Figure 1 - uploaded by Marco Leopardi
Content may be subject to copyright.
Source publication
Background: Several techniques of carotid endarterectomy have been described and currently used in clinical practice. We describe and report the midterm results of short non-patch arteriotomy technique. Methods: We analyzed patients treated at our Department for carotid artery stenosis. Main outcomes were mortality, stroke, restenosis and local com...
Context in source publication
Context 1
... arteriotomy was performed from the CCA to the ICA, with an extension of approximately 3 cm, avoiding exceeding 1 cm in the ICA (Figure 1). We prefer to perform arteriotomy on the posterolateral wall of common carotid artery, with the aid of carotid clamps, which are positioned and then rotated medially in order to expose the posterior side of carotid bifurcation. ...
Similar publications
Background Carotid revascularization is frequently complicated by hemodynamic depression (HD), which can increase the risk of stroke or vascular death. However, no studies yet exist describing the correlation between the timing of carotid revascularization and HD. The present study investigated whether carotid revascularization in the early phase o...
Background Our group previously described the protocol-based decision for choosing the proper surgical treatment option for carotid artery stenosis. The objective of this study is to describe our experiences of using this scoring protocol in the selection of endarterectomy or stenting for carotid artery stenosis.
Methods Between October 2014 and Ma...
Background:
There is conflicting information about the effect of vitamin C on brain oxygenation during anesthesia.
Objectives:
The current study was designed and performed to assess the effect of vitamin C infusion and brain oxygenation with cerebral oximetry on improving brain perfusion during general anesthesia in vascular surgery of diabetic...
Background:
Previous studies have reported that the use of a patch in carotid endarterectomy (CEA) surgery can reduce the rate of restenosis and perioperative complications. The goal of this study was to compare the short- and medium-term outcomes of endothelialization and neointimal hyperplasia of patch closure (PC) angioplasty in CEA with direct...
A best evidence topic has been constructed using a described protocol. The three-part question addressed was: In patients with significant asymptomatic carotid artery stenosis (ACAS), Does Carotid artery stenting (CAS) has a peri-procedural lower Stroke rate, As compared to Carotid endarterectomy (CEA)? The outcomes assessed were the stroke rate in...
Citations
... 1 Although CEA is a safe procedure allowing good results both in the postoperative period and in long-term follow-up, 2 perioperative neurological complications are reported in literature between 1-7%. [3][4][5] Several techniques have been proposed from both a surgical 6 and anesthetic point of view to reduce the rate of perioperative complications and death, that should be nowadays documented <3% for average surgical risk patients. 1 CEA can be performed both under general anesthesia (GA) and local anesthesia (LA). 1 The choice for the anesthetic protocol is nowadays based on surgeons preferences and centers experience, 1 as no definitive data supports the superiority of a technique over the other. ...
Background:
Carotid endarterectomy (CEA) can be performed both under general anesthesia (GA) or local anesthesia (LA) with good results. General anesthesia with preserved consciousness (GAPC) using remifentanil infusion has been already reported in literature and could potentially merge the advantages of GA and LA overcoming the disadvantages of this last technique. Although the good results of GAPC reported in literature, this technique is not widespread in clinical practice. The aim of this study was to report the perioperative results of CEA under GAPC in a large series of consecutive patients.
Methods:
This is a retrospective, single center, observational study including all patients treated for CEA under GAPC in our institution between January 2008 and October 2019. Primary endpoints were neurological complications rate, mortality rate in the perioperative period, need to GAPC conversion to GA during surgery and evaluation of the technique with a specific questionnaire regarding patients' satisfaction. Secondary endpoints were myocardial infarction (MI) rate, other perioperative complications rate, rate of intraoperative shunting and need of reintervention in the perioperative period.
Results:
In the considered period 1290 CEA under GAPC were performed and included in this study. Neurological complications rate was 2.01%, mortality rate in the perioperative period was 0.07%, need of GAPC conversion to GA rate during surgery was 0.46% and patients satisfaction regarding the technique were high with a mean vote of 9.1 in a 0 to 10 scale. In the perioperative period MI rate was 0.23%, other perioperative complications rate was 1.39%, intraoperative shunting rate was 7.1% and reintervention rate after surgery was 2.4%.
Conclusions:
CEA under GAPC may combine the advantages of LA and GA, with a very low rate of conversion to GA during surgery and good patients' satisfaction. Moreover, it does not increase neurological, cardiologic and systemic complications. For these reasons CEA under GAPC could represents a valid alternative to GA or LA.
... Computed Tomography (CT) is indicated only in selected cases. 28 Considering the high annual 15 rate of disease progression in the contralateral carotid artery, the role of DUS surveillance after 16 CEA is crucial. 15 DUS was found in all studies as an effective tool, not only for carotid 17 preoperative surveillance or for operative approach, but also for follow-up after CEA, to 18 determine progression of disease. ...
Objective
Progression of contralateral carotid artery stenosis after carotid endarterectomy (CEA) has been described by several authors. The aim of this study is to determine such disease progression and its related transient ischemic attacks (TIAs) or strokes by reviewing the existing literature.
Methods
We performed a systematic literature review to select randomized controlled trials (RCT) and observational studies reporting outcomes of patients treated by CEA and with concomitant contralateral carotid stenosis, regardless its degree of stenosis. The study was registered in the International Prospective Register of Systematic Reviews (PROSPERO registration number: CRD42019127595). The primary study endpoint was the progression of contralateral carotid artery stenosis after CEA, and secondary endpoint was incidence of TIAs and strokes due to contralateral carotid stenosis.
Results
Seventeen studies were retrieved, reporting data on a total of 7679 patients who had undergone CEA, in particular they were: one post-hoc analysis of a RCT, nine prospective and seven retrospective observational studies. Among these patients, follow-up information on the contralateral carotid artery was available in 5454 cases. Disease progression was observed in 18% of patients: single class progression from mild (<50%) and from moderate (50-70%) stenosis was observed in 15% and 23% of cases respectively. We found 105 TIAs (4%) and 88 strokes (3%) among 2781 patients with stenosis progression, based on result from 11 studies.
Conclusions
We found a progression of contralateral carotid stenosis in a significant number of patients treated with CEA and with baseline carotid stenosis. This systematic literature review suggests that patients with moderate contralateral carotid stenosis demonstrate more rapid progression to significant or symptomatic stenosis than patients with mild contralateral stenosis.
... The technique of choice was preferentially a short nonpatch arteriotomy; in alternative we performed patch arteriotomy or internal carotid artery eversion. 6 The degree of stenosis was measured according to the European Carotid Surgery Trial criteria by Doppler/duplex sonography, and computed tomography angiography in case of heavily calcified plaque. 7 Patients were treated under GA. ...
... The technique of choice was preferentially a short nonpatch arteriotomy; in alternative we performed patch arteriotomy or internal carotid artery eversion. 6 The degree of stenosis was measured according to the European Carotid Surgery Trial criteria by Doppler/duplex sonography, and computed tomography angiography in case of heavily calcified plaque. 7 Patients were treated under GA. ...
Background:
The use of shunt during carotid surgery is controversial. Different experiences are found in literature with transcranial Doppler (TCD), electroencephalogram (EEG), stump pressure (SP), and somatosensorial evoked potentials (SSEP).
Methods:
We realized a retrospective analysis of patients treated with carotid endarterectomy in our unit in the last 2 years. We use several cerebral monitoring: until 2017 we preferred SP + TCD, and, if not available, EEG. Since 2017 we introduced EEG with SSEP, always in association with SP. We analyzed those 2 groups of patients: before and after introduction of EEG with SSEP.
Results:
From January 2016 to December 2018 we performed 156 carotid revascularizations. In the first group of 93 patients treated under combined SP + TCD (or EEG), we observed 1 stroke (1.1%) and 2 transient ischemic attacks (TIAs) (2.1%); we selectively used a shunt in 21 cases (22.5%). In the second group, 63 patients had an SP + EEG with SSEP monitoring; we observed 1 stroke (1.5%) and 2 TIAs (3.1%), a shunt was necessary in 12 cases (12.9%).
Conclusions:
In our experience, EEG with SSEP represents an effective parameter to indicate shunt positioning, as we were able to reduce its use, with the same incidence of stroke and TIA.
Objective:
To compare the outcomes of patients who were submitted to partial carotid endarterectomy (P-CEA) to those of patients who underwent standard conventional CEA with patch closure (C-CEA) and eversion CEA (E-CEA) for a significant carotid stenosis.
Methods:
Data of patients who consecutively underwent CEA from 01/2014 to 12/2018 for a significant carotid stenosis were retrospectively collected. Primary outcomes included mortality and the occurrence of neurologic and cardiologic complications, both at 30-days and during follow-up. Secondary outcomes included the occurrence of perioperative local complications (i.e. cranial nerve injuries, hematomas) and restenosis during follow-up. P values <0.5 were considered statistically significant.
Results:
Three-hundred twenty-seven patients (241 males, 74%) underwent CEA for carotid stenosis (28.6% symptomatic). P-CEA was performed in 202 patients (61.8%), while C-CEA and E-CEA were performed in 103 and 22 cases respectively. At 30 days, neurologic complications were not significantly different among the three groups (2.8% in the group of C-CEA, 2.4% after P-CEA and 0% in E-CEA patients, P=0.81), neither during follow-up. Perioperative local complications also were not significantly different among the three groups (P=0.16) CONCLUSIONS: P-CEA had similar outcomes if compared to C-CEA and to E-CEA in terms of perioperative mortality, occurrence of neurologic and cardiologic complications, and occurrence of local complications. Also, in the long-term P-CEA, C-CEA and E-CEA were burdened by similar rates of mortality, neurologic and cardiologic complications and restenosis.
