The results of this trial support the contention that carotid stenting of short ICA lesions can be performed with a low neurological complication rate.
Background: The effectiveness of carotid endarterectomy (CEA) for stroke prevention depends on low procedural risks. The aim of this study was to assess the frequency and timing of procedural complications after CEA, which may clarify underlying mechanisms and help inform safe discharge policies. Methods: Individual-patient data were obtained from four large carotid intervention trials (VACS, ACAS, ACST-1 and GALA; 1983-2007). Patients undergoing CEA for asymptomatic carotid artery stenosis directly after randomization were used for the present analysis. Timing of procedural death and stroke was divided into intraoperative day 0, postoperative day 0, days 1-3 and days 4-30. Results: Some 3694 patients were included in the analysis. A total of 103 patients (2⋅8 per cent) had serious procedural complications (18 fatal strokes, 68 non-fatal strokes, 11 fatal myocardial infarctions and 6 deaths from other causes) [Correction added on 20 April, after first online publication: the percentage value has been corrected to 2⋅8]. Of the 86 strokes, 67 (78 per cent) were ipsilateral, 17 (20 per cent) were contralateral and two (2 per cent) were vertebrobasilar. Forty-five strokes (52 per cent) were ischaemic, nine (10 per cent) haemorrhagic, and stroke subtype was not determined in 32 patients (37 per cent). Half of the strokes happened on the day of CEA. Of all serious complications recorded, 44 (42⋅7 per cent) occurred on day 0 (20 intraoperative, 17 postoperative, 7 with unclear timing), 23 (22⋅3 per cent) on days 1-3 and 36 (35⋅0 per cent) on days 4-30.Conclusion: At least half of the procedural strokes in this study were ischaemic and ipsilateral to the treated artery. Half of all procedural complications occurred on the day of surgery, but one-third after day 3 when many patients had been discharged.
We report on a case of thickenings of the distal thoracic aorta in a young woman with hypertension. There were no associated vascular lesions or any evidence of an inflammatory process. The intima combined with a normal media was assessed by histopathology. These findings would strongly indicate a congenital origin of the disease. Blood supply to the spinal cord was studied preoperatively by selective angiography of intercostal and lumbar arteries. A simple endarteriotomy and a Dacron patch enabled normalization of the blood pressure. The etiological problems in pulseless disease are discussed as well as means of therapy.
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