Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “ENDARTERECTOMY”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 487 records · Page 27Linked to original sources
PubMed2003

Should carotid endarterectomy be performed for symptomatic carotid stenosis in Pakistan?

OBJECTIVE: The risk of stroke and death associated with carotid endarterctomy is operator dependant. Data regarding risks of this procedure are not available in Pakistan and therefore it is difficult to make accurate risk benefit analysis for individual patients. Our objective was to determine safety of carotid endarterectomy at an academic tertiary care center in Pakistan. METHODS: Patients who underwent carotid endarterectomy (CEA) at our hospital during a ten-year period were identified through ICD-9 coding system of the hospital medical records. Demographic features, associated medical problems and immediate postoperative complications were recorded and analyzed. RESULTS: Sixty-three carotid endarterectomies were performed on 59 patients. Ages range from 43 to 80 (mean 61 +/- 8) years; 53 were male and 10 were female. Common associated diseases among these patients were hypertension; 38 (64.4%), ischemic heart disease; 26 (44%), diabetes mellitus; 24 (40.7%), dyslipidemia; 19 (32.2%) and renal insufficiency; 13 (22%). Most common complication was neuropraxia (transient neuropathy); 5 (7.9%), followed by pneumonia and stroke; each in 3 (4.8%) patients. None of the strokes related to the surgical procedure were disabling. Two of the patients who had stroke, recovered fully within 17 weeks and one recovered partly but was independent in all daily activities of living (ADLs). One patient died following simultaneous coronary artery bypass graft (CABG) and CEA. The risk of stroke or death for patients undergoing CEA was high with simultaneous CABG (3/11, 27%) and low for patients undergoing CEA alone (1/52, 2%). CONCLUSION: Carotid endarterectomy is a safe procedure in patients with symptomatic carotid stenosis at our hospital and should be performed, when indicated.

Adult↗
PubMed1992

Epidemiology of carotid endarterectomies among Medicare beneficiaries.

Extensive debates exist in the literature on the indications, effectiveness, and risks of carotid endarterectomy. However, no investigations analyze the procedure's epidemiology. Medicare paid for essentially all carotid endarterectomies on patients over 65 years old, more than two thirds of all such surgery. Accordingly, we identified all 1985 to 1989 Medicare bills for ICD-9-CM code 38.12. This report found an average annual decrease of 6.4% in the frequency of carotid endarterectomies. Higher proportions and incidence rates occurred among 65- to 79-year-old people, men, and whites. Larger, urban, and nonprofit hospitals performed the procedure more often. The number of hospitals performing this procedure has increased over time. Mortality rates within 30 days decreased from 3.0% of procedures in 1985 to 2.5% in 1989. Higher than average death rates occurred among older, male, and black patients, and in low volume hospitals. Clinical trials undertaken in large, urban, teaching, high-volume institutions reported only 1% deaths. The institutions actually performing carotid endarterectomies differ from the clinical trials in their demography and perioperative mortality rates. This difference in community practice may limit the applicability of the clinical trials.

Adolescent↗
PubMed1992

The role of renin and catecholamine production in postcarotid endarterectomy hypertension.

Correlation between increased cranial and peripheral norepinephrines and increased cranial to systemic renin ratio has been observed in a small number of patients with postcarotid endarterectomy hypertension. In an effort to confirm these findings, we studied cranial and peripheral levels of catecholamines and peripheral renin activity in 120 consecutive carotid endarterectomies. Samples were taken before carotid clamping (Sample I) and just after clamp release (Sample II). Norepinephrine, epinephrine and dopamine values did not correlate with postcarotid endarterectomy hypertension. There was no association between peripheral renin values and postcarotid endarterectomy hypertension.

Aged↗
PubMedDate not supplied

[Eversion carotid endarterectomy].

It is widely accepted and proved the role of carotid endarterectomy in the prevention of cerebrovascular insufficiency. Some mater of controversy lies, presently, apart the role of the endovascular treatment, in the techniques of choice for the endarterectomy, as well as in the method employed for the arteriotomy closure. The authors report their experience with the eversion endarterectomy technique, discussing the results and enhancing the main indications of this alternative method for carotid endarterectomy.

Aged↗
PubMed1992

[Endarterectomy of the coronary arteries].

The authors analyze 50 patients with endarterectomy of the coronary arteries during the periods of 1972-1974 and 1988-1990. The results of endarterectomy of the right and left coronary artery provide evidence of its justification in indicated cases whereby contrary to some departments the results of endarterectomy of the left coronary artery are comparable with endarterectomy of the right coronary artery.

Coronary Disease↗
PubMed1992

Jugular venous vasopressin increases during carotid endarterectomy after cerebral reperfusion.

Several recent reports have suggested that pressor hormones may be released during and after carotid endarterectomy and that release of these factors may be associated with postoperative hypertension and other postoperative morbidity. We measured vasopressin, adrenocorticotropic hormone, and cortisol in jugular venous blood during carotid endarterectomy under general anesthesia in 43 patients with routine carotid shunting. Jugular venous vasopressin increased significantly after the second period of carotid occlusion for shunt removal and remained increased at closure. Vasopressin did not change during the initial carotid occlusion for shunt placement or during the endarterectomy itself, and neither ACTH nor cortisol changed at any sample time. Greater resting vasopressin and cortisol and larger responses of vasopressin were observed in patients receiving phenylephrine to correct intraoperative hypotension. There were no correlations between postoperative hypertension or postoperative complications and intraoperative hormone values. These results suggest (1) basal intraoperative vasopressin values reflect the blood volume of the patient, (2) increased vasopressin was not related to postoperative morbidity, and (3) intraoperative increases in pressor hormones are most likely physiologic responses to specific stimuli such as hypovolemia or hypotension rather than pathologic phenomena. We speculate that the increase of vasopressin after the second carotid occlusion and reperfusion of the brain may be due to the action of humoral factors released into the carotid circulation from the endarterectomy site.

Aged↗
PubMed2005

Is carotid endarterectomy in octogenarians more dangerous than in younger patients?

AIM: The risk for developing stroke increases with the advancing age, peaking over age 80. In elderly patients, carotid endarterectomy may provide prophylaxis against stroke. Aim of our study was to compare patients 80 years or older with patients younger than 80 undergoing carotid endarterectomy. Endpoints were perioperative mortality and morbidity. METHODS: From January 1996 to December 2002, 1 659 patients underwent a 1 733 carotid endarterectomy for a symptomatic or asymptomatic significant carotid lesion. Among them, 125 patients were 80 years or older. We analyzed death and stroke rate from cerebrovascular accidents, TIA as well as non cerebrovascular complications and death rate postoperatively and in the long term follow-up. The Pearson's chi-squared(2) test was used for the statistical analysis on risk factors, morbidity and mortality. The Log rank test was used for cumulative stroke-free and survival rates between the 2 groups (level of confidence p<0.05). RESULTS: Risk factors were similar in both groups. No statistical difference was observed in the stroke, TIA, mortality and stroke free rates between the 2 groups. CONCLUSIONS: The results of our study show that perioperative and postoperative mortality and morbidity as well as the long-term stroke-free rate does not differ significantly in patients 80 years or older compared to patients younger than 80 undergoing carotid endarterectomy.

Age Factors↗
PubMed2005

A single-stage procedure for carotid endarterectomy and myocardial revascularization: early and late results.

Cardiac events are some of the most frequent postoperative complications of carotid endarterectomy, while cerebrovascular accidents frequently occur in patients who have undergone coronary artery bypass grafting. The strategy for treatment of combined carotid and coronary artery disease is still controversial. We report our experience with a single-stage procedure for carotid endarterectomy and myocardial revascularization during cardiopulmonary bypass; then we evaluate our early and late results. From January 1994 through December 2001, 73 patients underwent combined myocardial revascularization and carotid endarterectomy in a single-stage procedure. Three patients (4.1%) died during the early postoperative period. Five patients (6.8%) showed temporary neurologic complications, while 1 patient (1.4%) had cerebrovascular accidents with late permanent neurologic deficit. At 5.5 +/- 2.1 years' follow-up (range: 2.6-10.4 years), 9 of the 70 surviving patients had died: 5 (71%) of cardiac-related events, 2 (2.9%) of cerebrovascular-related causes, and 2 (2.9%) of noncerebral or noncardiac causes. During the late postoperative period, 6 patients experienced cerebrovascular accidents, with a linearized rate of 2.3%/pt-yr (70% confidence interval: 1.5% to 3.2%/pt-yr), and 8 patients experienced cardiac-related events, with a linearized rate of 3.8%/pt-yr (70% confidence interval: 2.8% to 4.9%/pt-yr). A single-stage procedure for carotid endarterectomy and myocardial revascularization during cardiopulmonary bypass can be considered safe and effective when it incorporates systemic heparinization, hemodilution, and moderate hypothermia with pulsatile flow and normal blood pressure, which helps to preserve normal cerebrovascular autoregulatory mechanisms.

Aged↗
PubMed2005

[Permanent local nerve injuries after carotid endarterectomy].

UNLABELLED: Functional assessment of nerves, especially motor rami of cranial nerves, in patients at postoperative period after carotid endarterectomy (CEA), is particularly important in case of necessity of contralateral carotid artery surgery. Bilateral damage to recurrent laryngeal or hypoglossal nerve is a potentially life-threatening complication. Sensory disturbances due to intraoperative injuries of cervical plexus branches may cause residual discomfort in numerous patients. The aim of this study was the assessment and comparison of frequency of persistent (for more than 12 months postoperatively) manifestations of cranial and cervical nerves injuries in patients after CEA performed either in the standard or eversion technique. A prospective study evaluating cranial and cervical nerves dysfunction after carotid endarterectomies in 144 out of 193 patients operated on from January 1999 until June 2001 was undertaken at the Department of General and Vascular Surgery, Pomeranian Medical University in Szczecin, Poland. CEA was performed in the standard way (i.e. by primary closure) in 92 patients, while 52 others were operated on by eversion technique. Neurological examination with careful functional assessment of cranial nerves: V, VII, IX, X, XII and cervical plexus, was performed according to a standard protocol within two follow-up periods: 3 to 6 and 12 to 18 months after discharge from the hospital. RESULTS: Dysfunction of recurrent laryngeal nerve and hypoglossal nerve were registered 12 to 18 months after CEA with similar incidence of 1.4%. There was no sign of residual damage to other cranial nerves. Sensory disturbances in the area supplied by cervical plexus, mainly transverse cervical and greater auricular nerve, were diagnosed in 26% of patients. There were no statistically significant differences in local neurological complication rates between patients operated on according to standard and eversion procedures. CONCLUSIONS: 1. Permanent damage of cranial nerves refers to small group of patients after carotid endarterectomy and concern predominantly recurrent laryngeal nerve and hypoglossal nerve. 2. Majority of local neurological complications are injuries to cervical plexus branches. 3. Eversion carotid endarterectomy is not related to higher incidence of local neurological deficits compared to standard procedure.

Aged↗
PubMed2006

Results of one-year anticoagulation in patients with newly detected chronic thromboembolic pulmonary hypertension not treated with pulmonary endarterectomy.

INTRODUCTION: Currently pulmonary endarterectomy is considered the method of choice in patients with chronic thromboembolic pulmonary hypertension (CTEPH). It is not known if this option should be recommended in all suitable patients as it is highly variable with respect to prognosis. There is also doubt about selection of adequate time to refer patients with CTEPH for surgery. AIM: To establish whether some patients with CTEPH may clinically benefit from isolated anticoagulation with drugs and if the use of anticoagulation may have any impact on the time of patient referral for pulmonary endarterectomy. METHODS: The prospective analysis involved 29 patients (9 male, 20 female) aged 37 to 82 years, with pulmonary arterial systolic pressure ranging from 39 to 133 mmHg and newly diagnosed CTEPH who had not been treated with pulmonary endarterectomy and were not receiving anticoagulation. Survival, functional status according to NYHA classification, duration of thromboembolism, exercise tolerance and echocardiographic parameters of right ventricular overload before and at one year after initiation of therapy with anticoagulants were evaluated. RESULTS: During follow-up, 3 patients with PASP ranging from 120 to 133 mmHg died. In 26 patients with PASP 39-115 mmHg, who survived, improvement in echocardiographic parameters of right ventricular overload, better exercise tolerance as well as functional status according to NYHA classification was observed. In 12 survivors, pulmonary pressure returned to normal. CONCLUSIONS: The results of this study suggest that favourable effects of isolated anticoagulation are likely in patients with newly detected CTEPH, mild and moderate baseline pulmonary hypertension and acceptable exercise tolerance. They also indicate the necessity of anticoagulation in these patients prior to possible referral for pulmonary endarterectomy.

Acenocoumarol↗
PubMed2006

[Stenting of symptomatic stenosis of the internal carotid artery is not preferred over endarterectomy at this time].

Carotid endarterectomy reduces the risk of stroke in patients with symptomatic internal carotid-artery stenosis of 50% or greater. Carotid-artery stenting may be an attractive alternative. Two randomised trials comparing carotid endarterectomy with stenting have recently been terminated prematurely. Reasons for termination included an excess in stroke and death after stenting, compared with carotid endarterectomy (the EVA-3S trial) and futility reasons and the absence of funding (the SPACE trial). Given that both trials failed to prove the non-inferiority of stenting compared with carotid endarterectomy in the first 30 days, the use of stenting should be restricted to patients with contraindications to surgery and those participating in randomised clinical trials.

Carotid Artery, Internal↗
PubMed1991

[Coronary revascularization by long endarterectomy and reconstruction].

Endarterectomy and reconstruction of the coronary arteries is a technique for patients with diffuse coronary disease and in whom coronary bypass grafting is contraindicated. In a serie of 418 patients undergoing coronary bypass between May 1988 and April 1990, 55 had endarterectomy and reconstruction of a coronary artery. The mean age was 62.2 years (44-80 years). Twenty-five patients had class III (NYHA) angina and 30 had class IV angina. On the coronary angiogram, 10 patients had double-vessel disease and 45 had triple vessel disease. Endarterectomy and reconstruction were performed on one coronary artery in 53 patients and on two coronary arteries in 2 patients. At mean of 2.6 grafts per patient were performed. Four patients died during the perioperative period. Ten had a perioperative myocardial infarction. No other complications were noted. No residual postoperative angina was present. Five patients had a follow-up angiogram during the first postoperative month. All grafts were patent and correctly revascularised the endarterectomised artery and branches. These satisfactory preliminary results suggest that endarterectomy and reconstruction of the coronary arteries is a reliable and reproducible technique for coronary grafting. It is indicated in patients with diffuse atheromatous coronary disease who were previously not considered for surgery.

Adult↗
PubMed1991

Early and late geometric changes after carotid endarterectomy patch reconstruction.

This study examines the degree and location of vessel wall geometric changes after carotid endarterectomy-vein patch reconstruction. The external diameters of the proximal common carotid, common carotid bulb, and internal carotid arteries were measured during operation with a caliper after 349 carotid endarterectomies. There were 309 saphenous vein reconstructions, 31 synthetic patch reconstructions, and 9 primary closures. One or more B-mode ultrasound studies with cross-sectional views for common and internal carotid cursor measurements were performed from 3 months to 5 years after operation. The intraoperative-to-postoperative common carotid diameters were unchanged for the three types of reconstructions. The internal carotid diameters increased 20% to 30% for both the vein and synthetic patched arteries. This dilation was present at 3 and 6 months and progressed slightly over 5 years. Wall thickening greater than or equal to 1 mm was present in 62% of the carotid endarterectomies, with concentric stenosis in 3% and eccentric stenosis in 59%. Eccentric stenosis was present at 3 to 6 months, located on the endarterectomized posterior-medial wall of the common and internal carotid arteries, was always less than 50%, and changed very little over 5 years. No aneurysms or internal carotid occlusions were identified. Carotid endarterectomy-vein patch reconstruction results in early, mild, nonaneurysmal dilation of the internal carotid patched segment, frequent mild eccentric restenosis, and rare hemodynamically significant concentric restenosis.

Aged↗
PubMed1991

Carotid endarterectomy and prevention of cerebral ischemia in symptomatic carotid stenosis. Veterans Affairs Cooperative Studies Program 309 Trialist Group.

OBJECTIVE: To determine whether carotid endarterectomy provides protection against subsequent cerebral ischemia in men with ischemic symptoms in the distribution of significant (greater than 50%) ipsilateral internal carotid artery stenosis. DESIGN: Prospective, randomized, multicenter trial. SETTING: Sixteen university-affiliated Veterans Affairs medical centers. PATIENTS: Men who presented within 120 days of onset of symptoms that were consistent with transient ischemic attacks, transient monocular blindness, or recent small completed strokes between July 1988 and February 1991. Among 5000 patients screened, 189 individuals were randomized with angiographic internal carotid artery stenosis greater than 50% ipsilateral to the presenting symptoms. Forty-eight eligible patients who refused entry were followed up outside of the trial. OUTCOME MEASURES: Cerebral infarction or crescendo transient ischemic attacks in the vascular distribution of the original symptoms or death within 30 days of randomization. INTERVENTION: Carotid endarterectomy plus the best medical care (n = 91) vs the best medical care alone (n = 98). RESULTS: At a mean follow-up of 11.9 months, there was a significant reduction in stroke or crescendo transient ischemic attacks in patients who received carotid endarterectomy (7.7%) compared with nonsurgical patients (19.4%), or an absolute risk reduction of 11.7% (P = .011). The benefit of surgery was more profound in patients with internal carotid artery stenosis greater than 70% (absolute risk reduction, 17.7%; P = .004). The benefit of surgery was apparent within 2 months after randomization, and only one stroke was noted in the surgical group beyond the 30-day perioperative period. CONCLUSIONS: For a selected cohort of men with symptoms of cerebral or retinal ischemia in the distribution of a high-grade internal carotid artery stenosis, carotid endarterectomy can effectively reduce the risk of subsequent ipsilateral cerebral ischemia. The risk of cerebral ischemia in this subgroup of patients is considerably higher than previously estimated.

Aged↗
PubMed1991

A study of the sequential morphologic changes after manual coronary endarterectomy.

Manual coronary endarterectomies heal in the long-term by a poorly understood process of myofibrointimal proliferation. A retrospective analysis of detailed cardiovascular pathologic examinations of 51 patients dying at varying intervals after endarterectomy provides insight into the sequence of this proliferative response. Twenty-one patients died within 7 days, 6 at 8 to 30 days, 3 at 31 days to 6 months, 4 at 6 months to 5 years, and 17 at more than 5 years after endarterectomy. The observations made suggest that the denuded arterial surface heals after the fibrin-platelet mural thrombus that covers it is organized and is replaced by fibrosis and myofibroblast proliferation. In unusual cases proliferation is exuberant, resulting in significant restenosis, an outcome in which recurrent atherosclerosis contributes to only a minor degree. This is the first series in which the sequential reparative changes at varying times after manual coronary endarterectomy have been studied.

Adult↗
PubMed1990

[Intraoperative evaluation of carotid endarterectomy with electromagnetic flowmetry and portable DSA].

In order to perform carotid endarterectomy more safely, we have evaluated, intraoperatively, the result of an operation with electromagnetic flowmeter and portable digital subtraction angiography (DSA). During surgery, flow of the exposed internal and common carotid artery was measured with an electromagnetic flowmeter, before and after endarterectomy. After the closure of the arteriotomy, portable DSA was carried out by injecting contrast medium from the common carotid artery. Our simple portable DSA system consists of a surgical X-ray television set, image processor (Sigma X) and still video-recorder. This system almost gives us a real-time presentation of a subtracted view of angiography. There were twenty patients including one patient with major stroke, 14 with minor stroke, three with transient ischemic attack, and two asymptomatic patients. Increase of the flow through the internal carotid artery was documented with an electromagnetic flow-meter in 13 of 20 patients following endarterectomy. Flow reduction was seen in two patients, one of whom was found to have an intimal flap from residual plaque visualized in the portable DSA. The plaque was removed by reopening the artery. Among twenty patients, intraoperative portable DSA showed an intimal flap in three patients and a step in four patients. Although the incidence of abnormal findings was high, degree of abnormality was not severe enough to reopen the artery except in one case. The purposes of carotid endarterectomy is two-fold. It is used for the removal of the plaques which can be a source of emboli, and also for the augmentation of flow in the narrowed segment of the artery.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

Timing of carotid endarterectomy after acute stroke.

An arbitrary delay of at least 6 weeks before performing carotid endarterectomy after acute stroke has been recommended based on anecdotal reports. This prolonged interval may increase the danger of recurrent neurologic deficit before surgery. From September 1978 to September 1988, carotid endarterectomy was performed on 140 patients at variable intervals after stroke. Eleven patients had temporary stroke, which left 129 patients with neurologic symptoms that persisted for 3 weeks or had a cortical infarct on CT scanning. A prospective therapeutic protocol was applied to 82 patients admitted with acute stroke. They were observed until neurologic recovery reached a plateau, based on clinical observation by a neurologist, before performing angiography and carotid endarterectomy (group I). Forty-seven patients were not seen until after recovery from stroke was established (group II). At initial presentation, the severity of neurologic deficit was classified as mild, moderate, or severe in 31%, 58%, and 11%, respectively. Recovery before operation was registered as complete in 11%, mild residual in 66%, moderate residual in 21%, and severe residual in 2%. Group I patients (n = 82, 64%) were operated on within 6 weeks of stroke and group II (n = 47, 36%) were operated on at varying times after 6 weeks. No significant difference was found in the incidence of cerebrovascular events (1.2% vs 4.2%) and deaths (1.3% vs 2.1%) between groups I and II with respect to the timing of carotid endarterectomy, and no significant difference was found between patients operated on at 2, 4, 6, or more than 6 weeks after stroke.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1990

Saphenous vein rupture pressure, rupture stress, and carotid endarterectomy vein patch reconstruction.

Early postoperative patch rupture is a catastrophic complication of carotid endarterectomy reconstruction with greater saphenous vein. Mechanical determinants of saphenous vein rupture were identified by structural measurements and the results applied to carotid endarterectomy patch geometry. Diameter and rupture pressure was measured in fresh saphenous vein segments from the ankle, knee, or thigh in 157 patients undergoing bypass operations. Circumferential hoop rupture stress was calculated and the results were applied to 157 carotid endarterectomy reconstructions. All vein ruptures were in the cylindric axis. The mean vein diameter was 4.58 mm. The mean vein rupture pressure was 2873 mm Hg (3.78 atm). Vein diameter was larger in the thigh than in the ankle or knee (p less than 0.01), but there was no significant difference in rupture pressure between veins from the three locations. Women had a smaller vein diameter than had men at all locations (p less than 0.01). There was a positive linear correlation between vein diameter and rupture pressure. The mean maximum diameter of curvature of 157 carotid endarterectomy reconstructions with a vein patch was 13.3 mm. Multiple random applications of the 157 veins to 157 carotid diameters predicted a mean patch rupture pressure of 1087 mm Hg (1.43 atm), 1163 mm Hg (1.53 atm) for men, and 866 mm Hg (1.14 atm) for women. Predicted vein patch rupture pressures less than 300 mm Hg were found in 5.7% of cases (8.8% women and 1.2% men). Only 0.6% of patients (1.8% women and 0% men) had a predicted rupture pressure less than 200 mm Hg. No veins with a diameter greater than or equal to 4.0 mm had a predicted patch rupture pressure less than 300 mm Hg. These results suggest that small-diameter saphenous veins have a higher risk of rupture when used as a carotid patch.

Blood Pressure↗