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Biomedical subjects

D S Sumner

Publications and source records attributed to D S Sumner.

130 records · Page 8Linked to original sources
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Carotid endarterectomy: operative risks, recurrent stenosis, and long-term stroke rates in a modern series.

To determine whether carotid endarterectomy (CEA) safely and effectively maintained a durable reduction in stroke complications over an extended period, we reviewed our data on 478 consecutive patients who underwent 544 CEA's since 1976. Follow-up was complete in 83% of patients (mean 44 months). There were 7 early deaths (1.3%), only 1 stroke related (0.2%). Perioperative stroke rates (overall 2.9%) varied according to operative indications: asymptomatic, 1.4%; transient ischemic attacks (TIA)/amaurosis fugax (AF), 1.3%; nonhemispheric symptoms (NH), 4.9%; and prior stroke (CVA), 7.1%. Five and 10-year stroke-free rates were 96% and 92% in the asymptomatic group, 93% and 87% in the TIA/AF group, 92% and 92% in the NH group, and 80% and 73% in the CVA group. Late ipsilateral strokes occurred infrequently (8 patients, 1.7%). Late deaths were primarily cardiac related (51.3%). Stroke-free rates were significantly (p less than 0.0001) greater than stroke-free survival rates, confirming a non-stroke related cause for late death. Restenoses greater than 50% according to duplex scanning developed in 13%, most (67%) within 2 years after CEA. Most of these (77%) were asymptomatic, and only 0.3% (1 patient) presented with a permanent neurologic deficit. The results of carotid endarterectomy are superior to those of optimal medical management in symptomatic and asymptomatic patients in terms of long-term stroke prevention. When low perioperative stroke mortality/morbidity rates are achieved, carotid endarterectomy is justified for treatment of patients with carotid bifurcation disease.

Blindness↗
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Clinical follow-up and progression of carotid atherosclerosis determined by duplex scanning in patients suffering from TIA.

We investigated the clinical outcomes and the progression of the internal carotid arterial lesions of a group of patients presenting with hemispheric TIAs. The cumulative frequency of TIAs during a mean follow-up period of 40 +/- 14 months was 14%, and no relationship was found between new TIAs and the presence of known cardiovascular risk factors or plaque characteristics as determined by duplex scanning. With the exception of one patient who died of stroke, none of the patients developed a permanent neurologic deficit. The cumulative death rate was 6.5%; myocardial infarction was the most common cause (3 out of 7). Anatomic progression of plaques was determined by duplex scanning in 22% of the internal carotid arteries. No relationship between progression of these plaques and the development of new TIAs was evident. We conclude that, in this group of patients, TIAs do not inevitably lead to stroke and that TIAs are not predictable based on risk factors or plaques characteristics.

Aged↗
PubMedDate not supplied

Toe blood pressure. A valuable adjunct to ankle pressure measurement for assessing peripheral arterial disease.

Ankle pressure measurements fail to reflect the severity of peripheral ischemia when the underlying vessels are calcified or when there is extensive pedal or digital arterial disease. These problems may be obviated by measuring pressures at toe level. In this study, toe pressures were correlated with ankle pressures, clinical symptoms, and the presence or absence of diabetes in 294 limbs. The relationship of toe pressures to healing of ulcers or amputations of the foot was investigated in 58 limbs. Measurements were made with a digital pneumatic cuff and a photoplethysmograph. The ability of absolute toe pressure, ankle/brachial index, toe/brachial index, toe/ankle index, and the brachial pressure minus the toe pressure to differentiate between asymptomatic, claudicating, and ischemic limbs was determined. The toe/brachial index, arm minus toe pressure, and the absolute toe pressure had an average sensitivity and specificity of 85% and 88% for asymptomatic limbs and 89% and 86% for ischemic limbs. A toe pressure greater than 30 mmHg was indicative of a good healing potential, and ankle pressure less than 80 mmHg was associated with poor healing. The correlation between ankle and toe pressures was essentially the same in both diabetic (r = 0.60) and non-diabetic limbs (r = 0.62).

Amputation, Surgical↗