Carotid Artery Surgery Research Articles

Caseload and In-Hospital Outcome of Carotid Surgery Performed during the COVID-19 Pandemic vs. Previous Years: A Single-Centre Analysis.

With the beginning of the COVID-19 pandemic in March 2020, restrictions and challenges for elective and emergency vascular surgery as well as worse outcomes were reported. This study aims to compare our single-centre experience with carotid artery surgery during the pandemic and previous years.Our retrospective analysis included all consecutive patients undergoing carotid surgery for symptomatic and asymptomatic stenosis between January 2017 and December 2021. Caseload, operation specific parameters, and demographic data as well as in-hospital outcome were compared during the COVID-19 pandemic versus previous years.A total of 623 consecutive patients were included. The caseload comparison showed an average of 112 carotid artery surgeries per adjusted year (March 16th to December 31st) from 2017 to 2019, prior to the pandemic. The caseload reduction in the first year of the pandemic (2020) was 36.6% (n=71) and 17.9% (n=92) in the second year (2021). No rebound effect was observed. There was no significant difference (p=0.42) in the allocation of symptomatic and asymptomatic patients (asymptomatic patients: 37.1% prior vs. 40.8% during the pandemic; symptomatic patients: 62.9 vs. 59.2%). Major adverse event rates in years prior to the pandemic were postoperative bleeding requiring revision: n=31 (7.1%); stroke in symptomatic patients: n=9 (3.3%) and stroke in asymptomatic patients: n=4 (2.5%); symptomatic myocardial infarction (MCI): n=1 (0.2%); death: n=2 (0.5%). During the pandemic, major adverse event rates were postoperative bleeding requiring revision: n=12 (6.5%); stroke in symptomatic patients: n=1 (0.9%), stroke in asymptomatic patients: n=1 (1.3%); symptomatic MCI: n=1 (0.5%); death: n=1 (0.5%).Since the beginning of the COVID-19 pandemic in March 2020, there has been a significant reduction in carotid artery surgery performed both in symptomatic as well as in asymptomatic patients. There was no worsening of the outcome of carotid surgery performed during the COVID-19 pandemic, and this remained safe and feasible.

One month follow-up of carotid endarterectomy with in-hospital preoperative aspirin monotherapy and postoperative dual antiplatelet therapy in asymptomatic and symptomatic patients: A multi-center study

BackgroundThere is currently no consensus regarding the optimal perioperative antiplatelet strategy for carotid artery surgery. This multicentre study aimed to analyse the association between preoperative aspirin monotherapy following postoperative dual antiplatelet therapy (DAPT) and the risk for stroke and death after carotid endarterectomy (CEA). MethodsThis cohort study included 821 patients with carotid artery stenosis who underwent CEA. Primary outcomes included any stroke or death up to the one-month postoperative follow-up. Multilevel multivariate regression analyses and descriptive statistics were performed. ResultsPatients were predominantly male (53 %), with a mean age of 66.2 years. The primary outcome occurred in 1.6 % of patients. Univariate and multivariate analyses revealed that patients with chronic obstructive pulmonary disease (COPD) exhibited a high risk for stroke or death (P = 0.011). The occurrence of any local complications in the neck was accompanied by an increase in diastolic blood pressure (DBP) (P = 0.007). Patients with a high systolic blood pressure (SBP) (P = 0.002) experienced a longer operative duration. The length of hospital stay was longer in the patients with COPD (P = 0.020), minor stroke (P = 0.011), and major stroke (P = 0.001). A positive linear correlation was found between SBP and operative duration in the overall population (β 0.4 [95 % confidence interval (CI) 0.1–0.7]; P = 0.002). The resultant curve for DBP and any local complications in the neck exhibited a two-stage change and one breakpoint in the entire population (k = 68 mmHg, <68; odds ratio [OR] 0.9 [95 % CI 0.7–1.1], P = 0.461; ≥68: OR 1.1 [95 % CI 1.0–1.1], P = 0.003). ConclusionsPreoperative aspirin monotherapy and postoperative DAPT were safe and effective antiplatelet treatments for patients who underwent CEA.

Eversion endarterectomy from common femoral artery bifurcation

Common femoral artery (CFA) bifurcation is a critical arterial segment of the lower extremities. Dos Santos J.C. first described endarterectomy from CFA in 1946. It is still preferable method for many patients with occlusion of CFA bifurcation. Although this technique is common in carotid artery surgery and much less common for atherosclerotic lesion of CFA bifurcation, some authors describe favorable results after eversion endarterectomy. Eversion endarterectomy is preferable if synthetic material and autologous veins are unavailable for repair.

The Anti-Apoptotic Effect of Ranolazine on Cerebral Protection during Cardiopulmonary Bypass and Carotid Artery Surgery.

We aimed to determine the usability of ranolazine (Rn) as a neuroprotective during cardiac surgeries and carotid artery interventions where cerebral blood flow is interrupted. Female Wistar albino rats were used. The rats were divided into 4 groups of 8 rats each. The first group (Group 1) was the control group. Group 2 underwent ischemia induction but was not treated with Rn. Group 3 received 25 mg/kg/day and Group 4 50 mg/kg/day Rn intraperitoneally, starting 3 days before ischemia induction. Bilateral carotid arteries were explored and clamped simultaneously. Ischemia was induced for 15 minutes. After 72 hours, the experimental animals were sacrificed. Superoxide dismutase, alkaline phosphatase, and interleukin 6 levels were similar among the 4 groups. Acetylcholine esterase (Group 3: p = 0.007, Group 4: p = 0.002), tumor necrosis factor-alpha (Group 4: p = 0.01), and annexin V (Group 3: p = 0.001) levels were statistically significantly lower in the Rn-treated groups. Malondialdehyde (Group 3: p = 0.003, Group 4: p = 0.009), reduced glutathione (Group 4: p = 0.04), acid phosphatase (Group 3: p = 0.04), noradrenaline (Group 3: p = 0.01), and Bcl-2 (Group 4: p = 0.004) levels were significantly higher in the Rn-treated groups. The results of this study demonstrated the antiapoptotic effect of Rn in a brain ischemia-reperfusion model of rats receiving Rn before the procedure.

Methabolic reaction on the cerebral ischemia during carotid artery surgery

One of the ischemic stroke prevention methods is reconstructive surgery on the carotid arteries, during which there is a risk of ischemia-reperfusion phenomenon. Nevertheless, there is still a high risk of stroke at all stages of the surgery, which equally depends on the atherosclerotic plaque structure and on the technique and tactics of surgery. The aim of this study was to investigate the dynamics of redox homeostasis and nitric oxide production in the blood taken from the internal jugular vein in patients with carotid arteries pathology against the episode of cerebral blood flow restriction during carotid surgery. This prospective cohort study involved 56 patients which required carotid reconstructive surgery. The markers dynamics of oxygen metabolism, redox homeostasis and nitric oxide production in blood from the internal jugular vein on the side of surgery were studied. It was found that the activity of free radical processes is proportional to the level of jugular hypoxemia. Bidirectional dynamics of lactate concentration during intraoperative transient cerebral ischemia was revealed. In some patients, lactate production activates with an increase in free radical processes activity in proportion to the intensification of nitric oxide synthesis against a decrease in peroxynitrite production and activation of molecular compensatory mechanisms increasing concentrations of L-arginine and reduced glutathione. In others, the extraction of oxygen from the blood increases without lactate production, activation of nitric oxide synthesis and development of oxidative stress. This indicates good adaptive reserves against acute restriction of cerebral blood flow.

History of Carotid Artery Reconstruction around the World and in Japan.

Since ancient times, physicians have been aware of correlations between the carotid artery and consciousness; however, carotid stenosis was only recently identified as the cause of atherothrombotic ischemic stroke. In 1658, Wepfer described the first suggestion of a link between symptoms of cerebral arterial insufficiency and carotid pathology. In 1951, Fisher reported details of the symptoms and pathological findings and emphasized that cervical atheromatous lesions induced cerebral infarction with various symptoms. The beginning of carotid artery surgery was ligation of the carotid artery for neck or head injury, but surgeons were aware that this operation induced cerebral symptoms due to lack of blood supply. Carotid endarterectomy (CEA) was first reported by Eastcott et al. in 1954, and in Japan, Kimoto performed a successful CEA in 1962. In 1979, percutaneous transluminal angioplasty (PTA) was performed for patients with fibromuscular dysplasia, and then, carotid artery stenting (CAS) was first performed in 1989 by Mathias. In Japan, Kuwana et al. were the first to perform carotid PTA, in 1981, whereas Yamashita et al. performed the first CAS in 1997. Yoshimura et al. proposed staged carotid stenting to prevent hyperperfusion syndrome. Some issues in carotid reconstruction are still debated today, which include conventional (standard) CEA versus the eversion technique, CEA versus CAS versus medical therapy, and medical economic problems. In the future, we must continue to develop more effective, safer, and less expensive therapeutic methods to prevent carotid stroke, carrying on the efforts of the ancient peoples who pioneered this research.

Surgical Management of Diffuse Plexiform Neurofibroma in Von's Disease Recklinghausen: About a Case at Mopti Hospital

Introduction: Facial plexiform neurofibromas are considered a rare but disfiguring and devastating complication of facial neurofibromatosis. The objective of this work is to show the difficulties of the surgical management of the facial manifestations of neurofibromatosis. Observation: A 39-year-old woman consulted for a monstrous-looking swelling with an irregular texture on the left hemiface, evolving for 13 years. She underwent external carotid artery ligation, total tumor excision and thin skin grafting. Histology concluded to a facial plexiform neurofibroma. Discussion: Neurofibroma is a benign tumor arising from the connective elements of the Schwann sheath by proliferation of the endoneurial matrix. Complete surgical excision is the treatment of choice for neurofibroma. Conclusion: Facial neurofibromatosis surgery remains a challenge for the surgeon. We must have a critical look at our gestures and indications. In particular, provide for surgery after the age of puberty, ligation of the external carotid artery and reconstructive cosmetic surgery.

The Three Most Discussed Questions in Carotid Artery Surgery. Review of Russian and Foreign Studies in the Last Five Years

This literature review analyzes Russian and foreign publications over the past five years on the three most discussed issues related to carotid artery surgery: 1.Which is more effective: eversion carotid endarterectomy or conventional carotid endarterectomy with patch closure? 2. Which is better: carotid endarterectomy (CEE) or carotid angioplasty and stenting (CAS)? 3. How soon after the development of ischemic stroke should cerebral revascularization be performed? The authors of the article came to the following conclusions: 1. According to the majority of large studies and meta-analyses, conventional CEE with patch closure is associated with a higher risk of internal carotid artery restenosis compared to eversion carotid endarterectomy. Single-center trials with small samples of patients do not find statistical differences between the outcomes of applying both surgical techniques. 2. Large multicenter randomized trials are required to address the effectiveness of CEA and CAS in symptomatic and asymptomatic patients. To date, there has been no consensus on this matter. 3. CEE and CAS can be equally effective and safe in the most acute and acute periods of ischemic stroke when performed in the presence of a mild neurological deficit and the ischemic brain lesion not exceeding 2.5 cm in diameter. Nevertheless, the choice of treatment strategy should be made strictly personalized by a multidisciplinary council based on the experience of the institution and current recommendations.

Intraoperative Neuromonitoring of Hypoglossal Nerves Using Transcranial and Direct Electrical Stimulation During Extracranial Internal Carotid Artery Surgery.

We explored whether the electromyogram (EMG) and the motor evoked potential (MEP) are useful for monitoring the function of the hypoglossal nerve during surgery targeting the cervical segment of the internal carotid artery. The present study included 6 patients with internal carotid arterial stenosis (1 patient underwent bilateral surgeries) and 1 patient with a cervical carotid artery aneurysm. In 5 of the 8 procedures, the EMGs were recorded. We examined whether changes in the MEP and/or EMG were capable of predicting postoperative hypoglossal nerve deficits. None of the 6 patients who underwent a total of 7 carotid endarterectomy (CEA) procedures experienced postoperative hypoglossal nerve morbidity. In 2 of the 7 procedures, the MEP disappeared or decreased significantly during CEA. In all 4 cases in which the hypoglossal nerve was directly stimulated during CEA, stable and reproducible EMGs were obtained throughout the manipulation of the internal carotid artery. Hypoglossal nerve morbidity was observed in the one case that underwent aneurysm removal and end-to-end anastomosis of the internal carotid artery. In this case, while the MEP decreased significantly during the operation, the EMG showed true-positive results and false-negative results, depending on the stimulation site. The monitoring of hypoglossal nerve function using EMG appears to be accurate if an appropriate stimulation site is selected. Hypoglossal nerve monitoring using MEP can produce false-positive results. Combined monitoring using both MEP and EMG is recommended in cases where exposure of the hypoglossal nerve is expected to be technically difficult.

Higher Circulating Trimethylamine N-Oxide Aggravates Cognitive Impairment Probably via Downregulating Hippocampal SIRT1 in Vascular Dementia Rats.

Oxidative stress and inflammation damage play pivotal roles in vascular dementia (VaD). Trimethylamine N-oxide (TMAO), an intestinal microbiota-stemming metabolite, was reported to promote inflammation and oxidative stress, involved in the etiology of several diseases. Still, these effects have not been investigated in VaD. Here, we tested whether pre-existing, circulating, high levels of TMAO could affect VaD-induced cognitive decline. TMAO (120 mg/kg) was given to rats for a total of 8 weeks, and these rats underwent a sham operation or bilateral common carotid artery (2VO) surgery after 4 weeks of treatment. Four weeks after surgery, the 2VO rats exhibited hippocampal-dependent cognitive function declines and synaptic plasticity dysfunction, accompanied by an increase in oxidative stress, neuroinflammation, and apoptosis. TMAO administration, which increased plasma and hippocampal TMAO at 4 weeks postoperatively, further aggravated these effects, resulting in exaggerated cognitive and synaptic plasticity impairment, though not within the Sham group. Moreover, TMAO treatment activated the NLRP3 inflammasome and decreased SIRT1 protein expression within the hippocampus. However, these effects of TMAO were significantly attenuated by the overexpression of SIRT1. Our findings suggest that TMAO increases oxidative stress-induced neuroinflammation and apoptosis by inhibiting the SIRT1 pathway, thereby exacerbating cognitive dysfunction and neuropathological changes in VaD rats.

Eş zamanlı karotis endarterektomi ve koroner arter baypas greftleme operasyonu yapılan hastalarda otolog perikard alternatif bir karotis yama materyali olabilir.

Backround: Dacron, polytetrafluoroethylene, great saphenous vein, and bovine pericardium are the commonly used as patch materials. However, there is no study about autologous pericardial as a patch material in carotid endarterectomy surgery. We aimed to assess the results of the use of autologous pericardial patch in patients undergoing concomitant carotid endarterectomy and coronary artery by-pass graft surgery.&#x0D; Materials and Methods:: The study involved 30 patients who underwent concomitant carotid endarterectomy with patch angioplasty and coronary artery bypass grafting surgery from January 2016 to February 2020. Patchplasty is performed with autologous pericardium for 13 patients and dacron patch for 17 patients during carotid endarterectomy. &#x0D; Results: No statistical difference was found between the groups in terms of reoperation, arterial occlusion, restenosis, operation time, and neurological events. In the postoperative follow-up, it was determined that the amount of drainage from the area on which the carotid surgery was applied was less in the those in whom autologous pericardium was used compared to those in whom Dacron patch was used. (p=0.001)&#x0D; Conclusion: We concluded that the use of autologous pericardium as a carotid artery patch is a safe, feasible, and effective method in patients undergoing combined carotid artery and coronary bypass surgery.

Preoperative Anxiety is Associated With Postoperative Complications in Vascular Surgery: A Cross-Sectional Study.

Preoperative anxiety is associated with increased morbidity and/or mortality in surgical patients. This study investigated the incidence, predictors, and association of preoperative anxiety with postoperative complications in vascular surgery. Consecutive patients undergoing aortic, carotid, and peripheral artery surgery, under general and regional anesthesia, from February until October 2019 were included in a cross-sectional study. Anesthesiologists assessed preoperative anxiety using a validated Serbian version of the Amsterdam Preoperative Anxiety and Information Scale. Patients were divided into groups with low/high anxiety, both anesthesia- and surgery-related. Statistical analysis included multivariate linear logistic regression and point-biserial correlation. Of 402 patients interviewed, 16 were excluded and one patient refused to participate (response rate 99.7%). Out of 385 patients included (age range 39-86years), 62.3% had previous surgery. High-level anesthesia- and surgery-related anxieties were present in 31.2 and 43.4% of patients, respectively. Independent predictors of high-level anesthesia-related anxiety were having no children (OR = 0.443, 95% CI: 0.239-0.821, p = 0.01), personal bad experiences with anesthesia (OR = 2.294, 95% CI: 1.043-5.045, p = 0.039), and time since diagnosis for ≥ 4months (OR = 1.634, 95% CI: 1.023-5.983, p = 0.04). The female sex independently predicted high-level surgery-related preoperative anxiety (OR = 2.387, 95% CI: 1.432-3.979, p = 0.001). High-level anesthesia-related anxiety correlated with postoperative mental disorders (rpb = 0.193, p = 0.001) and pulmonary complications (rpb = 0.104, p = 0.042). Postoperative nausea (rpb = 0.111, p = 0.03) and postoperative mental disorders (rpb = 0.160, p = 0.002) correlated with high-level surgery-related preoperative anxiety. Since preoperative anxiety affects the postoperative course and almost every third patient experiences anxiety preoperatively, routine screening might be recommended in vascular surgery.

Design and baseline characteristics of participants in the COcoa Supplement and Multivitamin Outcomes Study (COSMOS)

BackgroundCocoa extract and multivitamins have been proposed to reduce the risk of cardiovascular disease (CVD) and cancer, respectively. However, few randomized clinical trials have tested their long-term effects on these outcomes.MethodsThe COcoa Supplement and Multivitamin Outcomes Study (COSMOS) is a randomized, double-blind, placebo-controlled, 2 × 2 factorial trial of a cocoa extract supplement and a multivitamin supplement to reduce the risk of CVD and cancer. Here we describe the pragmatic, hybrid design of the trial and baseline characteristics of the trial participants.ResultsThe nationwide study population includes 21,442 U.S. women aged ≥65 years and men aged ≥60 years without baseline myocardial infarction (MI), stroke, or a recent (within the past 2 years) cancer diagnosis. Participants were randomized in a 2 × 2 factorial design to one of four groups: (1) cocoa extract (containing 500 mg/d flavanols, including 80 mg (−)-epicatechin) and a multivitamin (Centrum Silver©); (2) cocoa extract and multivitamin placebo; (3) multivitamin and cocoa extract placebo; or (4) both placebos. Randomization successfully distributed baseline demographic, clinical, behavioral, and dietary characteristics across treatment groups. Baseline biospecimens were collected from 6867 participants, with at least one follow-up biospecimen from 2142 participants. The primary outcome for the cocoa extract intervention is total CVD (a composite of MI, stroke, cardiovascular mortality, coronary revascularization, unstable angina requiring hospitalization, carotid artery surgery, and peripheral artery surgery); the primary outcome for the multivitamin intervention is total invasive cancer.ConclusionCOSMOS will provide important information on the health effects of cocoa extract and multivitamin supplementation in older U.S. adults. Clinical Trials Registration: clinicaltrials.gov #NCT02422745

Midterm results of Carotid endarterectomy at Dong Nai General Hospital

Background: Stroke is one of the leading causes of death and disability worldwide. Carotid endarterectomy for carotid stenosis is a proven method to reduce the incidence of cerebral infarction.&#x0D; Subjects and methods: All carotid artery surgery patients at Dong Nai general hospital from January 2017 to October 2021. Retrospective case series.&#x0D; Results: 64 patients were chosen, including 56 men (87.5%) and 8 women (12.5%), the average age is 69, 8 ± 9.8, 22 patients (34.8%) were symptomatic, 5 patients had carotid endarterectomy 2 times. Conventional endarterectomy with PTFE patch in 63 arteries (91.3%), eversion carotid endarterectomy in 6 arteries (8.7%). Post-operative results: 1 death due to bleeding (1.45%), 1 cerebral infarction (1.45%). Mid-term follow-up: 23.74 months. There was 1 death due to late bleeding after 2 months, 0 patients had ipsilateral cerebral infarction, 5 deaths from all causes (7.9%).&#x0D; Conclusion: Carotid endarterectomy is a safe and effective method for stroke prevention. This method can be effectively deployed in tertiary hospitals.

Midterm results of carotid endarterectomy at Dong Nai General Hospital

Background: Stroke is one of the leading causes of death and disability worldwide. Carotid endarterectomy for carotid stenosis is a proven method to reduce the incidence of cerebral infarction.&#x0D; Subjects and methods: All carotid artery surgery patients at Dong Nai general hospital from January 2017 to October 2021. Retrospective case series.&#x0D; Results: 64 patients were chosen, including 56 men (87.5%) and 8 women (12.5%), the average age is 69, 8 ± 9.8, 22 patients (34.8%) were symptomatic, 5 patients had carotid endarterectomy 2 times. Conventional endarterectomy with PTFE patch in 63 arteries (91.3%), eversion carotid endarterectomy in 6 arteries (8.7%). Post-operative results: 1 death due to bleeding (1.45%), 1 cerebral infarction (1.45%). Mid-term follow-up: 23.74 months. There was 1 death due to late bleeding after 2 months, 0 patients had ipsilateral cerebral infarction, 5 deaths from all causes (7.9%).&#x0D; Conclusion: Carotid endarterectomy is a safe and effective method for stroke prevention. This method can be effectively deployed in tertiary hospitals.

Clamp-induced carotid artery dissection during carotid endarterectomy

Clamp-induced internal carotid artery dissection can develop during carotid endarterectomy surgery. If it is not noticed, serious complications such as acute occlusion of the carotid artery in the early period and false aneurysm formation in the late period may develop. Inadequate back-flow and circumferential halo around the distal internal carotid artery may the predictor of injury during carotid artery surgery.

A Fast-Track Protocol for Carotid Artery Surgery

A Fast-Track Protocol for Carotid Artery Surgery

Evaluating the inflammation levels of carotid atherosclerotic plaques by late-phase contrast-enhanced ultrasound.

Inflammation in carotid atherosclerotic plaques is closely related to the occurrence of cerebrovascular events. Studies have shown that the use of contrast-enhanced ultrasound technology can assess the level of inflammation in the plaques, but there is no pathological-relevant research. In this study, contrast-enhanced ultrasound was used to assess the level of inflammation in the plaques of patients undergoing carotid endarterectomy (CEA) and to discuss the correlation among ultrasound parameters and clinical symptoms and histopathology. Fifty-four patients were selected to receive CEA due to carotid artery stenosis in Department of Neurosurgery, Third Xiangya Hospital, among which 3 patients received CEA surgery for bilateral carotid artery. The patients were divided into a symptomatic group (33 cases) and an asymptomatic group (21 cases) according to the diagnosis and treatment guideline of carotid stenosis of Chinese Medical Association. All patients received late-phase contrast-enhanced ultrasound (LP-CEUS) examination, and quantitative analysis was applied to observe the intensity of late-phase plaque enhancement and the relative intensity ratio of late-phase plaque enhancement. CD68 histopathological examination was performed on carotid artery plaque after surgery, the number of macrophage infiltration was calculated, and the correlation between ultrasound parameters and histopathology was analyzed by Pearson correlation. The intensity of late-phase plaque enhancement and the relative intensity ratio of late-phase plaque enhancement in the symptomatic group were significantly higher than those in the asymptomatic group, with statistically significant differences (P<0.05). The number of macrophages in the plaque in the symptom group was significantly higher than that in the asymptomatic group, and the difference was statistically significant (P<0.05). The intensity of late-phase enhancement and the relative intensity of late-phase plaque enhancement were positively correlated with the number of macrophages (r=0.69, r=0.65, respectively, both P<0.05). The parameters of LP-CEUS are helpful in assessing inflammation in carotid plaque. The degree of macrophage infiltration in plaque of patients with symptoms was higher than that of asymptomatic patients.

Impact of the first COVID-19 pandemic peak and lockdown on the interventional management of carotid artery stenosis in France

ObjectiveThe aim of this study was to evaluate the impact of the COVID-19 pandemic on the trends of carotid revascularization (endarterectomy [CEA], transfemoral carotid artery stenting [TFCAS]) for symptomatic and asymptomatic carotid stenosis before, during, and after the end of the first lockdown in 2020 in France. MethodsNationwide data were provided by the French National Hospital Discharge database (Programme de Médicalisation des Systèmes d’Information). We retrospectively analyzed patients admitted for CEA or TFCAS in all French public and private hospitals during a 9-month period (January-September) in 2017, 2018, 2019, and 2020. Procedures were identified using the French Common Classification of Medical Procedures. Stenoses were considered symptomatic in the presence of stroke and/or transient ischemic attack codes (according to the International Classification of Diseases-Tenth Revision) during the stay, and asymptomatic in the absence of these codes. Hospitalization rates in 2020 were compared with the rates in the same period in the 3 previous years. ResultsBetween January and September 2020, 12,546 patients were hospitalized for carotid artery surgery (CEA and TFCAS) in France. Compared with the 3 previous years, there was a decrease in hospitalization rates for asymptomatic (–68.9%) and symptomatic (–12.6%) CEA procedures in April, starting at the pandemic peak concomitant with the first national lockdown. This decrease was significant for asymptomatic CEA (P < .001). After the lockdown, while CEA for asymptomatic stenosis returned to usual activity, CEA for symptomatic stenosis presented a significant rebound, up 18.52% in August compared with previous years. Lockdown also had consequences on TFCAS procedures, with fewer interventions for both asymptomatic (–60.53%) and symptomatic stenosis (–16.67%) in April. ConclusionsThis study demonstrates a severe decrease for all interventions during the first peak of the COVID-19 pandemic in France. However, the trends in the postlockdown period were different for the various procedures. These data can be used to anticipate future decisions and organization for cardiovascular care.

Cross-Comparison of 4-Dimensional Flow Magnetic Resonance Imaging and Intraoperative Middle Cerebral Artery Pressure Measurements Before and After Superficial Temporal Artery-Middle Cerebral Artery Bypass Surgery.

The hemodynamic changes after superficial temporal artery (STA) to middle cerebral artery (MCA) bypass surgery are unclear. To clarify the hemodynamics by comparing flow parameters obtained by 4-dimensional (4D) flow magnetic resonance imaging (MRI) and intraoperative MCA pressure measurement. We recruited 23 patients who underwent STA-MCA bypass surgery for internal carotid artery (ICA) or MCA stenosis. We monitored intraoperative MCA, STA, and radial artery (RA) pressure. All patients underwent 4D flow MRI preoperatively and 3 wk after surgery to quantify the blood flow volume (BFV) of the ipsilateral ICA (BFViICA), contralateral ICA (BFVcICA), basilar artery (BFVBA), ipsilateral STA (BFViSTA), and contralateral STA (BFVcSTA). The sum of intracranial BFV was defined as BFVtotal. We compared BFV parameters and intraoperative pressure. BFViSTA significantly increased after surgery (P<.001). BFViICA and BFVBA significantly decreased after surgery (BFViICAP=.005; BFVBAP=.02). No significant difference was observed between BFVcICA before and after surgery. As a result, BFVtotal postoperatively increased by 6.8%; however, no significant difference was observed. Flow direction at M1 changed from antegrade to unclear after surgery in 5 patients. Intraoperative MCA pressure and MCA/RA pressure ratio significantly increased after surgery (P<.001). We found a stronger positive correlation between MCA pressure increase ratio and BFVtotal increase ratio in patients with lower pre-MCA pressure (r=0.907, P<.001). The visual and quantitative assessment of 4D flow MRI revealed that intracranial blood flow changes complementarily after STA-MCA bypass surgery. 4D flow MRI may detect the improvement of cerebral perfusion pressure.