Clinical Outcomes of Carotid Endarterectomy in Symptomatic and Asymptomatic Patients with Ipsilateral Intracranial Stenosis

Ballotta, Enzo; Toniato, Antonio; Roit, Anna Da; Baracchini, Claudio

doi:10.1007/s00268-015-3165-7

Cited by 5 publications

(5 citation statements)

References 48 publications

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“…Our results were similar to that of few other studies in Asian countries, where the predominant presentation was with a stroke [12–14, 19]. This is in contrast to the Western world wherein more than 50% of patients undergo CEA after a hemispheric or a retinal TIA [8–11].…”

Section: Discussionsupporting

confidence: 89%

“…An analysis from the NASCET cohort reported that the benefit of CEA was less certain in those with severe intracranial atherosclerosis in view of smaller numbers [22]. Our results were similar to a large single-center Italian study that reported no difference in the occurrence of perioperative events among those with and without coexistent tandem intracranial atherosclerosis, who underwent CEA [11]. The presence of a proximal lesion may overestimate a distal lesion due to reduced flow.…”

Section: Discussionsupporting

confidence: 79%

“…However, randomized controlled trials (RCTs) include large volume centers with highly specialized surgeons and their results may not be replicable in all patient populations. While the majority of patients in the Western world undergo CEA even after a transient ischemic attack (TIA) [8][9][10][11], it is the reverse in low-and middle-income countries where CEA is done most often after a stroke [12][13][14] and tends to be delayed compared to the guideline recommended timing within 2 weeks. In this background, the application of these guidelines in low-and middle-income countries requires an understanding of the profile of patients who undergo carotid revascularization.…”

Section: Introductionmentioning

confidence: 99%

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Carotid Endarterectomy for Symptomatic Carotid Stenosis: Differences in Patient Profile in a Low-Middle-Income Country

Paramasivan

Sylaja

Pitchai

et al. 2022

Cerebrovasc Dis Extra

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Introduction: Carotid Endarterectomy (CEA) is the standard treatment for patients with symptomatic carotid stenosis. Data from Low- and Middle-Income Countries (LMIC) is sparse on CEA and its outcomes. We aimed to describe the profile of our patients, and factors associated with periprocedural cerebral ischemic events in patients with symptomatic carotid stenosis who underwent CEA in our institute. Methods: Retrospective review of patients with symptomatic carotid stenosis(50-99%) who underwent CEA between January 2011 and December 2021 was done. Clinical and imaging parameters and their influence on periprocedural cerebral ischemic events were analysed. Results: Of the 319 patients (77% males) with a mean age of 64 years (SD ±8.6), 207 (65%) presented only after a stroke. Majority (85%) had high grade stenosis (70%) of the symptomatic carotid. The mean time to CEA was 50 days (SD ±36), however only 26 patients (8.2%) underwent surgery within 2 weeks. Minor strokes and TIA occurred in 2.2%, while major strokes and death occurred in 4.1% patients. None of the clinical or imaging parameters predicted the periprocedural cerebral ischemic events. The presence of co-existing significant (50%) tandem intracranial atherosclerosis (n=77, 24%) or contralateral occlusion (n=24, 7.5%) did not influence the periprocedural stroke risk. Conclusion: There is a delay in patients undergoing CEA for symptomatic carotid stenosis. Majority have high grade stenosis and present late only after a stroke reflecting a lack of awareness. CEA can be performed safely even in patients with significant intracranial tandem stenosis and contralateral carotid occlusion.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 79%

Section: Introductionmentioning

confidence: 99%

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Carotid Endarterectomy for Symptomatic Carotid Stenosis: Differences in Patient Profile in a Low-Middle-Income Country

Paramasivan

Sylaja

Pitchai

et al. 2022

Cerebrovasc Dis Extra

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“…The previous study showed that patients with intracranial lesions benefit less from endarterectomy during oneyear follow-up period [13]. Other study demonstrated that patients with and without carotid tandem lesion who underwent CEA had similar rates of stroke and death [14][15]. Ballotta et al [14] analyzed 1,143 patients who underwent CEA.…”

Section: Discussionmentioning

confidence: 99%

“…Other study demonstrated that patients with and without carotid tandem lesion who underwent CEA had similar rates of stroke and death [14][15]. Ballotta et al [14] analyzed 1,143 patients who underwent CEA. Their results showed no significant perioperative ipsilateral strokes difference between those patients with (0.9 %) and without (0.5 %) carotid tandem lesion (P = 0.62).…”

Section: Discussionmentioning

confidence: 99%

Decreased Cerebral Flow Velocities from General Anesthesia are Not Associated with Cerebral Hyperperfusion Syndrome

Yumei,

Yang,

Yabing

et al. 2023

Advanced Ultrasound in Diagnosis and Therapy

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Objective: General anesthesia (GA) can decrease cerebral flow velocities and predispose patients to cerebral hyperperfusion syndrome (CHS) and other perioperative adverse events after carotid endarterectomy (CEA). The aim of this study was to investigate whether decreased pre-operative flow velocity is associated with an increased risk of CHS and perioperative cerebral infarct, and to further identify risk factors if there is any. Methods:We retrospectively evaluated 920 consecutive patients who received CEA from 2010 to 2020 at a major academic hospital in China. Middle cerebral artery (MCA) blood flow velocities were measured before and after induction of the GA by transcranial Doppler (TCD). Patients were classified into two groups: the NORMAL group if flow velocity decreased < 30% and the LOW group if flow velocity decreased ≥30%. The ultrasonographic diagnostic criterion of CHS was defined as the 100% increase in flow velocity by TCD from the baseline to post-CEA. The occurrence of CHS, perioperative cerebral infarction was compared between the two groups.Results: 399 (43.4%) were classified as LOW measurement, and 521 (56.6%) patients were classified as NORMAL measurement. In the LOW group, there were more patients with diabetes, fewer patients with ipsilateral ICA severe stenosis and the opening of anterior/posterior communicating artery. Although the occurrence of CHS per ultrasonography criteria was higher in the LOW group (21.3% vs 15.7%, P = 0.03), the occurrence of CHS per clinical criteria (3.2%, vs 2.1%, P = 0.28) or the perioperative cerebral infarct between the two groups (5.8% vs 5.0%, P = 0.60) is equivalent. Conclusion:Patients with decreased flow velocities post-GA were more likely to meet the ultrasonography criteria for CHS, but they are not at risk of developing clinical CHS or perioperative cerebral infarct.

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Vigencia de la endarterectomía carotídea para el tratamiento de estenosis asintomática en la era de las estatinas

Marine

2016

Angiología

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Clinical Outcomes of Carotid Endarterectomy in Symptomatic and Asymptomatic Patients with Ipsilateral Intracranial Stenosis

Cited by 5 publications

References 48 publications

Carotid Endarterectomy for Symptomatic Carotid Stenosis: Differences in Patient Profile in a Low-Middle-Income Country

Carotid Endarterectomy for Symptomatic Carotid Stenosis: Differences in Patient Profile in a Low-Middle-Income Country

Decreased Cerebral Flow Velocities from General Anesthesia are Not Associated with Cerebral Hyperperfusion Syndrome

Vigencia de la endarterectomía carotídea para el tratamiento de estenosis asintomática en la era de las estatinas

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