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 505 records · Page 28Linked to original sources
PubMedDate not supplied

Carotid artery atheroma: comparison of preoperative B-mode ultrasound appearance with carotid endarterectomy specimen pathology.

This paper describes a prospective study comparing the preoperative Duplex ultrasound appearance of carotid bifurcation atheroma with the pathological characteristics found in the endarterectomy specimens of the same vessels. Initial studies of carotid atheroma using Duplex scanning classified plaques into heterogeneous and homogeneous and found a strong correlation between heterogeneous lesions and the presence of intraplaque haemorrhage or ulceration in the endarterectomy specimen. The B-mode classification of plaque appearance described in this paper is an expansion of the above classification. The study group comprised 220 patients who underwent 244 procedures. The indication for carotid endarterectomy was symptomatic disease in the great majority of cases. We found a high incidence of unstable plaque pathology in the operative specimens, and a predominance of the more echolucent ultrasound plaque appearances (types 1 and 2). There is a statistically significant relationship (p less than 0.001) between ultrasound appearance types 1 and 2 and the presence of either intraplaque haemorrhage or ulceration in the endarterectomy specimen.

Aged↗
PubMed1988

Early healing after carotid endarterectomy: effect of high- and low-dose aspirin on thrombosis and early neointimal hyperplasia in a nonhuman primate model.

Platelet aggregation and release phenomena are central to most postulated mechanisms of thrombosis and neointimal hyperplasia after carotid endarterectomy. Therefore high-dose aspirin (HDA) has been advocated to minimize these sources of endarterectomy failure. We have defined low-dose aspirin (LDA) that selectively blocks platelet cyclooxygenase but preserves arterial wall cyclooxygenase in the nonhuman primate, Macaca fascicularis. We compared this theoretically optimal aspirin dose with HDA and no treatment (control) in a model of carotid endarterectomy. The aspirin was started before operation and continued for 6 weeks after operation, at which time the endarterectomized vessels were excised. The patency and morphologic findings of the arteries were measured. Platelet function was monitored by bleeding time and serum thromboxane A2 determinations. LDA and HDA were associated with 100% patency, whereas the control group had 50% patency. However, HDA did not protect the vessel from developing neointimal hyperplasia, which was seen in the control group and was associated with platelet adherence to the flow surface at 6 weeks. At 6 weeks, LDA significantly decreased but did not totally prevent neointimal hyperplasia and the flow surface was healed. Therefore the genesis of neointimal hyperplasia after endarterectomy may be more complex than simply a function of platelet-vessel wall interaction.

Animals↗
PubMedDate not supplied

Is venous patch grafting after carotid endarterectomy able to reduce the rate of restenosis? Prospective randomized pilot study with stratification.

Many studies have already demonstrated that the restenosis rate after carotid endarterectomy is greater as expected since ultrasound examination has become a routine procedure after endarterectomy. The purpose of our randomized study is to compare the rates of restenosis with two methods of carotid endarterectomy--direct suturing and autologous vein grafting. Sofar restenosis are found after endarterectomy and direct suturing. Different possible causes for restenosis are discussed. We hope to inform soon if patching with the autologous vein is the best method in order to prevent early restenosis after CEA.

Aged↗
PubMed1987

Endarterectomy in carotid artery disease. A decision analysis.

Carotid endarterectomy is being performed with increasing frequency, now over 100,000 times annually in the United States. We used the methods of decision analysis to examine the question of when to perform carotid endarterectomy. We developed a model that simulates the possible outcomes for a cohort of patients at risk for stroke. Estimates of surgical risk, surgical efficacy, annual stroke rate, and nonstroke mortality were derived from the literature. Using sensitivity analysis, we found that surgical risk, surgical efficacy, and stroke risk are the most important factors in determining when surgery is appropriate. By examining a series of clinical scenarios, we constructed guidelines for carotid endarterectomy based on the estimated risk of future stroke. The analysis suggests that for patients with a risk of less than 3% per year, surgery is not indicated. For patients with risk between 3% and 5% per year, low-risk surgery can be expected to provide a benefit of at most three months of quality life, depending on the efficacy of surgery. For stroke risk between 5% and 10% per year, even high-risk surgery is favored if surgical efficacy is above 30%. Above a stroke risk of 10% per year, even high-risk, low-efficacy surgery should be considered. The challenge to advocates of carotid endarterectomy is to develop a cost-effective strategy for identifying patients at high risk for stroke.

Carotid Artery Diseases↗
PubMed1986

Reappraisal of ocular pneumoplethysmography after carotid endarterectomy.

An initial report documented a 3-year experience (1978 through 1980) with ocular pneumoplethysmography (OPG-Gee) done in the recovery room after carotid endarterectomy. The present report analyzes a similar 4-year experience (1981 through 1984) on 864 carotid endarterectomies performed by 20 surgeons in which the results of OPG tests done in the recovery room suggested carotid endarterectomy thromboses in 33 of the 864 patients (3.8%). All patients underwent immediate reoperation, and thromboses were confirmed in 26 of the 33 patients (79%). In the seven patients without thromboses, findings at reoperation accounted for the abnormal physiology in six of the seven patients. Overall, in 32 of the 33 patients (97%) the recovery room OPG tests accurately reflected a source of hemodynamic compromise. The application of the special OPG-Gee criteria in this report will minimize needless reoperation after carotid endarterectomy.

Anesthesia Recovery Period↗
PubMed1987

Neointimal hyperplasia occurring after carotid endarterectomy in a canine model: effect of endothelial cell seeding vs. perioperative aspirin.

Neointimal hyperplasia of the arterial wall may occur after carotid endarterectomy. This proliferative lesion is a pathologic response of the injured arterial wall and may lead to progressive stenosis. We investigated the effect of endothelial cell seeding (ECS) or antiplatelet therapy with aspirin (ASA) on inhibition of this lesion in a canine model. Endarterectomies were performed in 160 carotid arteries; 46 endarterectomies were treated perioperatively with aspirin (325 mg per day), 34 were seeded with a high density (3 X 10(6)) of autogenous endothelial cells, and 80 were untreated control arteries. At selected time intervals, the patent arteries were perfusion-fixed and the cross-sectional area (measured in square millimeters) of neointimal hyperplasia was measured by means of digital planimetry. At 6 weeks, patency of the endarterectomized carotid artery was 88% in the ASA and ECS groups, in contrast to 35% in the control group (p less than 0.01). The cross-sectional area of neointimal hyperplasia was not significantly different in the ASA and the control groups at 6 weeks. However, the ECS group showed a marked reduction in neointimal hyperplasia at 6 weeks (p less than 0.01). This inhibition of neointimal hyperplasia after carotid endarterectomy by ECS may reflect accelerated luminal healing or a direct inhibition of smooth muscle cell proliferation in the injured arterial wall.

Animals↗
PubMed1987

Hypercholesterolemia and early restenosis after carotid endarterectomy.

Cellular proliferation in response to endothelial injury has been examined extensively in experimental animals. Under certain conditions (e.g., hypercholesterolemia and hypertension), this response can be exaggerated and develop into lesions that resemble early atherosclerosis. The injury caused by endarterectomy in human beings and the repair of the arterial wall that ensues may be analogous to the animal models. Presumably, those patients with an exaggerated proliferative response manifest myointimal hyperplasia and recurrent stenosis. To determine potential causes of recurrent stenosis after carotid endarterectomy, we studied 31 patients with early restenosis (group I), 35 patients with later restenosis (group II), and compared them with a control group of 100 consecutive patients who underwent uncomplicated carotid endarterectomy (group III). The known risk factors for atherosclerosis were analyzed. There was no significant difference in the male-to-female ratio, number of cigarettes smoked, or incidence of diabetes mellitus. However, the serum cholesterol level for group I was 282 +/- 57 mg/dl (p less than 0.001 versus controls) while the serum cholesterol level in group II was not significantly elevated over that of the control group. Both groups I and II had a higher incidence of hypertension (p less than 0.005 for both versus controls). There were no differences in the severity of hypertension. The data suggest that hypercholesterolemia has a strong association with early restenosis after carotid endarterectomy but not with late recurrent disease and that hypertension, even when treated, may be associated with both early and late recurrent stenosis.

Adult↗
PubMedDate not supplied

Stenosis following carotid endarterectomy.

Carotid endarterectomy is well established in the treatment of selected cases of atherosclerosis of the carotid bifurcation but the incidence of restenosis is unknown. During a four year period 80 endarterectomies of the internal carotid artery were performed in 73 patients. Post-operatively we studied our patients prospectively by means of Doppler ultrasound in combination with real time spectral analysis and where indicated digital venous angiography to determine the incidence of restenosis. We report a 12.5% incidence of stenosis following carotid endarterectomy with a 1% incidence of symptomatic restenosis. We therefore question the role of carotid endarterectomy in the treatment of asymptomatic carotid stenosis.

Aged↗
PubMed1979

Hypotension and hypertension as consequences of baroreceptor dysfunction following carotid endarterectomy.

Arterial pressure regulation is often labile following carotid endarterectomy. Hemodynamic data from 100 consecutive endarterectomies allowed definition of three distinct postoperative blood pressure responses. A hypotensive response (group I) affected 28 patients in whom mean arterial pressure decreased from 168 +/- 29/90 +/- 15 mm Hg before operation to 110 +/- 21/68 +/- 16 mm Hg after operation (P less than 0.001). Maximum hypotension occurred 5.3 hours after endarterectomy. The preoperative pulse, 80 +/- 9 beats/min, fell to a low of 64 +/- 12 beats/min after operation (P less than 0.001). A significant hypertensive response (group II) affected 19 patients in whom mean blood pressure rose from 160 +/- 29/87 +/- 15 to 223 +/- 32/110 +/- 22 mm Hg (P less than 0.001). Maximum hypertension was noted 2.3 hours after endarterectomy. This was unaccompanied by significant pulse changes. Fifty-three patients remained normotensive (group III). Their preoperative blood pressure (150 +/- 14 mmHg). Fluctuations in pressure did not correlate with age, indication for operation, or degree of ipsilateral and contralateral carotid arterial stenosis. Postendarterectomy hypotension and hypertension appear to represent transient baroreceptor dysfunctions.

Aged↗
PubMed1979

Recurrent stenosis after carotid endarterectomy.

Thirteen of 1,250 patients required a second operation for recurrent stenosis following carotid endarterectomy performed at the Cleveland Clinic between 1958 and 1978. Two other patients underwent reoperation because of recurrent stenosis following primary operations at other institutions. Thirteen of the 15 patients experienced neurologic symptoms caused by recurent stenosis, while two patients remained asymptomatic. Atherosclerosis was responsible for recurrent stenosis in 12 patients and appeared to be related to hypercholesterolemia. Three of the patients had myointimal fibroplasia. Eleven of the 16 reoperations for recurrent stenosis of the carotid artery consisted of carotid endarterectomy with vein patch angioplasty. Three patients had carotid endarterectomy with closure of the primary arteriotomy. One patient with occlusion of the internal carotid artery underwent endarterectomy of the external carotid artery because of amaurosis fugax, and a saphenous vein interposition graft was used to replace a previous Dacron graft in one patient with anastomotic stenosis. One patient had a stroke during reoperation manifest as multiple retinal emboli. Fourteen patients have remained asymptomatic from one to 70 months following reoperation. One patient with occlusion of the contralateral internal carotid artery has experienced persistent vertebrobasilar symptoms.

Age Factors↗
PubMedDate not supplied

Intraoperative monitoring and use of the internal shunt during carotid endarterectomy.

Carotid endarterectomy can be an effective form of therapy in stroke prevention in patients with carotid artery disease. A perioperative stroke is not only a devastating complication but negates the beneficial effects of the procedure. Careful attention to detail will prevent embolization during carotid endarterectomy and thus avoid the most common cause of perioperative cerebral infarction. The maintenance of adequate cerebral perfusion during carotid endarterectomy can be provided with the use of a shunt during carotid cross-clamping. This is necessary in approximately 15% of patients. Different approaches to the use of a shunt during carotid endarterectomy are discussed with their merits and disadvantages. Assessment of the technical results prior to completion of the operation should be an integral part of the procedure. The available methods, with their inherent limitations, are briefly discussed.

Angiography↗
PubMed1984

Carotid endarterectomy for nonhemispheric symptoms: predictors of success.

Over a 4-year period 335 patients underwent 402 carotid endarterectomies: 227 (56%) for carotid territory symptoms, 107 (27%) for nonhemispheric symptoms, and 68 (17%) for asymptomatic lesions. In 317 four-vessel arteriograms, proximal subclavian and/or vertebral lesions were found more frequently in the nonhemispheric group (80 of 97, or 82%) than in the carotid territory group (110 of 220, or 50%; p less than 0.05). EEG changes after carotid clamping occurred more often in the nonhemispheric group (15 of 65, or 23%) than in the carotid territory group (16 of 140, or 11%; p less than 0.001). The perioperative stroke rate was independent of whether nonhemispheric or carotid territory symptoms were present preoperatively (2.8% vs. 3.5%). Follow-up ranged from 1 month to 4 years. Carotid endarterectomy was successful in ameliorating symptoms in patients meeting the criteria for "classic" vertebrobasilar insufficiency more often than in patients not meeting these criteria (73% vs 43% asymptomatic at 24 months). Carotid endarterectomy was successful in patients with carotid stenoses of greater than 60% diameter reduction more often than in patients with smaller stenoses (77% vs. 36% asymptomatic at 24 months). Carotid endarterectomy appears justified in patients with nonhemispheric symptoms when classic vertebrobasilar insufficiency and/or hemodynamically significant carotid stenoses are present.

Aged↗
PubMed1984

Effect of heparin reversal following endarterectomy in an atherosclerotic animal model.

A focal atherosclerotic plaque was induced in the aortas of New Zealand White female rabbits by a balloon injury and an atherogenic diet. Under general anesthesia and systemic heparinization, endarterectomy was performed using the operating microscope. Animals were sacrificed at 5, 10, 20, and 60 min following the endarterectomy and operated aortic segments were perfused and examined using scanning electron microscopy. Each segment was compared to a similar segment of endarterectomized aorta from a normal, nonatherosclerotic rabbit. Thrombus formation including aggregated platelets, red cells, and fibrin was found to be more pronounced in the atherosclerotic segments. Ten more atherosclerotic rabbits underwent identical procedures except that heparin was reversed using protamine sulfate 5 min following the endarterectomy. When these specimens were compared to a similar atherosclerotic group without heparin reversal, it was evident that a tremendous thrombogenic process had taken place in the "reversed" segments. This study suggests that atherosclerosis may alter thrombogenesis following an operative vascular procedure and that early reversal of heparin following an endarterectomy should be viewed with caution.

Animals↗
PubMed1983

The use of shunts in patients undergoing bilateral carotid endarterectomies. Help or hindrance.

A retrospective study was undertaken to help assess the influence of shunting or nonshunting in the performance of bilateral, staged carotid endarterectomies. During the years 1969 to 1979, 323 consecutive patients underwent 646 staged, bilateral carotid endarterectomies. The indications included 271 patients (83.5%) with hemispheric and nonhemispheric findings and 52 patients (16.5%) who were asymptomatic. Thirty-six patients had sustained a previous stroke. General endotracheal anesthesia and systemic heparinization were used in all operations. An indwelling shunt was used in 485 (75.1%) endarterectomies whereas 161 operations (24.9%) were done without a shunt, reflecting the surgeons' routine preferences rather than specific criteria of selection. There were 30 (4.6%) neurologic events in 29 patients. Five patients died, representing an operative mortality of 1.5 per cent. Neither carotid occlusion time, interval between operation, nor severity of extracranial occlusive disease correlated significantly with the occurrence of postoperative stroke. An analysis of the neurologic deficits revealed 27 in the shunted group (5.5%) and three in the nonshunted group (1.8%). Results of this study showed that shunting cannot be relied upon to decrease the risk of neurologic deficit and that superior results may be obtained without an indwelling shunt in performing carotid endarterectomy.

Adult↗
PubMed1983

Durability of carotid endarterectomy.

Carotid endarterectomy is the preferred treatment for patients with transient ischemic attacks and carotid stenosis. Although clinically these patients do well, the long-term fate of the operated carotid artery has not been well documented. To address this question, repeated noninvasive testing has been employed to follow our carotid endarterectomy patients since 1976. Supraorbital Doppler examination, oculoplethysmography-Kartchner, carotid phonoangiography and, later in this series, spectral analysis of the carotid Doppler velocities were performed after 193 endarterectomies. One hundred fifty-eight patients were initially tested within 3 months of operation, and 35 were initially tested 3 or more months after operation. Twenty-four arteries, four of which were symptomatic, had an initial abnormal test and are excluded from this study of carotid artery durability. Of the 169 patients with normal carotid tests, 36 had no further evaluation. Among the 133 patients who returned for serial testing from 1 to 60 months (mean 20 months), 115 carotid arteries continued to test normal at late follow-up but 18 subsequently developed test abnormalities. Ten had more than 75% stenosis, eight had 50% to 75% stenosis. Eight of these patients had contrast studies: three had normal findings; the five that had abnormal findings underwent reoperation. Interestingly, only two patients presented with symptoms appropriate to the abnormal test. The findings suggest that carotid endarterectomy is a reasonably durable operation. Recurrent stenosis was presumed or proven in 10% of 133 serially tested carotid arteries. This threat of restenosis makes long-term follow-up of these patients mandatory.

Arterial Occlusive Diseases↗
PubMed1981

Motor speech malfunction following carotid endarterectomy.

Cranial nerve injury during carotid endarterectomy is a well-recognized complication of this procedure. The evaluation of the extent of the injury and the persistence of the malfunction is difficult to accomplish with conventional methods. A protocol designed to evaluate motor speech function was administered to 36 patients prior to carotid endarterectomy, 2 days after surgery, and 6 weeks postoperatively. The protocol included assessments of hypoglossal nerve function, superior-recurrent laryngeal function, glossopharyngeal nerve function, and integrated motor speech ability. Direct laryngoscopy also was performed at the same time intervals. The total number of operations was 40. Hypoglossal nerve palsy was present in eight (20%) and superior-recurrent laryngeal nerve palsy was found in 11 (27.5%). Seven (17.5%) had malfunction of the vocal cords by the second postoperative day. Only seven (17.5%) of the above cases were detected by the spontaneous speech sample. The malfunction persisted by the sixth postoperative week in one patient (2.5%) with hypoglossal palsy and in two (5%) with superior-recurrent laryngeal palsy (one of them with ipsilateral vocal cord paralysis). We think that motor speech-related difficulties are far more common following carotid endarterectomy than is generally believed, and although these difficulties are, by far, temporary in course, they deserve attention, especially in cases of planned bilateral carotid endarterectomy.

Carotid Arteries↗
PubMed1995

The role of carotid endarterectomy in the management of carotid artery disease and stroke.

BACKGROUND: Carotid endarterectomy to surgically clear the carotid artery bifurcation of atherosclerotic material was at one time one of the most common surgical procedures performed in this country. In recent years, however, there has been intense controversy over the appropriateness and efficacy of this procedure for the prevention of ischemic stroke. METHODS: This paper will first review the terminology and pathophysiology of cerebrovascular occlusive disease. The carotid endarterectomy procedure, as well as diagnostic techniques for the evaluation of carotid artery disease, will be described. Finally, the controversy surrounding the indications, benefits, and risks of carotid endarterectomy, the results of recent clinical trials and current recommendations for utilization will be discussed. RESULTS AND CONCLUSIONS: Initial results from multi-center clinical trials demonstrate that carotid endarterectomy can reduce the risk of subsequent stroke in patients with high grade (70-99 percent) stenosis who are symptomatic (i.e. who have had a documented ipsilateral transient ischemic attack or minor stroke). The complication rate of the surgeon, the patient's overall medical status, and the method of determining carotid stenosis should be factored into the decision to proceed. Surgical guidelines are less clear for patients with only moderate carotid stenosis or who are asymptomatic.

Carotid Arteries↗
PubMed1994

Postoperative treatment of patients undergoing carotid endarterectomy.

Carotid endarterectomy is a common procedure aimed at the prevention of cerebral vascular accident. Death after carotid endarterectomy is rare (approximately 1%). Postoperative complications occur infrequently (3% to 5%). Myocardial infarction and cerebral vascular accident, two of the most serious postoperative complications, are often associated with changes in blood pressure that occur early in the postoperative period. In addition, cerebral vascular accident often results from thrombosis at the operative site, which may occur during the operation or in the early perioperative phase. Therefore intense monitoring of neurologic and hemodynamic status during the early postoperative period is advocated to control blood pressure and detect changes in neurologic condition. Traditionally, this care is provided in an intensive care unit. Current studies suggest that more than 80% of patients who undergo carotid endarterectomy do not use unique intensive care unit resources; rather, they require monitoring services, which can be safely provided in less intensive alternate settings. This article provides an overview of carotid endarterectomy. Postoperative complications and early (24-hour) perioperative management are reviewed. Alternative strategies to intensive care unit monitoring are proposed.

Carotid Stenosis↗