Editor's Choice – An Updated Systematic Review and Meta-analysis of Outcomes Following Eversion vs. Conventional Carotid Endarterectomy in Randomised Controlled Trials and Observational Studies

Paraskevas, Kosmas I.; Robertson, Vaux; Saratzis, Athanasios; Naylor, A.R.

doi:10.1016/j.ejvs.2017.12.025

Cited by 54 publications

(24 citation statements)

References 33 publications

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“…It was documented that eversion technique improves perioperative stroke and death rates compared with the conventional method and less restenosis is achieved in the late period. However, it is also stated that similar results were obtained with the conventional method modified using a patch [18,19]. Routine shunt use during surgery does not provide superiority in terms of stroke and mortality compared to not using it at all.…”

Section: Discussionmentioning

confidence: 77%

Safe carotid endarterectomy: “one fits all strategy”

Ünlü¹,

Durukan²

2020

kitp

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Introduction: Carotid artery stenosis of 50% or more in the extracranial internal carotid artery is responsible for 10-15% of all strokes. Interventional treatment options include carotid endarterectomy and carotid artery stenting, where endarterectomy is proven to be superior. Aim: In this study, we report the carotid endarterectomy results of patients we operated on using the strategy we termed the "one fits all strategy". Material and methods: Seventy-six patients undergoing carotid endarterectomy between July 2016 and April 2020 were retrospectively studied. Conventional endarterectomy under general anesthesia with primary closure of the arteriotomy was performed in all patients. We used a near infrared spectroscopy oximeter to measure regional cerebral oxygenation continuously throughout the surgery. Results: The mean age of the patients was 70.96 8.15 years. There were 52 male and 24 female patients. The mean followup time was 20.6 ±13.6 months. Coronary artery disease was detected in 52 (73.6%) patients. Coronary artery bypass operation was indicated in 19 patients in whom a staged approach was performed in 13 and a reverse staged approach in 1. There were two perioperative strokes one of which recovered fully spontaneously and the other partially with physiotherapy. Eight cases were revised due to hematoma formation. Conclusions: Carotid endarterectomy continues to prove its safety in carotid artery stenosis patients. Continuous cerebral oxygenation monitoring is indispensable for carotid surgery. Despite discrepancies in surgical techniques, we believe that "one fits all strategy: general anesthesia, conventional endarterectomy without patch plasty, never shunter and always NIRS monitorization" may be used safely in patients undergoing carotid endarterectomy.

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Section: Discussionmentioning

confidence: 77%

Safe carotid endarterectomy: “one fits all strategy”

Ünlü¹,

Durukan²

2020

kitp

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“…For these patients, endarterectomies can reduce their 5-year risk of stroke occurrence from 12 to 6% (126). Recent studies have found that a modified version of this surgery, eversion carotid endarterectomy, might have better peri-operative outcomes but performs similarly for post-operative outcomes (127).…”

Section: Variation In Disease Prediction and Treatmentmentioning

confidence: 99%

Comparing the Role of Mechanical Forces in Vascular and Valvular Calcification Progression

Gomel

Lee

Grande‐Allen

2019

Front. Cardiovasc. Med.

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Calcification is a prevalent disease in most fully developed countries and is predominantly observed in heart valves and nearby vasculature. Calcification of either tissue leads to deterioration and, ultimately, failure causing poor quality of life and decreased overall life expectancy in patients. In valves, calcification presents as Calcific Aortic Valve Disease (CAVD), in which the aortic valve becomes stenotic when calcific nodules form within the leaflets. The initiation and progression of these calcific nodules is strongly influenced by the varied mechanical forces on the valve. In turn, the addition of calcific nodules creates localized disturbances in the tissue biomechanics, which affects extracellular matrix (ECM) production and cellular activation. In vasculature, atherosclerosis is the most common occurrence of calcification. Atherosclerosis exhibits as calcific plaque formation that forms in juxtaposition to areas of low blood shear stresses. Research in these two manifestations of calcification remain separated, although many similarities persist. Both diseases show that the endothelial layer and its regulation of nitric oxide is crucial to calcification progression. Further, there are similarities between vascular smooth muscle cells and valvular interstitial cells in terms of their roles in ECM overproduction. This review summarizes valvular and vascular tissue in terms of their basic anatomy, their cellular and ECM components and mechanical forces. Calcification is then examined in both tissues in terms of disease prediction, progression, and treatment. Highlighting the similarities and differences between these areas will help target further research toward disease treatment.

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“…Previous reviews such as the one by Paraskevasa et al 32 could be considered as ‘similar’ to this review. However, the differences can be found in the methodological approach.…”

Section: Introductionmentioning

confidence: 79%

Eversion technique versus conventional endarterectomy with patch angioplasty in carotid surgery: protocol for a systematic review with meta-analyses and trial sequential analysis of randomised clinical trials

et al. 2020

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IntroductionTraditional carotid endarterectomy is considered to be the standard technique for prevention of a new stroke in patients with a symptomatic carotid stenosis. Use of patch angioplasty to restore the arterial wall after longitudinal endarterectomy is, to date, not unequivocally proven to be superior to eversion technique. A systematic review is needed for evaluation of benefits and harms of the eversion technique versus the traditional endarterectomy with patch angioplasty in patients with symptomatic carotid stenosis.Methods and outcomesThe review will be conducted according to this protocol following the recommendations of the ‘Cochrane Handbook for Systematic Reviews’ and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Randomised clinical trials comparing eversion technique versus endarterectomy with patch angioplasty in patients with a symptomatic stenosis of the internal carotid artery will be included. Primary outcomes are all-cause mortality rate, health-related quality of life and serious adverse events. Secondary outcomes are 30-day stroke and mortality rate, symptomatic arterial restenosis or occlusion and non-serious adverse events. The databases Cochrane Central Register of Controlled Trials, PubMed/MEDLINE and EMBASE will be searched (November 2019). We will primarily base our conclusions on meta-analyses of trials with overall low-risk of bias. We will use trial sequential analysis to assist the evaluation of imprecision in Grading of Recommendations, Assessment, Development and Evaluation. However, if pooled point estimates of all trials are similar to pooled point estimates of trials with overall low risk of bias and there is lack of a statistical significant interaction between estimates from trials with overall high risk of bias and trials with overall low risk of bias we will consider the trial sequential analysis adjusted precision of the estimate achieved in all trials as the result of our meta-analyses.Ethics and disseminationThe proposed systematic review will collect and analyse data from published studies, therefore, ethical approval is not required. The results of the review will be disseminated by publication in a peer-review journal and submitted for presentation at conferences.PROSPERO registration numberCRD42019119361.

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Editor's Choice – An Updated Systematic Review and Meta-analysis of Outcomes Following Eversion vs. Conventional Carotid Endarterectomy in Randomised Controlled Trials and Observational Studies

Cited by 54 publications

References 33 publications

Safe carotid endarterectomy: “one fits all strategy”

Safe carotid endarterectomy: “one fits all strategy”

Comparing the Role of Mechanical Forces in Vascular and Valvular Calcification Progression

Eversion technique versus conventional endarterectomy with patch angioplasty in carotid surgery: protocol for a systematic review with meta-analyses and trial sequential analysis of randomised clinical trials

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