Carotid endarterectomy for symptomatic, but 'haemodynamically insignificant' carotid stenosis
| Autor: | Virginia Makeham, John P. Harris, Gabor Michael Halmagyi, Rebekah M. Ahmed, Craig S. Anderson |
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| Rok vydání: | 2010 |
| Předmět: |
Adult
Diagnostic Imaging Male medicine.medical_specialty medicine.medical_treatment Infarction Carotid endarterectomy Stroke risk Postoperative Complications Risk Factors Internal medicine medicine Humans Carotid Stenosis cardiovascular diseases Stroke Aged Retrospective Studies Medicine(all) Aged 80 and over Retrospective review Endarterectomy Carotid business.industry Hemodynamics Plaque morphology Insignificant stenosis Middle Aged equipment and supplies medicine.disease Stenosis Catheter surgical procedures operative Catheter angiography Cardiology Surgery Female Radiology business Cardiology and Cardiovascular Medicine Follow-Up Studies |
| Zdroj: | European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery. 40(4) |
| ISSN: | 1532-2165 |
| Popis: | Objective Carotid endarterectomy (CEA) guidelines in symptomatic carotid stenosis are based on NASCET and ECST criteria with 70% or greater carotid stenosis as estimated from a catheter angiogram the major indication. This has several problems: (1) lack of reliable correlation between non-invasive imaging and catheter angiography, which has been largely superseded by non-invasive imaging in investigating carotid stenosis; (2) errors inherent in estimating the degree of stenosis from catheter angiography; (3) disregard for the fact that stroke risk also depends on plaque stability, and number of ischaemic events. Methods A retrospective review of ischaemic events, imaging results, operative findings, surgical complications and stroke-free follow-up in 31 patients presenting over a 23 year period with TIA/stroke (symptoms lasting > 24 h and/or imaging evidence of infarction) who had 70% or less carotid stenosis (on non-invasive imaging), but nonetheless underwent CEA. Results Nineteen patients had small strokes, 7 had TIAs and 5 had ocular events; 28 patients had features of unstable plaque on imaging; 19 patients experienced multiple events before CEA. All had haemorrhagic, ruptured plaque at CEA. One patient suffered an intra-operative stroke, only 1 patient suffered a further stroke/TIA (mean follow-up 4.2 years). Conclusion To predict the likelihood of major stroke in symptomatic carotid stenosis and the benefit of CEA, plaque stability and the number of ischaemic events might be as important as an estimate of the degree of stenosis. |
| Databáze: | OpenAIRE |
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