Treatment Option For Carotid Stenosis Research Articles

General Versus Nongeneral Anesthesia for Carotid Endarterectomy: A Prospective Multicenter Registry-Based Study on 25 000 Patients.

Carotid endarterectomy (CEA) is a well-established treatment option for carotid stenosis. The choice between general anesthesia (GA) and nongeneral anesthesia (non-GA) during CEA remains a subject of debate, with concerns regarding perioperative complications, particularly myocardial infarctions. This study aimed to evaluate the outcomes associated with GA vs non-GA CEA using a large, nationwide database. The National Surgical Quality Improvement Project database was queried for patients undergoing CEA between 2013 and 2020. Primary outcome measures including surgical outcomes and 30-day postoperative complications were compared between the 2 anesthesia methods, after 2:1 propensity score matching. After propensity score matching, a total of 25 356 patients (16 904 in the GA and 8452 in the non-GA group) were included. Non-GA compared with GA CEA was associated with significantly shorter operative times (101.9, 95% CI: 100.5-103.3 vs 115.8 95% CI: 114.4-117.2 minutes, P < .001), reduced length of hospital stays (2.3, 95% CI: 2.15-2.4 vs 2.5, 95% CI: 2.4-2.6 days, P < .001), and lower rates of 30-day postoperative complications, including myocardial infarctions (0.8% vs 1.2%, P = .003), unplanned intubations (0.8% vs 1.1%, P = .016), pneumonia (0.5% vs 1%, P < .001), and urinary tract infections (0.4% vs 0.7%, P = .003). These outcomes were notably more pronounced in the younger (≤70 years) and high morbidity (American Society of Anesthesiologists 3-5) cohorts. In this nationwide registry-based study, non-GA CEA was associated with better short-term outcomes in terms of perioperative complications, compared with GA CEA. The findings suggest that non-GA CEA may be a safer alternative, especially in younger patients and those with more comorbidities.

The clinical application of a scoring protocol to select endarterectomy or stenting for carotid artery stenosis

Previously we described the protocol-based decision for choosing the proper surgical treatment option for carotid stenosis. The objective of this study is to describe our experiences of using this scoring protocol in the selection of endarterectomy or stenting for carotid stenosis. Between October 2014 and March 2018, the scoring protocol was applied to a total of 105 consecutive patients. Eighty (76.2%) patients had symptomatic stenosis ≥ 50%, and 25 (23.8%) patients had asymptomatic stenosis ≥ 80%. We also speculated about how effectively the protocol worked in the real clinical setting. Stenting was performed in 73 patients and endarterectomy in 32 patients. Overall, 98 (93.3%) patients were treated according to the protocol, while the protocol was violated in seven (6.7%) patients. Sixty-one (58.1%) patients received treatments that were decided by the protocol. There were 37 (35.2%) patients who had the same score for both treatment options. Among these patients, 28 patients underwent stenting and nine patients underwent endarterectomy. In the stenting cases, 90.4% of the patients followed the protocol and violations occurred in 9.6%. In the endarterectomy cases, all of the patients followed the protocol. Overall, one patient had a procedure-related complication without morbidity. During the 12-month follow-ups, there were no restenoses or major strokes. Minor strokes were diagnosed in three (2.8%) patients. In patients with carotid artery stenosis, stenting and endarterectomy should be considered simultaneously together, not against each other. Our scoring protocol can be used to weigh these options and applied in clinical practice.

Carotid Artery Stenting

In addition to medical therapy and carotid endarterectomy (CEA), carotid artery stenting (CAS) is a treatment option for carotid stenosis. Multi-centered clinical trials showed that CAS has a similar composite outcome of stroke, death, and MI to CEA. However, CAS has a higher stroke complication than CEA. Although controversy remains regarding appropriate patient selection for CAS, consensus is that CAS is a good option in patients who need an intervention and are at high risk for endarterectomy. New technology, techniques, and treatments continue to develop with resultant controversy and slow changes in practice. Although long-term follow-up is still needed. current data showed Transcarotid Carotid Revascularization (TCAR) has similar perioperative stroke risk compared to CEA, suggesting TCAR is a promising technique for CAS. This review 11 figures, 3 tables, and 36 references. Key Words: carotid artery angiogram, carotid artery stenting, carotid endarterectomy, Carotid Revascularization Endarterectomy versus Stenting Trial, cerebrovascular disease, transcarotid artery revascularization

Carotid Artery Stenting

In addition to medical therapy and carotid endarterectomy (CEA), carotid artery stenting (CAS) is a treatment option for carotid stenosis. Multi-centered clinical trials showed that CAS has a similar composite outcome of stroke, death, and MI to CEA. However, CAS has a higher stroke complication than CEA. Although controversy remains regarding appropriate patient selection for CAS, consensus is that CAS is a good option in patients who need an intervention and are at high risk for endarterectomy. New technology, techniques, and treatments continue to develop with resultant controversy and slow changes in practice. Although long-term follow-up is still needed. current data showed Transcarotid Carotid Revascularization (TCAR) has similar perioperative stroke risk compared to CEA, suggesting TCAR is a promising technique for CAS. This review 11 figures, 3 tables, and 36 references. Key Words: carotid artery angiogram, carotid artery stenting, carotid endarterectomy, Carotid Revascularization Endarterectomy versus Stenting Trial, cerebrovascular disease, transcarotid artery revascularization

Flow Reversal for Cerebral Protection in Carotid Artery Stenting: A Review

Carotid artery stenting has established itself as a valid treatment option for carotid stenosis. Many neuroprotective devices have been developed to minimize the risk of embolic events and stroke. Of the devices available today, flow reversal is unique in its conceptual similarity to carotid endarterectomy shunting techniques that maintain cerebral flow. This review focuses on the technical aspects, results, advantages, and disadvantages of carotid flow reversal for embolic protection during carotid artery stenting.