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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

Association between age and risk of stroke or death from carotid endarterectomy and carotid stenting: a meta-analysis of pooled patient data from four randomised trials
Publication date: Available online 12 February 2016 Source:The Lancet Author(s): George Howard, Gary S Roubin, Olav Jansen, Jeroen Hendrikse, Alison Halliday, Gustav Fraedrich, Hans-Henning Eckstein, David Calvet, Richard Bulbulia, Leo H Bonati, Jean-Pierre Becquemin, Ale Algra, Martin M Brown, Peter A Ringleb, Thomas G Brott, Jean-Louis Mas Background Age was reported to be an effect-modifier in four randomised controlled trials comparing carotid artery stenting (CAS) and carotid endarterectomy (CEA), with better CEA outcomes than CAS outcomes noted in the more elderly patients. We aimed to describe the ...
Source: The Lancet - February 14, 2016 Category: Journals (General) Source Type: research

An ischemic stroke patient with free floating thrombus in carotid artery, successfully treated by open carotid thrombectomy: a first case report in Nepal.
We present a case in which we performed open surgery and achieved successful retrieval of the thrombus. A 40 year-old male patient presented with ischemic stroke and mild left hemiparesis. Computerized tomography and magnetic resonance imaging showed infarction in the right parieto-occipital area. Carotid Doppler study showed carotid stenosis on the right side. Further investigation with CT angiography of the neck vessels confirmed significant carotid artery occlusion with a free-floating thrombus in the internal carotid artery. Carotid endarterectomy was planned under EEG monitoring. The right carotid artery was exposed w...
Source: Hiroshima Journal of Medical Sciences - December 12, 2015 Category: Journals (General) Tags: Hiroshima J Med Sci Source Type: research

Ischemic Stroke in Patients With Asymptomatic Severe Carotid Stenosis Without Surgical Intervention
To the Editor In a recent study of the clinical outcomes of 3737 adults with asymptomatic severe carotid stenosis who did not undergo carotid revascularization, the 5-year ipsilateral stroke rate was 4.7%. The authors concluded that “these findings may inform decision-making regarding surgical and medical treatment for patients with asymptomatic severe carotid artery stenosis.” A multicenter randomized prospective trial from 2021 reported similar 5-year stroke rates for 3625 patients with asymptomatic severe carotid stenosi s who underwent carotid endarterectomy. Based on these studies, one could come to the conclusion...
Source: JAMA - September 27, 2022 Category: General Medicine Source Type: research

Articles Association between age and risk of stroke or death from carotid endarterectomy and carotid stenting: a meta-analysis of pooled patient data from four randomised trials
In these RCTs, CEA was clearly superior to CAS in patients aged 70–74 years and older. The difference in older patients was almost wholly attributable to increasing periprocedural stroke risk in patients treated with CAS. Age had little effect on CEA periprocedural risk or on postprocedural risk after either procedure.
Source: LANCET - February 11, 2016 Category: Journals (General) Authors: George Howard, Gary S Roubin, Olav Jansen, Jeroen Hendrikse, Alison Halliday, Gustav Fraedrich, Hans-Henning Eckstein, David Calvet, Richard Bulbulia, Leo H Bonati, Jean-Pierre Becquemin, Ale Algra, Martin M Brown, Peter A Ringleb, Thomas G Brott, Jean-Lo Tags: Articles Source Type: research

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

Evolution of Carotid Surgical Practice in the last Decade.
Abstract Stroke units provide immediate care and appropriate intervention in the evolving stroke. The aims of this study were to review the practice of carotid endarterectomy (CEA) before and after the establishment of a Stroke Unit in St. James's Hospital. Prior to the introduction of the Stroke Unit, 263 CEA's were performed over a five-year period. 139/263 (53%) of these were for symptomatic disease. 229 were performed in the five years since. 179/229 (78%) of these were for symptomatic disease. The 30-day stroke and death rates were < 2% before the introduction of the Stroke Unit, and have remained unchange...
Source: Ir Med J - September 1, 2015 Category: Journals (General) Authors: Hanrahan L, Canning C, Abdulrahim O, Fitzgerald L, O'Neill S, Madhavan P, Harbison J, Colgan MP, Martin Z Tags: Ir Med J Source Type: research

Carotid endarterectomy for symptomatic carotid stenosis.
CONCLUSIONS: Endarterectomy was of some benefit for participants with 50% to 69% symptomatic stenosis (moderate-quality evidence), and highly beneficial for those with 70% to 99% stenosis without near-occlusion (moderate-quality evidence). We found no benefit in people with carotid near-occlusion (high-quality evidence). PMID: 28590505 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - June 7, 2017 Category: General Medicine Authors: Orrapin S, Rerkasem K Tags: Cochrane Database Syst Rev Source Type: research

Future management of carotid stenosis: role of urgent carotid interventions in the acutely symptomatic carotid patient and best medical therapy for asymptomatic carotid disease.
CONCLUSION: CAS has an increasingly higher risk of stroke with advancing age. Patients treated with CAS have a 1.76-fold increased risk of stroke (95% CI, 1.35-2.31) with each 10-year increase in age. No such age effect is seen in patients treated with CEA. Age is a critical variable in making informed choices regarding treatment of severe carotid artery stenosis. PMID: 25598726 [PubMed]
Source: Ochsner Journal - November 18, 2015 Category: Journals (General) Tags: Ochsner J Source Type: research

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