Guidelines for Carotid Endarterectomy

Biller, José; Feinberg, William M.; Castaldo, John; Whittemore, Anthony D.; Harbaugh, Robert E.; Dempsey, Robert J.; Caplan, Louis R.; Kresowik, Timothy F.; Matchar, David B.; Toole, James F.; Easton, J. Donald; Adams, Harold P.; Brass, Lawrence M.; Hobson, Robert W.; Brott, Thomas G.; Sternau, Linda

doi:10.1161/01.cir.97.5.501

Cited by 398 publications

(141 citation statements)

References 81 publications

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“…According to the AHA criteria [25], some 87 patients with >50% symptomatic stenosis and >70% asymptomatic stenosis underwent eversion endarterectomy and 25 asymptomatic subjects were not operated upon. 82 plaques were inspected in the operating room by a pathologist and macroscopic observations were recorded in the operation report file.…”

Section: Methodsmentioning

confidence: 99%

Genetic control of chemokines in severe human internal carotid artery stenosis

et al. 2008

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Background and purpose: Atherosclerosis is an inflammatory disease. Chemokines and chemokine receptors are known to be involved in atherogenesis. Common single nucleotide polymorphisms (SNPs) affect transcription in response to inflammatory stimuli. The aim of this study was to evaluate the correlations between MCP-1, RANTES, SDF-1, CCR2, and CCR5 gene polymorphisms with increased risk of internal carotid artery (ICA) stenosis. Methods: Hundred and twelve patients, consecutively recruited for ICA occlusive disease, and 282 controls were genotyped for MCP-1-2518G, RANTES-403A, CCR5D32, CCR2 V64I, and SDF-1-801A polymorphisms. Results: The frequency of the SDF-1A allele was significantly different between cases and controls: 0.32 vs. 0.20, respectively (OR 1.81; 95% CI 1.25-2.60; p = 0.007). The frequency of the RANTES-403G allele was significantly higher in patients with stenosis >70% (OR, 2.45; 95% CI 1.12-5.71; p = 0.015). No significant differences were observed with the other polymorphisms. Conclusion:The reported results seem to correlate the polymorphisms of the genes encoding for SDF-1, RANTES with pathogenesis and progression of ICA occlusive disease. Although suggestive, these results need confirmation in prospective cross-sectional studies.

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Section: Methodsmentioning

confidence: 99%

Genetic control of chemokines in severe human internal carotid artery stenosis

et al. 2008

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“…prevent stroke in patients with severe symptomatic IC stenosis [8][9][10][11][12] . Digital angiography (DGA) is the standard method to evaluate IC stenosis and to indicate endarterectomy [8][9][10] .…”

mentioning

confidence: 99%

“…Digital angiography (DGA) is the standard method to evaluate IC stenosis and to indicate endarterectomy [8][9][10] . However, there is a 1 to 4% risk of stroke or death related to this method 6,13,14 .…”

mentioning

confidence: 99%

Internal carotid artery stenosis: comparison of duplex scan and magnetic resonance angiography with digital subtraction angiography

André

Azevedo

et al. 2001

Arq. Neuro-Psiquiatr.

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-Objective: We compare duplex scan (DS) and magnetic resonance angiography (MRA) with digital angiography (DGA) in respect to accuracy in measuring internal carotid artery (IC) stenosis in symptomatic patients. Method: Ten symptomatic patients with IC stenosis greater than 70% previously diagnosed by DS were submitted to another DS and to both MRA and DGA. Both ICs from each patient (total 20 ICs) were evaluated by physicians blinded for the results of other tests. DS and MRA were compared with DGA, using the intraclass correlation coeficient (r) and its 95% confidence interval (95% ci). .or each diagnostic test, the study group (20 Ics) was also divided in surgical patients (IC stenosis between 70 and 99%) and non surgical patients, using kappa concordance coeficient (k) to compare the results. KEY WORDS: carotid stenosis, diagnosis, cerebrovascular disease, comparative study.Estenose da artéria carótida interna extracraniana: comparação de duplex-scan e angio-ressonância com angiografia digital RESUMO -Objetivo: .oram comparados duplex scan (DS) e angio-ressonância magnética (AGRM) com angiografia digital (AGD) na avaliação da estenose da artéria carótida interna (CI). Método: .oram estudados 10 pacientes sintomáticos com estenose da CI superior a 70% em estudos de triagem com DS. Os pacientes foram submetidos a novo DS, AGRM e AGD para estudo de ambas as CIs (total 20 CIs). O DS e a AGRM foram comparados com a AGD utilizando-se o coeficiente de correlação intra-classe (r) e o seu intervalo de confiança a 95% (ic 95%). Para cada método diagnóstico, o grupo de pacientes (considerando as 20 CIs) foi também dicotomizado em casos cirúrgicos (estenose entre 70% e 99%) e não cirúrgicos, utilizando-se o coeficiente kappa de concordância (k). Resultados: Na comparação entre DS e AGD, obteve-se r = 0,71 (0,4 -0,87). Entre AGRM e AGD, r = 0,61 (0,25 -0,82). Após a dicotomização da amostra, obteve-se, entre DS e AGD, k = 0,857, p < 0,0001; e entre AGRM e AGD, k = 0,545, p = 0,003. A maioria dos erros de DS e AGRM ocorreu nos casos de suboclusão arterial. Conclusão: Os resultados sugerem que o DS e a AGRM, usados em conjunto, podem substituir a AGD na indicação da endarterectomia carotídea, exceto quando há discordância entre os dois ou quando algum dos métodos detecta suboclusão arterial.

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“…Current standards postulate a surgical morbidity/mortality rate Ͻ6% for symptomatic stenoses and Ͻ3% for asymptomatic stenoses. 2,3 Strict patient selection criteria and a very high quality of surgical care are mandatory if such low complication rates are to be achieved. Institutions performing CEA are requested to keep an exact documentation of their results to maintain high performance standards and correct possible deviations from the accepted norms.…”

mentioning

confidence: 99%

Silent Cerebral Ischemia Detected by Diffusion-Weighted MRI After Carotid Endarterectomy

Barth

Remonda

Lövblad

et al. 2000

Stroke

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Background and Purpose-Small emboli arising from a friable plaque during carotid endarterectomy (CEA) constitute an important risk of perioperative ischemic complications. To evaluate the incidence and significance of silent cerebral ischemic lesions of embolic origin after CEA, we prospectively examined a series of surgical patients with high-grade carotid stenosis by using diffusion-weighted MRI (DWI). We also tried to correlate postoperative ischemic lesions with the occurrence of sonographic cerebral embolic signals, the presence of plaque ulcerations, and the use of intraoperative shunting. Methods-Of a consecutive series of 53 patients undergoing elective CEA for high-grade carotid stenosis, 48 patients with unchanged postoperative neurological status were prospectively studied with DWI of the brain the day before and the day after the operation. The magnetic resonance images were analyzed by 2 neuroradiologists blinded to the clinical result of the operation. Any new hyperintense signal was interpreted as a postoperative ischemic lesion. Results-Forty-six (95.8%) of 48 patients had unchanged postoperative brain DWI. In 2 patients (4.2%), a new single asymptomatic hyperintense signal was observed on the side of the operation. Both lesions were small and presumably of embolic origin. They were not related to sonographic embolic signals, plaque ulcerations, or intraoperative shunting. Conclusions-These results suggest that the incidence of silent ischemic brain lesions of embolic origin after CEA is low and does not correlate with the occurrence of intraoperative sonographic microemboli. They confirm that CEA is a safe procedure that carries a low risk of postoperative cerebral events. (Stroke. 2000;31:1824-1828.)

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Guidelines for Carotid Endarterectomy

Cited by 398 publications

References 81 publications

Genetic control of chemokines in severe human internal carotid artery stenosis

Genetic control of chemokines in severe human internal carotid artery stenosis

Internal carotid artery stenosis: comparison of duplex scan and magnetic resonance angiography with digital subtraction angiography

Silent Cerebral Ischemia Detected by Diffusion-Weighted MRI After Carotid Endarterectomy

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