implantation due to increased risk of periprocedural stroke and uncertain antihypertensive efficacy.
Source: Annals of Vascular Surgery - July 13, 2016 Category: Surgery Authors: Kay F. Weipert, Astrid Most, Oliver Doerr, Ahmed Koshty, Christian W. Hamm, Damir Erkapic, Joern Schmitt Source Type: research

Unusual Intersection: Elucidating the Role of Erdheim Chester Disease in Stroke (P4.366)
Conclusion:A unifying diagnosis of ECD was identified for this gentleman presenting with a stroke in the setting of critical ICA stenosis. Pathology from his CEA suggests that while ECD involves multisystem inflammation, it did not appear to play a direct role in his stroke.Disclosure: Dr. Sheikhi has nothing to disclose.
Source: Neurology - April 3, 2016 Category: Neurology Authors: Sheikhi, L. Tags: Cerebrovascular Case Reports Source Type: research

Natural History of Extracranial Carotid Stenosis in Asian Stroke Patients- A Retrospective Study (P1.182)
Conclusions- Symptomatic steno-occlusive disease of cervical carotid artery carries a high risk of subsequent vascular events and mortality despite best medical therapy. Perhaps, better methods of risk stratification and an aggressive approach towards revascularisation in eligible cases are warranted.Disclosure: Dr. Chandra has nothing to disclose. Dr. Woo has nothing to disclose. Dr. Woo has nothing to disclose. Dr. Liu has nothing to disclose. Dr. Kulkarni has nothing to disclose. Dr. Sharma has nothing to disclose.
Source: Neurology - April 3, 2016 Category: Neurology Authors: Chandra, B., Woo, J. W., Woo, R. W., Liu, R. J., Kulkarni, A., Sharma, V. Tags: Cerebrovascular Disease: Risk Factors and Prevention Source Type: research

Simultaneous coronary and carotid revascularisation
Conclusion According to our experiences and results, the simultaneous performance of CEA and CABG in patients with severe coexisting carotid artery disease who require coronary revascularization has proved to be a safe and efficacious operative strategy in these high-risk patients.
Source: Cor et Vasa - February 23, 2016 Category: Cardiology Source Type: research

Prevalence, Risk Factors, and Clinical Significance of Asymptomatic Extracranial Vertebral Artery Disease in Patients with Symptomatic Internal Carotid Artery Stenosis: Analysis of Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) Trial (S42.002)
Conclusions: There appears to be an increased risk of stroke and death in patients with symptomatic internal carotid artery stenosis with concurrent asymptomatic extracranial vertebral artery stenosis. Key words: Extracranial vertebral artery; carotid stenosis; vertebral artery stenosis; vertebral artery occlusion; stroke; death.Disclosure: Dr. Qureshi has nothing to disclose. Dr. Chaudhry has nothing to disclose. Dr. Jansen has nothing to disclose. Dr. Eckstein has nothing to disclose. Dr. Ringleb has nothing to disclose.
Source: Neurology - February 7, 2016 Category: Neurology Authors: Qureshi, A., Chaudhry, S., Jansen, O., Eckstein, H.-H., Ringleb, P. Tags: Stroke Mechanism and Modifiers Source Type: research

Early cardiovascular events in women with a history of gestational diabetes mellitus
Conclusions: A history of GDM was identified as a risk factor of CVD, especially coronary vascular diseases, within the 7 years postpartum. A lifestyle changes from postpartum onwards can be recommended and supported.
Source: Cardiovascular Diabetology - January 27, 2016 Category: Cardiology Authors: Karine GoueslardJonathan CottenetAnne-Sophie MarietMaurice GiroudYves CottinJean-Michel PetitCatherine Quantin Source Type: research

Transient ischemic attack as a medical emergency.
Authors: Okada Y Abstract Since transient ischemic attack (TIA) is regarded as a medical emergency with high risk for early stroke recurrence, the underlying mechanisms should be immediately clarified to conclude a definitive diagnosis and provide early treatment. Early risk stratification using ABCD(2) scores can predict the risk of ischemic stroke occurring after TIA. Carotid ultrasonography (US) can evaluate the degree of stenosis, plaque properties and flow velocity of ICA lesions. High-risk mobile plaques can be classified by carotid US, and aortogenic sources of emboli can be detected by transesophageal echoc...
Source: Frontiers of Neurology and Neuroscience - December 2, 2015 Category: Neuroscience Tags: Front Neurol Neurosci Source Type: research

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