Impact of routine completion angiography on outcome after carotid endarterectomy

Wieker, Carola Marie; Harcos, Katharina; Ronellenfitsch, Ulrich; Demirel, Serdar; Bruijnen, H.; Böckler, Dittmar

doi:10.1016/j.jvs.2018.06.210

Cited by 7 publications

(7 citation statements)

References 20 publications

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“…In the current study sample, 42 (55.3%) patients had a first CeAD event with ischaemic symptoms. This observed frequency is probably not a representative risk estimate, all the more since it is an order of magnitude above the risks due to other types of acute carotid injury [12–15]. All first and recurrent CeADs were diagnosed in the same centers by the same physicians with the same methods over the same years.…”

Section: Discussionmentioning

confidence: 99%

Recurrent versus first cervical artery dissection – a retrospective study of clinical and vascular characteristics

Kloß

Калашникова

Добрынина

et al. 2020

Euro J of Neurology

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Background and purpose: Most recurrent cervical artery dissection (CeAD) events occur shortly after the acute first CeAD. This study compared the characteristics of recurrent and first CeAD events and searched for associations between subsequent events of an individual person. Methods: Cervical artery dissection patients with a new CeAD event occurring during a 3-6 month follow-up were retrospectively selected in seven specialized stroke centers. Clinical and vascular characteristics of the initial and the recurrent CeADs were compared. Results: The study sample included 76 patients. Recurrent CeADs were occlusive in one (1.3%) patient, caused cerebral ischaemia in 13 (17.1%) and were asymptomatic in 39 (51.3%) patients, compared to 29 (38.2%) occlusive, 42 (55.3%) ischaemic and no asymptomatic first CeAD events. In 52 (68.4%) patients, recurrent dissections affected both internal carotid arteries or both vertebral arteries, whilst 24 (31.6%) patients had subsequent dissections in both types of artery. Twelve (28.6%) of 42 patients with an ischaemic first dissection had ischaemic symptoms due to the recurrent CeADs, too. However, only one (1.3%) of 34 patients with a non-ischaemic first CeAD suffered ischaemia upon recurrence. Conclusion: Recurrent CeAD typically affects the same site of artery. It causes ischaemic events less often than the first CeAD. The risk that patients who presented with solely non-ischaemic symptoms of a first CeAD will have ischaemic symptoms in the case of a recurrent CeAD seems very small.

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Section: Discussionmentioning

confidence: 99%

Recurrent versus first cervical artery dissection – a retrospective study of clinical and vascular characteristics

Kloß

Калашникова

Добрынина

et al. 2020

Euro J of Neurology

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“…44 ----------Bredenberg et al 45 ----------Schwartz et al 9 64 ---------Alpert et al 17 Na ---------Holder et al 46 60 Furthermore, it provides better assessment of the presence of flap or insufficient endarterectomy in the distal part of endarterectomy site, in particular in the presence of high bifurcation or of a kink. [14][15][16][17] The DUS technique provides the advantage of the hemodynamic assessment of a residual stenosis, in addition to other morphological findings. Finally, angioscopy's main advantage is the ability to identify and aspirate even small thombi, particularly those that are produced from the bleeding transected vasa vasorum in the endarterectomy site.…”

Section: Discussionmentioning

confidence: 99%

“…There is no specific protocol for the intra-operative DSA; and in most studies, after the completion of the CEA, a direct puncture of the proximal part of the CCA is undertaken with a needle (19-23 gauge) and the insertion of contrast. [14][15][16][17] Angioscopy has also been applied in completion imaging of carotid endarterectomy having a lot of advantages such as the detection of thrombus, plaque disruption, or restenosis, while giving the opportunity to treat any complication. 18 The aim of this study was to present the existing evidence of different completion imaging techniques after CEA and to highlight their potential role on the clinical outcome.…”

Section: Introductionmentioning

confidence: 99%

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Completion imaging techniques and their clinical role after carotid endarterectomy: Systematic review of the literature

et al. 2020

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Background Completion imaging has been suggested for the intraoperative quality control assessment of the carotid endarterectomy technical success, in order to immediately resolve pathologic findings and accordingly improve patients’ outcome. The aim of this study was to present existing evidence of different completion imaging techniques after carotid endarterectomy and their role on clinical outcome. Material and methods A systematic review was performed searching in MEDLINE, CENTRAL, and Cochrane databases including studies reporting on completion imaging techniques after carotid endarterectomy. Results A total of 12,378 patients in 35 studies (20 retrospective and 15 prospective) underwent a completion imaging technique after carotid endarterectomy: in 19 studies, 5340 patients underwent arteriography; in 5 studies, 2095 angioscopy; in 21 studies, 5722 DUS; and in 2 studies, 150 patients underwent transcranial Doppler. Ten studies assessed > 1 imaging technique. The mean age was 67 ± 7 years old (69% males) with common co-morbidities to be hypertension (74%), smoking (64%), and hyperlipidemia (54%). Almost half of the patients (4949; 44%) were treated for symptomatic disease. In 1104 (9.7%) patients, a major defect was identified intra-operatively, while in 329 patients (2.9%), a minor defect. Common pathological findings were the presence of mural thrombus, carotid dissection, residual stenosis, and intimal flaps. An immediate re-intervention was undertaken in 75% (790/1053) of the patients to treat a major intra-operative imaging finding. In patients with re-intervention, only 2.3% (14/609) had an intra-operative stroke and 0.8% (5/609), a transient ischemic attack, while only 1.4% (8/575) had a stroke and 0.2% a transient ischemic attack (1/575) during 30-day post-operative period. No intra-operative death was reported. In the same period, the restenosis rate of internal and common carotid artery was 0.5% (3/575) and 0.2% (1/575), respectively. Conclusion Completion imaging techniques can detect defects in almost 10% of patients that may lead to immediate intra-operative surgical revision with low intra-operative stroke/transient ischemic attack rate and low early carotid restenosis. During the 30-day follow-up period, in those patients, the incidence of stroke/transient ischemic attack may be low but present. This review cannot provide any evidence on which completion imaging technique is better, and the clinical impact conferred by each technique in the absence of a randomized control studies.

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“…Dies war insbesondere für die retrospektive DSA-Auswertung bemerkenswert, da diese formal und analog zur Auswertung der postoperativen Duplexsonographie erfolgte. Zwar lag die in unserer Untersuchung zur Anwendung kommende Kontrastmittel (KM)-Menge von5-10 ml in der unteren Hälfte der in der Literatur beschriebenen [9,15,17,18,20,[22][23][24], die übrige technische Durchführung (30°-laterale als primäre, ggf. um weitere Projektionen ergänzte Aufnahme) war allerdings vergleichbar mit den meisten publizierten Studien.…”

Section: Diskussionunclassified

Intraoperative Angiographie bei A.-carotis-Rekonstruktion – pathologische Befunde, Zuverlässigkeit und Bedeutung des Verfahrens

Dillner

Meyer

Halloul

et al. 2021

Chirurg

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Zusammenfassung Ziel Der Wert der intraoperativen Angiographie und deren Ad-hoc-Beurteilung im Hinblick auf operationstechnische Unzulänglichkeiten soll geprüft werden. Methode Insgesamt 523 konsekutive A.-cartotis-Thrombendarteriektomie(TEA)-Patienten mit intraoperativer Kontrollangiographie, postoperativer Duplexsonographie und retrospektiver Zweitbeurteilung der Angiographie wurden in die Auswertung einbezogen. Ergebnisse In der retrospektiven Zweitbeurteilung der Angiographie wurden 23 (4,4%) Verschlüsse oder hochgradige Stenosen der Arteria carotis communis (ACC) oder Arteria carotis interna (ACI) im Operationsbereich (12/2,3%) bzw. in der Abstrombahn (distale extrakranielle und intrakranielle ACI, A. cerebri media [ACM]) detektiert (11/2,1%), wohingegen bei der intraoperativen Ad-hoc-Beurteilung nur 13 (2,5%) derartige Pathologien beschrieben worden waren (7/1,3% im Operationsbereich, 6/1,1% in der Abstrombahn; p=0,002). Duplexsonographisch wurden postoperativ bei 50 von 505 untersuchten Patienten (10,1%) operationstechnische Unzulänglichkeiten lokal detektiert, was signifikant mehr war als in der Angiographie (p<0,001). In den meisten Fällen handelte es sich um nicht okkludierende/nicht hochgradig stenosierende Intima-Media-Ablösungen (19), Nahteinziehungen (13) und Kinkings/Kalibersprünge am distalen Patchende (14). Nahteinziehungen und Kinkings/Kalibersprünge waren mit einer linksseitigen TEA (adjustierte OR: 2,4; 95%-KI: 1,1‑5,1), einer Operation ohne Patch (adjustierte OR: 16,6; 95%-KI: 1,3–215,0) und der Verwendung eines Dacron- vs. Polytetrafluorethylen-Patch (adjustierte OR: 3,0; 95%-KI: 1,4–6,6) assoziiert. Schlussfolgerung Bei der Ad-hoc-Beurteilung der intraoperativen Kontrollangiographie kann eine nicht unerhebliche Zahl auch okkludierender und hochgradig stenosierender Pathologien übersehen werden (zur Detektion nicht okkludierender und nicht hochgradig stenosierender operativer Unzulänglichkeiten methodisch nicht geeignet – Ausweich: postoperative Duplexsonographie).

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Impact of routine completion angiography on outcome after carotid endarterectomy

Cited by 7 publications

References 20 publications

Recurrent versus first cervical artery dissection – a retrospective study of clinical and vascular characteristics

Recurrent versus first cervical artery dissection – a retrospective study of clinical and vascular characteristics

Completion imaging techniques and their clinical role after carotid endarterectomy: Systematic review of the literature

Intraoperative Angiographie bei A.-carotis-Rekonstruktion – pathologische Befunde, Zuverlässigkeit und Bedeutung des Verfahrens

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