Subject(s)
Carotid Stenosis/surgery , Endarterectomy, Carotid , Endovascular Procedures , Carotid Stenosis/diagnosis , Endarterectomy, Carotid/adverse effects , Endarterectomy, Carotid/methods , Endovascular Procedures/adverse effects , Endovascular Procedures/methods , Humans , Stents , Stroke/prevention & control , Time FactorsABSTRACT
OBJECTIVES: To evaluate the transition process from conventional carotid endarterectomy (cCEA) to eversion carotid endarterectomy (eCEA). METHODS: Patients operated with carotid endarterectomy (CEA; 164 patients, 171 CEA) in 2002-2003 were retrospectively included. RESULTS: In 2002, cCEA was applied in 64 (80%) and eCEA in 16 (20%) patients. There was an inversion on the preponderant surgical technique in 2003 (cCEA in 34 patients [37%] and eCEA in 57 patients [63%]). Perioperative stroke or death occurred in 3 patients (3.8%) in 2002 and 5 (5.5%) in 2003 (P = .78). Perioperative myocardial infarction occurred in 2 patients (2.5%) in 2002 and 2 in 2003 (2.2%, P = 1.00). Median follow-up was 83 (79-86) and 70 (67-74) months for the 2002 and 2003 cohorts, respectively, and there were no differences in survival or ipsilateral stroke between the groups. CONCLUSIONS: The transition from cCEA to eCEA is possible without significant changes in morbidity and mortality perioperatively and during follow-up.
Subject(s)
Carotid Artery Diseases/surgery , Endarterectomy, Carotid/methods , Aged , Carotid Artery Diseases/mortality , Chi-Square Distribution , Endarterectomy, Carotid/adverse effects , Endarterectomy, Carotid/mortality , Female , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Myocardial Infarction/etiology , Registries , Retrospective Studies , Stroke/etiology , Sweden , Time Factors , Treatment OutcomeSubject(s)
Carotid Stenosis/surgery , Endarterectomy, Carotid/methods , Antibiotic Prophylaxis , Carotid Stenosis/diagnosis , Carotid Stenosis/prevention & control , Consensus , Endarterectomy, Carotid/standards , Humans , Intraoperative Care/methods , Intraoperative Care/standards , Postoperative Care/methods , Postoperative Care/standards , Practice Patterns, Physicians' , Preoperative Care/methods , Preoperative Care/standards , Secondary Prevention , Surveys and Questionnaires , SwedenABSTRACT
We report a patient with a transient ischemic attack presumably caused by an entrapment of the internal carotid artery by the hyoid bone and without a significant carotid artery stenosis. The patient was operated on, with a release of the right internal and external carotid artery and resection of the right greater cornu of the hyoid bone. One year after treatment, the patient has not experienced any further neurologic symptoms, and a color duplex scan showed no stenosis of the right carotid artery. The hyoid bone is a potential cause of damage to the carotid vessels, depending on the individual's anatomy. Provocative maneuvers can be performed in patients with cerebrovascular symptoms who are not demonstrated to have significant anatomic stenosis with carotid imaging.
Subject(s)
Carotid Arteries , Hyoid Bone , Ischemic Attack, Transient/etiology , Female , Humans , Middle AgedSubject(s)
Ischemic Attack, Transient , Stroke , Carotid Stenosis/surgery , Emergencies , Humans , Ischemic Attack, Transient/diagnosis , Ischemic Attack, Transient/prevention & control , Ischemic Attack, Transient/surgery , Prognosis , Risk Factors , Stroke/diagnosis , Stroke/prevention & control , Stroke/surgery , Time Factors , Treatment OutcomeABSTRACT
Indications for and the results of carotid endarterectomy in symptomatic and asymptomatic carotid artery stenosis are reviewed. The main indication for carotid endarterectomy is symptomatic stenosis of a carotid artery with > 70 percent lumen reduction according to the NASCET method, or > 85 percent lumen reduction according to the ECST method. The operation should ideally be performed within two weeks after the onset of symptoms. Preliminary results from the ACST study, indicating significant beneficial effects of carotid endarterectomy also in asymptomatic carotid artery stenosis have been orally presented. Assessment of and surgery upon Swedish patients with significant carotid artery stenosis should be performed in specialised multidisciplinary "carotid artery centers". Endovascular treatment of carotid artery stenosis should at the present stage only be performed within clinical trials.
Subject(s)
Carotid Stenosis/surgery , Endarterectomy, Carotid , Stroke/prevention & control , Carotid Stenosis/complications , Endarterectomy, Carotid/adverse effects , Endarterectomy, Carotid/methods , Humans , Prognosis , Quality of Life , Stroke/etiology , Stroke/surgeryABSTRACT
The estimated degree of carotid stenosis is decisive for the selection of patients who would benefit from surgical treatment. Carotid thrombendarterectomy is recommended in patients with symptomatic > or = 80 procent internal carotid artery stenosis (ECST method). Many vascular centers now often rely entirely on duplex ultrasonography to select the patients for carotid surgery. The results of a recently published Swedish multicenter study (Jogestrand et al., Eur J Vasc Endovasc Surg 2002; 23:510-8) demonstrate that certain technical aspects of the ultrasound examination are of importance for the estimation of the degree of stenosis. Based on these results, the Swedish Quality Board for Carotid Surgery recommends the use of Doppler angle range specific cut off points for the peak systolic velocity in the internal carotid artery for identification of high-grade internal carotid artery stenosis: These cut off points are > or = 2.1 m/s for insonation angles of 0-49 degrees and > or = 3.2 m/s for angles 50-60 degrees. The angle of insonation should be kept as small as possible and should always be stated in the investigators report.
