Preoperative Risks Predict Neurological Outcome of Carotid Endarterectomy Related Stroke

Sieber, Frederick E.; TOUNG, T. J.; Diringer, Michael N.; WANG, H.; Long, Don M.

doi:10.1097/00132586-199304000-00028

Cited by 2 publications

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“…Fifteen patients (56%) had sustained one or more previous clinically significant strokes (major, n ϭ 3; minor, n ϭ 3) or hemispheric transient ischemic attacks (TIA) (n ϭ 9) in the territory of the treated vessel (Table I). Most patients fulfilled the criteria for medical (16 of 27 patients, 59%), angiographic (17 of 27 patients, 63%), and neurologic (10 of 27 patients, 37%) risk factors defined by Sundt et al 11 and Sieber et al 12 Lesion characteristics and technique. Twenty-four patients had unilateral stenosis, and 3 patients had bilateral stenosis.…”

Section: Resultsmentioning

confidence: 95%

Carotid artery revascularization through a radiated field

Lesèche

Castier

Chataigner

et al. 2003

Journal of Vascular Surgery

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Section: Resultsmentioning

confidence: 95%

Carotid artery revascularization through a radiated field

Lesèche

Castier

Chataigner

et al. 2003

Journal of Vascular Surgery

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“…2 with outcome in order to stratify patient risk for CEA. [89][90][91][92][93][94][95][96][97][98] Consistent predictors of a higher operative stroke and death rate have been hemispheric versus ocular ischemia presentations, female sex, age over 75 years, and occlusion of the opposite carotid artery. Ulceration or irregularity of the carotid plaque was a risk factor in several large series, as was intraluminal thrombus, atherosclerosis in the carotid siphon, peripheral vascular disease, severe hypertension and a history of congestive heart failure.…”

Section: Risk Of Carotid Endarterectomymentioning

confidence: 99%

Carotid Endarterectomy: A Review

Findlay

Marchak²,

Pelz³

et al. 2004

Can. j. neurol. sci.

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Background: Since the validation of carotid endarterectomy (CEA) as an effective means of stroke prevention, there has been renewed interest in its best indications and methods, as well as in how it compares to carotid angioplasty and stenting (CAS). This review examines these topics, as well as the investigation of carotid stenosis and the role of auditing and reporting CEAresults. Investigation: Brain imaging with CTor MRI should be obtained in patients considered for CEA, in order to document infarction and rule out mass lesions. Carotid investigation begins with ultrasound and, if results agree with subsequent, good-quality MRAor CTangiography, treatment can be planned and catheter angiography avoided. An equally acceptable approach is to proceed directly from ultrasound to catheter angiography, which is still the gold-standard in carotid artery assessment. Indications: Appropriate patients for CEA are those symptomatic with transient ischemic attacks or nondisabling stroke due to 70-99% carotid stenosis; the maximum allowable stroke and death rate being 6%. Uncertain candidates for CEA are those with 50 -69% symptomatic stenosis, and those with asymptomatic stenosis ≥ 60% but, if selected carefully on the basis of additional risk factors (related to both the carotid plaque and certain patient characteristics), some will benefit from surgery. Asymptomatic patients will only benefit if surgery can be provided with exceptionally low major complication rates (3% or less). Inappropriate patients are those with less than 50% symptomatic or 60% asymptomatic stenosis, and those with unstable medical or neurological conditions. Techniques: Carotid endarterectomy can be performed with either regional or general anaesthesia and, for the latter, there are a number of monitoring techniques available to assess cerebral perfusion during carotid cross-clamping. While monitoring cannot be considered mandatory and no single monitoring technique has emerged as being clearly superior, EEG is most commonly used. "Eversion" endarterectomy is a variation in surgical technique, and there is some evidence that more widely practiced patch closure may reduce the acute risk of operative stroke and the longerterm risk of recurrent stenosis. Carotid angioplasty and stenting: Experience with this endovascular and less invasive procedure grows, and its technology continues to evolve. Some experienced therapists have reported excellent results in case series and a number of randomized trials are now underway comparing CAS to CEA. However, at this time it is premature to incorporate CAS into routine practice replacing CEA. Auditing: It has been shown that auditing of CEA indications and results with regular feed-back to the operating surgeons can significantly improve the performance of this operation. Carotid endarterectomy auditing is recommended on both local and regional levels.RÉSUMÉ: L' e n d a rt é rectomie carotidienne: une revue. I n t r o d u c t i o n : Depuis la validation de l'endartérectomie carotidienne (EAC) comme ...

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Preoperative Risks Predict Neurological Outcome of Carotid Endarterectomy Related Stroke

Cited by 2 publications

References 0 publications

Carotid artery revascularization through a radiated field

Carotid artery revascularization through a radiated field

Carotid Endarterectomy: A Review

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