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At least 451 records · Page 25Linked to original sources
PubMed1992

Somatosensory evoked potentials sensitivity relative to electroencephalography for cerebral ischemia during carotid endarterectomy.

BACKGROUND AND PURPOSE: The relation between electroencephalographic pattern changes and cerebral ischemia during carotid endarterectomy under general anesthesia is well established. Pattern changes seen on somatosensory evoked potentials under the same conditions are reported to be more sensitive indicators of cerebral ischemia. We estimated the sensitivity and specificity of somatosensory evoked potentials relative to electroencephalography for detecting cerebral ischemia during carotid endarterectomy under general anesthesia. METHODS: We simultaneously monitored electroencephalographs and somatosensory evoked potentials in 53 carotid endarterectomies performed on 51 patients under general anesthesia, and we determined the extent to which somatosensory evoked potentials detected cerebral ischemia defined by electroencephalographic pattern changes at the time of carotid cross-clamp. RESULTS: Twenty-three of the 53 cases studied had electroencephalographic evidence of ischemia following carotid cross-clamp. Ten of these 23 cases had an increased somatosensory evoked potential latency of 0.1 msec or greater (sensitivity 0.43). One of these 23 patients had a decrease in somatosensory evoked potential amplitude of 50% or greater (sensitivity 0.04). Of the 30 subjects who had no electroencephalographic evidence of ischemia, 13 had either no change or a decrease in somatosensory evoked potential latency (specificity 0.45). None of these 30 cases had a significant decrease in somatosensory evoked potential amplitude (specificity 1.0). If somatosensory evoked potential latencies were a sensitive method for detecting cerebral ischemia (true sensitivity of 0.95 or higher), the probability of only 10 subjects having somatosensory evoked potential latency increases would be less than 0.001. Therefore, our observed sensitivity cannot be attributed to chance. CONCLUSIONS: We conclude that measuring somatosensory evoked potentials is not a sensitive method for detecting cerebral ischemia during carotid endarterectomy.

Adult↗
PubMed1992

Comparison of multicenter study designs for investigation of carotid endarterectomy efficacy.

BACKGROUND: Our report summarizes and compares the characteristics of six prospective, multicenter, randomized clinical trials of carotid endarterectomy underway in North America and Europe. SUMMARY OF REVIEW: Three trials are designed to evaluate the safety and efficacy of endarterectomy in patients with asymptomatic carotid artery stenosis. The other three trials enroll patients who have had transient ischemic attacks or a minor cerebral infarction in the distribution of the randomized artery. Considered together, these six clinical trials span the range of candidates for carotid endarterectomy. The inclusion and exclusion criteria, methodology, and statistical considerations of each study are detailed in tables. CONCLUSIONS: The results from these trials will be helpful in resolving some of the questions surrounding endarterectomy, provided the similarities and differences in the study designs are considered when interpreting the results.

Carotid Arteries↗
PubMed1995

Hemodynamic effects of carotid endarterectomy by magnetic resonance flow quantification.

BACKGROUND AND PURPOSE: Blood flow can be evaluated non-invasively using magnetic resonance phase-contrast flow quantification. The purpose of this prospective study was to assess the feasibility of this method and to evaluate the hemodynamic effects of carotid endarterectomy. METHODS: Volumetric flow rates and peak systolic velocities of the internal and common carotid and the vertebral arteries were measured by magnetic resonance flow quantification. Sixteen patients undergoing 18 endarterectomies had complete flow data recorded preoperatively and 3 days after surgery. RESULTS: The inverse correlation between the angiographic stenosis degree and the preoperative flow rate in the corresponding internal carotid artery was highly significant (r = -.69, P < .001). After endarterectomy, the mean flow in the ipsilateral internal carotid artery improved from 143 to 233 mL/min (P < .001). The mean peak systolic velocity increased from 23 to 37 cm/s (P < .001). No significant changes were seen in the contralateral carotid or the vertebral arteries. The mean total blood flow improved by 81 mL/min (P = .08). In the severely stenosed bifurcations (70% to 99%, n = 11), the flow rate improved by 106 mL/min and in the moderately (30% to 69%, n = 4) or mildly (< 30%, n = 3) stenosed bifurcations by 63 mL/min. If the contralateral carotid artery was occluded or severely stenosed, the improvement was 164 mL/min. CONCLUSIONS: Magnetic resonance flow quantification provides a useful tool for the follow-up of the hemodynamic effects of carotid endarterectomy. Our results indicate that surgery is followed by a significant increase of blood flow in the ipsilateral carotid artery and that there appear to be differences in flow increase between subgroups of patients with different degrees of stenosis.

Aged↗
PubMed1996

Performance of carotid ultrasound in evaluating candidates for carotid endarterectomy is optimized by an approach based on clinical outcome rather than accuracy.

BACKGROUND AND PURPOSE: The best method of selecting endarterectomy candidates for cerebral angiography is controversial. Carotid duplex ultrasound (CDUS) is widely used, but its performance varies across institutions. The clinical utility of CDUS could be improved with test criteria based on patient outcome rather than test accuracy. METHODS: In 155 carotid bifurcations studied by CDUS and cerebral angiography, the degree of angiographic stenosis was measured by a reader, blinded to CDUS, using the North American Symptomatic Carotid Endarterectomy Trial (NASCET) method. We calculated accuracy, sensitivity, and specificity for predicting > or = 70% angiographic carotid stenosis of different peak systolic frequencies (PSF) measured by CDUS and generated a receiver operator characteristic (ROC) curve. We used NASCET outcome data and published data on angiographic complications to define relative "costs" of false-positive and false-negative CDUS, and we determined the point on the ROC curve representing the CDUS criterion with the highest clinical utility. We compared projected morbidity and mortality rates for 1000 hypothetical endarterectomy candidates resulting from the use of the most accurate CDUS criterion versus the CDUS criterion with the highest clinical utility by ROC analysis. RESULTS: While PSF > or = 8 kHz had the highest CDUS accuracy (93%), its projected stroke and death rate due to CDUS error was 10.4/1000. On the other hand, PSF > or = 7 kHz, defined by ROC analysis to have the highest clinical utility, had a lower morbidity and mortality rate of 6.8/1000. CONCLUSIONS: The use of ROC analysis and available outcome data can improve the performance of CDUS in selecting endarterectomy candidates for cerebral angiography.

Algorithms↗
PubMed1997

Role of transcranial Doppler and stump pressure during carotid endarterectomy.

BACKGROUND AND PURPOSE: The aim of our study was to clarify the pathophysiology of perioperative cerebral complications during carotid endarterectomy in our series. METHODS: By means of transcranial Doppler ultrasonography and stump pressure measurement, we monitored 112 patients who underwent carotid endarterectomy under general anesthesia for symptomatic or asymptomatic severe carotid stenosis. RESULTS: Of 18 patients who underwent carotid endarterectomy with intra-arterial shunt, 2 (11.1%) developed an ischemic stroke. Of the other 94 patients, one suffered a nucleocapsular hemorrhage and 5 had cerebral ischemic complications. In these 5 patients, the duration of clamping was significantly longer (mean +/- SD, 16.4 +/- 1.1 versus 12.7 +/- 2.6 minutes; P = .0019), and the decrease of middle cerebral artery mean velocity on clamping was significantly greater (mean +/- SD, 56.4 +/- 4.9% versus 28.8 +/- 20.2%; P = .0031), while stump pressure was not significantly different. Microembolic signals were recorded in 70 patients (62.5%) and were not associated with cerebral ischemic complications. The 7 patients who developed cerebral ischemic complications had a significantly higher percentage of stenosis in the contralateral internal carotid artery (mean +/- SD, 82.0 +/- 17.8% versus 29.3 +/- 36.4%; P = .0018). CONCLUSIONS: The results of our study suggest that the major complications of carotid endarterectomy may be due to hemodynamic factors. Stump pressure alone is not a reliable indicator of hemodynamic changes that predict cerebral ischemia. Particulate microembolism may cause more subtle changes in cerebral parenchyma, but further studies are needed to clarify this point.

Aged↗
PubMed1998

Epidemiology of carotid endarterectomy among Medicare beneficiaries: 1985-1996 update.

BACKGROUND AND PURPOSE: This article describes changes in the rate and outcome of carotid endarterectomies among Medicare beneficiaries. METHODS: We analyzed International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes as shown on Medicare bills to calculate carotid endarterectomy frequency, rate, and perioperative mortality by patient demography and hospital characteristics. RESULTS: After initially peaking at 61273 procedures (20.6 per 10000 beneficiaries) in 1985, the frequency of carotid endarterectomy among Medicare beneficiaries declined to 46571 (14.3 per 10000) in 1989 and then rose to 108275 (28.6 per 10000) in 1996. Patients were predominantly aged 65 to 74 years, male, and white; surgery occurred mainly in large, urban, nonprofit, and teaching hospitals. Perioperative mortality declined from 3.0% in 1985 to 1.6% in 1996. CONCLUSIONS: The frequency and rate of carotid endarterectomy showed prompt response to reports from clinical trials. Perioperative mortality both improved and converged over time but did not attain the rates reported by the trials. Patients aged 85+ years suffered twice the average perioperative mortality.

Black or African American↗
PubMed1999

The North American Symptomatic Carotid Endarterectomy Trial : surgical results in 1415 patients.

BACKGROUND AND PURPOSE: This study reports the surgical results in those patients who underwent carotid endarterectomy in the North American Symptomatic Carotid Endarterectomy Trial (NASCET). METHODS: The rates of perioperative stroke and death at 30 days and the final assessment of stroke severity at 90 days were calculated. Regression modeling was used to identify variables that increased or decreased perioperative risk. Nonoutcome surgical complications were summarized. The durability of carotid endarterectomy was examined. RESULTS: In 1415 patients there were 92 perioperative outcome events, for an overall rate of 6.5%. At 30 days the results were as follows: death, 1.1%; disabling stroke, 1.8%; and nondisabling stroke, 3.7%. At 90 days, because of improvement in the neurological status of patients judged to have been disabled at 30 days, the results were as follows: death, 1.1%; disabling stroke, 0.9%; and nondisabling stroke, 4.5%. Thirty events occurred intraoperatively; 62 were delayed. Most strokes resulted from thromboembolism. Five baseline variables were predictive of increased surgical risk: hemispheric versus retinal transient ischemic attack as the qualifying event, left-sided procedure, contralateral carotid occlusion, ipsilateral ischemic lesion on CT scan, and irregular or ulcerated ipsilateral plaque. History of coronary artery disease with prior cardiac procedure was associated with reduced risk. The risk of perioperative wound complications was 9.3%, and that of cranial nerve injuries was 8.6%; most were of mild severity. At 8 years, the risk of disabling ipsilateral stroke was 5.7%, and that of any ipsilateral stroke was 17.1%. CONCLUSIONS: The overall rate of perioperative stroke and death was 6.5%, but the rate of permanently disabling stroke and death was only 2.0%. Other surgical complications were rarely clinically important. Carotid endarterectomy is a durable procedure.

Aged↗
PubMed1978

Failure of diphenhydramine hydrochloride to prevent thrombosis at sites of endarterectomy in dogs.

Our previous work has shown that the addition of diphenhydramine hydrochloride to platelet-rich plasma is capable of causing disaggregation of platelet aggregates already induced by adenosine diphosphate as well as of inhibiting platelet aggregation when added prior to the aggregating agent. This led us to attempt to prevent arterial thrombosis in a canine experimental model. Ten dogs received an injection of diphenhydramine (approximately 3 mg/kg of body-weight) into the right common femoral artery 1 cm proximal to the proximal end of a 2 cm endarterectomy immediately after closure of the endarterectomy site and prior to performing an endarterectomy of the other common femoral and both common carotid arteries. The dogs which received diphenhydramine were compared with ten control dogs and found to have no protection against thrombosis at the sites of endarterectomy after 4 and 24 hours.

Animals↗
PubMed2000

Safety, efficacy, and durability of carotid artery stenting for restenosis following carotid endarterectomy: a multicenter study.

PURPOSE: To present the results of a multicenter registry established to collect data on carotid stent procedures in patients with restenosis following carotid endarterectomy. METHODS: The procedural details, outcomes, and late follow-up results were collected from 14 centers in the United States. Thirty-day and late stroke and death rates were analyzed. RESULTS: Three hundred and thirty-eight patients (201 men; 71 +/- 8 years) underwent carotid stenting in 358 arteries. The average duration from carotid endarterectomy was 5.5 +/- 7.3 years. Sixty-one percent of the patients were asymptomatic. The overall 30-day stroke and death rate was 3.7%. The minor stroke rate was 1.7% (6/358), and the major nonfatal stroke rate was 0.8% (3/358). The fatal stroke rate was 0.3% (1/358), and the nonstroke-related death rate was 0.9% (3/338). There was 1 (0.3%) fatal and 1 (0.3%) nonfatal stroke during the follow-up period. The overall 3-year rate of freedom from all fatal and nonfatal strokes was 96% +/- 1% (+/- SE). CONCLUSIONS: Carotid artery stenting can be performed in patients with restenosis following carotid endarterectomy with 30-day complication rates comparable to those of most published studies on repeat carotid endarterectomy. Results of late follow-up suggest that this technique is durable and efficacious.

Aged↗
PubMed2001

Use of a balloon-expandable, radially reinforced ePTFE endograft after remote SFA endarterectomy: a single-center experience.

PURPOSE: To report our experience with endovascular femoropopliteal bypass grafting using a distensible, radially reinforced polytetrafluoroethylene endograft combined with remote endarterectomy. METHODS: Forty-one patients (33 men; mean age 70 years, range 45-79) with symptomatic femoropopliteal occlusive disease underwent remote endarterectomy of the superficial femoral artery (SFA) followed by implantation of a balloon-expandable Enduring endovascular graft. All patients entered an extensive surveillance program, including angiography and duplex scanning at regular intervals. RESULTS: Endarterectomy and endograft implantation were ultimately successful in all patients; 5 (12%) technical difficulties occurred intraoperatively and were treated with additional endovascular techniques. Control angiography at 1 week postoperatively demonstrated a patent endograft in 39 (95%) patients. Mean ankle-brachial index increased significantly from 0.57 to 0.91 (p < 0.001). Including the 2 early failures, 18 occlusions were documented over a median 15-month follow-up (range 3-24), due mainly to significant stenosis at the proximal and distal anastomoses. In 8 of 10 successfully reopened and revised endografts, reocclusion occurred after a median interval of only 1.8 months. Life-table analysis revealed cumulative primary and secondary patency rates of 42% and 56%, respectively, at 18 months. In the last 12 cases, the proximal end of the graft was sutured end-to-end to the transected SFA, which improved the short-term secondary patency rate to 83%. CONCLUSIONS: Insertion of the Enduring endovascular graft following remote endarterectomy effectively results in a less invasive treatment for femoropopliteal occlusive disease. Additional technical refinements of the procedure may be required to avoid early procedure- and graft-related failures.

Aged↗
PubMed2004

Are patients receiving maximal medical therapy following carotid endarterectomy?

BACKGROUND: Most patients in the North American Symptomatic Carotid Endarterectomy Trial (NASCET) did not receive lipid-lowering treatment. As vascular event rates can be lowered with statins, antihypertensive agents, and newer antiplatelet agents, the authors conducted a study to determine the usage of these medications in patients following carotid endarterectomy (CE). METHODS: Claims data from Blue Cross and Blue Shield Michigan were used to study non-Medicare members who underwent CE in the years 1999 to 2001 (n = 1,049). Prescription of pharmacotherapy and sustained use (>80% use of the follow-up period) were examined in the 365-day period following index CE. RESULTS: Overall, 1,049 individuals underwent CE during the years 1999 to 2001. For the 1-year period following CE, the statin prescription rate was 70, 66, and 73% for the 3 study years. Sustained statin use was noted, on average, in 38%. The 3-year average was lower for sustained use of angiotensin-converting enzyme inhibitor (19%) and even lower for prescription antiplatelet agents (5%). CONCLUSIONS: Use of statins has increased following carotid endarterectomy (CE) compared with the North American Symptomatic Carotid Endarterectomy Trial era, but sustained treatment with statins remains at <40%. Recent studies have shown a decrease in vascular event rates with statins regardless of low-density lipoprotein level, suggesting that statin use should be routine following CE. Increased statin use as part of a multimodality intensive medical regimen following CE has the potential to improve long-term vascular event rates in this population.

Aged↗
PubMed1995

Comparison and meta-analysis of randomized trials of endarterectomy for symptomatic carotid artery stenosis.

OBJECTIVE: Comparison and meta-analysis of randomized trials of carotid endarterectomy for symptomatic stenosis of the extracranial carotid artery. BACKGROUND: Randomized trials (North American Symptomatic Carotid Endarterectomy Trial [NASCET], the European Carotid Surgery Trial [ECST], and the VA Cooperative Study [VACS]) each show that carotid endarterectomy improves outcomes in selected symptomatic patients with high-grade extracranial carotid artery stenosis. Direct comparisons among the studies have not been possible because of differing methodologies, endpoints, and formats of data reporting. DESIGN/METHODS: Data for specified endpoints and corresponding person-years at risk were obtained for each trial. The rates of nonfatal stroke, nonfatal myocardial infarction, or death for surgically or medically treated patients in the perioperative period (30 days) and thereafter were compared (both including and excluding perioperative events) and then combined using meta-analytic techniques. Data from NASCET and ECST were also analyzed for differences in outcomes by sex. RESULTS: Event rate estimates (with 95% confidence intervals [95% CI]) for the first 30 days (events per person-year, primarily nonfatal stroke) for medically treated patients were 0.44 (0.22 to 0.76) for NASCET, 0.15 (0.04 to 0.38) for ECST, and 0.27 (0.03 to 0.96) for VACS. For surgically treated patients, the corresponding rates (per person-year) were 0.78 (0.49 to 1.19), 0.63 (0.41 to 0.94), and 1.27 (0.58 to 2.43). Event rates per year after 30 days were higher for medically treated patients (0.20 [0.16 to 0.25] versus 0.08 [0.05 to 0.11] for NASCET; 0.12 [0.10 to 0.15] versus 0.07 [0.06 to 0.09] for ECST; and 0.15 [0.07 to 0.25] versus 0.07 [0.03 to 0.16] for VACS). There were no significant differences among the trials, with an overall benefit for surgical therapy (risk ratio estimate, RR = 0.67, 95% CI = 0.54 to 0.83). There were no significant sex-based differences between NASCET and ECST and the overall benefit was not significantly different for men and women (RR = 0.58, 95% CI = 0.45 to 0.74 for men; RR = 0.84, 95% CI = 0.57 to 1.25 for women). CONCLUSIONS: Adjusting for primary endpoints and duration of follow-up, carotid endarterectomy has a similar benefit for symptomatic patients across trials and a similar benefit for men and women.

Aged↗
PubMed2005

Coronary endarterectomy with beating heart in patients with diffuse atheromatous coronary artery disease and poor ventricular function: early and midterm results.

BACKGROUND: In this study, we retrospectively reviewed our experience with off-pump coronary artery bypass grafting and coronary artery endarterectomy in patients with severely reduced left ventricular function and diffuse atheromatous coronary artery disease to evaluate the early and midterm results. METHODS: Between July 1998 and March 2004, 42 patients underwent off-pump myocardial revascularization with coronary artery endarterectomy. The mean age (+/-SD) for the 28 male and 14 female patients was 59 +/- 10.2 years. Twenty-seven patients (64.2%) had experienced a previous myocardial infarction, and 11 (26.2%) had undergone an operation on an emergency basis. All patients had an ejection fraction of less than 30%. The left anterior descending coronary artery was the most endarterectomized vessel (75% of patients). RESULTS: There were 5 early deaths (11%). Twenty-five (67.6%) of the surviving patients were symptom free, and 8 were in Canadian Cardiovascular Society classes II to IV. The ejection fraction improved after the operation in the 30 patients (71.42%) who underwent echocardiographic control and coronary angiography. The 28.4-month patency rate of the endarterectomized coronary arteries was 89%. The patency rates were 93.3% for the left internal thoracic artery-left anterior descending coronary artery and 88.8% for the right coronary artery. CONCLUSION: The results of this study show increased operative mortality and morbidity in patients requiring coronary artery endarterectomy. However, the early results and particularly the midterm survival rates, clinical status, and continued graft patency justify off-pump coronary artery endarterectomy in patients with severely depressed left ventricular function and diffuse coronary artery disease. Many of these patients have disease that would otherwise be inoperable.

Adult↗
PubMed2001

Coronary artery bypass and carotid endarterectomy: combined approach.

Controversy exists concerning the best management of patients with coronary artery and carotid artery disease. Between June 1994 and July 2000, 88 patients with coronary artery and carotid artery disease underwent combined coronary artery surgery and carotid endarterectomy. Demographics and perioperative variables of these patients were compared with those of 266 patients undergoing isolated coronary artery surgery. Patients in the combined coronary artery bypass grafting and carotid endarterectomy group were elderly patients (p=0.0001) with a higher prevalence of female gender (p=0.0001), left ventricular dysfunction (p=0.006), left main coronary artery disease (p=0.033), triple-vessel coronary artery disease (p=0.002), unstable angina pectoris (p=0.004), and history of prior neurologic events (p=0.0001). Three (3.4%) patients in the combined group and 5 (1.9%) patients in the isolated coronary artery surgery group (p=0.317) developed perioperative myocardial infarction. Two (2.3%) patients in the combined group developed a permanent postoperative neurologic event. Hospital mortality was 5.7% (5 patients) in the combined coronary artery bypass grafting and carotid endarterectomy group and 1.5% (4 patients) in the isolated coronary artery surgery group (p=0.046). Patients with concomitant carotid and coronary artery disease have an advanced arteriosclerosis. Although combined coronary artery bypass grafting and carotid endarterectomy is associated with a higher risk of death and perioperative myocardial infarction than simple coronary artery surgery, this procedure is a preferable approach for these high-risk patients and results in lower neurologic morbidity.

Aged↗
PubMed2000

Myocardial revascularization with coronary endarterectomy. Stratification of risk factors for early mortality.

OBJECTIVE: To determine the risk factors for mortality related to myocardial revascularization when performed in association with coronary endarterectomy. METHODS: We assessed retrospectively 353 patients who underwent 373 coronary endarterectomies between January '89 and November '98, representing 3.73% of the myocardial revascularizations in this period of time. The arteries involved were as follows: right coronary artery in 218 patients (58.45%); left anterior descending in 102 patients (27.35%); circumflex artery in 39 patients (10.46%); and diagonal artery in 14 patients (3.74%). We used 320 (85.79%) venous grafts and 53 (14.21%) arterial grafts. RESULTS: In-hospital mortality among our patients was 9.3% as compared with 5.7% in patients with myocardial revascularizations without endarterectomy (p=0.003). Cause of death was related to acute myocardial infarction in 18 (54.55%) patients. The most significant risk factors for mortality identified were as follows: diabetes mellitus (p=0.001; odds ratio =7.168), left main disease (<0.001; 9.283), female sex (0.01; 3.111), acute myocardial infarction (0.02; 3.546), ejection fraction <35% (<0.001; 5.89), and previous myocardial revascularization (<0.001; 4.295). CONCLUSION: Coronary endarterectomy is related to higher mortality, and the risk factors involved are important elements of a poor outcome.

Adult↗
PubMed2002

Ring-stripping retrograde common carotid endarterectomy: case report.

CONTEXT: Total occlusion of the common carotid is rare and the indications and techniques for surgical treatment are still a matter of controversy. OBJECTIVE: To demonstrate the feasibility of retrograde common carotid endarterectomy. DESIGN: Retrospective case report study. SETTING: Tertiary care private hospital. PARTICIPANTS: Three patients underwent ring-stripping retrograde common carotid endarterectomy. Their ages were 81, 68 and 65 years. All were hypertensive with generalized atherosclerosis, two had diabetes mellitus, and one had undergone coronary artery bypass some years earlier and had non-dialytic chronic renal insufficiency. Symptoms of brain ischemia were present in two patients. All patients had total occlusion of the common carotid, extending from the origin to the bifurcation and localized in the right common carotid in two cases. In two cases the internal carotid artery was also occluded. MAIN MEASUREMENTS: Postoperative early mortality and stroke rate, and the medium and long-term endarterectomy patency. RESULTS: There were no deaths. One patient had a transient ischemic attack. All endarterectomies were patent after eight months, four years and seven years of follow-up. CONCLUSION: There is low mortality, and the procedure can be done through only one cervical incision. Tandem lesions of the carotid arteries can be treated together. It is suitable for long total occlusions of the common carotid, and long-term patency.

Aged↗
PubMed1998

Carotid endarterectomy under regional anesthesia.

Regional anesthesia for carotid endarterectomy is a simple, reliable, and virtually complication-free technique. We began to perform a series of carotid endarterectomy under regional anesthesia at our institution in May 1990. This report describes our experience with 180 operated patients from May 1990 till December 1995, with regional anesthesia. All patients were operated with microsurgery and we utilized the deeply cervical plexus block at the C-4 level associated with superficial block, along the posterior border of the externocleidomastoid muscle. The main advantage of this technique of anesthesia is that it is the only exact method of assessing the need of a shunt by using the neurological status of the awaken patient during trial carotid cross-clamping. The regional anesthesia allows carotid endarterectomy to be safely performed on patients with advanced cardiac disease or severe chronic obstructive pulmonary disease who were not good candidates for general anesthesia. In this 180 patients we performed 198 consecutive endarterectomies (10% bilateral) with a total morbidity-mortality rate of 2.0%.

Anesthesia, Conduction↗
PubMed1997

Radical endarterectomy of severely calcified ascending aorta prevents stroke during open-heart surgery.

In ten patients (7 women), mean age 73 years, with severely calcified ascending aorta, aortic valve and coronary artery disease were surgically treated after radical endarterectomy of the ascending aorta during cardiopulmonary bypass and with or without deep hypothermic total circulatory arrest. One patient died 10 days and one 11 months postoperatively of complications which neither directly nor indirectly could be attributed to the aortic endarterectomy. The eight surviving patients are doing well after follow-up averaging 16 months. CT scans 1 year postoperatively showed no aneurysmal dilation of the ascending aorta or aortic dissection distal to the endarterectomy site. Radical endarterectomy of calcified ascending aorta thus can be performed with relatively low mortality and stroke risk and may be considered in patients undergoing valve replacement and/or coronary artery bypass grafting.

Aged↗