Carotid endarterectomy in the era of endovascular therapy: still the gold standard.

BACKGROUND: Carotid stenosis is the most common cause of ischemic stroke and is managed by carotid endarterectomy. We report our ten-year results of carotid surgery for stenosis and kinking of the internal carotid artery (ICA). METHODS: Four hundred sixty nine patients underwent surgery: 306 localized carotid endarterectomy, 107 extensive endarterectomy, 18 shortening of the ICA plus endarterectomy, 42 endarterectomy plus coronary artery bypass, 11 endarterectomy plus bypass to another cervical artery, and 1 endarterectomy with aortic valve replacement. RESULTS: Three patients had an ipsilateral stroke, 2 due to technical reasons and one for a stroke in evolution. Six had transient facial nerve dysfunction, 2 division of the hypoglossal nerve and one vocal cord paralysis. Thirty-one patients died, 16 during the hospital stay and 15 during the follow up. CONCLUSIONS: The short and long-term results of carotid endarterectomy are excellent. Carotid endarterectomy remains the "gold standard" for the treatment of carotid stenosis.

The "crush and aspiration" technique for debridement of the aortic annulus revisited.

An effective technique for the debridement of the aortic annulus using a needle holder to crush the calcify nodules, follow by the immediate aspiration of the pulverized material using a Yankauer suction device is reported.

Surgical treatment of right coronary arteries with anomalous origin and slit ostium.

BACKGROUND: Right coronary arteries arising in the left sinus or ectopically in the anterior coronary sinus with slit ostium course inside the aorta. They are subject to variable systolic compression and can cause myocardial ischemia with its sequelae or death. METHODS: From May 1991 to March 2003, we treated 16 patients with anomalous origin of the right coronary artery from the left sinus and 4 whose right coronary artery arose ectopically in the anterior sinus. All patients had a slit ostium and underwent transaortic unroofing of the trunk to modify the proximal portion of the anomalous artery. RESULTS: All patients survived operation, although 1 patient died of unrelated causes. Nineteen patients were followed for a period from 0.2 to 11.8 years (median age, 53 years). One experienced angina 1 year after surgery and underwent percutaneous transluminal coronary angioplasty of a left internal thoracic to left anterior descending coronary artery anastomosis. All patients are New York Heart Association class I, without angina; none has sustained a myocardial infarction or required reoperation. CONCLUSIONS: Right coronary arteries that arise in anomalous fashion with a slit ostium can cause myocardial ischemia or death. Transaortic modification of the anomalous trunk addresses the anatomic and pathophysiologic features of the malformation that cause myocardial ischemia. Excellent results can be achieved with this surgical approach.