Sequential morphological changes at the site of carotid endarterectomy

French, Barry N.; Rewcastle, N. B.

doi:10.3171/jns.1974.41.6.0745

Cited by 47 publications

(9 citation statements)

References 14 publications

(3 reference statements)

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“…13,17 In histological postmortem investigations, French and Rewcastle showed the site of the carotid endarterectomy to actually be covered by a thrombotic layer in the early phase and a neointimal layer thereafter. 18 As a result, the substrate of the sonographic soft layer at the site of a recent thromboendoarterectomy may correspond with the thrombotic layer that has been documented histologically in postmortem specimens. Furthermore, the histological and immunohistochemical findings of Komatsu et al.…”

Section: Discussionmentioning

confidence: 92%

In-stent hypodense area at two weeks following carotid artery stenting predicts neointimal hyperplasia after two years

et al. 2017

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Introduction It has not been reported how long the follow-up study after carotid artery stenting (CAS) should be continued. The purpose of the present study is to clarify the dynamic change of the in-stent neointimal layer and residual arterial lumen by two years following CAS using three-dimensional computed tomography angiography (3D CTA) with volume rendering. Methods Thirty-six stented carotid arteries in 34 consecutive patients were examined by 3D CTA with volume rendering at two weeks and 3, 6, 12, 24 months of follow-up. Results An in-stent hypodense area could be detected in 10 of 36 (27.8%) carotid arteries at two weeks after CAS. In-stent hypodense areas gradually declined thereafter by three months. In the course of longer follow-up, the layer of the in-stent hypodense area (neointimal hyperplasia) continued to grow in size for up to 24 months. Patients with an in-stent hypodense area at two weeks have a thicker layer of neointimal hyperplasia at 24 months than patients without in-stent hypodense area at two weeks' follow-up. The predictive factors for growing neointimal hyperplasia at 24 months in multiple regression analysis are ulcer formation in pretreatment stenosis and the thickness of in-stent hypodense area at two weeks following CAS. Conclusion Our results suggest that follow-up study should be continued for a longer period even if in-stent restenosis could not be detected at one year following CAS. Especially in cases with ulcer formation in pretreatment stenosis and with a subacute in-stent hypodense area after CAS, longer follow-up is strongly recommended.

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Section: Discussionmentioning

confidence: 92%

In-stent hypodense area at two weeks following carotid artery stenting predicts neointimal hyperplasia after two years

et al. 2017

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“…In humans, there are fewer data, but the sequence of events appears similar. 13 Our finding of a uniform decrease in platelet deposition in all patients studied late (0.5-24 months) after endarterectomy suggests that resolution of early mural thrombus occurs. This phenomenon has not been described previously in humans.…”

Section: Discussionmentioning

confidence: 61%

Platelet deposition at carotid endarterectomy sites in humans.

Stratton¹,

Zierler²,

Kazmers³

1987

Stroke

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Following carotid endarterectomy, early postoperative thrombosis or late restenosis occurs in up to 20% of vessels. Both complications may be related to platelet mechanisms. To assess platelet deposition at endarterectomy sites, we injected indium-Ill labelled platelets in 24 men <30 minutes after carotid endarterectomy, with subsequent imaging 24-96 hours later. To determine if deposition decreased over time, 12 patients had follow-up studies 0.5-24 months later. For comparison, 2 control groups were studied: 1) patients with noncarotid surgery (n = 6) and 2) normal young subjects without endarterectomy and without evidence of carotid disease (n = 12). Quantitative analysis was performed using a deposition index that compared activity in operated with unoperated sites in surgical patients or activity in the right with left carotid arteries in normal subjects. Patients with recent endarterectomy had a mean deposition index of 1.7 ± 0.5 (range 1.2-3.5) compared with a similarly determined ratio of 1.1 ± 0.1 in normal subjects and 1.2 ± 0.1 in the surgical controls (both p 2 0.05 vs. acute endarterectomy). At follow-up after endarterectomy, the mean deposition index decreased to 1.0 ± 0.1, documenting reduced platelet deposition over time. We conclude that the arterial injury of carotid endarterectomy results in early platelet deposition, which is no longer present in most patients who are studied late. These findings suggest a reduction in platelet thrombus formation with time and are compatible with reendothelialization of the endarterectomized surface. This model may be useful for the in vivo assessment of therapies designed to reduce platelet accumulation following endothelial injury in humans. (Stroke 1987;18:722-727) C arotid endarterectomy involves the removal of atherosclerotic plaque with resulting exposure of a relatively large area (approximately 4-12 cm 2 ) of underlying medial collagen and adventitia. Two complications that may be related to platelet mechanisms can occur. First, early thrombotic occlusion develops in approximately 2% of vessels.12 A second complication is late recurrent stenosis, which may be related to platelet release of factors that cause smooth muscle cell proliferation.3 Recurrent carotid stenosis following endarterectomy occurs relatively frequently (9-18%).4 " 8The purpose of this study was to assess platelet deposition early and late following carotid endarterectomy in humans using indium-Ill platelet imaging. Normal subjects without surgery, as well as subjects with surgery but no endarterectomy, served as controls. Subjects and Methods PatientsTwenty-four male patients, aged 47-82 years, underwent carotid endarterectomy for focal neurologic

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“…5 Spasm can occur in any medium-sized artery, usually in response to intraluminal insertion of instruments by stretching of the wall through increased intraluminal pres¬ sure, or through such external forces as trauma or rough operative manipulation.1011 The myogenic reflex does not depend on innervation, and it has been known since Hunter's era that such spasm can last for several days.12 Spasm, once initiated, may extend considerably beyond the point of stimulation.13 Carotid spasm has been documented most often after blunt trauma to the neck, where it has been associated with late neurologic deficits and has been noted to last several days.11 Postendarterectomy spasm has been mentioned only rarely, and was often considered to be of little significance.9 Usually, a cause for the occlusion cannot be demon¬ strated at the time of reoperation or autopsy.…”

Section: Commentmentioning

confidence: 99%

Carotid Artery Spasm

Lye¹

1982

Arch Surg

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Sequential morphological changes at the site of carotid endarterectomy

Cited by 47 publications

References 14 publications

In-stent hypodense area at two weeks following carotid artery stenting predicts neointimal hyperplasia after two years

In-stent hypodense area at two weeks following carotid artery stenting predicts neointimal hyperplasia after two years

Platelet deposition at carotid endarterectomy sites in humans.

Carotid Artery Spasm

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