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Stroke
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
The treatment of a TIA focuses on stroke prevention, using antiplatelet drugs and statins. For some patients – especially with high risk of stroke but no neurologic deficits, carotid endarterectomy or arterial angioplasty, plus stenting, can be effective. If there are cardiac sources of emboli, anticoagulation is needed. Stroke may be prevented by modifying risk factors, if this is possible.
Complications of carotid endarterectomy
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Laura T. Boitano, Mark F. Conrad
Carotid endarterectomy can be performed under local, regional, or general anesthesia. The type of anesthesia used is determined by patient risk factors, surgeon preference, and institutional familiarity with each approach. CEA should be performed with attention to the neurologic status of the patient while the internal carotid artery is clamped. Depending on the anesthetic chosen, different neuromonitoring strategies can be employed to reduce the risk of perioperative stroke due to lack of collateral flow. This will be discussed later in the chapter. There are no randomized trial data suggesting superiority of one anesthetic technique over another.5 However, for access to a high bifurcation (above C2), maneuvers to assist with exposure including nasotracheal intubation and subluxation of the mandible must be performed under general anesthesia.1
Beneficial Effect of Carotid Endarterectomy in Symptomatic Patients with High-Grade Carotid Stenosis
Published in Juan Carlos Jimenez, Samuel Eric Wilson, 50 Landmark Papers Every Vascular and Endovascular Surgeon Should Know, 2020
Juan Carlos Jimenez, Samuel Eric Wilson
As described in the abstract, the 659 patients who had a hemispheric transient attack, nondisabling stroke or retinal transient ischemic attack within 120 days of entry, and had 70%–99% stenosis were randomized to best medical treatment versus medical treatment and CEA. The cumulative risk for ipsilateral stroke at 2 years follow-up was 26% in the 331 medical patients and was decreased to 9% in the 328 surgical patients (p < 0.001). The VA Cooperative Trial found that after one year there was a reduction in stroke or crescendo transient ischemic attacks in men from 19.4% in medically treated patients to 7.7% in CEA patients. (p = 0.011).2 These studies, and others, established irrefutably the role of carotid endarterectomy in preventing stroke. A 2015 international systematic review found that 31 of 33 (94%) published guidelines for CEA in patients who had 50%–99% symptomatic stenosis recommended CEA.7
Long-term outcomes of symptomatic and asymptomatic patients undergoing carotid endarterectomy in an average-volume community hospital
Published in Acta Chirurgica Belgica, 2021
José M. Alvarez Gallesio, Patricio Gimenez Ruiz, Michel David, Martin Devoto, Alejandro Caride, Raúl A. Borracci
Despite a vast number of highly qualified publications, the discussion on certain technical topics still continues. Special attention was given to perioperative issues including diagnostic imaging [4], type of anesthesia [5], and some concerns about the surgical technique [6], such as the preferential use of patch repair [7] and/or shunt [8]. After the advent of endovascular techniques, several studies have sought to displace carotid endarterectomy without convincing results [9,10]. The long-term efficacy of carotid endarterectomy in ipsilateral stroke prevention is still to be established. It is important to highlight that the maximum follow-up time in the main studies was between 5 and 7 years [11–14], and rarely for longer periods of time [15]. Since patients’ survival time after the procedure was a decade or more, longer-term data are needed to assess the durability of carotid endarterectomy, especially regarding the incidence of stroke, acute coronary syndrome, restenosis and death in a longer term.
Nanotechnological approach to delivering nutraceuticals as promising drug candidates for the treatment of atherosclerosis
Published in Drug Delivery, 2021
Sindhu C. Pillai, Ankita Borah, Eden Mariam Jacob, D. Sakthi Kumar
Percutaneous coronary intervention (PCI), also known as coronary angioplasty, is performed by opening narrowed coronary arteries to place a stent thus improving the blood flow to the heart and mitigating chest pain. Coronary artery bypass grafting (CABG) involves the grafting of a new artery to bypass the narrowed coronary arteries while boosting blood flow and preventing heart attacks. In the list of surgical methods, carotid endarterectomy is a common surgical process that involves the correction of the internal carotid artery by removing plaque build-up eventually restoring the blood flow to the brain. Surgical procedures of the blood vessel-blockade have achieved clinical success for many years, yet are also associated with numerous complications such as restenosis, in-stent restenosis, and late-stage clotting to name a few (Giannini et al., 2018).
Choosing the right therapy for a patient with asymptomatic carotid stenosis
Published in Expert Review of Cardiovascular Therapy, 2020
Chrysi Bogiatzi, M. Reza Azarpazhooh, J. David Spence
Intraplaque hemorrhage, thought to be related to neovascularization of plaques, was identified as a high-risk feature of coronary plaques by Virmani et al [74]. Intraplaque hemorrhage identified on carotid endarterectomy specimens was associated with a higher risk of subsequent events over 3 years of follow-up [75]. Intraplaque hemorrhage identified by magnetic resonance imaging (MRI) predicts a higher risk of stroke among patients with asymptomatic stenosis [76]. Contrast-enhanced ultrasound can be used to identify plaque neovascularization, which is predictive of higher risk. Motoyama et al [77]. reported that MRI and contrast-enhanced carotid ultrasound were complementary in identifying vulnerable plaques. Contrast-enhanced carotid ultrasound was reviewed in 2017 [78]. More recently, it has been suggested that ‘superb microvascular ultrasound’ is a alternative to contrast-enhanced ultrasound [79,80].