Thirty-day Outcome of Delayed Versus Early Management of Symptomatic Carotid Stenosis

Charmoille, Emilie; Brizzi, Vincenzo; Lepidi, Sandro; Sassoust, G.; Roullet, Stéphanie; Ducasse, Éric; Midy, D.; Bérard, Xavier

doi:10.1016/j.avsg.2015.01.013

Cited by 8 publications

(2 citation statements)

References 46 publications

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“…В работе E. Charmoille и соавт. [16] проанализированы результаты ранней (1-14 сут, в среднем 9,3 сут) и отсроченной (более 14 дней) КЭЭ у пациентов с симптомными стенозами. Тридцатидневный показатель «инсульт+летальность» в группе ранней реконструкции ВСА составил 1,7% против 3,5% в группе отсроченной КЭЭ, в те же сроки по- Анализ результатов хирургического лечения пациентов, оперированных в сроки до 20 сут от момента ишемического события, продемонстрирован в работе A. Ivkošić и соавт.…”

Section: результаты и обсуждениеunclassified

Early reconstruction of supra-aortic vessels as a prevention of recurrent ischemic stroke

Хрипун

Salikov

Pryamikov

et al. 2016

Khir. Z. im. N.I. Pirogova

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Early surgical prevention of recurrent stroke (up to 7 days) can be performed effectively and safely in carefully selected patients with ischemic stroke (neurological deficit less than 3 Rankin scores and less than 7 NIHSS scores, ischemic lesion dimensions lass than 4 cm). Reconstruction of supra-aortic vessels in acute stage of stroke improves the neurological status and reduces the degree of motor and sensory disorders. However, currently there are no clear criteria for inclusion and exclusion of patients for early revascularization using both degree of neurological deficit and size of ischemic lesion. So our results need to be confirmed by large trials.

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Section: результаты и обсуждениеunclassified

Early reconstruction of supra-aortic vessels as a prevention of recurrent ischemic stroke

Хрипун

Salikov

Pryamikov

et al. 2016

Khir. Z. im. N.I. Pirogova

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“…More recent trials show that carotid revascularization performed within 15 days after symptom onset versus delayed CEA in symptomatic patients have no difference in outcomes. 48 A 2009 systematic review showed that the rate of perioperative stroke or mortality is significantly higher in emergent CEA (14.0%) compared with nonemergent CEA (4.0%). 49 Studies suggest that urgent CEA can be safely performed in symptomatic patients to improve neurologic outcome 50 without increased procedural risk, 51 although the poorest outcomes occur in patients with an evolving stroke, and urgent CEA should be offered with caution in these patients, 52 and can perhaps be offered within 48 hours after TIA or SIE to prevent recurrent stroke.…”

Section: Symptomatic Carotid Artery Stenosismentioning

confidence: 99%

Carotid Endarterectomy: Current Concepts and Practice Patterns

Saha

2015

Int J Angiol

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Background Stroke is the number one cause of disability and third leading cause of death among adults in the United States. A major cause of stroke is carotid artery stenosis (CAS) caused by atherosclerotic plaques. Randomized trials have varying results regarding the equivalence and perioperative complication rates of stents versus carotid endarterectomy (CEA) in the management of CAS. Objectives We review the evidence for the current management of CAS and describe the current concepts and practice patterns of CEA. Methods A literature search was conducted using PubMed to identify relevant studies regarding CEA and stenting for the management of CAS. Results The introduction of CAS has led to a decrease in the percentage of CEA and an increase in the number of CAS procedures performed in the context of all revascularization procedures. However, the efficacy of stents in patients with symptomatic CAS remains unclear because of varying results among randomized trials, but the perioperative complication rates exceed those found after CEA. Conclusions Vascular surgeons are uniquely positioned to treat carotid artery disease through medical therapy, CEA, and stenting. Although data from randomized trials differ, it is important for surgeons to make clinical decisions based on the patient. We believe that CAS can be adopted with low complication rate in a selected subgroup of patients, but CEA should remain the standard of care. This current evidence should be incorporated into practice of the modern vascular surgeon.

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Symptomatic Carotid Artery Stenosis: Surgery, Stenting, or Medical Therapy?

Wabnitz

Turan

2017

Curr Treat Options Cardio Med

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Opinion statementSymptomatic carotid artery disease is a significant cause of ischemic stroke, and these patients are at high risk for recurrent vascular events. Patients with symptoms of stroke or transient ischemic attack attributable to a significantly stenotic vessel (70–99% luminal narrowing) should be treated with intensive medical therapy. Intensive medical therapy is a combination of pharmacologic and lifestyle interventions consistent with best-known practices as follows: initiation of antiplatelet agent or anticoagulation if medically indicated, high potency statin medication, blood pressure control with goal blood pressure of greater than 140/90, Mediterranean-style diet, exercise, and smoking cessation. Further, patients who have extracranial culprit lesions should be considered for revascularization with either carotid endarterectomy or carotid angioplasty and stenting depending on several factors including the patient’s anatomy, age, gender, and procedural risk. Based on current evidence, patients with symptomatic intracranial stenosis should be managed with intensive medical therapy, including the use of dual antiplatelet therapy with aspirin and clopidogrel for the first 90 days following the ischemic event. While the literature has shown a stronger benefit of revascularization of extracranial symptomatic disease among certain subgroups of patients with greater than 70% stenosis, there is less benefit from revascularization with endarterectomy in patients with moderate stenosis of 50–69% if the surgeon’s risk of perioperative stroke or death rate is greater than 6%.

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Thirty-day Outcome of Delayed Versus Early Management of Symptomatic Carotid Stenosis

Abstract: During the study period, the reduction of the symptom-to-knife time in application to the carotid revascularization guidelines did not impact our outcomes suggesting that early CEA achieves 30-day mortality and morbidity rates at least equivalent to those of delayed CEA.

Cited by 8 publications

References 46 publications

Early reconstruction of supra-aortic vessels as a prevention of recurrent ischemic stroke

Early reconstruction of supra-aortic vessels as a prevention of recurrent ischemic stroke

Carotid Endarterectomy: Current Concepts and Practice Patterns

Symptomatic Carotid Artery Stenosis: Surgery, Stenting, or Medical Therapy?

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