scholarly journals One-day, sequential carotid artery stenting followed by cardiac surgery in patients with severe carotid and cardiac disease

2019 ◽  
Vol 24 (5) ◽  
pp. 431-438 ◽  
Author(s):  
Karolina Dzierwa ◽  
Jacek Piatek ◽  
Piotr Paluszek ◽  
Tadeusz Przewlocki ◽  
Lukasz Tekieli ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Surgery ◽  
Carotid Artery ◽  
Cardiac Disease ◽  
Carotid Artery Stenting ◽  
Artery Bypass ◽  
Neurological Complications ◽  
Class Iii ◽  
Sequential Approach ◽  
Ica Stenosis

Optimal management of patients with internal carotid artery (ICA) stenosis concurrent with severe cardiac disease remains undefined. The aim of this study is to evaluate the safety and feasibility of the one-day, sequential approach by carotid artery stenting (CAS) immediately followed by cardiac surgery. The study included 70 consecutive patients with symptomatic > 50% or ⩾ 80% asymptomatic ICA stenosis coexisting with severe coronary/valve disease, who underwent one-day, sequential CAS + cardiac surgery. The majority of patients (85.7%) had CSS class III or IV angina and 10% had non-ST elevation myocardial infarction. The EuroSCORE II risk was 2.4% (IQR 1.69–3.19%). All CAS procedures were performed according to the ‘tailored’ algorithm with a substantial use of proximal neuroprotection devices of 44.3%. Closed-cell (75.7%) and mesh-covered (18.6%) stents were implanted in most cases. The majority of patients underwent isolated coronary artery bypass grafting (88.6%) or isolated valve replacement (7.1%). No major adverse cardiac and cerebrovascular events (MACCE) occurred at the CAS stage. There were three (4.3%) perioperative MACCE: one myocardial infarction and two deaths. All MACCE were related to cardiac surgery and were due to the high surgical risk profile of the patients. Up to 30 days, no further MACCE were observed. No perioperative or 30-day neurological complications occurred. In this patient series, one-day, sequential CAS and cardiac surgery was relatively safe and did not result in neurological complications. Thus, a strategy of preoperative CAS could be considered for patients with severe or symptomatic ICA stenosis who require urgent cardiac surgery.

Carotid artery stenting

2010 ◽  
pp. 698-722
Author(s):  
Iqbal Malik
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
High Grade ◽  
The Third ◽  
Percutaneous Coronary ◽  
Ica Stenosis ◽  
Developed World

Stroke is the third leading cause of death in the developed world. Internal carotid artery (ICA) stenosis is a major correctable cause of ischaemic stroke, the risk being related to the degree of stenosis and the presence of recent symptoms. Carotid endarterectomy (CEA) has become the preferred method of treatment for patients with asymptomatic or symptomatic high-grade ICA stenosis, supplanting medical therapy alone. In coronary disease, the increasing use of percutaneous coronary intervention (PCI) has reduced the need for coronary artery bypass surgery (CABG). Unlike coronary stenting, where immediate relief of anginal symptoms can justify the procedure, carotid intervention is not usually done for haemodynamic or flow indications, but to reduce future emboli. For significant (greater than 50% angiographic) ICA stenosis, carotid artery stenting (CAS) is a reasonable alternative to CEA, but its true place is as yet undecided, and awaits the conclusion of several ongoing randomized trials.

Carotid artery stenting

2018 ◽  
pp. 681-702
Author(s):  
Iqbal Malik ◽  
Mohamed Hamady
Keyword(s):  
Diabetes Mellitus ◽  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Artery Bypass ◽  
High Grade ◽  
Invasive Treatment ◽  
The Third ◽  
Ica Stenosis ◽  
Developed World ◽  
Embolic Risk

Stroke can be debilitating or fatal, and is the third leading cause of death in the developed world. Correctable risk factors include the standard cardiovascular conditions of diabetes mellitus, hypertension, smoking, and hyperlipidaemia. Atrial fibrillation has to be sought and the need for anticoagulation to reduce embolic risk assessed. Stenosis of the internal carotid artery (ICA) is a major correctable cause of ischaemic stroke, the risk being related to higher degree of narrowing and the presence of recent symptoms. Coronary stenting or coronary artery bypass surgery can be used for immediate relief of anginal symptoms or to improve prognosis with haemodynamically significant stenoses. Carotid intervention is not usually done for haemodynamic or flow indications, but to reduce future emboli. Carotid endarterectomy (CEA) has become the preferred method of invasive treatment for patients with asymptomatic or symptomatic high-grade ICA stenosis. However, for significant (>50% angiographic) ICA stenosis, carotid artery stenting is a reasonable alternative to CEA. Its true place is as yet undecided, and awaits the conclusion of further randomized trials.

scholarly journals Carotid Artery Stenting Without Embolic Protection Device: A Single-Center Experience

2018 ◽  
Vol 26 (1) ◽  
pp. 121-127 ◽  
Author(s):  
Luca Garriboli ◽  
Gianguido Pruner ◽  
Tommaso Miccoli ◽  
Andrea Recchia ◽  
Paolo Tamellini ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Secondary Outcome ◽  
Protection Device ◽  
Safety And Efficacy ◽  
Embolic Protection Device ◽  
Embolic Protection ◽  
Ica Stenosis

Purpose: To evaluate the safety and efficacy of carotid artery stenting (CAS) performed without an embolic protection device (EPD) in a selected group of asymptomatic patients with primary internal carotid artery (ICA) stenosis or restenosis after carotid endarterectomy (CEA). Materials and Methods: Between May 2015 and May 2018, 77 patients (mean age 77 years; 60 men) underwent CAS without any embolic protection device. Forty-seven (61%) patients had primary ICA stenosis and were excluded from CEA because of high surgical risk; the other 30 (39%) patients had post-CEA restenosis (n=26) or a distal ICA flap after eversion CEA (n=4). The mean ICA stenosis was 82%. All procedures were performed from a femoral artery access. Pre- and/or postdilation were used in 64 patients. The primary outcome was the incidence of major complications (death, stroke, or myocardial infarction) during the procedure and within 30 days; the secondary outcome was the incidence of restenosis in follow-up. Results: No relevant bradycardia was encountered during CAS. The combined rate of stroke, death, or myocardial infarction at 30 days was 1.3%. The single stroke patient recovered fully after 2 months. Over a follow-up that ranged to 3 years (mean 24±18 months), no further neurological events were recorded. One (1.3%) patient had a >70% restenosis after 6 months; the lesion was dilated, successfully restoring the lumen contour. Conclusion: In our series, endovascular treatment of carotid stenosis without the use of protection devices in patients with primary stenosis or postsurgical restenosis can achieve satisfactory safety and efficacy outcomes. The choice of performing CAS without using EPDs should follow a tailored approach based on the appropriate patient anatomy and specific clinical parameters to minimize neurological complications.

Midterm Results After Simultaneous Carotid Artery Stenting and Cardiac Surgery

2020 ◽  
Vol 110 (5) ◽  
pp. 1557-1563
Author(s):  
Igor Zivkovic ◽  
Petar Vukovic ◽  
Petar Milacic ◽  
Miroslav Milicic ◽  
Dragan Sagic ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Midterm Results

Lactate dehydrogenase isoenzyme-1 in serum for detection of peri-operative myocardial infarction after cardiac surgery.

1988 ◽  
Vol 34 (12) ◽  
pp. 2469-2474 ◽  
Author(s):  
Z Rotenberg ◽  
J E Squires ◽  
M T Johnston ◽  
J Hoyt ◽  
R S Gibson ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Surgery ◽  
Lactate Dehydrogenase ◽  
Valve Replacement ◽  
Artery Bypass ◽  
Reference Intervals ◽  
Serum Lactate ◽  
Serum Lactate Dehydrogenase ◽  
Present Measurement ◽  
Dehydrogenase Isoenzyme

Abstract We prospectively studied changes in serum lactate dehydrogenase isoenzyme-1 (LD-1, EC 1.1.1.27) in 99 consecutive patients after either coronary artery bypass grafting (CABG, n = 61), isolated cardiac-valve replacement (n = 24), or the two procedures combined (n = 14); 86 of these had no clinical evidence of peri-operative myocardial infarction (MI). Blood was sampled immediately after surgery and at 6-h intervals for up to 42 h thereafter. LD-1 was isolated by using the LD M-subunit antiserum. Samples from the non-MI patients were used to establish the reference intervals for LD-1. By 24 h after surgery, mean serum LD-1 values were higher (P less than 0.001) in non-MI patients who underwent isolated valve replacement (222 +/- 74 U/L) or combined CABG and valve replacement (266 +/- 58 U/L) than in 50 non-MI patients who underwent CABG alone (134 +/- 42 U/L). Separate reference intervals were determined for CABG and other patients at each sampling time. By 24 h after operation, LD-1 exceeded these reference intervals in the 10 CABG and two combined-procedure patients in whom other evidence of MI was present. Measurement of LD-1 24 to 42 h after cardiac surgery appears to be a useful test for the diagnosis of perioperative MI.

scholarly journals Carotid Endarterectomy Versus Stenting: A Meta-Analysis of Randomized Trials

2011 ◽  
Vol 38 (2) ◽  
pp. 230-235 ◽  
Author(s):  
Daniel Yavin ◽  
Derek J. Roberts ◽  
Michael Tso ◽  
Garnette R. Sutherland ◽  
Misha Eliasziw ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Artery Stenosis ◽  
Carotid Artery Stenting ◽  
Meta Analysis ◽  
Artery Stenosis ◽  
Cranial Neuropathy ◽  
Cardiac Complications ◽  
Lower Odds

Background:A meta-analysis of randomized controlled trials (RCTs) was conducted to update the available evidence on the safety and efficacy of carotid endarterectomy (CEA) versus carotid artery stenting (CAS) in the treatment of carotid artery stenosis.Methods:A comprehensive search was performed of MEDLINE, EMBASE, CENTRAL, bibliographies of included articles and past systematic reviews, and abstract lists of recent scientific conferences. For each reported outcome, a Mantel-Haenszel random-effects model was used to calculate odds ratios (ORs) and 95% confidence intervals (CI). The I2 statistic was used as a measure of heterogeneity.Results:Twelve RCTs enrolling 6,973 patients were included in the meta-analysis. Carotid artery stenting was associated with a significantly greater odds of periprocedural stroke (OR 1.72, 95% CI 1.20 to 2.47) and a significantly lower odds of periprocedural myocardial infarction (OR 0.47, 95% CI 0.29 to 0.78) and cranial neuropathy (OR 0.08, 95% CI, 0.04 to 0.16). The odds of periprocedural death (OR 1.11, 95% CI 0.56 to 2.18), target vessel restenosis (OR 1.95, 95% CI 0.63 to 6.06), and access-related hematoma were similar following either intervention (OR 0.60, 95% CI 0.30 to 1.21).Conclusions:In comparison with CEA, CAS is associated with a greater odds of stroke and a lower odds of myocardial infarction. While the results our meta-analysis support the continued use of CEA as the standard of care in the treatment of carotid artery stenosis, CAS is a viable alternative in patients at elevated risk of cardiac complications.

Comparison of postoperative results between carotid endarterectomy and carotid artery stenting for patients with contralateral carotid artery occlusion: A meta-analysis

Vascular ◽  
2019 ◽  
Vol 27 (6) ◽  
pp. 595-603 ◽  
Author(s):  
Wen-Qiang Xin ◽  
Yan Zhao ◽  
Tie-Zhu Ma ◽  
Yi-Kuan Gao ◽  
Wei-Han Wang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Artery Stenting ◽  
Meta Analysis ◽  
Carotid Occlusion ◽  
Cochrane Library ◽  
Post Procedure ◽  
Pubmed Database ◽  
Significant Difference

Objectives The purpose of this study was to conduct a meta-analysis to systematically compare the safety and efficacy of carotid endarterectomy and carotid artery stenting in contralateral carotid occlusion patients who needed reperfusion. Methods This study retrieved potential academic articles comparing results between carotid endarterectomy and carotid artery stenting for patients with contralateral carotid occlusion from the MEDLINE database, the PubMed database the EMBASE database, and the Cochrane Library from January 1990 to May 2018. The reference articles for the identified studies were carefully reviewed to ensure that all available documents were represented in the study. Results Four retrospective cohort study involving 6252 patients with contralateral carotid occlusion were included in our meta-analysis. During 30-day follow-up, there is significant difference in post-procedure mortality (odds ratio (OR) = 0.476, 95% confidence interval (CI) (0.306–0.740), P = 0.001); no significant differences are not found in post-procedure stroke (risk difference (RD) = 0.002, 95%CI (–0.007 to 0.011); P = 0.631), myocardial infarction (RD = 0.003, 95%CI (–0.002 to 0.008); P = 0.301), and transient cerebral ischemia (RD = 1.059, 95%CI (–0.188 to 5.964); P = 0.948). Conclusions Carotid endarterectomy was associated with a lower incidence of mortality compared to carotid artery stenting for patients with contralateral carotid occlusion. Regarding stroke, myocardial infarction, and transient ischemic attack, there was no significant difference between the two groups. More randomized controlled trials and prospective cohorts are necessary to help further clarify the ideal approach for these patients.

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