scholarly journals Registry report on prediction by Pocock cardiovascular score of cerebral microemboli acutely following carotid endarterectomy

2018 ◽  
Vol 3 (3) ◽  
pp. 147-152
Author(s):  
Mahmud Saedon ◽  
Athanasios Saratzis ◽  
Rachel W S Lee ◽  
Charles E Hutchinson ◽  
Christopher H E Imray ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Carotid Endarterectomy ◽  
High Rate ◽  
Carotid Surgery ◽  
University Hospitals ◽  
Clinical Tool ◽  
Characteristic Analysis ◽  
Symptomatic Carotid ◽  
Asymptomatic Patients ◽  
Symptomatic Carotid Stenosis

BackgroundCerebral microemboli may lead to ischaemic neurological complications after carotid endarterectomy (CEA). The association between classical cardiovascular risk factors and acute cerebral microemboli following carotid surgery has not been studied. The aim of this study was to explore whether an established cardiovascular risk score (Pocock score) predicts the presence of cerebral microemboli acutely after CEA.Subjects and methodsPocock scores were assessed for the 670 patients from the Carotid Surgery Registry (age 71±1 (SEM) years, 474 (71%) male, 652 (97%) Caucasian) managed from January 2002 to December 2012 in the Regional Vascular Centre at University Hospitals Coventry and Warwickshire NHS Trust, which serves a population of 950 000. CEA was undertaken in 474 (71%) patients for symptomatic carotid stenosis and in 196 (25%) asymptomatic patients during the same period. 74% of patients were hypertensive, 71% were smokers and 49% had hypercholesterolaemia.ResultsA high Pocock score (≥2.3%) was significantly associated with evidence of cerebral microemboli acutely following CEA (P=0.039, Mann-Whitney (MW) test). A Pocock score (≥2.3%) did not predict patients who required additional antiplatelet therapy (microemboli signal (MES) rate >50 hour-1: P=0.164, MW test). Receiver operating characteristic analysis also showed that the Pocock score predicts acute postoperative microemboli (area under the curve (AUC) 0.546, 95% CI 0.502 to 0.590, P=0.039) but not a high rate of postoperative microemboli (MES >50 hour−1: AUC 0.546, 95% CI 0.482 to 0.610, P=0.164). A Pocock score ≥2.3% showed a sensitivity of 74% for the presence of acute postoperative cerebral microemboli. A Pocock score ≥2.3% also showed a sensitivity of 77% and a negative predictive value of 90% for patients who developed a high microembolic rate >50 hour−1 after carotid surgery.ConclusionThese findings demonstrate that the Pocock score could be used as a clinical tool to identify patients at high risk of developing acute postoperative microemboli.

scholarly journals Management of carotid stenosis for primary and secondary prevention of stroke: state-of-the-art 2020: a critical review

2020 ◽  
Vol 22 (Supplement_M) ◽  
pp. M35-M42
Author(s):  
Emmanuel Messas ◽  
Guillaume Goudot ◽  
Alison Halliday ◽  
Jonas Sitruk ◽  
Tristan Mirault ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
High Risk ◽  
Carotid Stenosis ◽  
Smoking Ban ◽  
First Line ◽  
Symptomatic Carotid ◽  
Therapy Strategy ◽  
Choice Of Procedure ◽  
Asymptomatic Patients ◽  
Symptomatic Carotid Stenosis

Abstract Carotid atherosclerotic plaque is encountered frequently in patients at high cardiovascular risk, especially in the elderly. When plaque reaches 50% of carotid lumen, it induces haemodynamically significant carotid stenosis, for which management is currently at a turning point. Improved control of blood pressure, smoking ban campaigns, and the widespread use of statins have reduced the risk of cerebral infarction to <1% per year. However, about 15% of strokes are still secondary to a carotid stenosis, which can potentially be detected by effective imaging techniques. For symptomatic carotid stenosis, current ESC guidelines put a threshold of 70% for formal indication for revascularization. A revascularization should be discussed for symptomatic stenosis over 50% and for asymptomatic carotid stenosis over 60%. This evaluation should be performed by ultrasound as a first-line examination. As a complement, computed tomography angiography (CTA) and/or magnetic resonance angiography are recommended for evaluating the extent and severity of extracranial carotid stenosis. In perspective, new high-risk markers are currently being developed using markers of plaque neovascularization, plaque inflammation, or plaque tissue stiffness. Medical management of patient with carotid stenosis is always warranted and applied to any patient with atheromatous lesions. Best medical therapy is based on cardiovascular risk factors correction, including lifestyle intervention and a pharmacological treatment. It is based on the tri-therapy strategy with antiplatelet, statins, and ACE inhibitors. The indications for carotid endarterectomy (CEA) and carotid artery stenting (CAS) are similar: for symptomatic patients (recent stroke or transient ischaemic attack ) if stenosis >50%; for asymptomatic patients: tight stenosis (>60%) and a perceived high long-term risk of stroke (determined mainly by imaging criteria). Choice of procedure may be influenced by anatomy (high stenosis, difficult CAS or CEA access, incomplete circle of Willis), prior illness or treatment (radiotherapy, other neck surgery), or patient risk (unable to lie flat, poor AHA assessment). In conclusion, neither systematic nor abandoned, the place of carotid revascularization must necessarily be limited to the plaques at highest risk, leaving a large place for optimized medical treatment as first line management. An evaluation of the value of performing endarterectomy on plaques considered to be at high risk is currently underway in the ACTRIS and CREST 2 studies. These studies, along with the next result of ACST-2 trial, will provide us a more precise strategy in case of carotid stenosis.

scholarly journals O37 Carotid surgery during the COVID-19 pandemic

2021 ◽  
Vol 108 (Supplement_5) ◽  
Author(s):  
A Busuttil ◽  
L Jacob ◽  
S Elanwar ◽  
C. S Lim ◽  
D. M Baker
Keyword(s):  
Carotid Endarterectomy ◽  
Carotid Surgery ◽  
Technical Success Rate ◽  
Symptomatic Disease ◽  
Symptomatic Carotid ◽  
Team Meetings ◽  
Symptomatic Carotid Stenosis ◽  
St Elevation ◽  
Mean Time

Abstract Introduction The aim of this prospective study was to evaluate the efficacy and safety of carotid endarterectomy for symptomatic carotid stenosis during the COVID-19 pandemic. Method Re-organisation of stroke services due to the COVID-19 pandemic resulted in carotid endarterectomy for symptomatic disease being performed in two hospitals; Covid-19 free and non-free sites. Patients were referred from multiple online regional neurovascular multi-disciplinary team meetings, and managed according to the pre-Covid-19 guidance. All patients referred for carotid endarterectomy between 23 March 2020 and 31 July 2020 were included. Demographic, medical history, imaging, peri-operative, complication and follow-up data were collected and analysed prospectively. Result 28 patients were referred for carotid endarterectomy, of whom 21 patients underwent surgery. The mean time to surgery was 11 days (3–35). The technical success rate was 100%. Peri-operatively and within 30-days post-operatively, no patient suffered death or stroke. There were 2 minor complications; one non-ST elevation myocardial infarction, and another wound haematoma and infection requiring readmission for antibiotics. No patient developed new COVID-19 infection post-operatively. Of the 7 patients not operated on; 2 were medically unfit for surgery, three declined surgery, and two had free floating thrombus that was managed successfully with anti-coagulation. Conclusion During the pandemic, the provision of carotid endarterectomy for symptomatic carotid diseases was carried out safely and within the current recommendations, with several pre-cautionary measures being undertaken. Therefore, symptomatic carotid intervention should still be considered to reduce the risk of stroke provided similar pre-cautionary measures are undertaken. Take-home Message Carotid surgery should continue during successive waves of the COVID-19 pandemic

Prognostic interaction between age and sex on outcomes following carotid endarterectomy

VASA ◽  
2021 ◽  
pp. 1-9
Author(s):  
Mario D’Oria ◽  
Barbara Ziani ◽  
Marco Damiano Pipitone ◽  
Paolo Manganotti ◽  
Roberta Pozzi Mucelli ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Proportional Hazards ◽  
Survival Rates ◽  
Cox Proportional Hazards ◽  
Term Survival ◽  
Symptomatic Carotid ◽  
Asymptomatic Patients ◽  
Symptomatic Carotid Stenosis ◽  
Age And Sex

Summary: Background: The aim of this study was to assess the prognostic interaction between age and sex on peri-operative and follow-up outcomes following elective carotid endarterectomy (CEA) for asymptomatic and symptomatic carotid stenosis. Patients and methods: A retrospective review of all patients admitted to a single vascular unit who underwent elective CEA between January, 2015 and December, 2019 was performed. The primary endpoints of the study were overall survival (from index operation) and cumulative stroke rate at thirty days. Results: A total of 383 consecutive patients were included in this study; of these 254 (66.4%) were males. At baseline, males were younger (mean age 73.4±11 vs. 76.3±10 years, p=.01) and with lower proportion of octogenarians (20.4% vs. 28.7%, p=.05). The rate of stroke in symptomatic and asymptomatic patients (males vs. females) were as follows: a) whole cohort 1.9% vs. 2% (p=1.00) and 2.7% vs. 1.3% (p=.66), respectively; b) ≥80 years old 3.7% vs. 0% (p=1.00) and 4% vs. 5.9% (p=1.00), respectively; c) <80 years old 1.2% vs. 3.3% (p=.47) and 2.5% vs. 0% (p=.55), respectively. The 3-year survival estimates were significantly lower for males (84% vs. 92%, p=.03). After stratification by age groups, males maintained inferior survival rates in the strata aged <80 years (85% vs. 97%, p=.005), while no differences were seen in the strata aged ≥80 years (82% vs. 79%, p=.92). Using multivariate Cox proportional hazards, age (HR: 2.1, 95% CI: 1.29–3.3, p=.002) and male gender (HR: 2.5, 95% CI: 1.16–5.5, p=.02) were associated with increased hazards of all-cause mortality. Conclusions: In this study of elective CEA for asymptomatic and symptomatic carotid stenosis, similar peri-operative neurologic outcomes were found in both males and females irrespective of age. Despite being usually older, females have superior long-term survival rates.

Efficacy of Carotid Endarterectomy for Mild (<50%) Symptomatic Carotid Stenosis with Unstable Plaque

2019 ◽  
Vol 121 ◽  
pp. e60-e69 ◽  
Author(s):  
Daina Kashiwazaki ◽  
Keitaro Shiraishi ◽  
Shusuke Yamamoto ◽  
Tetsuhiro Kamo ◽  
Haruto Uchino ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Unstable Plaque ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis

Obstructed Flow

2016 ◽  
Author(s):  
Ji Y. Chong ◽  
Michael P. Lerario
Keyword(s):  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Transient Ischemic Attack ◽  
Recurrent Stroke ◽  
Early Period ◽  
Carotid Stenting ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis ◽  
Ischemic Attack

Patients with symptomatic carotid stenosis benefit from revascularization. The risk of recurrent stroke is highest during the early period after a transient ischemic attack or stroke. Carotid endarterectomy and carotid stenting are options for treatment and should be considered within the first 2 weeks if feasible.

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