Long‐term Durability and Safety of Carotid Endarterectomy Closure Techniques

Nana, Petroula; Σπανός, Κωνσταντίνος; Piffaretti, Gabriele; Končar, Igor; Kouvelos, George; Zlatanović, Petar; Tozzi, Matteo; Davidović, Lazar; Giannoukas, Athanasios D.

doi:10.1007/s00268-020-05604-0

Cited by 5 publications

(8 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The rates of restenosis have been reported ranging from 7% to 36% [ 8 - 12 ] . Despite some studies reporting that PAC is an ineffective method in preventing the development of restenosis and that the outcomes are not different from those of PRC [ 11 ] , it is widely accepted that the PAC method is superior over PRC in terms of risk of restenosis development [ 3 , 6 , 8 , 23 ] . In our study, restenosis was defined as > 30% stenosis and impaired luminal blood flow.…”

Section: Discussionmentioning

confidence: 99%

“…Although carotid endarterectomy (CEA) is the gold standard treatment in carotid artery stenosis, the selection of the method for closure of the carotid artery is still controversial, along with plaque removal techniques, use of shunts, and the method of anesthesia, remaining a matter of debate [ 1 , 2 ] . Primary closure (PRC) and patch angioplasty closure (PAC) of the carotid artery or eversion techniques are the options [ 3 , 4 ] . PAC with autologous saphenous vein is associated with excellent outcomes in the early period; however, complications including ballooning or ruptures in the saphenous vein caused a search for different materials to be used in PAC [ 5 ] .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Outcomes of Arteriotomy Closure Technique for Carotid Endarterectomy: Bovine Pericardial Patch Closure versus Primary Closure

Becit¹,

Sevil²,

Tort³

et al. 2022

Braz J Cardiovasc Surg

View full text Add to dashboard Cite

Introduction The aim of our study was to compare the primary closure (PRC) and patch angioplasty closure (PAC) of carotid artery following carotid endarterectomy (CEA). Methods Data of patients who underwent CEA in the period from January 2005 to June 2020 were reviewed through files. Demographic characteristics, information about the operation, and postoperative follow-up outcomes of the patients were compared. Results Of the 144 CEA cases included in the study, PRC and PAC were applied to 62 (43.7%) and 82 (56.3%) patients, respectively, for the carotid artery closure. Duration of surgery and carotid artery clamping time were not different between the PRC and PAC groups (106.73±17.13 minutes vs. 110.48±20.67 minutes, P =0.635; 24.25±11.56 minutes vs. 25.19±8.99 minutes, P =0.351, respectively). Postoperative respiratory impairment was more common in the PRC group ( P =0.012); however, nerve injuries ( P =0.254), surgical wound hematomas ( P =0.605), surgical site infections ( P =0.679), and mortality ( P =0.812) were not significantly different between the groups. During the mean patient follow-up time of 26.13±19.32 months, restenosis was more common in the PRC group than in the PAC group (n=26, 41.9% vs. n=4, 4.9%, respectively; P =0.003). Frequencies of stroke (n=4, 2.8% vs. n=2, 2.4%, respectively; P =0.679), transient ischemic attacks (n=2, 1.4% vs. n=0, 0%, respectively; P =0.431), and mortality (n=4, 6.5% vs. n=4, 4.9%, respectively; P =0.580) were not significantly different between the PRC and PAC groups. Conclusion We are of the opinion that the PAC method is effective and safe for carotid artery closure in patients undergoing CEA.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Outcomes of Arteriotomy Closure Technique for Carotid Endarterectomy: Bovine Pericardial Patch Closure versus Primary Closure

Becit¹,

Sevil²,

Tort³

et al. 2022

Braz J Cardiovasc Surg

View full text Add to dashboard Cite

show abstract

“…Zatim se po sistemskom davanju heparina klemuju navedene arterije i proverava nivo moždane perfuzije tokom klemovanja te ukoliko je on adekvatan nastavlja se sa izvođenjem endarterektomije. Postoje dve različite metode endarterektomije, everziona i konvencionalna 10,11 . Kod everzione unutrašnja karotidna arterija se "odseče" sa bifurkacije, posuvrati i plak odstrani iz nje.…”

Section: Vaskularno I Endovaskularno Lečenje Karotidne Stenozeunclassified

“…Prema poslednjem vodiču dobre kliničke prakse Evropskog udruženja za vaskularnu hirurgiju, KEA je indikovana kod pacijenata kod kojih su se simptomi moždanog događaja već javili (moždani udar, TIA ili amaurosis fugax) ili kod kojih postoji povišen rizik od moždanih događaja 4,9,10 . Smatra se da se rizik od moždanog događaja povećava kod KS veće od 50% kada imamo progresiju rasta aterosklerotskog plaka za 20% unutar godinu dana, kada imamo morfološki značajne promene na plaku (ruptura kape, ulceracije, lucentnost plaka na ultrazvučnom pregledu odnosno intraplakalna hemoragija na NMR), spontane embolizacije na transkranijalnom dopleru odnosno kontralateralni TIA ili moždani udar ili ishemijske promene na moždanom parenhimu 4 .…”

Section: Vaskularno I Endovaskularno Lečenje Karotidne Stenozeunclassified

“…Smatra se da se rizik od moždanog događaja povećava kod KS veće od 50% kada imamo progresiju rasta aterosklerotskog plaka za 20% unutar godinu dana, kada imamo morfološki značajne promene na plaku (ruptura kape, ulceracije, lucentnost plaka na ultrazvučnom pregledu odnosno intraplakalna hemoragija na NMR), spontane embolizacije na transkranijalnom dopleru odnosno kontralateralni TIA ili moždani udar ili ishemijske promene na moždanom parenhimu 4 . Bilo koja od navedenih osobina, klinički ili dijagnostički, ukazuje na povećan rizik od moždanog udara i predstavlja indikaciju za operativno lečenje ukoliko ono može da se izvede sa rizikom od neuroloških komplikacija manjim od 3% 10,11 . Karotidna endarterektomija može se komplikovati ranim (krvarenje, tromboza sa posledičnom moždanom ishemijom, lezija perifernih nerava kao što su n. hipoglosus, n. glosofaringeus ili n. abducens, odnosno ramu mandibularis n. trigemini, n. vagus i r. reccurens n. vagus) odnosno kasnim komplikacijama (restenoza, infekcija, pseudoaeurizma).…”

Section: Vaskularno I Endovaskularno Lečenje Karotidne Stenozeunclassified

See 1 more Smart Citation

Modern treatment of patients with carotid stenosis

Končar¹

2022

Galenika Med J

View full text Add to dashboard Cite

Narrowing of the carotid arteries, carotid stenosis, (CS) is a frequent manifestation of atherosclerosis. It can be associated with other diseases of peripheral blood vessels, stenotic occlusive or aneurysmal, but also coronary arteries. Almost 15% of ischemic strokes are caused by this disease, which shares common risk factors with other atherosclerotic manifestations (age, male gender, hypertension, diabetes, smoking). The disease is progressive and with progression comes the progression of the degree of stenosis, the volume and morphological characteristics of the plaque. As these features progress, they increase the risk of clinical manifestations. Ischemic stroke, transient ischemic attack or transient blindness in the ipsilateral eye (amaurosis fugax) are the only clinical manifestations that can be directly related to carotid stenosis. Ischemic changes in the brain parenchyma, which can be seen on magnetic resonance imaging or computed tomography, are also associated with carotid stenosis. All the mentioned parameters are taken into account when making decisions about further treatment. Available drug therapy includes antiplatelet and statin therapy with control of risk factors (body weight correction, smoking cessation) and associated diseases (hypertension, diabetes, etc.). Invasive treatment includes carotid endarterectomy (CEA) as vascular or carotid stenting (CAS) as endovascular treatment. KEA is performed under local or general anesthesia, increasingly under local anesthesia, and after accessing the carotid arteries through a cervicotomy, they are clamped, the flow is interrupted, and after the artery is opened, plaque removal and endarterectomy are performed. In addition to the anesthesiological management of the patient and the performance of the surgical technique, the monitoring of cerebral perfusion during clamping is an important technical detail in these operations. KAS is performed through a percutaneous transfemoral approach under local anesthesia when a stent is implanted in the carotid artery at the site of the carotid stenosis. To perform this procedure, adequate access is required in terms of the quality of the femoral and iliac blood vessels, i.e. the aortic arch. KAS was introduced into practice much later, and in the last 20 years, there has been a significant improvement both in terms of performance and technology with the development of modern stents and the materials used in their installation. A special contribution to this technique was the introduction of embolization protection. KAS is a complementary method to CEA and an individual approach to the patient enables the choice of method, taking into account the advantages and disadvantages of one and the other method. When it comes to symptomatic patients, CEA certainly has a significantly greater advantage and when the use of CAS should be avoided. Complications of both methods are general, local and neurological, with the latter being the most important. Current recommendations state that performing these procedures is beneficial for the patient if the risk of neurological complications is less than 3% in asymptomatic patients, or less than 6% in symptomatic patients. At the Clinic for Vascular and Univascular Surgery of the Clinical Center of Serbia, in the last fifteen years, almost 9.000 procedures have been performed due to carotid stenosis, of which about 10% (960) were CAS. We opt for this method in patients who are at cardiorespiratory risk for CEA or in whom access to the carotid bifurcation is difficult. All, the CEA procedures are performed under conditions of the cervical block. The improvement of patient stratification and the use of artificial intelligence should in the future help doctors decide on the method of examination and treatment of these patients.

show abstract