Carotid Endarterectomy: Indications and Techniques for Carotid Surgery

Imparato, Anthony M.

doi:10.1002/9780470755815.ch66

Cited by 4 publications

(5 citation statements)

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“…One of the most thoroughly studied is carotid shunting, in which blood is supplied to the ICA during carotid clamping, but carotid shunts also have the disadvantages of air or plaque embolization, intimal tears, carotid dissection and requiring extension of the arteriotomy proximally in the common carotid artery, which prolongs operating time. Nevertheless, shunts might not be adequate for the cerebral oxygen requirements . Routine shunting compared with no shunting has been found to result in similar rates of perioperative (30‐day) stroke, ipsilateral stroke and death .…”

Section: Discussionmentioning

confidence: 99%

“…In a trial, shunting was done in 11 per cent of patients in eversion endarterectomy . Another cerebral‐protection method, artificially‐induced hypertension with drugs during carotid clamping, has been found to convert patients from having an intolerance to carotid clamping to having tolerance to it . In SCE, shunts could also be applied after endarterectomy during arteriotomy closure.…”

Section: Discussionmentioning

confidence: 99%

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Selective carotid endarterectomy and the advantages of conventional and eversion endarterectomy

2014

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Aim: Selective carotid endarterectomy (SCE) is described as the extraction of atheromatous plaque through an arteriotomy made starting from the common carotid artery and extending to the external carotid artery. The aim of the present study was to report the initial experience of SCE technique at our department. Patients and Methods: Collected data on all SCE were retrospectively analysed. The study period was from May 2010 to the end of April 2013. A total of 30 patients underwent SCE. The patients were operated on under general anaesthesia. Results: The mean age of the patients was 70.7 ± 6.0 years. The risk factors were coronary artery disease in nine patients, hypertension in 18 patients, smoking in nine patients, hypercholesterolemia in 17 patients, diabetes in 14 patients, peripheral arterial occlusive disease in three patients and a family history of coronary artery disease in six patients. One patient had simultaneous coronary artery bypass surgery for severe left main coronary artery disease. There were no hospital deaths. Two patients had cervical haematoma that regressed without intervention. The mean carotid artery clamping time was 13.5 ± 3.4 min (range: 8-25 min), and the mean postoperative hospitalization time was 3.2 ± 1.2 days. Conclusion: SCE is a safe and simple procedure that eliminates patching.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Selective carotid endarterectomy and the advantages of conventional and eversion endarterectomy

2014

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Section: Clinical Aspects and Indications For Interventionmentioning

confidence: 99%

“…Although rare, symptoms such as giddiness, vertigo, postural alterations or syncope may occur which generally suggests concomitant compromise of the basilar-vertebral region. At the extremes of the wide clinical range of cerebrovascular disease it is possible to have complaints such as slight and relapsing pins and needles in the hand, to sudden and irreversible hemiplegia states [30].Classically, the nomenclature of cerebral ischemic syndromes takes into account the reversibility and the time of evolution of the neurological deficit. When the clinical syndrome presents total reversal within 24 hours without leaving sequels, it is named a transient ischemic attack (TIA), with a risk of recurrence or evolution to a stroke of 30%.…”

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confidence: 99%

<![CDATA[<B>Vulnerability of atherosclerotic carotid disease</B>: <B>from laboratory to operating room - part 1</B>]]>

Albuquerque¹,

Narvaes²,

Filho³

et al. 2006

Braz. j. cardiovasc. surg.

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128ALBUQUERQUE, LC ET AL -Vulnerability of atherosclerotic carotid disease: from laboratory to operating room -Part 1 Braz J Cardiovasc Surg 2006; 21(2): 127-135 INTRODUCTION Cerebrovascular obstructive disease (COD) is currently a priority for public healthcare in developed countries, due to its significant prevalence in the adult population, the severity of ischemic events and the high potential to negatively affect productive life [l,2]. Almost 30% of all cases of strokes may be attributed to atherosclerotic disease of the carotid bifurcation, acute thrombotic mechanisms or more commonly to distal embolization [3,4].In spite of significant advances that occurred in the medicinal treatment of COD, carotid endarterectomy (CE) remains an important measure in the prophylaxis of strokes and the elective treatment in severe obstructive lesions, even when ipsilateral hemispherical symptoms are not present [5,6]. Although in the 1970s CE became the favorite method to treat strokes, only in the 1980s and 1990s, with the results of several clinical trials, the precise identification of subgroups of patients who really benefited from the surgical strategy was possible. These findings resulted in establishing the consensual indications for CE used today, based exclusively on the percentage of stenosis [7,8].However, the concept of vulnerability of atherosclerotic plaque, initially introduced for coronary artery obstructive disease, reveals that susceptible injuries are characterized by the presence of necrosis in the nucleus of the plaque, by locations with great lipid concentrations but little cellularized, by areas of intraplaque hemorrhage and by eccentric growth, a phenomenon denominated as positive remodeling [9,10]. Ischemic events are dependent on the rupture of the fibrous cover, allowing the thrombogenic content of the plaque to come in contact with the blood, and not on the degree of stenosis or the hemodynamic significance of the lesions [11,12].Evidence on the involvement of inflammatory mechanisms in atherosclerosis have contributed to changing of etiopathogenic paradigms, substituting the traditional model of progressive and concentric accumulation of lipids on the arterial wall for the concept that the inflammation plays a central role in the formation and progression of the atheroma.Part I of this review aims at analyzing recent studies and relevance related to the vulnerability of atherosclerotic disease of carotid arteries, expressed by its epidemiological, clinical and inflammatory aspects. In Part II currently used serum markers are discussed, as are histological aspects and diagnosis by imaging, related to the instability of carotid artery disease, together with possible therapeutic implications or possible changes of criteria related to the current indications for intervention. Epidemiological aspectsIn developed countries, strokes constitute the third commonest cause of death in the adult population and the greatest determinant of permanent invalidity [13]. The incidence has been calculated as f...

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“…However, in many cases (for example, stenosis or occlusion of the contralateral ICA, or anatomical variations of the circle of Willis) the collateral circulation might prove unable to respond to the needs for blood and oxygen and thus cerebral damage may develop. [1][2][3] The frequency of perioperative stroke during CEA ranges from 1.1 to 7.5% in several studies, [4][5][6][7][8] while a mortality rate between 0.1 and 1% is reported in the literature. 9 Being aware of the status of brain oxygenation is, therefore, a matter of importance during CEA, especially during the ICA cross-clamping.…”

Section: Introductionmentioning

confidence: 99%

Cerebral oximetry and stump pressure as indicators for shunting during carotid endarterectomy: comparative evaluation

Tambakis¹,

Papadopoulos

Sergentanis

et al. 2011

Vascular

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The purpose of this work is to investigate the correlation between regional oxygen saturation (rSO(2)) changes and stump pressure (SP) during cross-clamping of the internal carotid artery in carotid endarterectomy (CEA) and verify the perspectives of rSO(2) to become a criterion for shunting. Sixty consecutive CEAs under general anesthesia were studied prospectively. Selective shunting was based on SP ≤40 mmHg exclusively. Regression analysis with high order terms and receiver operating characteristic analysis were performed to investigate the association between ΔrSO(2)(%) and SP and to determine an optimal ΔrSO(2)(%) threshold for shunt insertion. A quadratic association between ΔrSO(2)(%) and SP was documented regarding the baseline to one and five minutes after cross-clamping intervals. A cut-off of 21 and 10.1% reduction from the baseline recording was identified as optimal for the distinction between patients needed or not a shunt regarding the first and fifth minute after cross-clamping, respectively. In conclusion, cerebral oximety reflects sufficiently cerebral oxygenation during CEA compared with SP, providing a useful mean for cerebral monitoring.

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Carotid Endarterectomy: Indications and Techniques for Carotid Surgery

Cited by 4 publications

References 132 publications

Selective carotid endarterectomy and the advantages of conventional and eversion endarterectomy

Selective carotid endarterectomy and the advantages of conventional and eversion endarterectomy

<![CDATA[<B>Vulnerability of atherosclerotic carotid disease</B>: <B>from laboratory to operating room - part 1</B>]]>

Cerebral oximetry and stump pressure as indicators for shunting during carotid endarterectomy: comparative evaluation

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