Comparison of Mid-, and Late- Term Morbidity and Mortality Results of Surgical Endarterectomy Versus Endovascular Stent Implantation in Carotid Artery Stenosis

Objective: Carotid artery stenosis is an important etiological cause of cerebrovascular events and stent implantation is widely used as an alternative treatment to endarterectomy. In this study, we compared the mid and late-term results of carotid artery stenosis patients who underwent endarterectomy and stent implantation. Methods: Patients who underwent endarterectomy (Group A, n: 27) and endovascular stent implantation (Group B, n: 22) due to carotid artery stenosis between 2008 and 2014 were included in the study. All examination, laboratory data and radiological images were collected from the hospital database. Morbidity and mortality developed in the mid (1-12 months) and late term (>12 months) periods were evaluated retrospectively. Results: While there were no neurological complications and restenosis in the midterm in Group A, 2 patients (9.09%) had stroke and 2 patients (9.09%) had restenosis in Group B. In the late-term, while there were no neurological complications in Group A, stroke in 3 patients (13.63%) (p=0.048) in Group B, restenosis was observed in 1 patient in Group A and 5 patients in Group B (3.7% vs 22.72%, p=0.043). Conclusion: We recommend endarterectomy as the primary approach for carotid artery revascularization and percutaneous approach especially in high-risk patients with recurrent ICA stenosis and distal carotid artery lesions.

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Comparative Study of Risk Factors Between Lacunar and Non-lacunar Ischemic Strokes

Bangladesh Journal of Neuroscience ◽

10.3329/bjn.v28i2.17176 ◽

2013 ◽

Vol 28 (2) ◽

pp. 88-95

Author(s):

Dewan Md Elyas ◽

Aminur Rahman ◽

Quazi Deen Mohammad ◽

Badrul Alam Mondol ◽

Sakhawat Hossain ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Myocardial Infarction ◽

Ischemic Stroke ◽

Carotid Artery ◽

Carotid Artery Stenosis ◽

Artery Stenosis ◽

Lacunar Stroke ◽

Group A ◽

Group B

Background: Stroke is a leading cause of mortality and morbidity in both developed as well as developing countries The risk factors in lacunar stroke differ in comparison to nonlacunar strokes. In this study risk factors of lacunar stroke in comparison to non-lacunar were evaluated. Objectives: The aim of the study was to compare the risk factors among lacunar stroke and non-lacunar stroke. Methodology: This comparative study conducted in the department of Medicine and Neurology, Dhaka Medical College Hospital, Dhaka from September 2010 to August 2011. MRI of brain was done in 151 patients above 18 years of age with ischemic stroke and Lacunar stroke was found in 31 patients and non-lacunar stroke was detected in 120 patients. Based on the inclusion and exclusion criteria from them 30 patients with lacunar stroke were selected as Group-A patients and equal number of non-lacunar stroke same ages as group B were compared of. The risk factors of stroke were defined as hypertension, diabetes mellitus, hypercholesterolemia, smoking, history of transient ischemic attack, myocardial infarction, atrial fibrillation and carotid artery stenosis. Results: Out of 151 patients with ischemic stroke non-lacunar stroke was predominant, which was 79.47% and lacunar stroke was 20.52%. The mean age was found 60.9±10.2 years in Group A and 56.2±11.8 years in Group B, which was almost similar between two groups (p>0.05). Male were predominant, which was 63.33% and 76.67% in lacunar and non-lacunar stroke respectively. Male and female ratio was 2.3:1. Regarding the risk factors hypertension was observed most common risk factor among the patients having lacunar and non-lacunar strokes. Hypertension and diabetes mellitus were common in lacunar stroke and myocardial infarction, carotid artery stenosis and hypercholesterolemia were common in non-lacunar stroke which were statistically significant (p<0.05) between the both groups. However, the percentage of smoking, previous TIA and atrial fibrillation were not significantly (p>0.05) different between lacunar and non-lacunar stroke. Conclusion: Hypertension and diabetes mellitus were common in lacunar stroke, and myocardial infarction, whereas carotid artery stenosis and hypercholesterolemia were common in non-lacunar stroke and the both groups were statistically significant (p<0.05) . So modification of risk factors may reduce the incidence of ischemic stroke. DOI: http://dx.doi.org/10.3329/bjn.v28i2.17176 Bangladesh Journal of Neuroscience 2012; Vol. 28 (2): 88-95

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An Ultrasound Model to Predict the Short-Term Effects of Endovascular Stent Placement in the Treatment of Carotid Artery Stenosis

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2020.607367 ◽

2021 ◽

Vol 7 ◽

Author(s):

Sheng-Jiang Chen ◽

Rui-Rui Liu ◽

Yi-Ran Shang ◽

Yu-Juan Xie ◽

Xiao-Han Guo ◽

...

Keyword(s):

Carotid Artery ◽

Stent Placement ◽

Carotid Artery Stenosis ◽

Resistance Index ◽

Peak Systolic Velocity ◽

Artery Stenosis ◽

Endovascular Stent ◽

Improvement Rate ◽

Preoperative Ultrasound ◽

Endovascular Stent Placement

Purpose: The present study aimed to explore the predictive ability of an ultrasound linear regression equation in patients undergoing endovascular stent placement (ESP) to treat carotid artery stenosis-induced ischemic stroke.Methods: Pearson's correlation coefficient of actual improvement rate (IR) and 10 preoperative ultrasound indices in the carotid arteries of 64 patients who underwent ESP were retrospectively analyzed. A predictive ultrasound model for the fitted IR after ESP was established.Results: Of the 10 preoperative ultrasound indices, peak systolic velocity (PSV) at stenosis was strongly correlated with postoperative actual IR (r = 0.622; P < 0.01). The unstable plaque index (UPI; r = 0.447), peak eccentricity ratio (r = 0.431), and plaque stiffness index (β; r = 0.512) moderately correlated with actual IR (P < 0.01). Furthermore, the resistance index (r = 0.325) and the dilation coefficient (r = 0.311) weakly correlated with actual IR (P < 0.05). There was no significant correlation between actual IR and the number of unstable plaques, area narrowing, pulsatility index, and compliance coefficient. In combination, morphological, hemodynamic, and physiological ultrasound indices can predict 62.39% of neurological deficits after ESP: fitted IR = 0.9816 – 0.1293β + 0.0504UPI – 0.1137PSV.Conclusion: Certain carotid ultrasound indices correlate with ESP outcomes. The multi-index predictive model can be used to evaluate the effects of ESP before surgery.

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Evaluation of the Effect of Seamless Nursing Model in Peri-Operative Period of Carotid Artery Stenosis Stent Implantation

Nursing Science ◽

10.12677/ns.2019.82016 ◽

2019 ◽

Vol 08 (02) ◽

pp. 77-82

Author(s):

学珍孙

Keyword(s):

Carotid Artery ◽

Stent Implantation ◽

Carotid Artery Stenosis ◽

Artery Stenosis

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Surgical treatment of recurrent carotid artery stenosis

Journal of Neurosurgery ◽

10.3171/jns.1994.80.5.0781 ◽

1994 ◽

Vol 80 (5) ◽

pp. 781-787 ◽

Cited By ~ 87

Author(s):

Fredric B. Meyer ◽

David G. Piepgras ◽

Nicolee C. Fode

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenosis ◽

Neurological Complications ◽

Artery Stenosis ◽

Intraluminal Thrombus ◽

Content Type ◽

Interposition Graft ◽

Patch Graft ◽

Organized Thrombus ◽

Fine Print

✓ Ninety-two surgical procedures were performed in 82 patients for recurrent carotid artery stenosis. The etiology was recurrent atherosclerosis in 45 cases, myointimal hyperplasia in 20, organized thrombus without a significant underlying plaque in 20, and scarring along the proximal arteriotomy site in seven. The operations included a repeat endarterectomy in 66 cases and reconstruction with an interposition graft in 22. All five major neurological complications occurred in symptomatic patients, and included three instances of intraoperative embolization during exposure of the carotid artery. The majority of neurological complications occurred in symptomatic patients who had intraluminal thrombus confirmed at surgery. There were four perioperative deaths, due to cerebral hemorrhage in two patients and myocardial infarction in two. In the patients whose original surgery was performed at the Mayo Clinic, the risk of recurrent carotid artery stenosis was 3.1% with a primary closure compared to 1.6% when a patch graft was used. These results indicate that surgery for recurrent carotid artery stenosis is technically more difficult and carries a significantly higher risk than surgery for primary disease. The difficulty is due to the friable recurrent plaque associated with intraluminal thrombus, which increases the risk of embolization during carotid artery exposure. In the majority of patients with recurrent atherosclerosis, a repeat endarterectomy can be achieved. However, in some patients, there is scarring without a definite plane of cleavage between the recurrent disease and the underlying media, making an endarterectomy difficult. In these cases, excision of the diseased segment and reconstruction with an interposition graft is the best treatment. The findings presented here also suggest that closure of the original arteriotomy with a patch graft decreases the risk of recurrent carotid artery stenosis.

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ASSA13-15-28 Long Term Outcome of Stent Implantation in 48 Patients with Carotid Artery Stenosis

Heart ◽

10.1136/heartjnl-2013-303992.233 ◽

2013 ◽

Vol 99 (Suppl 1) ◽

pp. A75.3-A75

Author(s):

Wang Xiao-Zeng ◽

Jing Quan-Min ◽

Han Ya-Ling ◽

Zhao Xin ◽

Deng Jie

Keyword(s):

Carotid Artery ◽

Stent Implantation ◽

Carotid Artery Stenosis ◽

Artery Stenosis ◽

Term Outcome ◽

Long Term Outcome

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Effects of Carotid Artery Stent and Carotid Endarterectomy on Cognitive Function in Patients with Carotid Stenosis

BioMed Research International ◽

10.1155/2020/6634537 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Pan Huang ◽

Xiao-ying He ◽

Min Xu

Keyword(s):

Cognitive Function ◽

Carotid Artery ◽

Carotid Endarterectomy ◽

Stent Implantation ◽

Carotid Artery Stenosis ◽

Mmse Score ◽

Artery Stenosis ◽

Carotid Artery Stent ◽

Significant Difference ◽

Moca Score

Background. Carotid artery stenosis is closely related to cognitive dysfunction, in which decreased cerebral perfusion is one of the important factors. Both carotid artery stent implantation and carotid endarterectomy can relieve stenosis and increase cerebral perfusion. In this study, we aimed to compare the effects of carotid artery stent implantation and endarterectomy on cognitive function. Methods. A total of 98 patients with carotid artery stenosis hospitalized in our hospital from July 2015 to January 2017 were included. Among them, 50 cases underwent carotid artery stent implantation treatment as stent implantation group (CAS group), and 48 cases underwent carotid artery endarterectomy treatment as carotid endarterectomy group (CEA group). Using the Mini-Mental State Examination Scale (MMSE Scale) and the Montreal Cognitive Assessment Scale (MoCA Scale), the cognitive function scores of the two groups of patients before and after 3 and 6 months of operation were measured, and the patients were also measured before and after surgery, after the serum NSE, hs-CRP content. Results. The serum NSE, hs-CRP content, MMSE score, and MoCA score of the two groups before treatment were not statistically significant ( P > 0.05 ). The MMSE score and MoCA score of the two groups of patients before treatment were lower than the normal value, suggesting carotid artery stenosis combined with different degrees of cognitive dysfunction. Carotid artery stenosis is different, and patients’ cognitive function is also different. The MMSE score and MoCA score of the two groups at 3 and 6 months after operation were higher than before treatment, and there was a statistically significant difference between 6 and 3 months after operation ( P < 0.05 ), but at each time There was no statistically significant difference between the two groups ( P > 0.05 ). The NSE content of the two groups of patients after operation decreased compared with that before treatment, and the decrease in 6 months after operation was more obvious than that in March ( P < 0.05 ). However, the difference between the two groups at each time point was not statistically significant ( P > 0.05 ). The content of hs-CRP in the two groups of patients was higher than that before the operation, and the CAS group was significantly higher than the CEA group; the difference was statistically significant ( P < 0.05 ). Conclusion. Carotid artery stent and carotid endarterectomy are effective in improving the cognitive function of patients with carotid stenosis, but there is no significant difference between the two.

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Arteriotomy for Carotid Endarterectomy, from Common to Interna or Externa?

Acta Medica ◽

10.32552/0.actamedica.420 ◽

2020 ◽

Vol 51 (3) ◽

pp. 25-31

Author(s):

Süreyya Talay

Keyword(s):

Carotid Artery ◽

Carotid Endarterectomy ◽

Facial Asymmetry ◽

Neurological Complications ◽

Early Postoperative Period ◽

External Carotid ◽

First Choice ◽

Group A ◽

Group B ◽

Carotid Shunt

Objectives: In this study, we described and compared a modified carotid endarterectomy surgical technique. Our comparison was between arteriotomy incision from common to interna and from common to externa. Methods: This study included 73 isolated carotid anrterctomy operations from two different centers. We performed external incision in 61 cases (Group A) and internal incision in 12 cases (Group B). We also elaborated perioperative data and surgical results between Groups. All cases were performed under general anaesthesia. Results: 2 patients in Group A and 2 patients in Group B died at the early postoperative period due to severe neurological deteriorations in 3 and myocardial infarction in 1 case. All cases were solely operated for carotid artery stenosis. None of these patients were presenting contrlaterally serious carotid artery lesions. 4 patients from Group A and 3 patients from Group B were receiving haemodialysis, perioperatively. Trancient minor neurological complications such as lingual deviation and/or facial asymmetry which were associated with N.Hypoglossus injuries, was observed in 8 cases and 2 cases in Group A and Group B, respectively. Patchplasty was necessary in 5 from Group A. No patchplasty was applied in Group B. We tried to avoid carotid shunt from common to interna in all standart procedures. However, carotid shunt was mandatory in 4 patients and in 1 patient from Group A and B. Conclusion: Our modified carotid incision from common to externa is almost always suitable for internal plaque removal. Thus, an incision to interna can be avoided which prevents internal artery narrowing, endothelial disruption and/or occlusion prone deterioration and internal artery intraoperative dissection risks. Therefore, we believe that an incision from common to external carotid artery is the first choice surgical approach for carotid endarterectomy.

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