Gender-related risk factors for perioperative stroke after carotid endarterectomy in symptomatic patients.

BACKGROUND: Carotid endarterectomy (CEA) is a surgical procedure used in ischemic brain stroke prevention in patients with symptomatic and asymptomatic severe carotid artery stenosis. OBJECTIVES: This study compares perioperative stroke or death rate after carotid endarterectomy (CEA) in male and female patients, and determines risk factors for perioperative incidents in women and men. MATERIAL AND METHODS: The outcome of surgical treatment of 269 consecutive symptomatic patients (181 men and 88 women) treated from January 2004 to August 2008 in the Department of Vascular, General and Oncologic Surgery was analyzed. RESULTS: Perioperative stroke-death rate (within 30 days after the surgery) in women was 6.8% (6/88) and 3.3% (6/181) in men (p > 0.05). In the female group, none of the analyzed risk factors were associated with a higher risk of periprocedural incident, while in men, only hypercholesterolemia was a significant predictor of perioperative stroke (TC > 240 vs 240 vs 200-240: OR = 6.59; 95% CI: 1.12-38.97; p = 0.0375). CONCLUSIONS: In men, hypercholesterolemia significantly increased the risk of perioperative stroke or death, while in females, none of the analyzed factors were determined as the predictors of the incident. The fact that plaque type VI by AHA was significantly more frequent in women and men more frequently were suffering from ischemic heart disease and peripheral artery occlusive disease appeared not to influence the outcome of CEA.

Neurologic and functional long-term outcome after carotid endarterectomy.

BACKGROUND: The aim of this research was to assess the neurologic status of patients a year after endarterectomy with the use of National Institutes of Health Stroke Scale (NIHSS) and the degree of disability using the modified Rankin Scale (mRS) and to examine the patients' subjective evaluation of their health. METHODS: One hundred two patients with symptomatic internal carotid artery stenosis who underwent endarterectomy and attended a 1-year follow-up examination were enrolled in the study. The material comprised 72 (70.6%) men and 30 (29.4%) women. Before the surgery, the patients' neurologic status was assessed according to the NIHSS, and their functional status was rated with the mRS. Additionally, the patients were asked to assess their life quality on a 10-point Likert scale. RESULTS: The mean NIHSS score before the operation was 2.76 points (SD 2.47), whereas a year after it was 2.05 points (SD 1.84) (P < .0001). The NIHSS scores that improved significantly a year after endarterectomy were level of consciousness-questions and commands, motor leg, and sensory (P < .05). CONCLUSIONS: The patients' neurologic status assessed with the NIHSS improved significantly 1 year after carotid endarterectomy mostly because of the improvement in their verbal and motor communication ability, physical condition and agility, and reduction in sensory disturbances. The observed changes in the neurologic status were reflected in the functional status and subjective life quality assessment, which appeared to be significantly better a year after the surgical treatment.

Endovascular management of aortic dissections involving the common carotid and subclavian arteries.

Aortic dissection is a life-threatening condition, in which rupture of the internal wall of the aorta is observed. The aim of the study was to present the techniques used in patients with type A Stanford aortic dissection treatment by means of carotid-carotid by-pass surgery and implantation of the aortic stent-graft with intentional occlusion of the left common carotid and subclavian arteries. Surgical methods were presented on the basis of three patients treated at the Department of Vascular, General and Oncological Surgery, Memorial Copernicus Hospital in Lódz. Different carotid- carotid bypass grafting techniques were also described. Our own clinical observations demonstrated that patients with retro-pharyngeal carotid-carotid bypass did not report dysphagia, and retropharyngeal grafting seems to be the optimal method considering patients in whom stent-grafts cause left carotid artery occlusion.

Influence of internal carotid endarterectomy on patients' life quality.

UNLABELLED: Appropriate treatment of symptomatic carotid artery stenosis can reduce ischemic cerebral strokes' risk and in some cases eliminate neurological symptoms. Endarterectomy is the most common surgical treatment. The aim of the study was to examine the influence of carotid endarterectomy on neurological symptoms and patients' life quality. MATERIAL AND METHODS: The material comprised of 102 patients who underwent endarterectomy. All of the patients were given a questionnaire with a list of neurological symptoms (vertigos, headaches, left hemiparesis, right hemiparesis, numbness, acroparaesthesia, single syncope, recurrent syncopies, diplopia, tinnitus, concentration disturbances and aphasia) and with a numerical life quality scale to fill in before and a year after the surgery. RESULTS: Vertigo, headache, single and recurrent syncopies and aphasia as well as cerebral stroke and amaurosis fugax were significantly more rarely observed after endarterectomy. The mean value of patients' life quality evaluated on a 10-point Likert scale after the surgery increased (3.9 vs 6.3). CONCLUSIONS: A year after carotid endarterectomy patients' life quality improves which is connected with neurological symptoms' regression and no further symptoms' occurrence due to a preventive role of the surgery.

Intracranial occlusions and internal carotid artery stenoses: clinical implications.

BACKGROUND: The aim of this research was to investigate the influence of intracranial stenoses or occlusions on the outcome of carotid endarterectomy (CEA) in patients with internal carotid artery stenosis. The authors also searched for internal carotid artery plaque's morphology influence on the atherosclerotic process in intracranial arteries. METHODS: The study included 154 patients who underwent angiography and CEA. Intracranial lesions (stenosis or occlusion) were stated in 28 (18.2%) patients. RESULTS: Perioperative stroke - death rate was 3.9%. Statistical analysis revealed that perioperative stroke after CEA appeared significantly more often in patients with intracranial stenoses or occlusions (p = 0.0104). Late death-stroke rate was 13.6%. Log-rank test revealed that after a 1-year follow-up period, there were significantly more survivals in patients without intracranial lesions than in those with intracranial lesions (p = 0.048). CONCLUSIONS: Intracranial stenosis or occlusion predicts poor perioperative neurological outcome. Patients with intracranial lesions benefit less from endarterectomy in a 1-year follow-up period. On the basis of internal carotid artery plaque's morphology, no conclusions on advancement of intracranial arteries' atherosclerosis can be made.

[Disseminated intravascular coagulation in abdominal aortic aneurysm--case report]. / Rozsiane krzepniecie sródnaczyniowe w przebiegu tetniaka aorty brzusznej--opis przypadku.

Disseminated intravascular coagulation (DIC) constitutes a rare presentation form of aortic aneurysms. In majority of cases, DIC is asymptomatic and has chronic course, but in 0.5-4% of patients it is clinically overt. Very seldom DIC leads to diagnosis of previously unknown aortic aneurysm. The authors describe a case of 84 years old man referred to hospital due to haemorrhagic diathesis with laboratory results consistent with overt DIC. A CT scan demonstrated abdominal aortic aneurysm (AAA) as an underlying disorder. The patient was treated with fresh frozen plasma and enoxoparine. After reaching the clinical and laboratory improvement he was proposed with placing an endoluminal stent graft, but he did not agree for operation. The multidisciplinary management of this patient is presented and some issues concerning the epidemiology, treatment and coagulation assessment of AAA patients with DIC are discussed.