Intravenously Administered Abciximab in the Management of Early Cerebral Ischemia after Carotid Endarterectomy: Case Report

Neurosurgery ◽  
2004 ◽  
Vol 55 (3) ◽  
pp. E713-E717 ◽  
Author(s):  
Garni Barkhoudarian ◽  
M. Jafer Ali ◽  
John Deveikis ◽  
B. Gregory Thompson
Keyword(s):  
Cerebral Ischemia ◽  
Carotid Endarterectomy ◽  
Treatment Options ◽  
Symptomatic Carotid ◽  
Angiography Suite ◽  
Symptomatic Carotid Stenosis ◽  
Her 2 ◽  
Perioperative Complication ◽  
No Gold Standard

Abstract OBJECTIVE AND IMPORTANCE: Cerebral ischemia is the most worrisome perioperative complication of carotid endarterectomy (CEA). The stroke rate occurring with CEA is estimated to range from 2.3 to 6.3%. Numerous treatment options are available to the neurosurgeon in this scenario, although no “gold standard” exists. CLINICAL PRESENTATION: A 61-year-old woman presented with acute left arm weakness 40 minutes after an uneventful CEA for symptomatic carotid stenosis. Emergent angiography demonstrated vascular irregularities in a “moth-eaten” pattern along the arteriotomy closure, suggestive of platelet-fibrin aggregates (“white clot”). INTERVENTION: Abciximab was immediately administered intravenously in the angiography suite, with subsequent improvement of the visualized vascular irregularities on a second angiogram performed 12 minutes after infusion and complete resolution of the presumed platelet-fibrin aggregates on a third angiogram performed the next day. The patient had no further episodes of cerebral ischemia. She was discharged home on the fifth postoperative day with improving left arm weakness, which had completely resolved by her 2-month follow-up visit. CONCLUSION: To our knowledge, this is the first reported case of abciximab administered intravenously in the setting of acute thromboembolic brain ischemia after CEA. For the unique situation in which an acute thrombus, or white clot, is thought to be the cause of cerebral ischemia, we believe that abciximab may offer an effective and potentially safer alternative than fibrinolytics and may be a more appropriate drug to use from a physiological perspective.

Carotid Endarterectomy for Symptomatic Carotid Stenosis

2017 ◽  
Author(s):  
Hardik A. Amin
Keyword(s):  
Vascular Surgery ◽  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Study Design ◽  
Clinical Case ◽  
Nonsurgical Treatment ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis ◽  
Study Intervention

This chapter provides a summary of the landmark surgical study known as the NASCET trial, which compared surgical versus nonsurgical treatment for patients with symptomatic carotid stenosis. The chapter describes the basics of the study, including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a relevant clinical case regarding vascular surgery.

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

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

Vascular Neurosurgery

2016 ◽  
pp. 25-46
Author(s):  
Thomas Leipzig
Keyword(s):  
Aneurysmal Subarachnoid Hemorrhage ◽  
Treatment Options ◽  
Physical Symptoms ◽  
Spinal Dural Arteriovenous Fistula ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis ◽  
Key Points ◽  
Treatment Plans ◽  
Vascular Neurosurgery ◽  
Treatment Risks

Vascular neurosurgery has long been one of the focal points of neurosurgical practice, and the topic is routinely included in the Oral Board Examination process. Each case involves clinical and diagnostic acumen, a solid grasp of the natural history and treatment risks, consideration of operative approaches, alternative treatment options, and the management of potentially catastrophic complications, as a result of what we have done or what we failed to do. Five cases are discussed in this chapter, and for each case the history and physical symptoms, imaging studies, analyses of the cases and treatment plans, and complications are provided. Key points are also presented after each case. The cases discussed include an aneurysmal subarachnoid hemorrhage (aSAH), an unruptured brain arteriovenous malformation (AVM), an intracerebral hemorrhage (ICH), a spinal dural arteriovenous fistula (dAVF), and symptomatic carotid stenosis.

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