Carotid Endarterectomy Surgery Research Articles

AB034. TIA to CEA: time from symptoms to surgery for carotid endarterectomy at a tertiary referral centre

Background: Stroke is the leading cause of disability and second leading cause of death globally. Carotid artery stenosis accounts for 10-15% of ischaemic strokes. Carotid endarterectomy (CEA) is a surgical method of stroke risk reduction in patients with high-grade stenosis. Best evidence recommends CEA within 14 days of an acute neurological event in patients with ipsilateral stenosis >70% to confer maximum preventative benefit.

Timeliness and outcomes of carotid endarterectomy for symptomatic carotid artery stenosis: a single centre audit

For patients presenting with symptomatic internal carotid artery stenosis, carotid endarterectomy (CEA) surgery is recommended to be performed generally within a 48-hr to 14-day window. This study aimed to assess timeliness of delivery, and outcomes, of CEA surgery in a tertiary vascular centre. Patients with symptomatic internal carotid artery stenosis who underwent CEA between 1 June 2014 and 31 June 2017 were identified and data were obtained from hospital records. The timeline of their journey from presentation to surgery was then mapped together with their outcomes. One hundred and seventy-two cases were included in the study. Overall, the median time from development of presenting symptoms to surgery was 9 days and 119 (69%) cases were operated on within 14 days. The median time from development of presenting symptoms to ultrasound imaging was 2 days and the median time from symptoms to vascular referral was also 2 days. There were no deaths, strokes or transient ischaemic attacks within 30 days of CEA. At 1 year, survival was 100% but 15 (8.7%) had experienced at least one transient ischaemic attack or stroke. In the 53 cases operated upon beyond 14 days the dominant cause of delay in 32 (60%) was accessing surgery after review by the vascular service. The aim of delivering CEA within 14 days of developing relevant symptoms was achieved in most cases with good outcomes. Nevertheless, points of delay in the patient journey that could be targeted for future quality improvement were identified.

Concomitant carotid endarterectomy and cardiac surgery does not decrease postoperative stroke rates

ObjectiveThe timing of operative revascularization for patients with concomitant carotid artery stenosis and coronary artery disease remains controversial. We examined the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database to evaluate the association of combined carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) with postoperative outcomes. MethodsAll patients undergoing CABG with known carotid stenosis of >80% were identified from 2011 to 2016. Individuals were stratified by use of cardiopulmonary bypass and whether a concomitant CEA was performed at the time of CABG. Multivariate logistic regression was used to model the probability of combined CABG and CEA. The resulting propensity scores were used to match individuals on the basis of clinical and operative characteristics to evaluate primary (30-day mortality and in-hospital transient ischemic attack and stroke) and secondary (STS morbidity composite events and length of stay) end points, with P < .05 required to declare statistical significance. ResultsAfter propensity score matching, 994 off-pump CABG patients (497 CABG only and 497 CABG-CEA) and 5952 on-pump CABG patients (2976 CABG only and 2976 CABG-CEA) were identified. For patients who received on-pump operations, those undergoing CABG-CEA had no observed difference in rate of in-hospital stroke (odds ratio [OR], 0.93; 95% confidence interval [CI], 0.72-1.21; P = .6), higher incidence of STS morbidity composite events (OR, 1.15, 95% CI, 1.01-1.31; P = .03), longer length of stay (7.0 [interquartile range, 5.0-9.0] days vs 6.0 [interquartile range, 5.0-9.0] days; P < .005), and no observed difference in 30-day mortality (OR, 1.28; 95% CI, 0.97-1.69; P = .08) compared with those undergoing CABG only. For off-pump procedures, CABG-CEA patients had no observed difference in rate of in-hospital stroke (OR, 0.80; 95% CI, 0.37-1.69; P = .56) compared with those undergoing CABG only. ConclusionsWhereas the differences are relatively small, these data suggest that a combined CABG-CEA approach is unlikely to provide significant stroke reduction benefit compared with CABG only. However, comparison with staged approaches merits further investigation.

Progressive bilateral ocular ischemic syndrome despite previously performed carotid endarterectomy

The ocular ischemic syndrome (OIS) is a rare condition with vision-threatening potentials. It is characterized by chronic ischemia of the anterior and/or posterior segment of the eye primarily caused by severe carotid artery occlusive diseases. In this article, we present a case of a 67-year-old male patient presented with the gradual diminution of vision in the right eye for 6 months. The patient had undergone a right internal carotid artery (ICA) endarterectomy (CEA) twice before. On the day of admission, intraocular pressure (IOP) was 34 mm Hg in the right eye (RE) and 20 mm Hg in the left eye (LE). On anterior segment examination, neovascularization of iris in the right eye was noted. On fundoscopy dilated retinal veins, attenuated retinal arteries, blot hemorrhages, cotton wool spots and microaneurysms were present. The patient underwent the appropriate investigations including computed tomography angiography (CTA) of carotid arteries, fundus fluorescence angiography (FFA) and Doppler ultrasound (DUS) of ophthalmic and central retinal arteries, which were all consistent with a diagnosis of bilateral OIS. Intraocular pressure was pharmacologically reduced and stabilized. Subsequently, panretinal photocoagulation (PRP) of peripheral capillary nonperfusion areas was performed in both eyes.

Somatosensory Evoked Potential and Transcranial Doppler Monitoring to Guide Shunting in Carotid Endarterectomy.

Clamping of the internal carotid artery (ICA) during carotid endarterectomy (CEA) is a critical step. In our neurosurgical department, CEAs are performed with transcranial Doppler (TCD) and somatosensory evoked potential (SEP) monitoring with a 50% flow velocity/amplitude decrement warning criteria for shunting. The aim of our study was to evaluate our protocol with immediate neurologic deficits after surgery for the primary end point. This is a single-center retrospective cohort study of symptomatic and asymptomatic ICA stenosis patients from January 2012 to June 2015. Only those cases in which CEA was performed with both modalities (TCD and SEP) were included. The Mann-Whitney U test was applied to evaluate TCD and SEP ratios based on immediate postoperative neurologic deficits. A total of 144 patients were included, 120 (83.3%) with symptomatic ICA stenosis. The primary end point was met by six patients (4.2%); all of them were patients with a symptomatic ICA stenosis. The stroke and death rate was 1.4%. Ratios of SEP amplitudes demonstrated significant differences between patients with and without an immediate postoperative neurologic deficit at the time of ICA clamping (p = 0.005), ICA clamping at 10 minutes (p = 0.044), and ICA reperfusion (p = 0.005). Ratios of TCD flow velocity showed no significant difference at all critical steps. In this retrospective series of simultaneous TCD and SEP monitoring during CEA surgery of predominantly symptomatic ICA stenosis patients, the stroke and death rate was 1.4%. SEP seemed to be superior to TCD in predicting the need for an intraoperative shunt and for predicting temporary postoperative deficits. Further prospective studies are needed.

KAROTİS ENDARTEREKTOMİ OPERASYONU GEÇİREN HASTALARDA ALT EKSTREMİTE PERİFERİK ARTER HASTALIĞI SIKLIĞININ BELİRLENMESİ

<div><!--block-->Objective: Atherosclerotic vascular disease is a systemic pathology. The aim of our study was to determine the frequency of lower extremity peripheral artery disease (PAD) in patients who underwent carotid endarterectomy (CEA) and to identify risk factors.&nbsp;<br><br>Material and Method: The study included 65 patients who underwent carotid endarterectomy in Istanbul Medical Faculty, Department of Cardiovascular Surgery between January 2011 and January 2015. The medical history, physical examination, ankle brachial index and lower extremity duplex ultrasonography results were evaluated and the patients were examined for peripheral artery disease.&nbsp;<br><br>Results: Among 65 patients, 47 of them were male and 18 of them were female. The patients’ ages ranged from 48 to 88 years, with an average of 66.26±8.84 years. In our study, being above the age of 65 (ODDS ratio (OR) 4.65, 95% CI: 1.61-13.4), male gender (OR 6.75, 95% CI: 1.71-26.50), smoking (OR 10.50, 95% CI: 2.15-51.13), the family history (OR 0.23, 95% CI: 0.060,80), the presence of chronic renal failure (OR 0.41, 95% CI: 0.300.56) were found to increase peripheral artery disease in patients who underwent carotid endarterectomy statistically significant. In cases with low HDL levels, the frequency of peripheral artery disease was found increased. In our study, peripheral artery disease was detected in 30 (46.2%) of 65 patients who underwent carotid endarterectomy operation.&nbsp;<br><br>Conclusion: Due to systemic involvement of atherosclerosis, lower extremity peripheral artery disease should be considered in patients who underwent carotid endarterectomy operation, and patients should be evaluated accordingly</div>

Comparison of Coronary Bypass Grafting Surgery with Carotid Endarterectomy and Coronary Bypass Grafting Surgery

Introduction: Treatment of combined coronary artery surgery (CABG) and severe carotid artery stenosis is still controversial. The decision of surgical priority can change according to the severity of the coronary artery disease or carotid artery disease at staged surgery. The aim of the study is to compare the outcomes of simultaneous surgery (CEA + CABG) and CABG alone at our department. Materials and Methods: We retrospectively reviewed the CABG and CEA + CABG patients which were performed between 2010 and 2015. If the patients had simultaneous another operation, they were excluded from the study. A total of 294 patients (252 CABG patients and 42 combined surgery patients), were retrospectively examined. Results: Two patients in CABG group and two patients in CABG + CEA group developed stroke. There was no statistically significant difference between the two groups in terms of early stroke rate (p > 0.05). One patient in CEA + CABG group and three patients in CABG group died. The average carotid clamp time was 19.93 ± 5.06 minutes. Aortic clamp times were 42.89 ± 6.38 minutes in CABG and 42.81 ± 5.70 minutes in CEA + CABG patients. Results of the two groups were similar. Conclusion: Combined CEA and CABG can be performed successfully and safely in patients.

Carotid Endarterectomy Surgery Results in Yozgat Province

Carotid Endarterectomy Surgery Results in Yozgat Province

The results of simultaneous revascularization operations of the carotid and coronary territory in patients with multifocal atherosclerosis

Objective : To determine the effectiveness of simultaneous surgical interventions for revascularization of the carotid and coronary basins. Materials and methods : The effectiveness of the surgical intervention was assessed in 34 patients (31 male patients, 3 female patients, average age 61.8 ± 1.52 years) who underwent simultaneous carotid endarterectomy and coronary artery bypass grafting. The indications for surgical treatment for carotid arteries disease were determined by a neurosurgeon, and for coronary artery bypass grafting — by a cardiac surgeon. Results : Postoperative complications were observed in 55.9 % of patients. In 3 (8.8 %) patients, an acute ischemic stroke with a neurological deficit developed on the first day after the operation. One patient (2.9 %) presented with both an acute myocardial infarction in the postoperative period and an acute heart failure. Perioperative rhythm disturbances in the form of atrial fibrillation were observed in 6 (17.6 %) cases. Postoperative mortality was 2.9 %. During the first year after surgery, an improvement in the quality of life was observed in 31 (93.9 %) patients in the form of an improvement in the functional state of angina pectoris, a reduction of the heart failure symptoms, or a complete regression of cardiac symptoms. Two (6.06 %) patients needed for repeated myocardial revascularization. Within 3 years of follow-up, no patient developed an ischemic stroke. The patients who developed cerebral event immediately after surgery had a stable neurological status. The commutative survival rate (percentage of patients who survived within the indicated period) of patients for 1 year of observation was 100 %, for 3 years — 96 %. A significant drop in survival function was observed in the fourth year of observation up to 75 % due to the development of repeated acute myocardial infarction. Conclusions: The simultaneous revascularization of the carotid and coronary territory in the form of a carotid endarterectomy and aortocoronary bypass surgery is an effective modern method for preventing the development of stroke and acute myocardial infarction, improving the neurological and general somatic status, quality of life of patients with combined atherosclerotic lesions of the carotid and coronary arteries.

Surgeon specialty significantly affects outcome of asymptomatic patients after carotid endarterectomy

BackgroundThis study evaluates the impact of surgical specialty, specifically vascular surgery (VS) versus non-VS (NVS; namely, cardiac surgery, thoracic surgery, general surgery, or neurosurgery) on perioperative carotid endarterectomy (CEA) outcomes stratified by symptom status on presentation. MethodsThe National Surgical Quality Improvement Program Vascular Procedure Targeted database was queried for elective asymptomatic or symptomatic CEA (excluding concomitant CEA and cardiac surgery) from 2011 to 2016. Data were stratified by VS versus NVS and symptom presentation. Primary end points were 30-day stroke and stroke/death; secondary end points included perioperative complications. Multivariable logistic regression determined predictors of all assessed primary outcomes and propensity-weight analysis was used to confirm results. ResultsOverall, 21,060 CEA (12,671 [59%] asymptomatic) were identified with 19,687 (93%) done by VS. In the asymptomatic CEA cohort, VS had lower unadjusted stroke (1.3% vs 2.4%; P = .021) and stroke/death (1.7% vs 3.2%; P = .006) rates. In addition, VS had fewer deaths (0.6% vs 1.3%; P = .033) and pulmonary complications (1.6% vs 2.7%; P = .036). After risk adjustment, the NVS asymptomatic cohort predicted stroke (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.1-3.1; P = .032), driven by neurosurgery (OR, 3.1; 95% CI, 1.3-7.2; P = .008). This NVS cohort also predicted stroke/death (OR, 1.8; 95% CI, 1.1-2.9; P = .013), driven by neurosurgery (OR, 2.5; 95% CI, 1.1-5.7; P = .035). After propensity weighting, these differences persisted (stroke: OR, 1.9; 95% CI, 1.1-3.3; P = .030; stroke/death: OR, 1.9; 95% CI, 1.2-3.0; P = .011). Among symptomatic CEA, there was no difference between VS and NVS in unadjusted primary end points of stroke (3.1% vs 4.2%; P = .106) or stroke/death (3.8% vs 4.6%; P = .275). However, in this cohort, VS had fewer major complications (12.7% vs 15.5%; P = .029). ConclusionsThis study identifies the VS specialty as having significantly better outcomes after CEA in patients presenting with asymptomatic disease than NVS specialty, as evidenced by lower rates of stroke and stroke death, which persisted after risk adjustment and propensity weighting. This difference in stroke and stroke/death was not apparent in the symptomatic cohort; however, NVS did have increased unadjusted rates of major complications. Although this finding may reflect multiple factors, including higher operative volume, training, or technical approach, these differences in 30-day CEA outcomes may be crucial for the proper interpretation of ongoing national outcome trials such as CREST2.

Which Specialty Should Perform Carotid Endarterectomy and Carotid Artery Stenting?

Introduction: Different competencies and skills are required and obtained during medical specialization. However, whether or not these impact on procedural outcomes of carotid endarterectomy (CEA) or carotid artery stenting (CAS) is unclear. We assessed the reported association between operator specialization and procedural outcomes following CEA or CAS to determine whether CEA and CAS should be performed by specific specialties. Methods: We systematically searched PubMed and EMBASE up to 21 August 2017 for randomized clinical trials and observational studies that compared two or more specialties performing CEA or CAS for symptomatic and asymptomatic carotid artery stenosis. For CEA, we included vascular surgeons, neurosurgeons, general surgeons and cardiothoracic surgeons. Additionally, we included interventional cardiologists and radiologists for CAS. The composite primary outcome was procedural stroke or death (i.e., occurring within 30-days of the procedure or prior to discharge). Reported or calculated risk estimates were pooled with a generic inverse variance random effects model. Risk of bias was assessed with an adapted version of the Newcastle-Ottawa Scale. Results: A total of 35 studies (26 providing data on CEA, 8 on CAS and 1 both CEA and CAS) were included, describing 256,033 CEA and 38,605 CAS procedures. For CEA, a decreased risk of procedural death or stroke for operations performed by vascular surgeons was found with pooled unadjusted relative risks of 0.63 (95% CI 0.46 to 0.86; 7 studies) compared to neurosurgeons, and 0.81 (95% CI 0.66 to 0.99; 6 studies) compared to general surgeons. For CAS, no significant differences in procedural outcomes were found comparing operator specializations. Conclusion: Some operator specializations were associated with a decreased risk of adverse procedural outcomes after CEA, but studies were at high risk of bias mainly due to confounding by indication. For CAS, the available data are too limited to draw valid conclusions. Based on the current available literature, there is insufficient evidence that CEA and CAS should be restricted to specific specialities. Disclosure: Nothing to disclose

Hybrid surgery for symptomatic chronic complete occlusion of the internal carotid artery: A case report

Currently, there are antiplatelet drugs, extracranial-intracranial (EC-IC) vascular bypass, carotid endarterectomy (CEA), endovascular intervention (EI), and other revascularization procedures for symptomatic chronic internal carotid artery occlusion (CICAO). In consulting the literature, we found that existing techniques for single treatments cannot achieve satisfactory results when there is a long segment occlusion with plaque attached to the intracranial segment and a short stump at the initial segment. We reported the case of a 50-year-old male patient with blurred vision, headache, and weakness in the right upper limb. After the exclusion of other neurological diseases, he was diagnosed with symptomatic CICAO; the occlusion segment was long and the stump was too short. We performed a novel hybrid surgery for the patient—a carotid endarterectomy combined with internal carotid artery stenting. After 6 months of follow-up, computed tomography angiography (CTA) confirmed that the left internal carotid artery was unobstructed, and the symptoms were relieved. A brief review of the literature is presented in addition to this report.

ATRİAL FİBRİLASYON NEDENİYLE KAROTİS ENDARTEREKTOMİSİ GEÇİREN HASTALARDA POSTOPERATİF ANTİKOAGÜLAN VE ANTİAGREGAN STRATEJİSİ - TEK MERKEZ TECRÜBESİ

<div><!--block-->Objective: Literature does not contain a standard procedure about anticoagulant therapy aimed at patients with atrial fibrillation and carotid artery stenosis following carotid endarterectomy. In this paper, we present our therapy modality at these patients in our clinic.&nbsp;<br><br>Material and Method: The study includes 424 patients and 498 carotid endarterectomy operations performed by two surgeons with the same technique between June 2010 and December 2017. Fourty-five patients had chronic or paroxysmal atrial fibrillation. Therefore, the patients were receiving Coumadin and aspirin. The median age was 63.4±7.9. There were 27 female and 18 male patients. Thirty seven patients were hypertensive and 17 patients were diabetic. Nine patients underwent bilateral carotid endarterectomy operations. Thirty three patients were symptomatic. Eleven patients had coronary artery disease and 5 patients had cardiac valvular pathologies.&nbsp;<br><br>Results: The whole carotid endarterectomy operations were performed under locoregional anesthesia. Early mortality occured in one patient because of hypertensive intracranial bleeding. The median follow up period was 68.4±19.2 months. One patient was lost due to aging and co-morbid factors and one patient was lost due to malignancy in late follow up period. Three patients required revisions for hematoma at incision region but an active bleeding focus could not be detected. There was no re-stenosis in any patient during follow-up.&nbsp;<br><br>Conclusion: The large and multi-centered studies are needed for the anticoagulant therapy protocol for the patients with atrial fibrillation following carotid endarterectomy. We prefer combination of warfarin, providing INR value between 2-3, and 100 mg aspirin per day at our patients as therapy modality.</div>

Timing of Carotid Endarterectomy for Symptomatic Carotid Stenosis: A Snapshot of Current Trends and Systematic Review of Literature on Changing Paradigm towards Early Surgery

Carotid revascularization has been recommended as the maximally beneficial treatment for stroke prevention in patients with recently symptomatic carotid stenosis (SCS). The appropriate timing for performing carotid endarterectomy (CEA) within the first 14 d after the occurrence of the index event remains controversial. We aim to provide a snapshot of the pertinent current literature related to the timing of CEA for patients with SCS. A systematic review of literature was conducted to study the timing of CEA for SCS. The guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) were followed. A total of 63 articles were identified as relevant to this topic. A summary of 15 articles favoring urgent CEA (within 48 h) for SCS within 48 h of index event and 9 articles not favoring urgent CEA is presented. A consensus is still to be achieved on the ideal timing of CEA for SCS within the 14-d window presently prescribed. The current literature suggests that patients who undergo urgent CEA (within 48 h) after nondisabling stroke as the index event have an increased periprocedural risk as compared to those who had transient ischemic attack (TIA) as the index event. Further prospective studies and clinical trials studying this question with separate groups classified as per the index event are required to shed more light on the subject. The current literature points to a changing paradigm towards early carotid surgery, specifically targeted within 48 h if the index event is TIA, and within 7 d if the index event is stroke.

Flow Cytometry-Based Characterization of Mast Cells in Human Atherosclerosis.

The presence of mast cells in human atherosclerotic plaques has been associated with adverse cardiovascular events. Mast cell activation, through the classical antigen sensitized-IgE binding to their characteristic Fcε-receptor, causes the release of their cytoplasmic granules. These granules are filled with neutral proteases such as tryptase, but also with histamine and pro-inflammatory mediators. Mast cells accumulate in high numbers within human atherosclerotic tissue, particularly in the shoulder region of the plaque. These findings are largely based on immunohistochemistry, which does not allow for the extensive characterization of these mast cells and of the local mast cell activation mechanisms. In this study, we thus aimed to develop a new flow-cytometry based methodology in order to analyze mast cells in human atherosclerosis. We enzymatically digested 22 human plaque samples, collected after femoral and carotid endarterectomy surgery, after which we prepared a single cell suspension for flow cytometry. We were able to identify a specific mast cell population expressing both CD117 and the FcεR, and observed that most of the intraplaque mast cells were activated based on their CD63 protein expression. Furthermore, most of the activated mast cells had IgE fragments bound on their surface, while another fraction showed IgE-independent activation. In conclusion, we are able to distinguish a clear mast cell population in human atherosclerotic plaques, and this study establishes a strong relationship between the presence of IgE and the activation of mast cells in advanced atherosclerosis. Our data pave the way for potential therapeutic intervention through targeting IgE-mediated actions in human atherosclerosis.

Preliminary application of one-step hybrid operation in the treatment of carotid artery occlusion

Objective: To evaluate the prognosis and surgical complication of the recanalization treatments for internal carotid artery (ICA) occlusion by using one-step hybrid carotid endarterectomy and endovascular surgery. Methods: Retrospective analysis was performed on the clinical data and follow-up data of 22 patients with occluded ICA treated by one-step hybrid surgery. Difference in Barthel score and occurrence of ischemic stroke were compared with surgical group and conventional group which was treated by oral taking anti-platelet drugs. Further, the complications were analyzed to evaluate the safety and effectiveness of the surgery. Results: The difference in ischemic event rate and Barthel scores improvement between the two groups were significant. Occlusive ICAs in 19 cases were recanalized successfully. The possibility of brain hyperperfusion related to the surgery was 10.5% (2/19) while the possibility of carotid artery cavernous fistula was 9.1% (2/22). We also observed rare dissecting ICA caused by the treatment (4.5%) and distal restenosis (5.3%). Conclusions: One-step hybrid carotid endarterectomy and endovascular surgery could help recanalize the ICA, improve the blood supply and improve the prognosis. It's a safe and effective treatment for ICA occlusion.

Indications for General versus Local Anesthesia during Carotid Endarterectomy.

Both general anesthesia (GA) and local anesthesia (LA) are used in our department for carotid endarterectomy. The decision of which anesthetic technique to use during surgery is made on an individual basis. The aim of our study was to analyze the reasons for using GA or LA. The reasons that led to the selection of either GA or LA were analyzed retrospectively in a group of 409 patients. GA was used in 304 patients (74%) and LA in 105 patients (26%). The reasons for a preference for GA were clopidogrel use (88 patients), patient preference (80), increased risk of shunt insertion (43), unfavorable anatomical conditions (41), surgeon preference (21), simultaneous carotid endarterectomy and cardiac surgery (18), emergent carotid endarterectomy (12), and sleep apnea syndrome (1). The reasons for selecting LA were internal comorbidities (46 patients), patient preference (39), unavailability of intraoperative electrophysiologic monitoring (15), and pacemaker (5). GA is the dominant choice for carotid endarterectomy in our department because of its prevailing benefits and its preference among neurosurgeons and patients. However, in some subgroups of patients, LA is preferable. An optimal approach is therefore an individual indication for both anesthesia techniques.

Clinical experience of carotid endarterectomy for the treatment of carotid stenosis

Objective To investigate the clinical outcomes and prognosis of carotid endarterectomy (CEA) for moderate to severe carotid stenosis. Method The clinical data of 78 patients with moderate or severe carotid stenosis treated with CEA from March 2015 to December 2017 at Department of Neurosurgery, the First Affiliated Hospital of Zhengzhou University (18 cases) and Department of Neurosurgery, General Hospital of Tianjin Medical University (60 cases) were retrospectively analyzed. There were 72 cases of symptomatic stenosis, 6 cases of asymptomatic stenosis. Among them, there were 66 cases of unilateral stenosis and 12 cases of bilateral stenosis. All patients were treated with standard CEA. There were 72 cases of unilateral CEA and 6 cases of bilateral CEA. A total of 84 CEA operations were performed. Results All operations were performed successfully. The clamping duration was 18.0 to 52.0 minutes, with an average of 28.0±4.2 minutes. During perioperative period, there were 3 new cases of cerebral infarction, including 1 case of massive cerebral infarction and 1 case of transient ischemic attack. The incidence of cerebral ischemic events was 4.8% (4/84). No intracranial hemorrhage or death occurred after operation. All patients were followed up for 6.0 to 38.0 months, with an average of 18.0±3.2 months. There were 4 (4.8%) cases of restenosis (stenosis degree ≥50%) after operation, including 2 cases of cerebral infarction, 1 case of transient ischemic attack and 1 asymptomatic case. Conclusions CEA is an effective treatment for moderate to severe carotid stenosis. Standardized perioperative management and operative procedures could help to reduce postoperative complications and achieve good clinical results. Key words: Endarterectomy, cartoid; Carotid stenosis; Atherosclerosis; Complication

The timing and surgical choice of surgical treatment for carotid stenosis after radiotherapy

Objective: To evaluate the safety and efficacy of carotid endarterectomy (CEA) and carotid angioplasty with stenting(CAS) for carotid artery stenosis after radiotherapy. Methods: The clinical data of 73 cases with carotid artery stenosis after radiotherapy from October 2007 to September 2017 were analyzed retrospectively. Among them, 36 cases underwent CEA and 37 cases underwent CAS. Results: No complications occurred during the perioperative period in both groups. During the follow-up period, transient cerebral ischemia occurred in 1 case in the CEA group. There was no in-stent restenosis or adverse events such as stroke or myocardial infarction. In the CAS group, transient cerebral ischemia occurred in 2 cases, postoperative restenosis occurred in 2 cases, and myocardial infarction occurred in 1 case. The restenosis rate and incidence of adverse events were lower in the CEA group. Conclusions: Both surgical methods are safe and effective in the treatment of carotid artery stenosis after radiotherapy. CEA surgery can be more beneficial to long-term outcome, and it is supposed to be the preferred surgical method.

The effect of cerebral oximeter use on the shunt placement concerning carotid endarterectomy surgery

Background:During carotid arterial endarterectomy (CAE) surgery, an intraluminal shunt is used to prevent hypoperfusion, which can be caused by a cross-clamping cerebral ischemia. However, routine shunt use is not recommended. Various cerebral monitoring techniques are used to determine the need for shunt placement. In this study, retrospective analysis of data on the efficacy of cerebral oximetry in the decision of shunt use during elective CAE surveys was planned.Materials and Methods:We collected data on 68 patients operated under general anesthesia between December 2016 and December 2017. Patients were evaluated for near infrared spectrometry (NIRS) and stump pressure values and whether shunt was placed or not.Results:Eight (11.7%) patients were shunting. NIRS value after cross-clamping was lower in patients with shunt. Stump pressure values were below 40 mmHg.Conclusions:Cerebral monitoring in elective CAE operations has great importance in determining the necessity of using intraluminal shunt to reduce the complications that may occur.