Prophylactic Carotid Endarterectomy in Patients with High-Grade Carotid Stenosis Undergoing Coronary Bypass: Does It Decrease the Incidence of Perioperative Stroke?

1998 ◽  
Vol 12 (1) ◽  
pp. 23-27 ◽  
Author(s):  
George L. Hines ◽  
William C. Scott ◽  
Scott L. Schubach ◽  
Edward Kofsky ◽  
Ulla Wehbe ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Coronary Bypass ◽  
High Grade ◽  
Perioperative Stroke

scholarly journals Associations of Perioperative Variables With the 30-Day Risk of Stroke or Death in Carotid Endarterectomy for Symptomatic Carotid Stenosis

Stroke ◽  
2019 ◽  
Vol 50 (12) ◽  
pp. 3439-3448 ◽  
Author(s):  
Christoph Knappich ◽  
Andreas Kuehnl ◽  
Bernhard Haller ◽  
Michael Salvermoser ◽  
Ale Algra ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Local Anesthesia ◽  
Neurological Deficit ◽  
Primary Outcome ◽  
High Grade ◽  
Perioperative Stroke ◽  
Symptomatic Carotid ◽  
Clinical Variables ◽  
Symptomatic Carotid Stenosis

Background and Purpose— This analysis was performed to assess the association between perioperative and clinical variables and the 30-day risk of stroke or death after carotid endarterectomy for symptomatic carotid stenosis. Methods— Individual patient-level data from the 5 largest randomized controlled carotid trials were pooled in the Carotid Stenosis Trialists’ Collaboration database. A total of 4181 patients who received carotid endarterectomy for symptomatic stenosis per protocol were included. Determinants of outcome included carotid endarterectomy technique, type of anesthesia, intraoperative neurophysiological monitoring, shunting, antiplatelet medication, and clinical variables. Stroke or death within 30 days after carotid endarterectomy was the primary outcome. Adjusted risk ratios (aRRs) were estimated in multilevel multivariable analyses using a Poisson regression model. Results— Mean age was 69.5±9.2 years (70.7% men). The 30-day stroke or death rate was 4.3%. In the multivariable regression analysis, local anesthesia was associated with a lower primary outcome rate (versus general anesthesia; aRR, 0.70 [95% CI, 0.50–0.99]). Shunting (aRR, 1.43 [95% CI, 1.05–1.95]), a contralateral high-grade carotid stenosis or occlusion (aRR, 1.58 [95% CI, 1.02–2.47]), and a more severe neurological deficit (mRS, 3–5 versus 0–2: aRR, 2.51 [95% CI, 1.30–4.83]) were associated with higher primary outcome rates. None of the other characteristics were significantly associated with the perioperative stroke or death risk. Conclusions— The current results indicate lower perioperative stroke or death rates in patients operated upon under local anesthesia, whereas a more severe neurological deficit and a contralateral high-grade carotid stenosis or occlusion were identified as potential risk factors. Despite a possible selection bias and patients not having been randomized, these findings might be useful to guide surgeons and anesthetists when treating patients with symptomatic carotid disease.

scholarly journals Redo Carotid Endarterectomy Versus Primary Carotid Endarterectomy

Stroke ◽  
2001 ◽  
Vol 32 (suppl_1) ◽  
pp. 332-332
Author(s):  
Ali F AbuRahma ◽  
Tucker G Jennings ◽  
John T Wulu ◽  
Lisa Tarakji ◽  
Patrick A Robinson
Keyword(s):  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Nerve Injury ◽  
Cranial Nerve ◽  
Survival Rates ◽  
Carotid Stenting ◽  
Free Survival ◽  
Perioperative Stroke ◽  
Cranial Nerve Injury ◽  
Patch Closure

90 Background/Purpose: Several authorities have recently advocated carotid stenting for recurrent carotid stenosis because of the perception that redo surgery carries a higher complication rate than primary carotid endarterectomy (CEA). This study will compare early and late results of reoperations versus primary CEA. Patient Poplulation and Methods: All redo operations for recurrent carotid stenosis performed during a recent 7-year period by a single vascular surgeon were compared with primary CEA. Since all redo CEAs were done using polytetrafluoroethylene (PTFE) or vein patch closure, only primary CEAs using the same patching were analyzed. A Kaplan Meier life-table analysis was used to estimate stroke-free survival rates and freedom from ≥50% recurrent stenosis. Results: Out of 510 primary CEAs, 265 had PTFE or vein patch closure. One hundred twenty-four reoperations using PTFE or vein patch closure were done during the same period. Both groups had similar demographic characteristics. Indications for reoperations and primary CEAs were symptomatic stenosis in 78% and 58%, and asymptomatic ≥80% stenosis in 22% and 42%, respectively (p<0.001). The 30-day perioperative stroke and transient ischemic attack rates for reoperation and primary CEA were 4.8% versus 0.8% (p=0.015) and 4% versus 1.1%, respectively, with no perioperative deaths in either group. Cranial nerve injury was noted in 17% in reoperation patients versus 5.3% in primary CEA patients, however most of these were transient (p<0.001). The mean hospital stay was 1.8 days for reoperation versus 1.6 days for primary CEA. The cumulative stroke-free survival and freedom from ≥50% recurrent stenosis rates for reoperation at 1, 3, and 5 years were 96%, 91%, 82%, and 98%, 96%, 95%, respectively; and 94%, 92%, 91% and 98%, 96%, 96%, respectively for primary CEA (no statistically significant differences). Conclusions: Reoperation carries higher perioperative stroke and cranial nerve injury rates than primary CEA. However, redo operations are durable and have stroke-free survival rates that are similar to primary CEA. These considerations should be kept in mind when recommending carotid stenting versus reoperation.

scholarly journals Significance of plaque ulceration in symptomatic patients with high-grade carotid stenosis. North American Symptomatic Carotid Endarterectomy Trial.

Stroke ◽  
1994 ◽  
Vol 25 (2) ◽  
pp. 304-308 ◽  
Author(s):  
M Eliasziw ◽  
J Y Streifler ◽  
A J Fox ◽  
V C Hachinski ◽  
G G Ferguson ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
North American ◽  
High Grade ◽  
Symptomatic Carotid ◽  
Plaque Ulceration
Sign in / Sign up

Export Citation Format

Share Document