Guidelines for Carotid Endarterectomy

Biller, José; Feinberg, William M.; Castaldo, John; Whittemore, A. D.; Harbaugh, Robert E.; Dempsey, Robert J.; Caplan, Louis R.; Kresowik, Timothy F.; Matchar, David B.; Toole, James F.; Easton, J. Donald; Adams, Harold P.; Brass, Lawrence M.; Hobson, Robert W.; Brott, Thomas G.; Sternau, Linda

doi:10.1161/01.str.29.2.554

Cited by 343 publications

(29 citation statements)

References 81 publications

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“…11 Preoperative evaluation included ultrasound assessment of plaque density and presence of ulceration. Carotid endarterectomies were performed by standard eversion technique.…”

Section: Methodsmentioning

confidence: 99%

“…8 -10 Internal carotid artery (ICA) stenosis has been recognized as a major cause of stroke, and carotid endarterectomy has been validated by several large trials as effective in prevention of stroke secondary to severe ICA stenosis. [11][12][13][14][15][16] Interactions within the ICA stenosing plaque between connective tissue and the cells embedded in the fibrous cap overlying the inner core filled with lipids and necrotic debris appear to determine the history of the ICA stenosis, including complications that are recognized cause of stroke, such as plaque rupture or ulceration, intraplaque hemorrhage, and luminal thrombosis. 17,18 The aim of this study was to investigate whether the MMP-3 and/or the MMP-1 promoter polymorphisms are associated with the presence of severe ICA stenosis in patients subjected to carotid endarterectomy.…”

mentioning

confidence: 99%

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Matrix Metalloproteinase-1 and Matrix Metalloproteinase-3 Gene Promoter Polymorphisms Are Associated With Carotid Artery Stenosis

Ghilardi

Biondi

DeMonti

et al. 2002

Stroke

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Background and Purpose-The matrix metalloproteinases (MMPs) are a family of enzymes that are important in the resorption of extracellular matrix and are involved in atherogenesis. Recently, 2 common polymorphisms on MMP-1 (1G/2G) and MMP-3 (5A/6A) gene promoters have been described. The aim of this study was to investigate a possible association between MMP polymorphisms and increased risk of internal carotid artery (ICA) stenosis. Methods-We studied 91 patients consecutively recruited for ICA stenosis who had undergone carotid endarterectomy and 133 subjects without ICA stenosis (controls). Polymorphic genotypes were determined by polymerase chain reaction and sequencing analysis.

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“…11 Preoperative evaluation included ultrasound assessment of plaque density and presence of ulceration. Carotid endarterectomies were performed by standard eversion technique.…”

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

Matrix Metalloproteinase-1 and Matrix Metalloproteinase-3 Gene Promoter Polymorphisms Are Associated With Carotid Artery Stenosis

Ghilardi

Biondi

DeMonti

et al. 2002

Stroke

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“…The indication for endarterectomy was based on clinical and radiological criteria as recommended by guidelines for carotid endarterectomy. 12,13 An ICA stenosis Ͼ70% was considered a surgical indication in symptomatic and asymptomatic patients; in selected symptomatic patients, a surgical approach was proposed in patients with stenosis Ͼ50%. The endovascular treatment was performed in patients with a stenosis Ͼ70% who could not be submitted to a surgical procedure because of a poor general condition.…”

Section: Contrast-enhanced Magnetic Resonance Angiographymentioning

confidence: 99%

Contrast-Enhanced Three-Dimensional Magnetic Resonance Angiography of Atherosclerotic Internal Carotid Stenosis as the Noninvasive Imaging Modality in Revascularization Decision Making

Cosottini

Pingitore

Puglioli

et al. 2003

Stroke

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Background and Purpose-In patients with severe internal carotid artery stenoses, thromboendarterectomy significantly reduces both ischemic stroke and the risk of more ischemic attacks. Digital subtraction angiography (DSA) is the accepted preoperative test to determine whether a high-grade stenosis is present and requires surgical therapy. However, DSA has a procedural risk of stroke between 0.7% and 1%. An accurate, noninvasive imaging protocol with no risk of severe complications would significantly increase the benefit of surgical treatment. The aims of the study were (1) to evaluate the diagnostic accuracy of contrast-enhanced magnetic resonance angiography (CEMRA) in detecting and grading internal carotid artery stenoses and (2) to assess the misclassification rate of vessels suitable for revascularization by CEMRA. Methods-Ninety-two patients with sonographic evidence of neck vessel stenosis were enrolled in the study. All patients were submitted to CEMRA and DSA. CEMRA images were evaluated for the presence of mild, moderate, or severe stenosis and occlusion. Results-Sensitivity, specificity, and diagnostic accuracy were 97%, 82%, and 92.5%, respectively. Agreement with DSA was optimal at ϭ0.87. The misclassification rate of CEMRA was 3.1% because of its tendency to overestimate the stenosis. Conclusions-The high diagnostic accuracy and limited misclassification rate suggest that CEMRA can be considered a powerful tool for the preoperative, noninvasive evaluation of atherosclerotic pathology of carotid arteries.

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“…Thus the margin of success of CE in asymptomatic ICA stenosis is much narrower than for those with symptomatic ICA stenosis and largely depends on the ability to keep surgical complications rates exceptionally low (<3%). The AHA [37]has recently published guidelines for CE, particularly in asymptomatic patients. AHA [37]recommends CE in asymptomatic ICA stenosis in the following conditions: proven indications for stenotic lesions ≥60% diameter reduction for patients with a surgical risk <3% and life expectancy of at least 5 years, whereas they recommend acceptable but not proven indications for ICA stenosis ≥75% concerning patients with a surgical risk of 3–5%.…”

Section: Surgical Preventionmentioning

confidence: 99%

“…The AHA [37]has recently published guidelines for CE, particularly in asymptomatic patients. AHA [37]recommends CE in asymptomatic ICA stenosis in the following conditions: proven indications for stenotic lesions ≥60% diameter reduction for patients with a surgical risk <3% and life expectancy of at least 5 years, whereas they recommend acceptable but not proven indications for ICA stenosis ≥75% concerning patients with a surgical risk of 3–5%. The intervention is justified if the patient has a probability of survival more than 5 years and if we dispose of a good surgical center (mortality-stroke morbidity <3%), and the stenosis is ≥60% [37].…”

Section: Surgical Preventionmentioning

confidence: 99%