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1.
Rev. ADM ; 78(1): 51-55, ene.-feb- 2021. ilus
Article in Spanish | LILACS | ID: biblio-1178203

ABSTRACT

La endarterectomía carotídea es el procedimiento quirúrgico de elección para tratar la obstrucción y/o estenosis de la arteria carótida extracraneal y prevenir los eventos neurológicos. La aparición de síntomas depende de la gravedad y progresión de la lesión, del adecuado flujo colateral, de las características de la placa y de la presencia de otros factores de riesgo. Analizamos el resultado de la endarterectomía carotídea como procedimiento quirúrgico de elección para la estenosis carotídea, así como la presentación de un caso clínico de un adulto mayor con oclusión del 100% y la resolución completa de los síntomas posteriores al procedimiento quirúrgico (AU)


Endarterectomy of the carotid is the surgical procedure of choice to treat obstruction and/or stenosis of the extracranial carotid artery and prevent neurological events. The appearance of symptoms depends on the severity and progression of the lesion, the adequate collateral flow, the characteristics of the plaque and the presence of other risk factors. We analyze the result of carotid endarterectomy as the surgical procedure of choice for carotid stenosis as well as the presentation of a clinical case of an elderly adult patient with 100% occlusion and complete resolution of symptoms after the surgical procedure (AU)


Subject(s)
Humans , Male , Aged , Carotid Artery, Internal , Endarterectomy, Carotid , Carotid Stenosis , Endarterectomy , Signs and Symptoms , Surgical Procedures, Operative , Risk Factors , Constriction, Pathologic , Mexico
2.
Rev. cuba. angiol. cir. vasc ; 21(3): e158, sept.-dic. 2020. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1156377

ABSTRACT

Introducción: La enfermedad carotídea es una de las formas de presentación de la enfermedad cerebrovascular, que se encuentra entre las principales causas de morbi-mortalidad y de invalidez en el mundo. La endarterectomía carotídea resulta el tratamiento quirúrgico por excelencia. Objetivo: Caracterizar las complicaciones posoperatorias en la fase temprana de la endarterctomia carotídea en un período de cinco años. Métodos: Se realizó un estudio descriptivo y retrospectivo de corte transversal en 35 pacientes ingresados en el Instituto de Angiología, que fueron operados mediante endarterectomía carotídea por presentar enfermedad carotídea. Se analizaron las variables sociodemográficas, clínicas y quirúrgicas. Se utilizó la estadística descriptiva e inferencial. Resultados: Hubo un predominio del sexo masculino (72,2 por ciento) y de los mayores de 60 años. Las comorbilidades más frecuentes fueron la hipertensión arterial (94,4 por ciento), el tabaquismo (77,8 por ciento) y la enfermedad arterial periférica (61,1 por ciento). El 50 por ciento de todos los pacientes presentó complicaciones en la fase temprana de la cirugía sin mortalidad; la más frecuente resultó el hematoma de la herida (44,4 por ciento), que estuvo presente en el 50 por ciento de las endarterectomías convencionales. Los operados con anestesia general presentaron mayor número de complicaciones, excepto el hematoma, que se observó más en el empleo de anestesia loco-regional. El ictus posoperatorio ocurrió en pacientes con anestesia general. Conclusiones: Las características de las complicaciones posoperatorias en la fase temprana de la endarterectomía carotídea identificadas se asociaron con los tipos de endarterectomía y anestesia, y las comorbilidades(AU)


Introduction: Carotid disease is one of the onset manifestations of cerebrovascular disease, which is among the main causes of morbidity, mortality and disability worldwide. Carotid endarterectomy is the gold standard surgical treatment. Objective: To characterize postoperative complications in the early phase of carotid endarterectomy. Methods: A descriptive and retrospective cross-sectional study was carried out with 35 patients admitted to the Institute of Angiology and who underwent carotid endarterectomy due to carotid disease. Sociodemographic, clinical and surgical variables were analyzed. Descriptive and inferential statistics were used. Results: There was a predominance of males (72.2 perecnt) and of patients aged more than 60 years. The most frequent comorbidities were arterial hypertension (94.4 percent), smoking (77.8 percent), and peripheral arterial disease (61.1 percent). 50 percent of all patients presented complications in the early phase of surgery and without mortality; the most frequent was wound hematoma (44.4 percent), accounting for 50 percent of conventional endarterectomies. Those operated on with general anesthesia presented a greater number of complications, except for hematoma, observed more in the use of local-regional anesthesia. Postoperative stroke occurred in patients under general anesthesia. Conclusions: The characteristics of postoperative complications identified in the early phase of carotid endarterectomy were associated with the types of endarterectomy, anesthesia, and comorbidities(AU)


Subject(s)
Humans , Male , Female , Postoperative Complications , Cross-Sectional Studies , Endarterectomy, Carotid , Stroke , Peripheral Arterial Disease
3.
Korean Circulation Journal ; : 330-342, 2020.
Article in English | WPRIM | ID: wpr-811367

ABSTRACT

BACKGROUND AND OBJECTIVES: There is insufficient evidence regarding the optimal treatment for asymptomatic carotid stenosis.METHODS: Bayesian cross-design and network meta-analyses were performed to compare the safety and efficacy among carotid artery stenting (CAS), carotid endarterectomy (CEA), and medical treatment (MT). We identified 18 studies (4 randomized controlled trials [RCTs] and 14 nonrandomized, comparative studies [NRCSs]) comparing CAS with CEA, and 4 RCTs comparing CEA with MT from MEDLINE, Cochrane Library, and Embase databases.RESULTS: The risk for periprocedural stroke tended to increase in CAS, compared to CEA (odds ratio [OR], 1.86; 95% credible interval [CrI], 0.62–4.54). However, estimates for periprocedural myocardial infarction (MI) were quite heterogeneous in RCTs and NRCSs. Despite a trend of decreased risk with CAS in RCTs (OR, 0.70; 95% CrI, 0.27–1.24), the risk was similar in NRCSs (OR, 1.02; 95% CrI, 0.87–1.18). In indirect comparisons of MT and CAS, MT showed a tendency to have a higher risk for the composite of periprocedural death, stroke, MI, or nonperiprocedural ipsilateral stroke (OR, 1.30; 95% CrI, 0.74–2.73). Analyses of study characteristics showed that CEA-versus-MT studies took place about 10-year earlier than CEA-versus-CAS studies.CONCLUSIONS: A similar risk for periprocedural MI between CEA and CAS in NRCSs suggested that concerns about periprocedural MI accompanied by CEA might not matter in real-world practice when preoperative evaluation and management are working. Maybe the benefits of CAS over MT have been overestimated considering advances in medical therapy within10-year gap between CEA-versus-MT and CEA-versus-CAS studies.


Subject(s)
Carotid Arteries , Carotid Stenosis , Endarterectomy, Carotid , Myocardial Infarction , Stents , Stroke
4.
Chinese Medical Journal ; (24): 2688-2695, 2020.
Article in English | WPRIM | ID: wpr-877836

ABSTRACT

BACKGROUND@#Metabolic syndrome (MetS) is relatively common worldwide and an important risk factor for cardiovascular diseases. It is closely linked to arterial stiffness of the carotid artery. However, the association of MetS with the safety of carotid revascularization has been rarely studied. The aim of this study was to observe the current status of MetS and its components in Chinese carotid revascularized patients, and investigate the impact on major adverse clinical events (MACEs) after carotid endarterectomy (CEA) or carotid artery stenting (CAS).@*METHODS@#From January 2013 to December 2017, patients undergoing CEA or CAS in the Neurosurgery Department of Xuanwu Hospital were retrospectively recruited. The changes in prevalence of MetS and each component with time were investigated. The primary outcome was 30-day post-operative MACEs. Univariable and multivariable analyses were performed to identify the impact of MetS on CEA or CAS.@*RESULTS@#A total of 2068 patients who underwent CEA (766 cases) or CAS (1302 cases) were included. The rate of MetS was 17.9%; the prevalence rate of MetS increased with time. The occurrence rate of MACEs in CEA was 3.4% (26 cases) and in CAS, 3.1% (40 cases). There was no statistical difference between the two groups (3.4% vs. 3.1%, P = 0.600). For CEA patients, univariate analysis showed that the MACE (+) group had increased diabetes history (53.8% vs. 30.9%, P = 0.014) and MetS (34.6% vs. 15.8%, P = 0.023). For CAS patients, univariate analysis showed that the MACE (+) group had increased coronary artery disease history (40.0% vs. 21.6%, P = 0.006) and internal carotid artery tortuosity (67.5%% vs. 37.6%, P < 0.001). Furthermore, the MACE (+) group had higher systolic blood pressure (143.38 ± 22.74 vs. 135.42 ± 17.17 mmHg, P = 0.004). Multivariable analysis showed that the influencing factors for MACEs in CEA included history of diabetes (odds ratio [OR] = 2.345; 95% confidence interval [CI] = 1.057-5.205; P = 0.036) and MetS (OR = 2.476; 95% CI = 1.065-5.757; P = 0.035). The influencing factors for MACEs in CAS included systolic blood pressure (OR = 1.023; 95% CI = 1.005-1.040; P = 0.010), coronary artery disease (OR = 2.382; 95% CI = 1.237-4.587; P = 0.009) and internal carotid artery tortuosity (OR = 3.221; 95% CI = 1.637-6.337; P = 0.001).@*CONCLUSIONS@#The prevalence rate of MetS increased with time in carotid revascularized patients. MetS is a risk for short-term MACEs after CEA, but not CAS.


Subject(s)
Carotid Arteries/surgery , Carotid Stenosis/surgery , China/epidemiology , Endarterectomy, Carotid/adverse effects , Humans , Metabolic Syndrome/epidemiology , Retrospective Studies , Risk Factors , Sample Size , Stents/adverse effects , Stroke , Time Factors , Treatment Outcome
5.
Rev. cuba. angiol. cir. vasc ; 20(2): e386, jul.-dic. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1003856

ABSTRACT

Introducción: Los accidentes cerebrovasculares constituyen un problema de salud mundial con tendencia creciente; en la actualidad es la tercera causa de muerte. Objetivo: Describir la efectividad y durabilidad de la endarterectomía carotidea a largo plazo en la enfermedad carotidea extracraneal. Métodos: Se realizó un estudio descriptivo, ambispectivo en 44 pacientes sometidos a un total de 52 endarterectomías carotideas realizadas en el servicio de Angiología y Cirugía Vascular del Hospital Docente Clínico Quirúrgico Hermanos Ameijeiras. A todos se les realizó un seguimiento clínico con ultrasonografía doppler. El período de tiempo analizado fue de ocho años. Se tuvo en cuenta las variables: sexo, edad, factores de riesgo asociados, categoría clínica, localización topográfica de las lesiones, complicaciones tardías, tiempo de permeabilidad y resultados posquirúrgicos. Resultados: Predominó el sexo masculino (68,2 por ciento). Las lesiones carotideas asintomáticas y sintomáticas representaron el 50 por ciento respectivamente. El hábito de fumar y la dislipidemia fueron los factores de riesgo más frecuentes. Hubo predominio de las complicaciones tardías (55,8 por ciento) con relevancia de la restenosis carotidea (n= 21). El tiempo promedio de permeabilidad primaria del sector revascularizado fue de cinco años. El 86,5 por ciento de los pacientes seguidos a largo plazo mostraron resultados posquirúrgicos satisfactorios al no presentar eventos neurológicos isquémicos o lesiones carotideas con repercusión hemodinámica. Conclusiones: La endarterectomía carotidea es un procedimiento seguro con baja morbilidad y mortalidad perioperatorias que garantiza una reducción significativa en las tasas de enfermedad cerebrovascular isquémica en el seguimiento a largo plazo con baja incidencia de complicaciones vasculares y neurológicas tardías(AU)


Introduction: Cardiovascular events constitute a global health problem with a growing tendency. Nowadays, they represent the third cause of death. Objective: To describe the effectiveness and durability of long-term carotid endarterectomy in the extracranial carotid disease. Methods: A descriptive, ambispective study was conducted in 44 patients subjected to 52 carotid endarterectomies that were performed in the service of Angiology and Vascular Surgery of Hermanos Ameijeiras Teaching-Clinical- Surgical Hospital. A clinical follow-up was performed with Doppler ultrasonography to all the patients. The period analyzed was eight years. The variables considered were: sex, age, associated risk factors, clinical category, topographical localization of the lesions, late complications, time of permeability and postsurgical results. Results: Male sex predominated (68,2 percent). Asymptomatic and symptomatic carotid lesions represented 50 percent respectively. The smoking habit and dyslipidemia were the most common risk factors. There was predominance of late complications (55,8 percent) being notable the carotid restenosis (n = 21). The average time of primary permeability of the revascularized sector was five years. 86,5 percent of the patients followed in the long term showed satisfactory postsurgical results by not presenting ischemic neurological events or carotid lesions with hemodynamic impact. Conclusions: Carotid endarterectomy is a safe procedure with low morbidity and peri-operative mortality that ensures a significant reduction in ischemic cerebrovascular disease´s rates in long-term follow-up with low incidence of late vascular and neurological complications(AU)


Subject(s)
Humans , Male , Female , Risk Factors , Endarterectomy, Carotid/methods , Cerebrovascular Trauma/surgery , Dyslipidemias/prevention & control
6.
Rev. bras. cir. cardiovasc ; 34(5): 581-587, Sept.-Oct. 2019. tab, graf
Article in English | LILACS | ID: biblio-1042051

ABSTRACT

Abstract Objective: The aim of this study was to determine the prevalence and risk factors of carotid artery stenosis (CAS) using carotid duplex ultrasound in patients undergoing coronary artery bypass grafting (CABG). Methods: This retrospective study was conducted between January 2017 and January 2018 and included 166 consecutive patients [130 males (78.31%), 36 females (21.69%); mean age: 64.25±9.78 years] who underwent elective and isolated CABG. Patients who had significant CAS (≥50% stenosis) were compared with patients who had non-significant CAS (<50% stenosis). Logistic regression analysis was applied across the selected parameters to identify risk factors for significant CAS. Results: Of all patients, 36 (21.68%) had CAS ≥50% and 8 (4.81%) had unilateral carotid stenosis ≥70%. Carotid endarterectomy/CABG was performed simultaneously in five (3.01%) patients. None of these patients had cardiac and neurological problems during the postoperative period. The overall incidence of cerebrovascular accident (CVA) after CABG was 1.20% (n=2). Age (P=0.011) and history of CVA (P=0.035) were significantly higher in the CAS ≥50 group than in the CAS <50 group. Significant CAS was identified as a risk factor for postoperative CVA (P=0.013). Conclusion: Age and history of CVA were identified as risk factors for significant CAS. Furthermore, significant CAS was identified as a risk factor for postoperative CVA. For this reason, carotid screening is recommended for patients undergoing CABG even in the absence of associated risk factors.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Coronary Artery Bypass/methods , Carotid Stenosis/diagnostic imaging , Ultrasonography, Doppler, Duplex/methods , Postoperative Complications/etiology , Time Factors , Severity of Illness Index , Logistic Models , Coronary Artery Bypass/adverse effects , Retrospective Studies , Risk Factors , Treatment Outcome , Endarterectomy, Carotid/adverse effects , Endarterectomy, Carotid/methods , Carotid Stenosis/etiology , Stroke/etiology , Preoperative Period
7.
Rev. bras. cir. cardiovasc ; 34(2): 136-141, Mar.-Apr. 2019. tab
Article in English | LILACS | ID: biblio-990569

ABSTRACT

Abstract Introduction: The aim of this study was to examine the association of inter-arm systolic blood pressure difference (IASBPD) with carotid artery stenosis, subclavian artery stenosis and vertebral artery stenosis in patients who underwent carotid endarterectomy. Methods: A total of 141 patients (29 females, 112 males; mean age 71.2±10.4 years; range 47 to 92 years) who underwent carotid endarterectomy between September 2010 and December 2017 were retrospectively evaluated. We classified patients into four groups according to the IASBPD ˂ 10 mmHg, ≥ 10 mm Hg, ≥ 20 mmHg and ≥ 30 mmHg. The stenosis of both subclavian and vertebral arteries was considered as ≥ 50%. Results: Of the 141 patients, 44 (31.2%) had ≥ 10 mmHg, 29 (20.5%) had ≥ 20 mmHg and 4 (2.8%) had ≥ 30 mmHg of IASBPD. 26 patients (18.4%) were diagnosed with significant subclavian artery stenosis and 18 (69.2%) of them had more than 20 mmHg of IASBPD. Of the 29 patients with IASBPD ≥ 20 mmHg, 19 patients (65.5%) had a significant subclavian artery stenosis. We found a significant correlation between preoperative symptoms and subclavian artery stenosis (P=0.018) and overall perioperative stroke was seen more frequently in patients with subclavian artery stenosis (P=0.041). A significant positive correlation was observed between vertebral artery stenosis and subclavian artery stenosis (P=0.01). Conclusion: Patients who were diagnosed with both subclavian artery stenosis and IASBPD (≥ 20 mmHg) had a higher risk of postoperative stroke and death, had higher total cholesterol, LDL-C, blood creatinine level, and were more symptomatic.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Subclavian Steal Syndrome/physiopathology , Vertebrobasilar Insufficiency/physiopathology , Blood Pressure/physiology , Endarterectomy, Carotid/methods , Postoperative Complications/etiology , Reference Values , Subclavian Steal Syndrome/complications , Vertebrobasilar Insufficiency/complications , Blood Pressure Determination/methods , Retrospective Studies , Risk Factors , Statistics, Nonparametric , Stroke/etiology , Preoperative Period
8.
Article in Chinese | WPRIM | ID: wpr-775229

ABSTRACT

Restoration of cerebral blood flow is particularly important for the treatment of ischemic cerebrovascular disease. It is notable that surgical approaches play a unique role in treating this devastating disease. Among them, mechanical thrombectomy facilitates rapid and effective recanalization of occluded intracranial large vessels causing ischemic stroke, which contributes to improvement of cerebral perfusion in the ischemic penumbra; decompressive craniectomy is an important therapeutic option for acute massive cerebral infarction, and the timing of surgery determines the final clinical outcomes; for carotid endarterectomy in carotid-artery stenosis, individualized surgical plan is important for the safety and effectiveness of the operation; in the surgical revascularization of Moyamoya disease, precise evaluation of clinical and radiological characteristics, optimal surgical strategies and accuracy of intraoperative judgment will yield maximal therapeutic effects; and hybrid surgery is feasible for the therapy of complex ischemic cerebrovascular diseases, such as extracranial/intracranial arteries tandem stenosis and symptomatic chronic total occlusion of carotid artery. This paper reviews recent technical and clinical advances in the surgical treatment of ischemic cerebrovascular disease.


Subject(s)
Brain Ischemia , General Surgery , Carotid Artery, Internal , General Surgery , Carotid Stenosis , General Surgery , Endarterectomy, Carotid , Humans , Stroke , General Surgery , Treatment Outcome
9.
Neurointervention ; : 82-90, 2019.
Article in English | WPRIM | ID: wpr-760599

ABSTRACT

PURPOSE: Although carotid endarterectomy (CEA) is recommended as a treatment for carotid stenosis rather than carotid artery stenting (CAS), CAS has been preferred in Korea. The aim of this study was to analyze long-term outcomes after CAS compared with CEA using Korean nationwide insurance data. MATERIALS AND METHODS: We obtained all data from the nationwide database of the Health Insurance Review & Assessment Service (HIRA) during the study period using several codes regarding the procedure or operation. We included the HIRA data, which included at least one-year follow-up after the procedures. The outcomes associated with both procedures were death, recurrence of ischemic stroke, and admission for cerebral hemorrhage. RESULTS: A total of 16,065 eligible patients who were treated with CAS or CEA between 1 January 2007 and 31 December 2016 were analyzed. The number of patients with CAS and CEA was 12,173 (75.8%) and 3,892 (24.2%), respectively. 8,976 patients (55.9%) were classified as symptomatic patients. CAS was associated with a higher risk of all-cause mortality (adjusted hazard ratio [HR], 1.282; 95% confidence interval [CI], 1.173–1.400). The adjusted rates for recurrent ischemic stroke and cerebral hemorrhage between CAS versus CEA were 24.9% versus 15.9% (HR, 1.474; 95% CI, 1.325–1.639) and 1.5% versus 0.9% (HR, 2.026; 95% CI, 1.322–3.106), respectively. In young symptomatic patients, there was no statistically significant difference in all-cause mortality and cardiovascular death between CAS and CEA. CONCLUSION: Our study using Korean nationwide insurance data demonstrated similar results to previous studies. Until further evidence of CAS is established through prospective studies, CAS should be performed in selected patients according to current guidelines.


Subject(s)
Carotid Arteries , Carotid Stenosis , Cerebral Hemorrhage , Endarterectomy , Endarterectomy, Carotid , Follow-Up Studies , Humans , Insurance , Insurance, Health , Korea , Mortality , Prognosis , Prospective Studies , Recurrence , Stents , Stroke
10.
Article in English | WPRIM | ID: wpr-762702

ABSTRACT

PURPOSE: We aimed to compare clinical outcomes after carotid endarterectomy (CEA) between Korean patients with and without severe contralateral extracranial carotid stenosis or occlusion (SCSO). METHODS: Between January 2004 and December 2014, a total of 661 patients who underwent 731 CEAs were stratified by SCSO (non-SCSO and SCSO groups) and analyzed retrospectively. The study outcomes included the occurrence of major adverse cardiovascular events (MACE), defined as stroke or myocardial infarction, and all-cause mortality during the perioperative period and within 4 years after CEA. RESULTS: There were no significant differences in the incidence of MACE or any individual MACE manifestations between the 2 groups during the perioperative period or within 4 years after CEA. On multivariate analysis to identify clinical variables associated with long-term study outcomes, older age (hazard ratios [HRs], 1.06; 95% confidence intervals [CIs], 1.03–1.09; P < 0.001) and diabetes mellitus (HR, 1.71; 95% CI, 1.14–2.57; P = 0.010) were significantly associated with an increased risk of MACE occurrence, while preexisting SCSO was not associated with long-term incidence of MACE and individual MACE components. Kaplan-Meier survival analysis showed similar MACE-free (P = 0.509), overall (P = 0.642), and stroke-free (P = 0.650) survival rates in the 2 groups. CONCLUSION: There were no significant differences in MACE incidence after CEA between the non-SCSO and SCSO groups, and preexisting SCSO was not associated with an increased risk of perioperative or long-term MACE occurrence.


Subject(s)
Carotid Stenosis , Diabetes Mellitus , Endarterectomy, Carotid , Humans , Incidence , Mortality , Multivariate Analysis , Myocardial Infarction , Perioperative Period , Retrospective Studies , Stroke , Survival Rate
11.
Article in English | WPRIM | ID: wpr-762027

ABSTRACT

PURPOSE: Traditional longitudinal incision for carotid endarterectomy (CEA) can be painful, aesthetically displeasing, and associated with a high incidence of cranial nerve injury (CNI). This study describes the outcomes of CEA performed through small (<5 cm long), transversely oriented incisions located directly over the carotid bifurcation, as identified by color-enhanced duplex ultrasound. MATERIALS AND METHODS: Patient demographics and operative data were collected retrospectively from an in-house database of consecutive vascular patients undergoing CEA with a small transversely oriented incision for both symptomatic and asymptomatic carotid artery stenoses. RESULTS: A total of 52 consecutive patients underwent CEA between 2012 and 2016 (median age, 73.5 years; interquartile range, 67-80.3; male/female ratio, 40:12). CEA was performed under regional/local anesthesia (LA) in 48 (92.3%) patients, with 4 (7.7%) being performed under general anesthesia. One patient under LA experienced intraoperative neurological dysfunction intraoperatively (manifesting as an inability to count out loud) that resolved with insertion of shunt. One patient experienced a transient neurological event (expressive dysphasia) within the immediate postoperative period, which resolved within 6 hours. No in-hospital death or perioperative major adverse cardiovascular events were noted. Follow-up data were available for a median period of 3.1 years and for all patients. Three patients experienced strokes following discharge (2 strokes contralateral to the operated side and 1 transient ischemic attack ipsilateral to the operated side). No persistent CNIs nor bleeding complications necessitating re-exploration were reported. CONCLUSION: Small, transversely orientated incisions, hidden within a neck skin crease can be safely performed in the majority of patients undergoing CEA.


Subject(s)
Anesthesia , Anesthesia, General , Carotid Stenosis , Cranial Nerve Injuries , Demography , Endarterectomy, Carotid , Follow-Up Studies , Hemorrhage , Humans , Incidence , Ischemic Attack, Transient , Neck , Postoperative Period , Retrospective Studies , Skin , Stroke , Ultrasonography
12.
Article in English | WPRIM | ID: wpr-786668

ABSTRACT

BACKGROUND: The surgical strategies for carotid endarterectomy (CEA) vary in terms of the anesthesia method, neurological monitoring, shunt usage, and closure technique, and no gold-standard procedure has been established yet. We aimed to analyze the feasibility and benefits of CEA under regional anesthesia (RA) and CEA under general anesthesia (GA).METHODS: Between June 2012 and December 2017, 65 patients who had undergone CEA were enrolled, and their medical records were prospectively collected and retrospectively reviewed. A total of 35 patients underwent CEA under RA with cervical plexus block, whereas 30 patients underwent CEA under GA. In the RA group, a carotid shunt was selectively used for patients who exhibited negative results on the awake test. In contrast, such a shunt was used for all patients in the GA group.RESULTS: There were no cases of postoperative stroke, cardiovascular events, or mortality. Nerve injuries were noted in 4 patients (3 in the RA group and 1 in the GA group), but they fully recovered prior to discharge. Operative time and clamp time were shorter in the RA group than in the GA group (119.29±27.71 min vs. 161.43±20.79 min, p<0.001; 30.57±6.80 min vs. 51.77±13.38 min, p<0.001, respectively). The hospital stay was shorter in the RA group than in the GA group (14.6±5.05 days vs. 18.97±8.92 days, p=0.022). None of the patients experienced a stroke or restenosis during the 27.23±20.3-month follow-up period.CONCLUSION: RA with a reliable awake test reduces shunt use and decreases the clamp and operative times of CEA, eventually resulting in a reduced length of hospital stay.


Subject(s)
Anesthesia , Anesthesia, Conduction , Anesthesia, General , Carotid Arteries , Cervical Plexus Block , Endarterectomy , Endarterectomy, Carotid , Follow-Up Studies , Humans , Length of Stay , Medical Records , Methods , Mortality , Myocardial Infarction , Operative Time , Prospective Studies , Retrospective Studies , Stroke
13.
14.
Arq. bras. cardiol ; 111(4): 618-625, Oct. 2018. tab, graf
Article in English | LILACS | ID: biblio-973768

ABSTRACT

Abstract Severe carotid atherosclerotic disease is responsible for 14% of all strokes, which result in a high rate of morbidity and mortality. In recent years, advances in clinical treatment of cardiovascular diseases have resulted in a significant decrease in mortality due to these causes. To review the main studies on carotid revascularization, evaluating the relationship between risks and benefits of this procedure. The data reviewed show that, for a net benefit, carotid intervention should only be performed in cases of a periprocedural risk of less than 6% in symptomatic patients. The medical therapy significantly reduced the revascularization net benefit ratio for stroke prevention in asymptomatic patients. Real life registries indicate that carotid stenting is associated with a greater periprocedural risk. The operator annual procedure volume and patient age has an important influence in the rate of stroke and death after carotid stenting. Symptomatic patients have a higher incidence of death and stroke after the procedure. Revascularization has the greatest benefit in the first weeks of the event. There is a discrepancy in the scientific literature about carotid revascularization and/or clinical treatment, both in primary and secondary prevention of patients with carotid artery injury. The identification of patients who will really benefit is a dynamic process subject to constant review.


Resumo A doença aterosclerótica carotídea grave é responsável por 14% de todos os acidentes vasculares cerebrais (AVC), que refletem em uma alta taxa de morbimortalidade. Nos últimos anos, os avanços no tratamento clínico das doenças cardiovasculares geraram um decréscimo importante na mortalidade por estas causas. Revisar principais estudos que dizem respeito à revascularização carotídea avaliando a relação entre risco e beneficio deste procedimento. Os dados encontrados indicam que o procedimento só deve ser realizado se houver um risco periprocedimento menor que 6% em pacientes sintomáticos para que haja beneficio líquido na intervenção carotídea. O tratamento clínico reduziu significativamente o benefício líquido da revascularização na prevenção de AVC em pacientes assintomáticos. Registros que refletem a prática diária demonstram que a angioplastia carotídea esta associada a um risco periprocedimento mais elevado. O volume anual de procedimentos por operador e a idade dos pacientes têm uma importante influência nas taxas de AVC e morte pós angioplastia. Pacientes sintomáticos têm uma maior incidência de AVC e morte após procedimento. A revascularização tem o maior benefício nas primeiras semanas do evento. Existem discrepâncias na literatura científica com relação à revascularização carotídea e/ou tratamento clínico, tanto na prevenção primária quanto secundária de pacientes com lesão carotídea. A identificação do paciente que realmente será beneficiado é um processo dinâmico sujeito a constante revisão.


Subject(s)
Humans , Stents , Endarterectomy, Carotid/methods , Carotid Stenosis/surgery , Angioplasty/methods , Risk Assessment , Carotid Arteries/surgery , Risk Factors , Treatment Outcome , Carotid Stenosis/complications , Stroke/etiology
16.
Article in English | WPRIM | ID: wpr-787095

ABSTRACT

BACKGROUND: Carotid endarterectomy (CEA) has been performed under regional and general anesthesia (GA). The general anesthesia versus local anesthesia for carotid surgery study compared the two techniques and concluded that there was no difference in perioperative outcomes. However, since this trial, new sedative agents have been introduced and devices that improve the delivery of regional anesthesia (RA) have been developed. The primary purpose of this pilot study was to compare intraoperative hemodynamic stability and postoperative outcomes between GA and ultrasound-guided superficial cervical plexus block (UGSCPB) under dexmedetomidine sedation for CEA.METHODS: Medical records from 43 adult patients who underwent CEA were retrospectively reviewed, including 16 in the GA group and 27 in the RA group. GA was induced with propofol and maintained with sevoflurane. The UGSCPB was performed with ropivacaine under dexmedetomidine sedation. We compared the intraoperative requirement for vasoactive drugs, postoperative complications, pain scores using the numerical rating scale, and the duration of hospital stay.RESULTS: There was no difference between groups in the use of intraoperative antihypertensive drugs. However, intraoperative inotropic and vasopressor agents were more frequently required in the GA group (p < 0.0001). In the GA group, pain scores were significantly higher during the first 24 h after surgery (p < 0.0001 between 0–6 h, p < 0.004 between 6–12 h, and p < 0.001 between 12–24 h). The duration of hospital stay was significantly more in the GA group (13.3±4.6 days in the GA group vs. 8.5±2.4 days in the RA group, p < 0.001).CONCLUSION: In this pilot study, intraoperative hemodynamic stability and postoperative outcomes were better in the RA compared to the GA group.


Subject(s)
Adult , Anesthesia, Conduction , Anesthesia, General , Anesthesia, Local , Antihypertensive Agents , Cervical Plexus Block , Cervical Plexus , Dexmedetomidine , Endarterectomy, Carotid , Hemodynamics , Humans , Length of Stay , Medical Records , Pilot Projects , Postoperative Complications , Propofol , Retrospective Studies , Ultrasonography , Vasoconstrictor Agents
17.
Article in English | WPRIM | ID: wpr-759491

ABSTRACT

Although perioperative stroke is uncommon during low-risk non-vascular surgery, if it occurs, it can negatively impact recovery from the surgery and functional outcome. Based on the Society for Neuroscience in Anesthesiology and Critical Care Consensus Statement, perioperative stroke includes intraoperative stroke, as well as postoperative stroke developing within 30 days after surgery. Factors related to perioperative stroke include age, sex, a history of stroke or transient ischemic attack, cardiac surgery (aortic surgery, mitral valve surgery, or coronary artery bypass graft surgery), and neurosurgery (external carotid-internal carotid bypass surgery, carotid endarterectomy, or aneurysm clipping). Concomitant carotid and cardiac surgery may further increase the risk of perioperative stroke. Preventive strategies should be individualized based on patient factors, including cerebrovascular reserve capacity and the time interval since the previous stroke.


Subject(s)
Anesthesiology , Aneurysm , Consensus , Coronary Artery Bypass , Critical Care , Embolism , Endarterectomy, Carotid , Hemorrhage , Humans , Ischemia , Ischemic Attack, Transient , Mitral Valve , Neurosciences , Neurosurgery , Stroke , Thoracic Surgery , Transplants
18.
Article in English | WPRIM | ID: wpr-740134

ABSTRACT

PURPOSE: To determine the value of the appearance of the high signal intensity halo sign for detecting carotid intraplaque hemorrhage (IPH) on maximum intensity projection (MIP) of time-of-flight (TOF) MR angiography (MRA), based on high signal intensity on magnetization-prepared rapid acquisition with gradient-echo (MPRAGE) sequencing. MATERIALS AND METHODS: A total of 78 carotid arteries in 65 patients with magnetization-prepared rapid acquisition gradient-echo (MPRAGE) positive on carotid plaque MR imaging were included in this study. High-resolution MR imaging was performed on a 3.0-T scanner prior to carotid endarterectomy or carotid artery stenting. Fast spin-echo T1- and T2-weighted axial imaging, TOF, and MPRAGE sequences were obtained. Carotid plaques with high signal intensity on MPRAGE > 200% that of adjacent muscle on at least two consecutive slices were defined as showing IPH. Halo sign of high signal intensity around the carotid artery was found on MIP from TOF MRA. Continuous and categorical variables were compared among groups using the Mann-Whitney test and Fisher's exact tests. RESULTS: Of these 78 carotid arteries, 53 appeared as a halo sign on the TOF MRA. The total IPH volume of patients with a positive halo sign was significantly higher than that of patients without a halo sign (75.0 ± 86.8 vs. 16.3 ± 18.2, P = 0.001). The maximum IPH axial wall area in patients with a positive halo sign was significantly higher than that of patients without a halo sign (11.3 ± 9.9 vs. 3.7 ± 3.6, P = 0.000). CONCLUSION: High signal intensity halo of IPH on MIP of TOF MRA is associated with total volume and maximal axial wall area of IPH.


Subject(s)
Angiography , Atherosclerosis , Carotid Arteries , Endarterectomy, Carotid , Hemorrhage , Humans , Magnetic Resonance Imaging , Stents
19.
Rev. chil. cir ; 70(1): 35-39, 2018. tab
Article in Spanish | LILACS | ID: biblio-899653

ABSTRACT

Resumen Introducción En la endarterectomía carotídea (EC) durante el clampeo, la perfusión cerebral se mantiene por circulación contralateral a través del Polígono de Willis, que se relaciona con la presión de muñón carotídeo (PM). Si ésta es menor a 50 mmHg existe riesgo de Accidente Cerebrovascular (ACV) por hipoperfusión y está indicado uso de shunt para asegurar suficiente circulación cerebral, pero también se puede elevar transitoriamente la presión arterial sistémica haciendo innecesario el uso de shunt. Objetivo Mostrar los resultados de EC con medición de PM para evaluar la perfusión cerebral del hemisferio clampeado con manejo hemodinámico intraoperatorio minimizando el uso de shunt. Material y Métodos Estudio retrospectivo de 73 pacientes sometidos a EC bajo anestesia general con medición de PM, manejo hemodinámico intraoperatorio y uso selectivo de shunt. Se analizaron variables demográficas, clínicas y morbimortalidad perioperatoria. Resultados 73 pacientes, edad promedio 71,1 años, 69,9% sintomáticos. En 54 pacientes la PM fue superior a 50 mmHg y no se usó shunt, en 19 la PM fue menor a 50 mmHg y con manejo hemodinámico intraoperatorio se elevó en 16 que no requirieron shunt. Sólo en 3 casos la PM no alcanzó los 50 mmHg y se usó un shunt de Pruitt-Inahara. Dos pacientes sintomáticos presentaron déficit neurológico central transitorio postoperatorio y 2 pacientes fallecieron por infarto cardíaco. Conclusión La EC con medición de PM y manejo hemodinámico minimizó el uso de shunt transitorio y fue un procedimiento seguro para tratar los pacientes con estenosis carotídea con indicación quirúrgica.


Introduction During carotid endarterectomy (CEA) clamping cerebral perfusion is maintained by contralateral circulation through the Circle of Willis and it is correlated to the stump pressure (SP). If it is below 50 mmHg there is risk of stroke due to hypoperfusion and a shunt must be used, but systemic blood pressure can be temporarily elevated making the use of shunt unnecessary. Aim Results of CEA with SP measurement to evaluate cerebral perfusion in cross-clamped hemisphere and hemodynamic intraoperative management reducing the use of shunt. Material and Methods Retrospective study of CEAs performed in 73 patients under general anaesthesia with SP measurement, hemodynamic management and selective use of shunt. Demographics, clinical and perioperative morbimortality variables were analized. Results 73 patients, average age 71.1 years, 69.9% symptomatic. In 54 patients SP was above 50 mmHg and shunt was not used, in 19 SP was below 50 mmHg, it was elevated through intraoperative hemodynamic management and shunt was not needed. In only 3 cases SP did not reach 50 mmHg and a Pruitt-Inahara shunt was used. Two patients presented postoperative transient central neurological deficit and 2 died due to myocardial infarction. Conclusion CEA with SP measurement and hemodynamic management reduced the use of carotid shunting and it was a safe procedure to treat patients with severe carotid stenosis who need surgical intervention.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Blood Pressure , Monitoring, Intraoperative , Endarterectomy, Carotid , Carotid Stenosis/surgery , Carotid Stenosis/physiopathology , Postoperative Complications , Blood Pressure Determination , Arteriovenous Shunt, Surgical , Retrospective Studies , Circle of Willis/physiopathology , Treatment Outcome
20.
Article in English | WPRIM | ID: wpr-742475

ABSTRACT

PURPOSE: The aim of this study is to analyze postoperative outcomes for carotid endarterectomy (CEA) in addition to the preoperative clinical characteristics related to selective shunting based on dual monitoring with stump pressure (SP) and electroencephalography (EEG). MATERIALS AND METHODS: We retrospectively reviewed medical records of 70 patients who underwent CEA from March 2010 to December 2017. CEA was performed under general anesthesia and selective shunting was done if the SP was lower than 35 mmHg regardless of EEG or if intraoperative EEG showed any changes different from preoperative one regardless of SP. RESULTS: There was no postoperative 30-day adjusted mortality or adverse cardiac events. Three patients (4.3%) had postoperative minor stroke finally reaching pre-operative neurologic status at the time of discharge. Twenty-six patients (37.1%) used shunting and severe contralateral internal carotid stenosis or occlusion was related to shunting (P < 0.010). There were larger number of symptomatic patients in shunt group in spite of no statistical significance (P=0.116). CONCLUSION: Perioperative stroke rate was 4.3% for CEA under general anesthesia based on dual intraoperative monitoring with SP and EEG. There was no 30-day adjusted mortality and adverse cardiac event. Severe stenosis or occlusion of contralateral internal carotid artery is related to shunting (P < 0.010).


Subject(s)
Anesthesia, General , Carotid Artery Diseases , Carotid Artery, Internal , Carotid Stenosis , Constriction, Pathologic , Electroencephalography , Endarterectomy , Endarterectomy, Carotid , Humans , Intraoperative Neurophysiological Monitoring , Medical Records , Monitoring, Intraoperative , Mortality , Retrospective Studies , Stroke
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