High-Risk Patients for Carotid Endarterectomy: The Candidates for Carotid Angioplasty and Stent Placement

2002 ◽  
Vol 13 (3) ◽  
pp. 257-264
Keyword(s):  
High Risk ◽  
Carotid Endarterectomy ◽  
Stent Placement ◽  
Carotid Angioplasty ◽  
High Risk Patients ◽  
Risk Patients

scholarly journals Carotid endarterectomy in sapphire-eligible high-risk patients: implications for selecting patients for carotid angioplasty and stenting

2004 ◽  
Vol 39 (5) ◽  
pp. 958-965 ◽  
Author(s):  
Geza Mozes ◽  
Timothy M Sullivan ◽  
Diego R Torres-Russotto ◽  
Thomas C Bower ◽  
Tanya L Hoskin ◽  
...  
Keyword(s):  
High Risk ◽  
Carotid Endarterectomy ◽  
Carotid Angioplasty ◽  
High Risk Patients ◽  
Risk Patients ◽  
Angioplasty And Stenting ◽  
Carotid Angioplasty And Stenting

Carotid Angioplasty and Stent Placement: A Prospective Analysis of Perioperative Complications and Impact of Intravenously Administered Abciximab

Neurosurgery ◽  
2002 ◽  
Vol 50 (3) ◽  
pp. 466-475 ◽  
Author(s):  
Adnan I. Qureshi ◽  
M. Fareed K. Suri ◽  
Zulfiqar Ali ◽  
Stanley H. Kim ◽  
Giuseppe Lanzino ◽  
...  
Keyword(s):  
High Risk ◽  
Stent Placement ◽  
Perioperative Complications ◽  
Treated Group ◽  
Neurological Deficits ◽  
Bleeding Complications ◽  
Minor Bleeding ◽  
Carotid Angioplasty ◽  
High Risk Patients ◽  
Risk Patients

Abstract OBJECTIVE: To determine the frequency of perioperative complications since the introduction of abciximab, we prospectively evaluated our experience in a consecutive series of patients undergoing carotid angioplasty and stent placement (CAS). CAS has been introduced recently for treatment of carotid artery stenosis. A major limitation to this modality is the risk of perioperative thromboembolic and ischemic events. To reduce the risk of ischemic complications, abciximab, a platelet glycoprotein IIb/IIIa receptor inhibitor, has been introduced as adjunctive treatment for high-risk patients. METHODS: Each patient was evaluated by a neurologist before, immediately after, and 24 hours after CAS for identification and classification of new neurological deficits. Bleeding events or other complications during hospitalization were recorded. Bleeding complications were classified as major (hemoglobin decrease, >5 g/dl), minor (hemoglobin decrease, 3–5 g/dl), or insignificant. Abciximab was administered intravenously as a single bolus (0.25 mg/kg) and then via infusion (10 μg/min) for 12 hours as an adjunct to CAS in patients considered to be at high risk for thromboembolic events owing to recent ischemic symptoms and/or complex lesion morphology. RESULTS: Intravenously administered abciximab was used in 37 patients (mean age, 70 yr; 21 patients were men) as an adjunct to high-risk CAS. Thirty-three other patients underwent CAS performed with standard intraprocedural heparinization (mean age, 69 yr; 17 patients were men). Minor ischemic strokes were observed in 1 of 37 abciximab-treated patients and in 4 of 33 heparin-treated patients. No major ischemic strokes were observed in either group. Transient neurological deficits were observed in nine patients in the abciximab-treated group and in one patient in the heparin-treated group. Transient neurological deficits in abciximab-treated patients were mainly related to hemodynamic factors (associated with balloon inflation in two patients and with hypotension in another two patients) or occurred after completion of infusion (in three patients). Minor bleeding complications were observed in three patients who received abciximab and in four patients who received standard heparinization. Major bleeding complications were observed in four patients from each group. Two patients who received abciximab developed intracerebral hemorrhages; one hemorrhage was fatal. CONCLUSION: The frequency of ischemic stroke in high-risk patients (3%) with the use of intravenously administered abciximab was lower, but not significantly so, than rates observed in lower-risk patients (12%), although the benefit was lost because of the high rate of intracranial hemorrhages (5%). Further efforts are required to determine appropriate selection criteria for use of intravenously administered abciximab and the effect of other strategies that involve distal protection devices.

Outcome of carotid endarterectomy under local anaesthesia with respect to the patients’ risk profile

VASA ◽  
2009 ◽  
Vol 38 (3) ◽  
pp. 225-233 ◽  
Author(s):  
Aleksic ◽  
Luebke ◽  
Brunkwall
Keyword(s):  
Myocardial Infarction ◽  
High Risk ◽  
Carotid Endarterectomy ◽  
Complication Rate ◽  
Local Anaesthesia ◽  
High Risk Group ◽  
High Risk Patients ◽  
Hostile Neck ◽  
Risk Patients ◽  
Angioplasty And Stenting

Background: In the present study the perioperative complication rate is compared between high- and low-risk patients when carotid endarterectomy (CEA) is routinely performed under local anaesthesia (LA). Patients and methods: From January 2000 through June 2008 1220 consecutive patients underwent CEA under LA. High-risk patients fulfilled at least one of the following characteristics: ASA 4 classification, “hostile neck”, recurrent ICA stenosis, contralateral ICA occlusion, age ≥ 80 years. The combined complication rate comprised any new neurological deficit (TIA or stroke), myocardial infarction or death within 30 days after CEA, which was compared between patient groups. Results: Overall 309 patients (25%) were attributed to the high-risk group, which differed significantly regarding sex distribution (more males: 70% vs. 63%, p = 0,011), neurological presentation (more asymptomatic: 72% vs. 62%, p = 0,001) and shunt necessity (33% vs. 14%, p < 0,001). In 32 patients 17 TIAs and 15 strokes were observed. In 3 patients a myocardial infarction occurred. Death occurred in one patient following a stroke and in another patient following myocardial infarction, leading to a combined complication rate of 2,9% (35/1220). In the multivariate analysis only previous neurological symptomatology (OR 2,85, 95% CI 1,38-5,91) and intraoperative shunting (OR 5,57, 95% CI 2,69-11,55) were identified as independent risk factors for an increased combined complication rate. Conclusions: With the routine use of LA, CEA was not associated with worse outcome in high-risk patients. Considering the data reported in the literature, it does not appear justified to refer high-risk patients principally to carotid angioplasty and stenting (CAS) when LA can be chosen to perform CEA.

Stent placement for superficial femoral arterial occlusive disease in high-risk patients: Preliminary results

Surgery Today ◽  
2009 ◽  
Vol 39 (1) ◽  
pp. 21-26 ◽  
Author(s):  
Toshiya Nishibe ◽  
Yuka Kondo ◽  
Masayasu Nishibe ◽  
Akihito Muto ◽  
Alan Dardik
Keyword(s):  
High Risk ◽  
Stent Placement ◽  
Arterial Occlusive Disease ◽  
Occlusive Disease ◽  
Preliminary Results ◽  
High Risk Patients ◽  
Risk Patients

Carotid Angioplasty and Stenting in High-risk Patients

Neurosurgery ◽  
1998 ◽  
Vol 43 (3) ◽  
pp. 685-686 ◽  
Author(s):  
Felipe C. Albuquerque ◽  
George P. Teitelbaum ◽  
Steven L. Giannotta
Keyword(s):  
High Risk ◽  
Carotid Angioplasty ◽  
High Risk Patients ◽  
Risk Patients ◽  
Angioplasty And Stenting ◽  
Carotid Angioplasty And Stenting

Comparison of nonneurological events in high-risk patients treated by carotid angioplasty versus endarterectomy

2003 ◽  
Vol 185 (4) ◽  
pp. 301-304 ◽  
Author(s):  
Karthikeshwar Kasirajan ◽  
Brian Matteson ◽  
John M Marek ◽  
Mark Langsfeld
Keyword(s):  
High Risk ◽  
Carotid Angioplasty ◽  
High Risk Patients ◽  
Risk Patients

Carotid endarterectomy in high-risk patients: A challenge for endovascular procedure protocols

Surgery ◽  
2004 ◽  
Vol 135 (1) ◽  
pp. 74-80 ◽  
Author(s):  
Enzo Ballotta ◽  
Giuseppe Da Giau ◽  
Claudio Baracchini ◽  
Renzo Manara
Keyword(s):  
High Risk ◽  
Carotid Endarterectomy ◽  
Endovascular Procedure ◽  
High Risk Patients ◽  
Risk Patients

scholarly journals Carotid Endarterectomy Remains Safe in High-Risk Patients

2020 ◽  
Vol 71 (3) ◽  
pp. e39
Author(s):  
Nathan M. Droz ◽  
Sean P. Lyden ◽  
James Bena ◽  
Christopher J. Smolock ◽  
David Hardy ◽  
...  
Keyword(s):  
High Risk ◽  
Carotid Endarterectomy ◽  
High Risk Patients ◽  
Risk Patients
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