scholarly journals 664 Factors and Outcomes Associated with Delays in Carotid Endarterectomy in Symptomatic Patients

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Hussain
Keyword(s):  
Carotid Endarterectomy ◽  
Surgical Outcomes ◽  
Retrospective Cohort ◽  
Stroke Risk ◽  
Adverse Outcome ◽  
Carotid Artery Disease ◽  
Index Event ◽  
Factors Associated ◽  
Artery Disease ◽  
Significant Factors

Abstract Introduction Carotid artery disease (CAD) contributes to 20% of ischaemic stroke. Carotid endarterectomy (CEA) reduces stroke risk significantly if performed within 14 days of the index event in symptomatic patients. Studies report delayed CEA is common in practice, however underlying reasons are poorly understood. The aim is to assess factors associated with delayed CEA, and to compare outcomes between timely and delayed CEA. Method This retrospective cohort study included 24 symptomatic CAD patients planned for CEA between October 2018 and December 2019 in a tertiary vascular unit. Time from index event to CEA was measured in “timely” (≤14 days) and “delayed” (>14 days) cohorts and causes for delay were explored. Univariate logistic regression was performed to assess factors associated with delay. Surgical outcomes at 30-days and 1-year were compared between cohorts. Results Overall, 58.3% (n = 14/24) patients underwent delayed CEA. Median time from index event to CEA was 10.5 (IQR 7.5-12) and 22 (IQR 16-32) days in timely and delayed cohorts respectively (P < 0.0001). The main cause of delay was deterioration in patient condition (50%, n = 7/14). In 35.7% (n = 5/14) reasons were unclear. No statistically significant factors were associated with a delay. All surgical outcomes, including 30-day mortality (0%, n = 0/10 vs 7.1%, n = 1/14;P>0.9999) and all-stroke (0%, n = 0/10 vs 14.3%, n = 2/14;P=0.4928), were not statistically significant between timely and delayed cohorts respectively. Conclusions A substantial proportion of patients undergo delayed CEA, with inconclusive associated factors. Those undergoing a delayed CEA did not comparatively have an adverse outcome, but numbers in our study were limited. A larger scale study with increased power is required.

Transcarotid Artery Revascularization and Advances in Vascular Surgery for Carotid Artery Disease

2021 ◽  
Author(s):  
James Hu ◽  
◽  
Andy Sohn ◽  
Justin George ◽  
Rajesh Malik ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Vascular Surgery ◽  
Carotid Endarterectomy ◽  
Surgical Management ◽  
Carotid Artery Stenosis ◽  
Carotid Artery Stenting ◽  
Carotid Artery Disease ◽  
Artery Stenosis ◽  
Cerebrovascular Accidents ◽  
Artery Disease

Carotid artery atherosclerotic disease impacts over 2 million Americans annually. Since the advent of the carotid endarterectomy by Debakey in 1953, the surgical management of carotid artery stenosis has prevented cerebrovascular accidents. The technology utilized to manage carotid artery stenosis continued to evolve with the utilization of carotid artery stenting in 1989 and more recently transcarotid artery revascularization (TCAR). This review discusses the modern management of carotid artery stenosis with an emphasis on transcarotid artery revascularization (TCAR) and reversal of flow for reversal of flow for embolic protection.

Advances in Management of Carotid Atherosclerosis

1997 ◽  
Vol 12 (2) ◽  
pp. 55-65
Author(s):  
Marc D. Malkoff ◽  
Linda S. Williams ◽  
Jose Biller
Keyword(s):  
Magnetic Resonance Angiography ◽  
Carotid Artery ◽  
Carotid Stenosis ◽  
Carotid Atherosclerosis ◽  
Stroke Risk ◽  
Carotid Artery Disease ◽  
Carotid Angioplasty ◽  
Conventional Angiography ◽  
Artery Disease ◽  
Experimental Treatments

Carotid artery stenosis is a common and potentially treatable cause of stroke. Stroke risk is increased as the degree of carotid stenosis increases, as well as in patients with neurological symptoms referable to the stenosed carotid artery. Carotid stenosis can be quantified by ultrasound imaging, magnetic resonance angiography, or conventional angiography. Medical treatment with platelet antiaggregants reduces stroke risk in some patients; other patients are best treated with carotid endarterectomy. Experimental treatments for carotid stenosis, including carotid angioplasty with or without stenting, are under investigation. We summarize the current literature and provide treatment recommendations for patients with atherosclerotic carotid artery disease.

Surgical Advances for Extracranial Carotid Stenosis

Neurosurgery ◽  
2014 ◽  
Vol 74 (suppl_1) ◽  
pp. S83-S91 ◽  
Author(s):  
Robert E. Harbaugh ◽  
Akshal Patel
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Internal Carotid ◽  
Carotid Artery Disease ◽  
Carotid Angioplasty ◽  
Artery Disease ◽  
Angioplasty And Stenting ◽  
Carotid Angioplasty And Stenting

Abstract Carotid endarterectomy is a commonly performed operation to prevent stroke in patients who have asymptomatic or symptomatic internal carotid artery atherosclerotic stenosis. Carotid angioplasty and stenting has also been advocated for treatment of these patients. In this article, we address a number of questions for which a review of available data will advance our understanding of the role of carotid endarterectomy in stroke prevention. These include the following: Are carotid endarterectomy and carotid angioplasty and stenting equivalent procedures for the treatment of carotid artery disease? Which patients should be deemed at high risk for carotid endarterectomy? Should carotid endarterectomy be an urgent procedure in symptomatic patients with severe internal carotid artery stenosis? Finally, what is the role of carotid endarterectomy in asymptomatic patients? We also review the senior author's personal experience with >2000 consecutive carotid endarterectomies, with special attention to his present approach to this operation. We believe that carotid endarterectomy, in experienced hands, is a minimally invasive operation that remains the procedure of choice for most patients with carotid artery disease who will benefit from invasive treatment.

scholarly journals Approach To Unstable Plaque In Carotid Disease

2017 ◽  
pp. 29
Author(s):  
Mojdeh Ghabaee
Keyword(s):  
Stroke Risk ◽  
Early Recognition ◽  
Carotid Artery Disease ◽  
Unstable Plaque ◽  
Prognostic Information ◽  
Carotid Disease ◽  
Luminal Stenosis ◽  
Duplex Doppler ◽  
Artery Disease ◽  
Aggressive Interventions

Risk of cerebral infarction due to thrombo emboli originating  from carotid artery disease estimated to be near 15%, and this risk  is closely associated with the severity of luminal stenosis. But at the same time characteristics  of the plaque should be taken into account for therapeutic planning when the patient is asymptomatic and the diameter of the stenosis does not reach the threshold of 70%. Search for markers of plaque vulnerability, instability, or thromboembolic potential as complementary to the degree of the luminal stenosis in stroke risk prediction should be considered .These morphologic features of carotid plaques are increasingly believed to be one of those markers that could carry further prognostic information, and early recognition of these plaques features may identify a high-risk subgroup of patients who might particularly benefit from aggressive interventions with aggressive medical treatment.Color and duplex Doppler sonography  evaluates both  morphologic and hemodynamic   abnormalitie of carotid. Echogensity, degree of stenosis and plaque surface features are essential parameters of morphological abnormality.        

scholarly journals Outcome of Carotid Endarterectomy in a Tertiary Center of Nepal: A Retrospective Study

2021 ◽  
Vol 43 (1) ◽  
pp. 31-35
Author(s):  
Prashiddha B Kadel ◽  
Uttam K Shrestha ◽  
Kajan R Shrestha ◽  
Dinesh Gurung
Keyword(s):  
Postoperative Complications ◽  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Artery Disease ◽  
Total Study Population ◽  
Tertiary Center ◽  
Artery Disease ◽  
Postoperative Cardiac Event ◽  
Clinical Records

Introduction Carotid endarterectomy for carotid artery disease is one of the surgeries performed by vascular surgeons for carotid artery disease. The objective of this study is to describe the early and late outcome of the patient undergoing carotid endarterectomy and the association between the complication and comorbidities present previously in the patient. MethodsAll patients undergoing carotid endarterectomy at Manmohan Cardiothoracic Vascular and Transplant Centre between April 2010 to April 2020 were included. The follow-up data for upto a year from medical and clinical records, telephone interview regarding the immediate and late postoperative complications in patients with and without comorbidities were investigated and compared. ResultsThe total study population was 42 patients. Two patients (4.7%) developed stroke, one immediately in postoperative period and the other during follow up. There were two deaths (4.7%) postoperatively due to cardiac events and three (7.14%) recurrences of carotid stenosis among whom one (2.5%) developed late stroke. Twenty six patients (61.90%) were symptomatic prior to the procedure of which 20 patients (47.61%) had brain infarct. Overall one year survival was 95.2% post procedure and overall complication rate was 7.14%. The consequence in the form of death and stroke occurred more in the patients with comorbidities (3vs1) p=0.42. ConclusionThe immediate and late postoperative complications following carotid endarterectomy were death (4.7%), stroke (4.7%), cranial nerve injury (9.5%). The most frequent cause of death was postoperative cardiac event. Though major complications occurred more frequently in patients having comorbidities, it was statistically insignificant.

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