Follow-up after carotid endarterectomy and stenting: What to look for and why

2020 ◽  
Vol 33 (3-4) ◽  
pp. 47-53
Author(s):  
Dennis F. Bandyk
Keyword(s):  
Carotid Endarterectomy

Risk of late stroke and survival following carotid endarterectomy procedures for symptomatic patients

1990 ◽  
Vol 73 (2) ◽  
pp. 193-200 ◽  
Author(s):  
Dennis A. Turner ◽  
Jay Tracy ◽  
Stephen J. Haines
Keyword(s):  
Carotid Endarterectomy ◽  
Life Table ◽  
Stroke Risk ◽  
Neurological Symptoms ◽  
Treatment Modalities ◽  
Control Group ◽  
Content Type ◽  
Postoperative Stroke ◽  
Fine Print

✓ The long-term outcome following carotid endarterectomy for neurological symptoms was analyzed using a retrospective life-table approach in 212 patients who had undergone 243 endarterectomy procedures. The postoperative follow-up period averaged 38.9 ± 2.1 months (mean ± standard error of the mean). The endpoints of stroke and death were evaluated in these patients. Patient groups with the preoperative symptoms of amaurosis fugax, transient ischemic attack, and prior recovered stroke were similar in terms of life-table outcome over the follow-up period. Sixty-two percent of symptomatic patients were alive and free of stroke at 5 years. The late risk of stroke (after 30 days postoperatively) averaged 1.7% per year based on a linear approximation to the hazard at each life-table interval (1.3% per year for ipsilateral stroke). The trend of late stroke risk was clearly downward, however, and could be fitted more accurately by an exponential decay function with a half-life of 33 months. Thus, the risk of stroke following carotid endarterectomy for neurological symptoms was highest in the perioperative period, slowly declined with time, and occurred predominantly ipsilateral to the procedure. The definition of a prospective medical control group remains crucial for a critical analysis of treatment modalities following the onset of premonitory neurological symptoms. In the absence of an adequate control group for this series, the calculated perioperative and postoperative stroke risk from this study was compared to data obtained from the literature on stroke risk in medically treated symptomatic patients. This uncontrolled comparison of treatment modalities suggests the combined perioperative and postoperative stroke risk associated with carotid endarterectomy to be modestly improved over medical treatment alone.

Transient brain ischaemia (20 January 1978, p. 6): clarification and correction

1978 ◽  
Vol 16 (23) ◽  
pp. 92-92
Keyword(s):  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Brain Ischaemia

Our statement that in patients with transient brain ischaemia carotid endarterectomy reduces the risk of a subsequent stroke from 28% to 3% (based on the report by Wylie & Ehrenfeld, 1970) should have been qualified. We should have referred also to the study by W. S. Fields et al. (J. Amer. med. Ass. 1970, 211, 1993), in which 4% of the surgically treated patients with unilateral carotid stenosis and 12% of the controls had a stroke during the follow-up period of, on average, 3½ years. These results are based on a small total number of strokes and remain inconclusive. The paper by Whisnant was cited in error. The conclusion of our article is not affected.

scholarly journals Postoperative follow-up by B-mode ultrasonography after carotid endarterectomy. Validity of vein patch angioplasty.

Neurosonology ◽  
1996 ◽  
Vol 9 (4) ◽  
pp. 110-113
Author(s):  
Masahito AGAWA ◽  
Toshio TSUDA ◽  
Hiromi UETA ◽  
Kensaku TAKASE ◽  
Shin UEDA
Keyword(s):  
Carotid Endarterectomy ◽  
Patch Angioplasty

Cognitive Performance in Elderly Patients Undergoing Carotid Endarterectomy or Carotid Artery Stenting: A Twelve-Month Follow-Up Study

2010 ◽  
Vol 30 (3) ◽  
pp. 244-251 ◽  
Author(s):  
F.T. Feliziani ◽  
M.C. Polidori ◽  
P. De Rango ◽  
F. Mangialasche ◽  
R. Monastero ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Elderly Patients ◽  
Carotid Endarterectomy ◽  
Cognitive Performance ◽  
Carotid Artery Stenting ◽  
Follow Up Study

Management of postoperative internal carotid artery intimal flap after carotid endarterectomy: a cohort study and systematic review

2021 ◽  
pp. 1-8
Author(s):  
Jonathan Rychen ◽  
Adrian Madarasz ◽  
Michael Murek ◽  
Philippe Schucht ◽  
Mirjam R. Heldner ◽  
...  
Keyword(s):  
Systematic Review ◽  
Carotid Artery ◽  
Literature Review ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Systematic Literature Review ◽  
Internal Carotid ◽  
Management Strategies ◽  
Intimal Flap

OBJECTIVE Postoperative internal carotid artery (ICA) intimal flap (IF) is a potential complication after carotid endarterectomy (CEA) for carotid artery stenosis. There are no clear recommendations in the current literature on the management of this condition due to sparse evidence. Some authors advocate carotid stent placement or reoperation, while others suggest watchful waiting. The aim of this study was to analyze incidence and management strategies of postoperative ICA-IF, and moreover, to put these findings into context with a systematic literature review. METHODS The authors retrospectively reviewed all consecutive CEA cases performed at the University Hospital of Bern over a decade (January 2008 to December 2018). The incidence of postoperative ICA-IF, risk factors, management strategies, and outcomes were analyzed. These results were put into context with a systematic review following the PRISMA guidelines. RESULTS A total of 725 CEAs were performed between January 2008 and December 2018. Postoperative ICA-IF was detected by routine duplex neurovascular ultrasound (NVUS) in 13 patients, corresponding to an incidence rate of 1.8% (95% CI 1.0%–3.1%). There were no associated intraluminal thrombi on the detected IF. Intraoperative shunt placement was used in 5.6% and one or more intima tack sutures were performed in 42.5% of the 725 cases. There was no significant association between intraoperative shunt placement and the occurrence of an IF (p > 0.99). Two patients (15.4%) with IF experienced a transient postoperative neurological deficit (transient ischemic attack). In these cases, the symptoms resolved spontaneously without any interventions or change in the antiplatelet regimen. All other cases (84.6%) with IF were asymptomatic. In 1 patient (7.7%) with IF, the antiplatelet treatment was switched from a mono- to a dual-antiaggregating regimen because the IF led to a stenosis > 70%; this patient remained asymptomatic. All cases of IFs were managed conservatively with close radiological follow-up evaluations, without reoperation or stenting of the ICA. All 13 IFs vanished spontaneously after a mean duration of 6.9 months (median 1.5 months, range 0.5–48 months). A systematic literature review revealed a postoperative ICA-IF incidence of 3.0% (95% CI 2.1%–4.1%) with relatively heterogenous management strategies. CONCLUSIONS Postoperative ICA-IF is a rare finding after CEA. Conservative therapy with close NVUS follow-up evaluations appears to be an acceptable and safe management strategy for asymptomatic IFs without associated intraluminal thrombi.

Changes in CBF After Carotid Endarterectomy: Follow-up in Neurologically Asymptomatic Patients

1992 ◽  
pp. 232-236
Author(s):  
J. A. Rem ◽  
O. Gratzl ◽  
H. R. Müller ◽  
J. Müller-Brand ◽  
E. W. Radü
Keyword(s):  
Carotid Endarterectomy ◽  
Asymptomatic Patients

Carotid endarterectomy: Results and long-term follow-up of a single institution

2011 ◽  
Vol 59 (3) ◽  
pp. 390 ◽  
Author(s):  
BasantK Misra ◽  
Rahul Ved ◽  
HarshadR Purandare ◽  
PP Ashok
Keyword(s):  
Carotid Endarterectomy ◽  
Single Institution ◽  
Long Term Follow Up

scholarly journals Surgical Treatment of Proximal Segmental Occlusion of the Internal Carotid Artery

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Srdjan Babić ◽  
Slobodan Tanasković ◽  
Mihailo Nešković ◽  
Predrag Gajin ◽  
Dragoslav Nenezić ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Intracerebral Hemorrhage ◽  
Carotid Endarterectomy ◽  
Internal Carotid ◽  
Long Term Results ◽  
Common Symptom ◽  
Coronary Syndrome

Purpose. To present the feasibility, safety, and efficacy of carotid endarterectomy in patients with type II internal carotid artery occlusions, including the long-term outcomes. Methods. From March 2008 to August 2015, 74 consecutive patients (48 men with a mean age of 65.1 ± 8.06 years) underwent carotid endarterectomy because of internal carotid artery (ICA) segmental occlusions. These were verified with preoperative carotid duplex scans (CDS) and CT angiography (CTA). Also, brain CT scanning was performed in all these patients. The indication for treatment was made jointly by a vascular surgeon, neurologist, and an interventional radiologist in a multidisciplinary team (MDT) context. After successful treatment, all the patients were followed-up at 1, 3, 6, and 12 months, then every 6 months thereafter. Results. The most common symptom at presentation was transient ischaemic attack (TIA) in 49 patients (66.2%), followed by stroke in the past six months in the 17 remaining patients (23%). Revascularisation of the ICA with endarterectomy techniques was performed successfully in all the patients with an average clamp time of 11.9 min. All the procedures were performed under general anaesthesia in combination with a superficial cervical block. The early complication rate was 8.1% and included two cardiac events (2.7%) (one rhythm disorder and one acute coronary syndrome), three TIAs (4.1%), and one intracerebral hemorrhage (1.3%). Only one patient with the intracerebral hemorrhage died 5 days after surgery giving a postoperative mortality of 1.3% for this series. During the follow-up period (mean 50.4 ± 31.3 months), the primary patency rates at 1, 3, 5, and 7 years were 98.4%, 94.9%, 92.9%, and 82.9%, respectively. Likewise, the survival rates were 98.7%, 96.8%, 89%, and 77.6%, respectively. Ultrasound Doppler controls during follow-up detected 8 ICA restenoses; however, only 3 of these patients required further endovascular treatment. Conclusions. Carotid endarterectomy of internal carotid artery (ICA) segmental occlusion is a safe and effective procedure associated with acceptable risk and good long-term results. Therefore, the current guidelines which do not recommend carotid endarterectomy in this patient group should be reassessed, with the requirement for ongoing large-scale randomized controlled trials to compare CEA with best medical therapy in this patient cohort.

Non-Arteritic Anterior Ischaemic Optic Neuropathy: A New Indication for Carotid Endarterectomy

2002 ◽  
Vol 17 (3-4) ◽  
pp. 137-140
Author(s):  
S. O. Ogunbiyi ◽  
M. Coxon ◽  
G. Morris-Stiff ◽  
R. Ram ◽  
M. H. Lewis
Keyword(s):  
Carotid Endarterectomy ◽  
Optic Neuropathy ◽  
Complete Resolution ◽  
Internal Carotid ◽  
Internal Carotid Artery Stenosis ◽  
Sudden Loss ◽  
Ischaemic Optic Neuropathy ◽  
Anterior Ischaemic Optic Neuropathy ◽  
Objective Improvement

We present a case of non-arteritic anterior ischaemic optic neuropathy (NAION) associated with ipsilateral internal carotid artery stenosis, in a patient who presented with sudden loss of vision. This patient underwent a carotid endarterectomy and reported both subjective and objective improvement in vision in the immediate postoperative period and a complete resolution of symptoms at 6 weeks follow-up. This case raises the question of a new indication for carotid endarter-ectomy in selected cases of NAION.

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