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TransCarotid Revascularization With Dynamic Flow Reversal Versus Carotid Endarterectomy in the Vascular Quality Initiative Surveillance Project
Objective: To compare the outcomes of TCAR with flow reversal to the gold standard CEA using data from the Society for Vascular Surgery Vascular Quality Initiative TCAR Surveillance Project. Summary of Background Data: TCAR is a novel minimally invasive procedure for carotid revascularization in high-risk patients that is associated with significantly lower stroke rates compared with carotid artery stenting via the transfemoral approach. Methods: Patients in the United States and Canada who underwent TCAR and CEA for carotid artery stenosis (2016-2019) were included. Propensity scores were calculated base...
Source: Annals of Surgery - July 15, 2022 Category: Surgery Tags: Original Articles Source Type: research

Central retinal artery occlusion: a retrospective study of disease presentation, treatment, and outcomes
CONCLUSIONS: The majority of patients with CRAO presented to eye care providers, and few present within the potential window for thrombolysis of 4.5 hours, highlighting the need for public awareness strategies. Our cohort highlights the significant rate of systemic comorbidity that exists in these patients.PMID:35307340 | DOI:10.1016/j.jcjo.2022.02.015
Source: Canadian Journal of Ophthalmology - March 21, 2022 Category: Opthalmology Authors: Meghan J Smith Matthew D Benson Matthew Tennant Imran Jivraj Source Type: research

Protamine Reduces Serious Bleeding Complications Associated with Carotid Endarterectomy in Asymptomatic Patients without Increasing the Risk of Stroke, Myocardial Infarction, or Death in a Large National Analysis.
CONCLUSION: Protamine reduces serious bleeding complications at the time of CEA without increasing the risk of MI, stroke, or death, in this large North American analysis. Based on this and previous regional work regarding protamine use in CEA, it is believed that there is now sufficient evidence to support its routine use, and it should be considered as a benchmark for quality during CEA. PMID: 33127243 [PubMed - as supplied by publisher]
Source: PubMed: Eur J Vasc Endovasc ... - October 27, 2020 Category: Surgery Authors: Stone DH, Giles KA, Kubilis P, Suckow BD, Goodney PP, Huber TS, Powell RJ, Cronenwett JL, Scali ST Tags: Eur J Vasc Endovasc Surg Source Type: research

Asymptomatic Carotid Stenosis Is Associated With Circadian and Other Variability in Embolus Detection
Conclusions: Embolism associated with asymptomatic carotid stenosis shows circadian variation with highest rates 4–6 h before midday. This corresponds with peak circadian incidence of stroke and other vascular complications. These and ASED Study results show that monitoring frequency, duration, and time of day are important in ES detection. Introduction Transcranial Doppler (TCD) detected microembolism in the ipsilateral middle cerebral artery (MCA) may help stratify the risk of stroke and other arterial disease complications in persons with advanced (≥60%) asymptomatic carotid stenosis. If so, this t...
Source: Frontiers in Neurology - April 15, 2019 Category: Neurology Source Type: research

Glucose screening in pregnancy and future risk of cardiovascular disease in women: a retrospective, population-based cohort study
Publication date: Available online 27 March 2019Source: The Lancet Diabetes & EndocrinologyAuthor(s): Ravi Retnakaran, Baiju R ShahSummaryBackgroundIn studies to date, gestational diabetes has consistently been associated with an increased future risk of cardiovascular disease, irrespective of the antepartum screening protocol or diagnostic criteria by which gestational diabetes is diagnosed. We reasoned that the resultant heterogeneity in the severity of dysglycaemia in women with gestational diabetes suggests that the relationship between gestational glycaemia and subsequent cardiovascular disease probably extends into t...
Source: The Lancet Diabetes and Endocrinology - March 28, 2019 Category: Endocrinology Source Type: research

Carotid Endarterectomy Outcomes in the Elderly: A Canadian Institutional Experience
Carotid endarterectomy (CEA) is a well-established surgical intervention for stroke prevention in patients with carotid stenosis of all ages. However, the decision to proceed to operate in the elderly involves a more complicated risk-benefit assessment due in part, to increased comorbidities and reduced life expectancy. Some studies suggest that CEA is more risky in the elderly with worse outcomes, while others have found no difference. Our objective was to evaluate and compare outcomes of CEA between elderly and younger patients at our institution.
Source: Annals of Vascular Surgery - February 22, 2019 Category: Surgery Authors: R.J. Doonan, Abdullah Abdullah, Samantha Steinmetz-Wood, Sandra Mekhaiel, Oren K. Steinmetz, Daniel I. Obrand, Marc M. Corriveau, Kent S. Mackenzie, Heather L. Gill Tags: Clinical Research, Basic Science Source Type: research

Long-term Outcomes of Carotid Endarterectomy Versus Stenting in a Multicenter Population-based Canadian Study
Objective: To compare the long-term outcomes of patients treated with carotid endarterectomy and carotid-artery stenting. Background: Evidence for the long-term safety and efficacy of carotid-artery stenting compared with endarterectomy is accumulating from randomized trials. However, comparative data on the long-term outcomes of carotid revascularization strategies in real world practice are lacking. Methods: We conducted a population-based, multicenter, observational cohort study using validated linked databases from Ontario, Canada. We identified all individuals treated with carotid endarterectomy and stenting (...
Source: Annals of Surgery - July 11, 2018 Category: Surgery Tags: Original Articles Source Type: research

Factors associated with delay in carotid endarterectomy for patients with symptomatic severe internal carotid artery stenosis: a case-control study.
Abstract BACKGROUND: The Canadian Best Practice Recommendations for Stroke Care (2008 update) recommend that patients with neurologic symptoms secondary to severe internal carotid artery stenosis undergo carotid endarterectomy within 14 days of symptom onset to prevent stroke. The purpose of this study was to identify patient and system factors associated with meeting, or failing to meet, the guideline. METHODS: In this case-control study, potential study participants were identified through an electronic search of the Discharge Abstract Database. We reviewed the charts of patients who presented to our centre...
Source: cmaj - May 15, 2018 Category: General Medicine Authors: Meyer D, Karreman E, Kopriva D Tags: CMAJ Open Source Type: research

Trends in Carotid Revascularization Procedures —Reply
In Reply Dr Hussain and colleagues point out interesting comparisons in carotid revascularization trends in Ontario, Canada, and in the US Medicare population, including similar 30-day stroke or death outcomes after carotid endarterectomy and stenting. We agree that differing reimbursement policies in the United States and Canada may account for differing patterns of carotid stenting after 2006. A noted difference is the lower receipt of procedures among symptomatic patients in the United States vs Ontario. However, such variation is expected because the approach to asymptomatic treatment has been shown to vary among Western countries.
Source: JAMA - January 16, 2018 Category: General Medicine Source Type: research