Carotid Endarterectomy In Patients Research Articles

Outcomes of carotid endarterectomy: Insights from a single-center retrospective cohort study.

To analyze the outcomes of carotid endarterectomy in individuals with carotid artery stenosis in the context of a tertiary care center. We carried out a retrospective cohort investigation between 2015-2022. Patient data includes demographics, risk factors, preoperative medications, and operative details. The primary outcomes were 30-day postoperative stroke and mortality rates, while the secondary outcome of the study was to assess the morbidity of the procedure. The mean age of the 54 patients was 66.9±9.88 years, and 57.4% were men. The 30-day stroke rate was 3.7%, and the mortality rate was 1.9%. Most patients did not develop postoperative complications; however, surgical site hematoma was the most common complication encountered (12.9%). Long-term follow-up showed disease regression in 68.5% of patients, with a minority of patients developing ipsilateral restenosis. Admission to an intensive care monitoring unit was the only independent predictor of postoperative complications. This study provided insights into the outcomes of carotid endarterectomy in patients with carotid artery stenosis, emphasizing the importance of careful patient selection and postoperative monitoring. Perioperative risks, including stroke and mortality, were within acceptable limits. Further research incorporating structured and non-structured data for predictive analyses, should explore refining patient profiling and optimizing treatment approaches for different carotid artery stenosis clinical and morphological presentations.

Trans-Carotid Artery Revascularization Versus Carotid Endarterectomy in Patients With Carotid Artery Disease: Systematic Review and Meta-analysis of 30-day Outcomes.

This systematic review and meta-analysis compared trans-carotid artery revascularization (TCAR) as an alternative approach to carotid endarterectomy (CEA) in patients with carotid artery disease. An electronic search was conducted using PubMed, Scopus, and Cochrane databases including comparative studies with patients who underwent either TCAR or CEA. This meta-analysis is according to the recommendations of the PRISMA statement. Eight studies met our eligibility criteria, incorporating 7,606 and 7,048 patients in the TCAR and CEA groups, respectively. Thirty-day mortality (odds ratio [OR]: 0.94, 95% confidence interval [CI]: 0.56-1.56, P = .81) and stroke (OR: 0.92, 95%CI 0.70-1.22, P = .57) were similar between the two groups, with low heterogeneity. The odds of myocardial infarction (OR: 1.79, 95% CI: 1.18-2.71, P = .01) and cranial nerve injury were significantly higher in patients undergoing CEA compared with TCAR (OR: 4.11, 95% CI: 2.59-6.51, P < .001). The subgroup analysis according to symptomatic pre-intervention status revealed no statistically significant difference regarding 30-day mortality (symptomatic OR: 0.91, 95% CI: 0.40-2.07, P = .82, asymptomatic OR: 0.93, 95% CI: 0.46-1.86, P = .83) and stroke (symptomatic OR: 0.88, 95% CI:0.47-1.64, P = .68, asymptomatic OR: 0.93, 95% CI: 0.64-1.35, P = .70). TCAR offers an alternative treatment for patients with carotid artery stenosis with comparable to CEA mortality and stroke rates during a 30-day post-operative period.

Retracted: Safety and Efficacy of Early Carotid Endarterectomy in Patients with Symptomatic Carotid Artery Stenosis: A Meta-Analysis.

[This retracts the article DOI: 10.1155/2021/6623426.].

Clinical outcomes of transcarotid artery revascularization vs carotid endarterectomy from a large single-center experience

BackgroundTranscarotid artery revascularization (TCAR) has been practiced as an alternative for both carotid endarterectomy (CEA) and transfemoral carotid artery stenting, specifically in high-risk patients. More recently, the Centers for Medicare and Medicaid Services expanded coverage for TCAR in standard surgical risk patients if done within the Society for Vascular Surgery Vascular Quality Initiative TCAR surveillance project. A few registry studies (primarily from the Society for Vascular Surgery Vascular Quality Initiative) compared the early and up to 1-year outcomes of TCAR vs CEA or transfemoral carotid artery stenting. There is no large single-center study that reported late clinical outcomes. The present study compares intermediate clinical outcomes of TCAR vs CEA. MethodsThis study retrospectively analyzed collected data from TCAR surveillance project patients enrolled in our institution and compare it with CEA patients done by the same providers at the same time period. The primary outcome was combined perioperative stroke/death and late stroke/death. Secondary outcomes included combined stroke, death, and myocardial infarction, cranial nerve injury (CNI), and bleeding. Propensity matching was done to analyze outcome. Kaplan-Meier analysis was used to estimate freedom from stroke, stroke/death, and ≥50% and ≥80% restenosis. ResultsWe analyzed 646 procedures (637 patients) (404 CEA, 242 TCAR). There was no significant difference in the indications for carotid intervention. However, TCAR patients had more high-risk criteria, including hypertension, coronary artery disease, congestive heart failure, and renal failure. There was no significant differences between CEA vs TCAR in 30-day perioperative stroke (1% vs 2%), stroke/death rate (1% vs 3%; P = .0849), or major hematomas (2% vs 2%). The rate of CNI was significantly different (5% for CEA vs 1% for TCAR; P = .0138). At late follow-up (2 years), the rate of stroke was 1% vs 4% (P = .0273), stroke/death 8% vs 15% (P = .008), ≥80 % restenosis 0.5% vs 3% (P = .0139) for CEA patients vs TCAR patients, respectively. After matching 242 CEAs and 242 TCARs, the perioperative stroke rate was 1% for CEA vs 2% for TCAR (P = .5037), the stroke/death rate was 2% vs 3% (P = .2423), and the CNI rate was 3% vs 1% (P = .127). At late follow-up, rates of stroke were 1% for CEA vs 4% for TCAR (P = .0615) and stroke/death were 8% vs 15% (P = .0345). The rate of ≥80% restenosis was 0.9% for CEA vs 3% for TCAR (P = .099). The rates of freedom from stroke at 6, 12, 18, and 24 months for CEA vs TCAR were 99%, 99%, 99%, and 99% vs 97%, 95%, 93% and 93%, respectively (P = .0806); stroke/death were 94%, 90%, 87%, and 86% vs 93%, 87%, 76%, and 75%, respectively (P = .0529); and ≥80% restenosis were 100%, 99%, 98%, and 98% vs 97%, 95%, 93%, and 93%, respectively (P = .1132). ConclusionsIn a propensity-matched analysis, both CEA and TCAR have similar perioperative clinical outcomes. However, CEA was superior to TCAR for the rates of late stroke/death and had a somewhat lower rate of ≥80% restenosis at 2 years, but this difference was not statistically significant.

Safety of carotid endarterectomy in patients over 70 years old in early period after ischemic stroke

Safety of carotid endarterectomy in patients over 70 years old in early period after ischemic stroke

Outcome of carotid endarterectomy in patients with symptomatic carotid near occlusion with partial collapse

Background Symptomatic carotid near occlusion with partial collapse (CNOPC) of the distal internal carotid artery (ICA) is an uncommon condition. Guidelines for its treatment have recommended conservative management, although surgery may be indicated for many patients. In this work, our goal was to examine the postoperative outcomes of CNOPC patients who had undergone carotid endarterectomy (CEA) for symptomatic disease. Methods Symptomatic CNOPC patients were identified in this single-center retrospective study from January 2019 to February 2022. Patients’ demographics, comorbidities, and CEA indications were gathered. At 30 days and 1 year after surgery, postoperative complications including stroke and death, hospital stay, and operational details were evaluated. Results In the 3-year study period, 128 CEAs were done, and 21 (16.4%) patients had CNOPC. Males were 15 (71.4%) with no sex difference in comorbidities except a significantly higher IHD in men, P less than 0.01. The mean ipsilateral to contralateral distal ICA luminal narrowing ratio was 34.1%. All patients had carotid patches. General anesthesia was associated with more shunt usage, P less than 0.05. High carotid bifurcation lengthened CEA time (P&lt;0.05), but neither anesthetic type, nor the use of a shunt or patch did. At 30-day post CEA, there was only 1 (4.7%) recorded cerebrovascular event (CVA), no mortality, and no carotid restenosis or occlusion was found. At 1-year, no new CVA were reported but 1 (4.7%) fatality was recorded. Conclusion Carotid endarterectomy for patients with carotid near occlusion and partial distal collapse is safe and may be considered despite marginally higher procedural risks than patients with low-to-moderate risk anatomy.

Socioeconomic status as a predictor of post-operative mortality and outcomes in carotid artery stenting vs. carotid endarterectomy.

The association between low socioeconomic status (SES) and worse surgical outcomes has become an emerging area of interest. Literature has demonstrated that carotid artery stenting (CAS) poses greater risk of postoperative complications, particularly stroke, than carotid endarterectomy (CEA). This study aims to compare the impact of low SES on patients undergoing CAS vs. CEA. The National Inpatient Sample (NIS) was queried for patients undergoing CAS and CEA from 2010 to 2015. Patients were stratified by highest and lowest median income quartiles by zip code and compared through demographics, hospital characteristics, and comorbidities defined by the Charlson Comorbidity Index (CCI). Primary outcome was in-hospital mortality. Secondary outcomes included acute kidney injury (AKI), post-operative stroke, sepsis, and bleeding requiring reoperation.Multivariable logistic regression was used to determine the effect of SES on outcomes. Five thousand four hundred twenty-five patients underwent CAS (Low SES: 3,516 (64.8%); High SES: 1,909 (35.2%) and 38,399 patients underwent CEA (Low SES: 22,852 (59.5%); High SES: 15,547 (40.5%). Low SES was a significant independent predictor of mortality [OR = 2.07 (1.25-3.53); p = 0.005] for CEA patients, but not for CAS patients [OR = 1.21 (CI 0.51-2.30); p = 0.68]. Stroke was strongly associated with low SES, CEA patients (Low SES = 1.5% vs. High SES = 1.2%; p = 0.03), while bleeding was with high SES, CAS patients (Low SES = 5.3% vs. High SES = 7.1%; p = 0.01). CCI was a strong predictor of mortality for both procedures [CAS: OR1.45 (1.17-1.80); p < 0.001. CEA: OR1.60 (1.45-1.77); p < 0.001]. Advanced age was a predictor of mortality post-CEA [OR = 1.03 (1.01-1.06); p = 0.01]. While not statistically significant, advanced age and increased mortality trended towards a positive association in CAS [OR = 1.05 (1.00-1.10); p = 0.05]. Low SES is a significant independent predictor of post-operative mortality in patients who underwent CEA, but not CAS. CEA is also associated with higher incidence of stroke in low SES patients. Findings demonstrate the impact of SES on outcomes for patients undergoing carotid revascularization procedures. Prospective studies are warranted to further evaluate this disparity.

The dosage of thiopental as pharmacological cerebral protection during non-shunt carotid endarterectomy: A retrospective study.

Thiopental has been used as a pharmacological cerebral protection strategy during carotid endarterectomy surgeries. However, the optimal dosage required to induce burst suppression on the electroencephalogram (EEG) remains unknown. This retrospective study aimed to determine the optimal dosage of thiopental required to induce burst suppression during non-shunt carotid endarterectomy. The Neurological Institute of Thailand Review Board approved the study. Data were collected from 2009 to 2019 for all non-shunt carotid endarterectomy patients who received thiopental for pharmacological cerebral protection and had intraoperative EEG monitoring. Demographic information, carotid stenosis severity, intraoperative EEG parameters, thiopental dosage, carotid clamp time, intraoperative events, and patient outcomes were abstracted. The study included 57 patients. Among them, 24 patients (42%) achieved EEG burst suppression pattern with a thiopental dosage of 26.3±10.1 mg/kg/hr. There were no significant differences in perioperative events between patients who achieved burst suppression and those who did not. After surgery, 33.3% of patients who achieved burst suppression were extubated and awakened. One patient in the non-burst suppression group experienced mild neurological deficits. No deaths occurred within one month postoperative. The optimal dosage of thiopental required to achieve burst suppression on intraoperative EEG during non-shunt carotid endarterectomy was 26.3±10.1 mg/kg/hr.

Association of Impedance Aggregometry-Measured Platelet Aggregation With Thromboembolic Events in Patients Who Undergo Carotid Endarterectomy: A Pilot Study

ObjectivesThe aim of the current study was to assess the relationship between thrombin receptor activator peptide 6 (TRAP test), adenosine-5′-diphosphate (ADP test) and arachidonic acid (ASPI test) and stroke/TIA, using the multiple electrode aggregometry (Multiplate®) in patients undergoing CEA. DesignA retrospective study. SettingVascular surgery operating rooms of university hospital. ParticipantsOne hundred and thirty-one out of 474 patients undergoing CEA between November 2020 and October 2022. InterventionsNone. Measurements & Main ResultsA pre-operative blood sample of all enrolled patients was analyzed using the multiplate analyzer. Receiver operating characteristics curves were generated to test the ability of TRAP, ADP and ASPI in discriminating perioperative thromboembolic stroke/TIA. A logistic LASSO regression model was used to identify factors independently associated with stroke/TIA. Eight patients suffered of perioperative stroke/TIA. Although all the platelet functional assays showed an excellent predictive performance an ADP value exciding 72 U showed the highest specificity (87%) and sensitivity (68%) in discriminating patients who had perioperative thromboembolic stroke/TIA with a negative predictive value of 99% and a positive predictive value of 15%. After LASSO regression an ADP> 72 U and need of shunt during CEA were the only two variables independently associated with perioperative stroke/TIA. ConclusionSince the ADP test was independently associated with perioperative stroke/TIA, the assessment of platelet reactivity using Multiplate® may offer potential utility in monitoring patients undergoing CEA.

Haptoglobin 1 gene polymorphism protects against postoperative cardiovascular events

Abstract Background Haptoglobin (Hp) is a plasma glycoprotein with antioxidant properties that plays a role in maintaining the integrity of the bloodstream and in clearing plasma lipids. The human haptoglobin gene is polymorphic, with two prevalent alleles (Hp1 and Hp2) resulting in three distinct phenotypes. The Hp subtypes have been linked to the risk of symptomatic carotid stenosis and major ischemic cardiovascular events, with some studies suggesting a protective role of the Hp1 allele. However, observed discrepancies in the relationship between Hp genotype and cardiovascular events suggest the presence of additional underlying mechanisms or differences among Hp1 allele subtypes. This study aims to examine the role of Hp1 alleles (Hp1F and Hp1S) in atherosclerosis and determine their association with cardiovascular events in our cohort of carotid endarterectomy patients. Methods The study included a total of 691 patients who underwent a carotid endarterectomy. All patients underwent genotyping for Haptoglobin. A total of 668 carotid plaques were collected, and 45 of these plaques were randomly selected for histopathological analysis and underwent staining for lipids using (Oil Red O), hemorrhage (glycophorin A), macrophages (CD68 [cluster of differentiation 68]), smooth muscle cells (alpha-actin) and collagen (Movat pentachrome). Participants were subsequently followed-up for postoperative cardiovascular events using data from clinical registers. The median follow-up for cardiovascular events was 48 months. All included patients gave written informed consent. The study was approved by the local ethical review board and followed the declaration of Helsinki. Results There were no significant differences in the baseline clinical characteristics between Hp1S carriers (36.6%) and non-carriers (63.4%). Postoperative cardiovascular and mortality events were found to be significantly associated with Hp1S subtype, with carriers exhibiting a decreased risk (HR=0.372, 95%CI 0.180-0.769, p=0.008). The histological examination of the plaques revealed that Hp1S carriers had a significantly greater percentage of plaque area stained positive alpha-actin (p=0.033). However, there were no significant differences observed in other histological markers. Conclusions Hp1S was associated with lower risk of postoperative cardiovascular events in our cohort of carotid endarterectomy patients. Patients with this genotype had plaques with more smooth muscle cells, so possibly more stable. This suggests that Hp1 subtypes could be of interest in risk stratification of this patient population, deserving further studies.

Association of carotid endarterectomy at low-volume centers with higher likelihood of major complications and nonroutine discharge.

Carotid artery stenosis (CAS) is associated with an annual stroke risk of 2%-5%, and revascularization with carotid endarterectomy (CEA) can reduce this risk. While studies have demonstrated that hospital CEA volume is associated with mortality and myocardial infarction, CEA volume cutoffs in studies are relatively arbitrary, and no specific analyses on broad complications and discharge disposition have been performed. In this study, the authors systematically set out to identify a cutoff at which CEA procedural volume was significantly associated with major complications and nonroutine discharge. Asymptomatic and symptomatic CAS patients undergoing CEA were retrospectively identified in the Nationwide Readmissions Database (2010-2018). The association of CEA volume with outcomes was explored as a continuous variable using locally estimated scatterplot smoothing. The identified volume cutoff was used to generate dichotomous volume cohorts, and multivariate analyses of patient and hospital characteristics were conducted to evaluate the association of CEA volume with major complications and discharge disposition. Between 2010 and 2018, 308,933 asymptomatic and 32,877 symptomatic patients underwent CEA. Analysis of CEA volume with outcomes as a continuous variable demonstrated that an increase in volume was associated with a lower risk until a volume of approximately 7 cases per year (20th percentile). A total of 6702 (2.2%) asymptomatic and 1040 (3.2%) symptomatic patients were treated at the bottom 20% of hospital procedure volume. Increased rates of complications were seen at low-volume centers among asymptomatic (3.66% vs 2.77%) and symptomatic (7.4% vs 6.87%) patients. Asymptomatic patients treated at low-volume centers had an increased likelihood of major complications (OR 1.26, 95% CI 1.07-1.49; p = 0.007) and nonroutine discharge (OR 1.36, 95% CI 1.24-1.50; p < 0.0001). Symptomatic patients treated at low-volume centers were also more likely to experience major complications (OR 1.47, 95% CI 1.07-2.02; p = 0.02) and nonroutine discharge (OR 1.26, 95% CI 1.07-1.47; p = 0.005). Mortality rates were similar between low- and high-volume hospitals among asymptomatic (0.36% and 0.32%, respectively) and symptomatic (1.06% and 1.49%, respectively) patients, while volume was not significantly associated with mortality among asymptomatic (OR 1.06, 95% CI 0.67-1.65; p = 0.81) and symptomatic (OR 0.81, 95% CI 0.43-1.54; p = 0.52) patients in multivariate analysis. CEA patients, asymptomatic or symptomatic, are at a higher risk of major complications and nonroutine discharge at low-volume centers. Analysis of CEA as a continuous variable demonstrated a cutoff at 7 cases per year, and further study may identify factors associated with improved outcome at the lowest-volume centers.

Customary paradigm in anesthetic management of carotid endarterectomy patients shifts in Covid 19 outbreak: experiences of an advanced practice centre

Customary paradigm in anesthetic management of carotid endarterectomy patients shifts in Covid 19 outbreak: experiences of an advanced practice centre

Provider care segregation and hospital-region racial disparities for carotid interventions in the USA

BackgroundReasons for racial disparities in the utilization and outcomes of carotid interventions (carotid endarterectomy (CEA) and carotid artery stenting (CAS)) are not well understood, especially segregation of care associated with...

Near-Infrared Spectroscopy-Guided, Individualized Arterial Blood Pressure Management for Carotid Endarterectomy under General Anesthesia: A Randomized, Controlled Trial.

Background: Differences in blood pressure can influence the risk of brain ischemia, perioperative complications, and postoperative neurocognitive function in patients undergoing carotid endarterectomy (CEA). Methods: In this single-center trial, patients scheduled for CEA under general anesthesia were randomized into an intervention group receiving near-infrared spectroscopy (NIRS)-guided blood pressure management during carotid cross-clamping and a control group receiving standard care. The primary endpoint was postoperative neurocognitive function assessed before surgery, on postoperative days 1 and 7, and eight weeks after surgery. Perioperative complications and cerebral autoregulatory capacity were secondary endpoints. Results: Systolic blood pressure (p < 0.001) and norepinephrine doses (89 (54-122) vs. 147 (116-242) µg; p < 0.001) during carotid cross-clamping were lower in the intervention group. No group differences in postoperative neurocognitive function were observed. The rate of perioperative complications was lower in the intervention group than in the control group (3.3 vs. 26.7%, p = 0.03). The breath-holding index did not differ between groups. Conclusions: Postoperative neurocognitive function was comparable between CEA patients undergoing general anesthesia in whom arterial blood pressure during carotid cross-clamping was guided using NIRS and subjects receiving standard care. NIRS-guided, individualized arterial blood pressure management resulted in less vasopressor exposition and a lower rate of perioperative complications.

Guideline Compliant Minimum Asymptomatic Carotid Endarterectomy Surgeon and Hospital Volume Cutoffs

There is a known association between volume and outcomes after carotid endarterectomy (CEA). A recent analysis suggested rates of stroke and death do not significantly reduce after a surgeon volume cutoff of 20 CEAs per year. However, these results would severely limit access. The objective here is to identify a lower optimal cutpoint for surgeon and hospital volume for asymptomatic CEA. We evaluated asymptomatic CEA patients using The New York Statewide Planning and Research Cooperative System database from 2000-2014. The relationship of 3-year averaged volumes for surgeons and hospitals to 30-day stroke were assessed using multiple logistic regression and included both hospital and surgeon volume in all analyses. Optimized cutpoints were the lowest significant volume cutoff that minimized the adjusted odds ratio of stroke. We studied 32,549 CEAs performed by 271 surgeons in 136 centers by vascular surgeons. The median surgeon volume was 26.3(IQR:12.3-51.7) and the median hospital volume was 67(IQR:36.3-119.3). The surgeon volume cutpoint was 3 and the hospital volume cutpoint was 6 cases per year. There were 756(2.3%) procedures performed by surgeons with a volume <3 and 560 (1.7%) procedures performed by hospitals with a volume <6. Perioperative stroke and death rates were 2.0% (95%CI:1.8-2.1) and 3.8% (95%CI:2.6-5.5) for an average yearly surgeon volume ≥3 and <3 (p=0.070), respectively. The combined Stroke and death rate was 2.0% (95%CI:1.8-2.1) and 4.8% (95%CI:3.2-7.0) for an average yearly center volume ≥6 and <6 (p=0.007), respectively. A combined surgeon and hospital volume variable also predicted outcomes and low volume procedures did not meet previously proposed AHA and SVS quality measures. These data demonstrate an improvement in outcomes at a lower volume threshold than previously reported. These modest cutoff values should be used for asymptomatic CEA volume guideline formation and for future studies, after accounting for the impact of other important factors that may be driving volume-outcomes relationships in asymptomatic CEA.

The dosage of thiopental as pharmacological cerebral protection during non-shunt carotid endarterectomy: A retrospective study

Background: Thiopental has been used as a pharmacological cerebral protection strategy during carotid endarterectomy surgeries. However, the optimal dosage required to induce burst suppression on the electroencephalogram (EEG) remains unknown. This retrospective study aimed to determine the optimal dosage of thiopental required to induce burst suppression during non-shunt carotid endarterectomy. Methods: The Neurological Institute of Thailand Review Board approved the study. Data were collected from 2009 to 2019 for all non-shunt carotid endarterectomy patients who received thiopental for pharmacological cerebral protection and had intraoperative EEG monitoring. Demographic information, carotid stenosis severity, intraoperative EEG parameters, thiopental dosage, carotid clamp time, intraoperative events, and patient outcomes were abstracted. Results: The study included 57 patients. Among them, 24 patients (42%) achieved EEG burst suppression pattern with a thiopental dosage of 26.3+10.1 mg/kg/hr. There were no significant differences in perioperative events between patients who achieved burst suppression and those who did not. After surgery, 33.3% of patients who achieved burst suppression were extubated and awakened. One patient in the non-burst suppression group experienced mild neurological deficits. No deaths occurred within one month postoperative. Conclusions: The optimal dosage of thiopental required to achieve burst suppression on intraoperative EEG during non-shunt carotid endarterectomy was 26.3+10.1 mg/kg/hr.

New Data on Endovascular Stenting vs. Carotid Endarterectomy for Patients at High Surgical Risk

New Data on Endovascular Stenting vs. Carotid Endarterectomy for Patients at High Surgical Risk

O068 Magnesium, the anaesthetists’ friend during carotid endarterectomy (CEA)

Abstract Introduction Magnesium can be used as an antihypertensive for CEA patients, with the added benefit of anti-arrhythmic and anti-convulsive effects without the negative chronotropic effect of classic antihypertensives. It however causes vasodilation and increased diuresis, possibly increasing post-operative vasopressor requirements. This study determines the postoperative haemodynamic impact of magnesium therapy on CEA patients. Methods A retrospective review of CEA patients’ medical records between April 2020 and December 2021 was undertaken. In our unit, the postoperative trigger for commencing vasopressors (metaraminol or noradrenaline) is a systolic blood pressure &amp;lt;110 mmHg. A comparison of the postoperative vasopressor requirements in patients given intraoperative magnesium {5g IV infusion over 20 min if SBP &amp;gt;170mmHg} with those not given magnesium therapy was made (using Chi-square test). A secondary outcome was to assess the development of new acute postoperative kidney injury (AKI) (eGFR &amp;lt;60 ml/min/1.73m2). Results Of the 89 CEA patients; 8 had incomplete data and 65% were over 70 years old. The Surgical Outcome Risk Tool (SORT) score identified 44 (53%) patients as high risk (&amp;gt;5% risk of perioperative mortality). There was no difference between the magnesium vs non-magnesium therapy groups postoperatively in vasopressor requirement. (p=0.38, X2=0.74) or AKI rates (n=14, 16.8%). Conclusion Organ perfusion and cardiac stability can be achieved perioperatively in CEA patients with magnesium therapy without increasing vasopressors requirement or renal impairment; making it a good first-line therapy for intraoperative hypertension.

Effect of regional versus general anesthesia on thirty-day outcomes following carotid endarterectomy: a cohort study.

The effect of regional versus general anesthesia on carotid endarterectomy outcomes is debated. This study assesses the effect of anesthetic technique on major morbidity and mortality and additional secondary endpoints following carotid endarterectomy. This was a retrospective propensity-matched-cohort analysis investigating elective carotid endarterectomy patients in the 2015-2019 American College of Surgeons National Surgical Quality Improvement Program ( n =37204). The primary endpoint was 30-day mortality and major morbidity, defined as stroke, myocardial infarction, or death. Secondary endpoints included minor morbidity, bleeding events, healthcare resource utilization, and length of hospital stay. Univariate, multivariable, and survival analyses were applied. The 1:1 propensity-matched-cohort included 8304 patients (4152 in each group). Regional anesthesia was associated with similar incidences of major morbidity and mortality [odds ratio (OR), 0.81 (95% CI, 0.61-1.09); P = 0.162] and unplanned resource utilization [OR, 0.93 (95% CI, 0.78-1.11); P = 0.443], but lower incidences of minor morbidity [OR, 0.60 (95% CI, 0.44-0.81); P < 0.001] and bleeding events [OR, 0.49 (95% CI, 0.30-0.78); P = 0.002], and a shorter length of hospital stay [1.4 vs. 1.6 days; mean difference, -0.16 days (95% CI, -0.25 to -0.07); P < 0.001]. On multivariable analysis, regional anesthesia remained independently predictive of minor morbidity [adjusted odds ratio (AOR), 0.58 (95% CI, 0.42-0.79); P = 0.001] and bleeding events [AOR, 0.49 (95% CI, 0.30-0.77); P = 0.003]. Significance was maintained on survival analysis for these two endpoints. A mortality benefit was observed on univariate [OR, 0.50 (95% CI, 0.25-1.00); P = 0.045], multivariable [AOR, 0.49 (95% CI, 0.24-0.96); P = 0.043], and survival analysis ( P = 0.045). Carotid endarterectomy patients receiving regional anesthesia experience favorable outcomes compared to propensity-matched general anesthesia controls.

Preoperative Novel Magnetic Resonance Fusion Imaging for Carotid Endarterectomy Patients with Contrast Contraindications: A Pilot Study

For carotid endarterectomy (CEA) patients with renal dysfunction and allergies to contrast media, we developed a preoperative novel method of non-contrast three-dimensional magnetic resonance fusion imaging (NC-3DMRFI) which could describe well blood vessels, plaques, and bony structures even in surgical position. In this study, we examined the usefulness of this method. We extracted non-contrast magnetic resonance images of bones, blood vessels, and plaques to create a three-dimensional (3D) fusion image. An image acquired in the normal position and another in the surgical position during CEA were used to create a fusion image. We compared the fusion imaging results with the intraoperative findings of six patients with contrast contraindications received CEA. Preoperative NC-3DMRFI could clearly show the positions of the carotid bifurcation, the distal end of plaque, and the bony structure in five of the six cases. Intraoperative findings and preoperative fusion imaging results were comparable in all cases where fusion images could be created. The fusion imaging in the surgical position during CEA was useful for preoperative examination, and the surgical space could be secured in the case of a high cervical location. This pilot study showed our novel NC-3DMRFI method is useful for preoperative simulation in CEA, especially in patients with renal dysfunction and allergies to contrast media.