Spectral CT Imaging Using MARS Scanners
Katsuyuki Taguchi, Ira Blevis, Krzysztof Iniewski in Spectral, Photon Counting Computed Tomography, 2020
Patients with advanced unstable plaques identified following a stroke are often treated by carotid endarterectomy, a surgical procedure where the carotid artery is cut open and the plaque tissue is peeled off the artery muscle layer. This surgery has a significant risk associated with it, so surgeons prefer to operate only when there is a clear risk to the patient from further rupture events. The current imaging techniques, though, provide only limited indications of the plaque stability with much of the decision based on level of stenosis, calcification, and the patient's general health for surgery. MARS imaging of excised atheroma, under typical clinical x-ray dose and energy levels, has shown that the key features of these vulnerable plaques can be clearly seen [6, 18, 92, 93].
Vascular Surgery
Elizabeth Combeer in The Final FRCA Short Answer Questions, 2019
A very brief description of the surgical approach to carotid endarterectomy:Exposure of carotid.Cross-clamping above and below the area of stenosis (heparin given immediately prior to this).Vertical incision.Cerebral blood flow reduced whilst cross-clamp on, dependent on the collateral flow via Circle of Willis. Ipsilateral blood flow can be improved with a shunt from below to above cross-clamps. Some surgeons use shunts routinely, some only in anaesthetised patients (as neurological status cannot be monitored), some only if perfusion appears inadequate.Atheroma removed, defect closed by primary closure or using a patch (synthetic or autologous vein graft). Using a patch reduces the risk of re-stenosis.
Complications of carotid endarterectomy
Sachinder Singh Hans, Mark F. Conrad in Vascular and Endovascular Complications, 2021
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
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).
Anticoagulation strategy in patients with atrial fibrillation after carotid endarterectomy
Published in Acta Chirurgica Belgica, 2019
Murat Ugurlucan, Hakki Tankut Akay, Ibrahim Erdinc, Didem Melis Oztas, Cenk Conkbayir, Erdal Aslim, Cenk Eray Yildiz, Kubilay Aydin, Ufuk Alpagut
A standard incision parallel to the sternocleidomastoid muscle was performed and common carotid artery (CCA), internal carotid artery (ICA), and external carotid artery (ECA) were prepared and dissected. After systemic 5000 IU of heparin injection, the arteries were clamped. The consciousness and the neurologic status of the patient were evaluated with patient’s response to verbal stimuli and ability to move contralateral side hand and foot for at least 2–3 min prior to arteriotomy. In the case of neurologic disturbance, endarterectomy was performed with insertion of a shunt. The carotid endarterectomy with or without patchplasty was performed as usual fashion. The symptomatic otherwise more stenotic side was prioritized followed by the surgery of the contralateral side in cases with bilateral carotid disease.
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].
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