Computerised tomography findings as a risk factor in carotid endarterectomy: Early and late results

Cao, Piergiorgio; Giordano, Giuseppe; Rango, Paola De; Carlini, G; Verzini, Fabio; Parente, Basso; Moggi, L

doi:10.1016/s1078-5884(96)80273-5

Cited by 13 publications

(4 citation statements)

References 29 publications

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“…The literature on the influence of CIL on carotid revascularization outcome is discordant. In their analysis of 503 symptomatic patients, Cao et al 14 found, similarly to our study, an incidence of CIL in patients with stroke of 54% and TIA of 33%. Stroke and death in their series were significantly higher in patients with CIL; however, their study considered both ipsilateral and contralateral lesions.…”

Section: Journal Of Vascular Surgerysupporting

confidence: 89%

“…Many retrospective studies have analyzed the influence of the clinical characteristics, such as TIA and stroke, on carotid revascularization outcome 18,19 ; however, one must consider that a significant number of patients with TIA (30%-40%) may present with a CIL and that many patients with a minor stroke (50%) do not have any CIL visible at CT, as shown also in our study. 14 In fact, 18.9% of patients with clinical stroke did not present a CIL at CT, which was instead present in 43% of patients with clinical TIA. Consequently, the evaluation of the type of symptoms is not sufficient to define the extension of brain damage.…”

Section: Journal Of Vascular Surgerymentioning

confidence: 96%

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Impact of acute cerebral ischemic lesions and their volume on the revascularization outcome of symptomatic carotid stenosis

Pini

Faggioli

Longhi

et al. 2017

Journal of Vascular Surgery

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Section: Journal Of Vascular Surgerysupporting

confidence: 89%

Section: Journal Of Vascular Surgerymentioning

confidence: 96%

Impact of acute cerebral ischemic lesions and their volume on the revascularization outcome of symptomatic carotid stenosis

Pini

Faggioli

Longhi

et al. 2017

Journal of Vascular Surgery

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“…However, different data are reported in the literature. Cao et al (27), in their analysis of 503 symptomatic patients, identified CIL in 54% of patients with stroke and 33% of those with TIA. CIL influenced the outcome of CEA in their series: stroke and death were significantly higher in patients with CIL (OR: 6.37; 95% CI, 5.12-7.63).…”

Section: Carotid Revascularization Outcome According To the Presence Of Cilmentioning

confidence: 99%

Impact of cerebral ischemic lesions on the outcome of carotid endarterectomy

et al. 2020

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Patients with carotid artery stenosis (CAS) are commonly defined as asymptomatic or symptomatic according with their neurological conditions, however, emerging evidences suggest stratifying patients according also with the presence of cerebral ischemic lesions (CIL). In asymptomatic patients, the presence of CIL increases the risk of future neurologic event from 1% to 4% per year, leading to a stronger indication to carotid revascularization. In symptomatic patients, the presence of CIL does not seem to influence the outcome of the carotid revascularization if the volume of the lesion is small (<4,000 mm 3 ); the benefit of the revascularization is also more significant if performed within 2 weeks from the index event.However, high volume (>4,000 mm 3 ) CIL are associated in some experiences with a higher risk of carotid revascularization suggesting to delay the carotid revascularization for at least 4 weeks. As a matter of fact, the evaluation of CIL dimensions and characteristics in patients with CAS gives to the physician involved in the treatment a valuable adjunctive tool in the choice of the ideal treatment.

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“…In contrast, "silent" cerebral infarction might be more important for the operative risk of stroke during and immediately after carotid surgery. Some surgeons have reported an extraordinarily high perioperative complication rate (up to 14%) [7,8], whereas others have contested an association [9 -14]. These studies can be criticized, as they were either retrospective or did not include adjustments for patient differences with respect to confounding variables.…”

mentioning

confidence: 99%

Silent Cerebral Infarction: Risk Factor for Stroke Complicating Carotid Endarterectomy

et al. 2001

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"Silent" cerebral infarction is found in 20% to 30% of patients with significant internal carotid artery (ICA) disease. Our purpose was to determine whether such "silent" cerebral infarction in the operated carotid territory represents a risk factor for stroke during and immediately after carotid endarterectomy. Over 5 years we followed a cohort of 663 patients with symptomatic and asymptomatic ICA stenosis who were consecutively scheduled for surgery. The stenosis was more than 70% in patients with transient ischemic attacks and more than 95% in asymptomatic stenosis patients. All patients underwent preoperative computed tomography to determine the frequency, extent, and location of any "silent" cerebral infarction. Patients were grouped by the absence or presence of infarction in the operated carotid territory. Among the entire cohort, 20 patients had a major perioperative stroke (3.0%). All deaths were stroke-related. No intracranial bleeding occurred. Major stroke occurred in four (0.8%) patients without appropriate "silent" cerebral infarction, compared with 16 (8.8%) with an appropriate "silent" cerebral infarct (p < 0.001). After adjustment for confounding co-variables (e.g., gender, presence of preoperative symptoms, and age), "silent" cerebral infarction was found to be the only independent predictor of perioperative major stroke for symptomatic and asymptomatic stenosis (overall adjusted relative risk 11.5, 95% confidence interval 3.8-34.9, p < 0.0001). Patients with "silent" cerebral infarction seem to be at increased risk of perioperative stroke. Consequently, preoperative cerebral imaging is important for risk classification.

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Computerised tomography findings as a risk factor in carotid endarterectomy: Early and late results

Abstract: A positive CT finding, regardless of congruity of the lesion, should be regarded as an indicator of an increased risk of stroke and death in patients scheduled for carotid surgery, especially in those with asymptomatic stenosis.

Cited by 13 publications

References 29 publications

Impact of acute cerebral ischemic lesions and their volume on the revascularization outcome of symptomatic carotid stenosis

Impact of acute cerebral ischemic lesions and their volume on the revascularization outcome of symptomatic carotid stenosis

Impact of cerebral ischemic lesions on the outcome of carotid endarterectomy

Silent Cerebral Infarction: Risk Factor for Stroke Complicating Carotid Endarterectomy

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