scholarly journals Novel Simple Closure of Arteriotomy in Carotid Endarterectomy

2021 ◽  
Vol 49 (6) ◽  
pp. 480-483
Author(s):  
Kentaro HAYASHI ◽  
Chika SOMAGAWA ◽  
Yukishige HAYASHI ◽  
Mitsuto IWANAGA
Keyword(s):  
Carotid Endarterectomy ◽  
Simple Closure

PATCH ANGIOPLASTY INCREASES PLATELET DEPOSITION FOLLOWING CAROTID ENDARTERECTOMY

1987 ◽  
Author(s):  
A C Meek ◽  
P Jarvis ◽  
R A Harper ◽  
C N McCollum
Keyword(s):  
Carotid Endarterectomy ◽  
Gamma Camera ◽  
Thrombus Formation ◽  
Uptake Ratio ◽  
Simple Closure ◽  
Patch Angioplasty ◽  
Significant Difference ◽  
Patch Closure ◽  
Platelet Accumulation ◽  
Dacron Patch

Patch angioplasty with vein or Dacron may be required to prevent narrowing when the arteriotomy is closed following carotid endarterectomy. We studied the effect of such patches on intraluminal thrombus formation by measuring radiolabelled platelet uptake in patients following simple closure and patch angioplasty.Following unilateral carotid endarterectomy in 33 patients, the arteriotomy was closed by direct suture in 23, Dacron patch in 6 and saphenous vein patch in 4. Autologous 111In-platelets were infused on the second postoperative day and platelet uptake over the carotid measured on daily gamma camera images for 3 days. Radioactivity over the operated and contralateral carotids were compared as the Carotid Uptake Ratio.Mean (±sem) counts per gamma camera cell at 24 hours in the operated carotid of 43.6±3.0 were consistently higher than the reference artery of 35.4±2.4 (p<0.001). The overall carotid uptake ratio was 1.21±0.04 with that of 1.41±0.07 in patch angioplasty significantly higher than 1.14±0.04 found following standard arteriotomy closure (p<0.01). All 10 patch angioplasties were easily visible as "hot spots" on gamma camera compared to only 11 out of 23 with simple closure but there was no significant difference between platelet uptake with vein or Dacron patches with ratios of 1.47±0.35 and 1.37±0.15 respectively (p>0.5).The greater local platelet accumulation with patch angioplasty may be due to turbulence from excessive widening of the vessel combined with the thrombogenic surface following endarterectomy. Until the significance of platelet accumulation is established platelet inhibitory therapy should be considered when patch closure is unavoidable.

Carotid endarterectomy following thrombolysis for acute ischaemic stroke

VASA ◽  
2017 ◽  
Vol 46 (2) ◽  
pp. 116-120 ◽  
Author(s):  
Naz Ahmed ◽  
Damian Kelleher ◽  
Manmohan Madan ◽  
Sarita Sochart ◽  
George A. Antoniou
Keyword(s):  
Ischaemic Stroke ◽  
Carotid Endarterectomy ◽  
Acute Ischaemic Stroke ◽  
Intravenous Thrombolysis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Wound Complications ◽  
Cardiac Complications ◽  
High Dependency ◽  
Low Incidence

Abstract. Background: Insufficient evidence exists to support the safety of carotid endarterectomy (CEA) following intravenous thrombolysis (IVT) for acute ischaemic stroke. Our study aimed to report a single-centre experience of patients treated over a five-year period. Patients and methods: Departmental computerised databases were interrogated to identify patients who suffered an ischaemic stroke and subsequently underwent thrombolysis followed by CEA. Mortality and stroke within 30 days of surgery were defined as the primary outcome end points. Results: Over a five-year period, 177 out of a total of 679 carotid endarterectomies (26 %) were performed in patients presenting with acute ischaemic stroke. Twenty-five patients (14 %) received IVT prior to CEA in the form of alteplase. Sixty percent of patients were male with a mean age of 68 years. Sixteen patients (64 %) underwent CEA within 14 days of IVT and the median interval between thrombolysis and CEA was 7.5 days (range, 3–50 days). One female patient died of a further intraoperative stroke within 30 days of surgery, yielding a mortality rate of 4 %. Two patients (8 %) suffered from cardiac complications postoperatively resulting in a short high dependency unit stay. Another two patients (8 %) developed local wound complications, which were managed conservatively without the need for re-operation. The median hospital length of stay was 4.5 days (range, 1–33 days). Conclusions: Our experience indicates that CEA post-thrombolysis has a low incidence of mortality. Further high quality evidence is required before CEA can be routinely recommended following IVT for acute ischaemic stroke.

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.

Carotid endarterectomy in patients with foetal-type posterior circle of Willis: Is there an indication for local anaesthesia?

VASA ◽  
2011 ◽  
Vol 40 (5) ◽  
pp. 404-407
Author(s):  
Maras ◽  
Tzormpatzoglou ◽  
Papas ◽  
Papanas ◽  
Kotsikoris ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Local Anaesthesia ◽  
Anatomical Variation ◽  
Anatomical Variations ◽  
Circle Of Willis ◽  
Variable Degree ◽  
Operative Complications ◽  
The Right ◽  
Ica Stenosis ◽  
Symptomatic Stenosis

Foetal-type posterior circle of Willis is a common anatomical variation with a variable degree of vessel asymmetry. In patients with this abnormality, carotid endarterectomy (CEA) may create cerebral hypo-perfusion intraoperatively, and this may be underestimated under general anaesthesia. There is currently no evidence that anatomical variations in the circle of Willis represent an independent risk factor for stroke. Moreover, there is a paucity of data on treating patients with such anatomical variations and co-existing ICA stenosis. We present a case of CEA under local anaesthesia (LA) in a 52-year-old female patient with symptomatic stenosis of the right ICA and coexistent foetal-type posterior circle of Willis. There were no post-operative complications and she was discharged free from symptoms. She was seen again 3 months later and was free from complications. This case higlights that LA should be strongly considered to enable better intra-operative neurological monitoring in the event of foetal-type posterior circle of Willis.

Sign in / Sign up

Export Citation Format

Share Document