Processes of care for carotid endarterectomy: Surgical and anesthesia considerations

AbuRahma, Ali F.

doi:10.1016/j.jvs.2009.04.071

Cited by 17 publications

(12 citation statements)

References 84 publications

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“…The percentage of restenosis occurring during the first 2 years is of about 0e33% depending on the method of evaluation, definition of restenosis, and time of follow-up. 41 Considering that, it is possible that restenosis could not occur in our cohort. On the other hand, this percentage is not negligible, and the corresponding clinical problem deserves much attention in terms of study of the possible causes.…”

Section: Cfd Analysismentioning

confidence: 93%

Computational Fluid-Dynamic Analysis after Carotid Endarterectomy: Patch Graft versus Direct Suture Closure

Domanin

Buora

Scardulla

et al. 2017

Annals of Vascular Surgery

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Both OSI and RRT values resulted higher when PG was preferred to DS and also areas with disturbed flow resulted wider. The absolute higher values computed by means of CFD were observed when PG was used indiscriminately regardless of carotid diameters. DS does not seem to create negative hemodynamic conditions with potential adverse effects on long-term outcomes, in particular when CEA is performed at the common carotid artery and/or the bulb or when ICA diameter is greater than 5.0 mm.

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Section: Cfd Analysismentioning

confidence: 93%

Computational Fluid-Dynamic Analysis after Carotid Endarterectomy: Patch Graft versus Direct Suture Closure

Domanin

Buora

Scardulla

et al. 2017

Annals of Vascular Surgery

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“…7 Another trial by AbuRahma AF, concluded that the perioperative stroke/myocardial infarction and death rates were similar in CEA done under local anesthesia or general anesthesia. 12 The results of (Vassiliou T) clinical trial support the theory that the indication for insertion of intraluminal shunts was significantly reduced by loco-regional anesthesia (14% vs. 43%) due to the more reliable diagnosis of neurological complications. 13 The use of loco-regional anesthesia by itself carries some complications including intrathecal or intravascular injection of local anesthesia, respiratory compromise related to phrenic nerve paralysis, and systemic local anesthetic toxicity if a deep CPB is employed.…”

mentioning

confidence: 67%

Prevention of Intra-operative Cerebral Ischemia during Carotid Endarterectomy, Loco-regional versus General Anesthesia

Tawfic¹,

Ismaili²,

Ahmed³

2012

Oman Med J

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Carotid endarterectomy (CEA), as a prophylactic operation is becoming more popular. It is performed in patients who are at risk of stroke from dislodged atheromatous plaque at the carotid bifurcation. The major concern during CEA is the detection of cerebral hypoperfusion or ischemia during carotid cross clamping. Some studies have shown that the introduction of loco-regional anesthesia has lowered the incidence of major complications compared with general anesthesia since ischemia detection is easier in conscious patient.

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“…More importantly, there was no difference in the outcome between LA and GA for patients above the age of 75 years [82].…”

Section: Cea In Elderly Patientsmentioning

confidence: 82%

Management of Carotid Artery Disease in the Elderly

Ahmed¹,

Jibawi

Barkat

et al. 2011

Aging Health

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The carotid plaque prevalence increased significantly with increasing age. However, significant stenosis only increases slightly with age. Pujia and colleagues found in their study that all flow-reducing lesions (lumen reduction >50%) were found in the age group 75-94 years [6]. Risk factors for carotid stenosis in elderly patientsThere is no evidence of a significant difference in the risk factors for atherosclerosis in the elderly compared with other age groups, including gender, hypertension, diabetes mellitus, smoking, renal impairment and hypercholesterolemia [7]. Nevertheless, there seem to be certain metabolic and inflammatory risk factors that are of importance in the development of the carotid arteries in the elderly population. Inflammatory risk factorInflammation may play a key role in the pathogenesis of atherosclerosis. A study of 5417 participants over 65 years of age conducted by Cao and colleagues found that the elevation of C-reactive protein, an important inflammatory marker, is correlated with a higher future occurrence of ischemic stroke in this cohort [8]. This was however, largely independent of atherosclerosis severity as measured by the carotid intima-media thickness (IMT). There seems to be some supportive evidence that the association of C-reactive protein and stroke might be stronger in men than in women [8]. However, further research is required in this area.Stroke remains one of the leading causes of death in western countries and puts a large burden on healthcare budgets [1,2]. Atherosclerotic disease at the carotid bifurcation is responsible for approximately 20-25% of all strokes incidents [3]. Although it is well known that carotid artery disease incidence increases with age, the accurate incidence and survival in very old patients remains limited [3]. As the population is growing older, this information is of the utmost i mportance, p articularly for healthcare planners [4].This article aims to review the incidence, clinical presentation, diagnostic options and treatment modalities available for this significant group of patients based on the current available evidence. Prevalence of carotid disease in elderly patientsThe Rotterdam study was one of the largest population-based studies in The Netherlands to confirm the increased incidence of stroke with increasing age, with a peak incidence occurrence at the age of 75-79 years, declining by 85 years of age and beyond. The study also demonstrated a slight increase in incidence among women [3].In addition, Avendano and colleagues studied the effect of socioeconomic status on stroke incidence among the elderly population. They found rather interesting results, whereby patients at the age of 65-74 years, with a lower education and/or income, had a higher stroke incidence of stroke. Patients of 75 years and older with a higher socioeconomic status, however, had higher stroke rates even after adjustment for other risk factors [5].Stroke is one of the leading causes of death in western countries and puts a large burden on healthcare budg...

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Processes of care for carotid endarterectomy: Surgical and anesthesia considerations

Cited by 17 publications

References 84 publications

Computational Fluid-Dynamic Analysis after Carotid Endarterectomy: Patch Graft versus Direct Suture Closure

Computational Fluid-Dynamic Analysis after Carotid Endarterectomy: Patch Graft versus Direct Suture Closure

Prevention of Intra-operative Cerebral Ischemia during Carotid Endarterectomy, Loco-regional versus General Anesthesia

Management of Carotid Artery Disease in the Elderly

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