Clinical Characteristics and Outcomes in Carotid Endarterectomy for Internal Carotid Artery Stenosis in a Japanese Population: 10-Year Microsurgical Experience

Iwasaki, Motoyuki; Kuroda, Satoshi; Nakayama, Naoki; Hokari, Masaaki; Yasuda, Hiroshi; Saito, Hisatoshi; Iwasaki, Yoshinobu

doi:10.1016/j.jstrokecerebrovasdis.2009.11.001

Cited by 10 publications

(6 citation statements)

References 29 publications

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“…The outcomes of CEA in Japan have been good, even if publication bias is considered, including a perioperative mortality rate < 1% and a morbidity rate (including stroke) of approximately 3%. 7,12,13 Our results are comparable to those of previous major studies involving large numbers of patients, 4,5 despite the high cervical level of carotid artery bifurcation in Japanese individuals. 6 The difficulty in CEA for higher lesions is in achieving visualization of the surgical site.…”

Section: Discussionsupporting

confidence: 88%

“…1 Although the cervical level of the carotid artery bifurcation is relatively higher in Japanese individuals than in the Western population, 6 the outcomes of CEA in Japan have been good despite this unfavorable condition. 7 In addition, we reported good short-term outcomes of CEA with established surgical strategies including intraoperative monitoring with near-infrared spectroscopy and autologous vein patchplasty. 8,9 In this study, we investigated the long-term outcomes of CEA in our institute and evaluated the influence of lesion level on procedural quality.…”

Section: Introductionmentioning

confidence: 82%

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Stenotic lesion level did not affect outcomes of carotid endarterectomy

Suhara

Hoshina

Akai

et al. 2017

Asian Cardiovasc Thorac Ann

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Background Carotid endarterectomy is the established treatment for carotid artery stenosis, and remains the primary surgical option due to its superior outcomes compared to carotid arterial stenting. However, Japanese patients are known to have unfavorable anatomical conditions for carotid endarterectomy, with a relatively higher level of the carotid artery bifurcation than in the Western population. We investigated the outcomes of carotid endarterectomy in our institute and evaluated the procedural quality by comparing patients based on higher or lower lesion levels. Methods The clinical data of 65 patients who underwent carotid endarterectomy were collected retrospectively. The outcomes reviewed included stroke-free survival and stroke-free rate. The patients were divided into a higher group ( n = 25) and a lower group ( n = 40), based on lesion location in respect of the 2nd cervical vertebral level. Results There was no perioperative death and only one case of stroke in the higher group within 30 days after carotid endarterectomy. At 5 years after carotid endarterectomy, the stroke-free survival rates were 83.4% in the higher group and 87.8% in the lower group, while the stroke-free rates were 96.0% and 94.0%, respectively; there were no significant differences between groups. Conclusions Stenotic lesion level did not affect the outcome or procedural quality of carotid endarterectomy.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 82%

Stenotic lesion level did not affect outcomes of carotid endarterectomy

Suhara

Hoshina

Akai

et al. 2017

Asian Cardiovasc Thorac Ann

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“…Volatile anesthetics were not used during surgery. CEA was performed as described previously (13). Briefly, the carotid bifurcation was dissected, and then an intravenous bolus of heparin (3000 units) was administered before carotid clamping.…”

Section: Anesthesia and Surgical Proceduresmentioning

confidence: 99%

Intraoperative Dual Monitoring During Carotid Endarterectomy Using Motor Evoked Potentials and Near-Infrared Spectroscopy

et al. 2012

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“…[10][11][12]23,28) Briefly, the common carotid artery and its bifurcation were exposed in the usual fashion.…”

Section: Methodsmentioning

confidence: 99%

Spontaneous Echo Contrast and Thrombus Formation at the Carotid Bifurcation After Carotid Endarterectomy

Kawabori

Yoshimoto

Ito

et al. 2012

Neurol. Med. Chir.(Tokyo)

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Spontaneous echo contrast (SEC) consists of numerous microechoes swirling in the cardiovascular lumen and is usually seen during blood stasis in dysfunctional left atrium. However, SEC and consecutive local thrombus formation at the carotid artery early after carotid endarterectomy (CEA) have not been reported. This study retrospectively investigated the clinical importance and therapeutic strategy of postoperative SEC and thrombus formation in 113 consecutive patients who underwent CEA between 2001 and 2009. Ultrasonography was routinely performed preoperatively, intraoperatively, and 1 day and 1 week after the operation. If SEC and/or thrombus was detected at any time after the operation, follow-up ultrasonography was performed at short intervals, once a week for inpatients and once every 1-2 months for outpatients. Eight of the 113 patients (7%) had SEC after the operation from Day 1 to 12 (mean 7.2 days), and 6 of these 8 patients developed local de novo thrombus formation at the site of SEC from Day 6 to 33 (mean 14.7 days). The maximum luminal narrowing by the thrombi were 26-62% (mean 37%). After administering anticoagulant therapy, all thrombi disappeared from Day 13 to 190 (mean 57 days) from CEA. SEC seen after CEA is highly associated with consecutive local thrombus formation. Postoperative geometric blood stasis with the absence of intima may be the causative factor for its development.

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Clinical Characteristics and Outcomes in Carotid Endarterectomy for Internal Carotid Artery Stenosis in a Japanese Population: 10-Year Microsurgical Experience

Cited by 10 publications

References 29 publications

Stenotic lesion level did not affect outcomes of carotid endarterectomy

Stenotic lesion level did not affect outcomes of carotid endarterectomy

Intraoperative Dual Monitoring During Carotid Endarterectomy Using Motor Evoked Potentials and Near-Infrared Spectroscopy

Spontaneous Echo Contrast and Thrombus Formation at the Carotid Bifurcation After Carotid Endarterectomy

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