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 901 records · Page 50Linked to original sources
PubMed1995

Endarterectomy for asymptomatic carotid artery stenosis. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study.

OBJECTIVE: To determine whether the addition of carotid endarterectomy to aggressive medical management can reduce the incidence of cerebral infarction in patients with asymptomatic carotid artery stenosis. DESIGN: Prospective, randomized, multicenter trial. SETTING: Thirty-nine clinical sites across the United States and Canada. PATIENTS: Between December 1987 and December 1993, a total of 1662 patients with asymptomatic carotid artery stenosis of 60% or greater reduction in diameter were randomized; follow-up data are available on 1659. At baseline, recognized risk factors for stroke were similar between the two treatment groups. INTERVENTION: Daily aspirin administration and medical risk factor management for all patients; carotid endarterectomy for patients randomized to receive surgery. MAIN OUTCOME MEASURES: Initially, transient ischemic attack or cerebral infarction occurring in the distribution of the study artery and any transient ischemic attack, stroke, or death occurring in the perioperative period. In March 1993, the primary outcome measures were changed to cerebral infarction occurring in the distribution of the study artery or any stroke or death occurring in the perioperative period. RESULTS: After a median follow-up of 2.7 years, with 4657 patient-years of observation, the aggregate risk over 5 years for ipsilateral stroke and any perioperative stroke or death was estimated to be 5.1% for surgical patients and 11.0% for patients treated medically (aggregate risk reduction of 53% [95% confidence interval, 22% to 72%]). CONCLUSION: Patients with asymptomatic carotid artery stenosis of 60% or greater reduction in diameter and whose general health makes them good candidates for elective surgery will have a reduced 5-year risk of ipsilateral stroke if carotid endarterectomy performed with less than 3% perioperative morbidity and mortality is added to aggressive management of modifiable risk factors.

Adult↗
PubMed1994

Evolution of carotid restenosis after endarterectomy.

Some 176 consecutive carotid endarterectomies performed during 1987 were assessed after 11.5 and 44 months. There were four perioperative deaths. At mean follow-up of 32.5 months the 50% restenosis rate progressed from 9.7% to 11.9%. Of the 168 carotid arteries with a normal patency at discharge, 36 showed progression of stenoses as judged by duplex scanning during the observation period of 44 months. Twenty-nine stenoses were present within 1 year and seven developed between 12 and 44 months. Successive assessments revealed marked differences in the evolution of restenoses which usually depended on the degree of severity reached at the end of the first year: 44% progressed, 28% regressed and only 28% remained stable. The risk of late occlusion in vessels with a < 50% restenosis at 1 year was below 1% and the risk of progressing to a stenosis > 50% was 3.3%. Assessment at 56 months was limited to patients who had a restenotic lesion during the first 44 months. It confirmed that the disease was still unstable with progression in 7% of cases and regression in 10%. This study did not demonstrate any significant restenosis after 20 endarterectomies using the eversion technique compared with an incidence of 13.4% after 156 standard endarterectomies.

Adult↗
PubMed1994

[Results of endarterectomy combined with angioplasty in aortocoronary bypass].

From January 1989 until April 1990, 472 consecutive patients were operated for coronary artery bypass grafting. The patients were classified into three different groups. In group I, 412 patients were operated without endarterectomy. Group II consisted of 37 cases operated with endarterectomy-bypass to 41 vessels. Group III consisted of 23 cases of endarterectomy combined with patch-plastybypass to 24 vessels. The length of the segment endarterectomized was 25 to 70 mm (mean 37.86 +/- 12.18 mm). Peri-operative myocardial infarction occurred in 19 cases in group I (4.61%), 6 cases in group II (16.21%), and 3 cases in group III (13.04%). The percentage of IABP utilization was 2.91% in group I; 10.81% in group II; 8.69% in group III. The hospital mortality for group I, group II and group III was 3.88%; 8.10% and 8.69%. Mean follow-up was 16.4 months for 72% of patients. In 5 cases of group I (1.80%), in 8 cases of group II (27.58%) and in one case of group III (5.55%), myocardial infarction occurred in the late post-operative period. Late mortality was 1.44% for group I; 17.24% for group II and 5.55% for group III. There was no statistically significant difference between groups II and III, but the late results of group III are probably better.

Adult↗
PubMed1995

The relationship of cardiac and neurological complications to blood pressure changes following carotid endarterectomy.

This study was undertaken to study serial blood pressure changes following carotid endarterectomy (CE) and to analyze their relationship to neurological and cardiac complications. Over a 41 month period, 330 carotid endarterectomies (CE) were studied prospectively. Elevation of blood pressure developed in 214 of 330 (64%) patients undergoing CE. Four patients in the CE group developed perioperative myocardial infarction. None of these patients had hypertension following CE. Eleven patients (3.3%) developed new neurological deficits; 10 of these patients had perioperative hypertension (P = 0.041). Hypertension following carotid endarterectomy increased the likelihood of neurological deficit, but not a myocardial infarction.

Aged↗
PubMed1994

[Iatrogenic lesions of cranial nerves during endarterectomy of the carotid artery].

Cranial nerve injuries may result from carotid endarterectomy. In a retrospective study of 222 surgical procedures, from July 1982 through June 1990 only three cranial nerve injuries were documented (1.35%). In a prospective study of 79 carotid endarterectomies performed from July 1990 through June 1992, there were 11 nerve injuries (13.9%), fortunately most of them were temporary. We conclude that carotid endarterectomy is associated with a much higher incidence of local nerve injury than retrospective surveys would indicate.

Cranial Nerve Injuries↗
PubMed1994

The morphology of the carotid artery after uncomplicated endarterectomy.

Endarterectomy of the carotid sinus is one of the most frequent vascular operations. Until now, however, few details have been reported on the characteristic features of the disobliteration site during uncomplicated postoperative progress. Full histological and morphometric investigation was performed on the bifurcation of the carotid artery of 23 autopsies with previous endarterectomy, in some cases on both sides. The postoperative interval was of up to 10 years duration (early phase up to 6 months postoperatively 15x, late phase 14x). The findings were compared with surgical specimens of 9 restenoses. The reconstruction of an inner layer (so-called neointima) and the smoothing of the marginal layers of the disobliteration site takes place rapidly through the proliferation of smooth muscle cells from the remaining portions of the media. The narrower this remaining portion of the media, the greater the width achieved by these "neo-intima" (p < 0.05). There is occasional formation of elastic lamellae, similar to an elastic internal lamina, close to the luminal surface. Furthermore, in some cases the reconstruction of an intimal thickening (fibrous ridge) characteristic of the carotid bifurcation was observed at the entrance to the carotid sinus; this can be assessed as an indication that flow irregularities apparently persist postoperatively at this location. In the late phase, intramural calcification and new sclerotic plaques usually occur; these plaques closely resemble those of surgically removed restenoses. The distribution of plaques of this kind is largely congruent with the pattern of plaques in asymptomatically diseased carotid arteries. Thus, following endarterectomy in the carotid sinus, sclerotic plaques recur even during an uncomplicated course subsequent to reparative processes; as with the natural history of sclerotic plaques at the carotid bifurcation, this recurrence seems to be largely determined by hemodynamic factors.

Adult↗
PubMed1994

[Results of endarterectomy combined with angioplasty in aortocoronary bypass operations].

From January 1989 until April 1990, 472 consecutive patients were operated for coronary artery bypass grafting. The patients were classified into three different groups. In group I, 412 patients were operated without endarterectomy. Group II consisted of 37 cases operated with endarterectomy-bypass to 41 vessels. Group III consisted of 23 cases of endarterectomy combined with patch-plasty-bypass to 24 vessels. The length of the segment endarterectomized was 25 to 70 mm (mean 37.86 +/- 12.18 mm). Peri-operative myocardial infarction occurred in 19 cases in group I (4.61%), 6 cases in group II (16.21%), and 3 cases in group III (13.04%). The percentage of IABP utilization was 2.91% in group I; 10.81% in group II; 8.69% in group III. The hospital mortality for group I, group II and group III was 3.88%; 8.10% and 8.69%. Mean follow-up was 16.4 months for 72% of patients. In 5 cases of group I (1.80%), in 8 cases of group II (27.58%) and in one case of group III (5.55%), myocardial infarction occurred in the late post-operative period. Late mortality was 1.44% for group I; 17.24% for group II and 5.55% for group III. There was no statistically significant difference between groups II and III, but the late results of group III are probably better.

Adult↗
PubMed1993

Risk assessment in patients undergoing carotid endarterectomy.

Factors that contribute to the outcome of carotid endarterectomy include appropriate patient selection, preoperative medical optimization, meticulous operative technique and postoperative management. This study was designed to evaluate associated medical and operative risk factors with surgical outcomes for 9795 consecutive carotid endarterectomies performed by members of a voluntary regional vascular society. All data were reviewed and subject to a variety of statistical analyses in a blinded retrospective fashion. Factors including sex, increased age (> 70 years), cigarette smoking, chronic pulmonary disease and diabetes did not contribute independently to either increased operative neurologic morbidity or mortality rates. Cardiac disease (P < 0.0001) and chronic renal failure (P < 0.001) correlated independently with increased operative mortality, while hypertension (P < 0.05), cardiac disease (P < 0.01), renal failure (P < 0.0001), emergency surgery (P < 0.0001) and advanced neurologic symptoms at the time of operation (P < 0.0001) were associated with an increased operative stroke rate. In a group of 9021 patients who underwent 9795 carotid endarterectomies with a combined 3.1% incidence of operative neurologic morbidity or mortality (neurologic morbidity, 2.0%; mortality, 1.5%), specific preoperative medical risk factors could be identified. Only cardiac disease and chronic renal failure were associated with both significantly increased operative neurologic morbidity and operative mortality rates.

Adult↗
PubMed1993

Carotid endarterectomy: current status, and effects of clinical trials.

With the interim results of the North American Symptomatic Carotid Endarterectomy Trial (NASCET) and the European Carotid Surgery Trial (ECST) now reported, it has been shown that carotid endarterectomy is superior to conventional medical therapy for the treatment of symptomatic patients with > 70% diameter-reducing stenosis. The Veterans' Administration trial in asymptomatic patients with a > 50% diameter-reducing stenosis has shown that endarterectomy is superior to conventional non-operative treatment for the prevention of transient ischemic attacks and strokes when these events are combined. The design, impact and potential shortcomings of these trials are reviewed.

Carotid Artery, Internal↗
PubMed1994

Carotid endarterectomy in the very elderly: is it worthwhile?

BACKGROUND: Stroke continues to be the third leading cause of death in this country, its incidence and corresponding mortality rate increase with age, and in the majority of cases it results from arteriosclerosis of the carotid artery. Although recent studies have clearly shown the benefit of carotid endarterectomy in reducing the incidence of stroke, performance of this procedure in very elderly patients, the patient population for whom it should be most beneficial, has been challenged by some investigators on the basis of perceived increased operative risk. METHODS: The records of all carotid endarterectomies (n = 63) performed during the last 12 years for all patients (n = 59) with a minimum age of 75 years were reviewed to define the short-term risk of operative mortality, stroke and other major complications, and the long-term outcome. RESULTS: No (0%) operative deaths and three (4.8%) perioperative strokes occurred. Major cardiac complications occurred in five cases (7.9%). Follow-up, ranging from 1 to 122 months (mean, 27.4 months), was available for 54 patients (91.5%). Cumulative freedom from stroke was 92% at 2 years and 80% at 5 and 10 years of follow-up. Long-term survival rate was 80% at 5 years and 52% at 10 years, and stroke-free survival rate was 68% at 5 years and 42% at 10 years of follow-up. CONCLUSIONS: Carotid endarterectomy can be performed in very elderly patients with low operative risk and excellent long-term results.

Aged↗
PubMed1993

Carotid endarterectomy without angiography. The reliability of Doppler ultrasonography and duplex scanning in preoperative assessment.

OBJECTIVE: To validate the use of Doppler ultrasonography and duplex scanning as the only means of preoperative assessment in carotid disease. DESIGN: A retrospective study performed between January 1980 and December 1989. PATIENTS: Of 597 carotid endarterectomies carried out by one author, 130 procedures were performed on 118 patients (47 women, 71 men, ranging in age from 49 to 85 years) without preoperative cerebral angiography. Justifications for proceeding without angiography were risk of angiography (27 patients), iodine allergy (8 patients), renal insufficiency (5 patients), technical problems (4 patients) and surgeon's preference (74 patients). INTERVENTIONS: Doppler ultrasonography and duplex scanning were the only means of preoperative assessment on 130 occasions. The studies were done by fully trained radiologists. Until 1982 carotid stenosis was assessed with a continuous wave bidirectional Doppler flowmeter and gray-scale ultrasonography in equivocal cases. Thereafter, a real-time spectrum analyser connected on-line to a Doppler flowmeter was used. Duplex scanning was introduced in 1985. MAIN OUTCOME MEASURES: Surgical observations confirmed the preoperative assessment on 124 occasions (96%). RESULTS: Six patients had occlusion of the internal carotid artery (ICA); five patients had recent thrombosis that had occurred between the noninvasive assessment and the endarterectomy. Revascularization was successful in all. In one patient, the ICA was chronically occluded. In 63 patients, the mean pressure in the ICA stump and the mean gradient across the stenosis, measured intraoperatively, were 40 +/- 3 mm Hg (95% confidence interval: 34 to 48 mm Hg) and 55 +/- 3 mm Hg (95% confidence interval: 46 to 58 mm Hg), respectively, which confirmed the severity of the stenosis. CONCLUSION: The authors conclude that in their institution, carotid endarterectomy based on Doppler ultrasonography and duplex scanning only is reliable and safe.

Aged↗
PubMed1994

[Coronary endarterectomy: has the time come for randomized evaluation of clinical research?].

The authors review contemporary and hitherto not uniform views on the clinical impact of endarterectomy in the surgical treatment of diffuse coronary disease. Exact evaluation of this problem is still lacking. The authors suggest an original, prospective project for the objective evaluation of this therapeutic method by a randomized study called PROCESS. Initial experience indicates that revascularization procedures with endarterectomy are in the early postoperative stage associated with a higher mortality and morbidity than conventional surgery using only bypasses without endarterectomy of diffusely altered coronary arteries. Hypothetically it is possible that the long-term fate of patients with more complete revascularization, i.e. with reconstruction of diffusely altered arteries, will be more favourable than the prognosis of patients with partial reconstruction of the coronary circulation. The objective of the proposed project is to test this hypothesis. This will be, however, possible only after a longer time interval.

Coronary Artery Bypass↗
PubMed1994

[Value of the prosthetic patch after carotid endarterectomy].

INTRODUCTION: Carotid patching after carotid endarterectomy remains a subject of controversy. However the recent medical literature shows that carotid patching lowers the incidence of both residual stenosis and early restenosis. Carotid patching seems also to lower the incidence of postoperative carotid occlusion. Some authors advocate systematic patching, others recommend a more selective use of carotid patching, among patients with small caliber carotid artery and among those with restenosis. STUDY: We have realized this study to determine (1) the incidence of restenosis after direct closure in patients with internal carotid artery of more than 3.5 mm internal diameter, (2) the adequate size of the patch in carotid arteries of less than 3.5 mm interval diameter (3), the adequate material to use for carotid patching. To answer these questions, we have done a prospective study of 188 carotid endarterectomy comparing direct closure (Group A), saphenous patch (Group B), and prosthetic Gore-Tex patch (Group C) with randomization between saphenous and prosthetic patch. RESULTS: In this study we were unable to show any difference among the three groups concerning postoperative mortality and neurologic complications. However we have been able to show more residual stenosis in group A than in groups B and C. One saphenous patch rupture occurred in Group B. After one year follow-up, five out of 43 restenosis occurred in Group A (11.6%). The rate of restenosis in groups B and C was 1.5% (2/135). In group B, six patients (8.7%) had a dilatation of the saphenous patch of more than 50% of their initial diameter. CONCLUSIONS: In this study, carotid patch seems to lower the incidence of residual stenosis and early restenosis in small diameter internal carotid arteries. Carotid patching with a 5 mm diameter PTFE patch seems to be the ideal choice after carotid endarterectomy. Furthermore, prosthetic patching carry no risk of dilatation or rupture and spare the saphenous vein.

Blood Vessel Prosthesis↗
PubMed1994

[Reverse endarterectomy of the internal carotid].

We have described an original technique of eversion carotid endarterectomy which has been performed in two series of patients. In the first series the patients were operated on in Angers. They were 65 carotid stenosis in 56 patients with a mean follow-up of 27 months (18-36 months). In the later series, the patients were operated on in Lyon. They were 51 carotid stenosis in 43 patients with a follow-up from 1 to 24 months. The two series were comparable in term of symptoms and grade of stenosis as determined by duplex-scan and arteriography. The technique which has been previously described is safe and presents a lot of advantages over classical endarterectomy or vein graft. We observed no postoperative neurological deficit and no postoperative thrombosis. Two residual stenosis (1.7%) were measured at 30% but they did show any impairment during two years of follow up in the first series. Eversion endarterectomy of internal artery is a safe and deficient alternative to others techniques in the surgical treatment of atherosclerosis stenosis of internal carotid artery.

Aged↗
PubMed1993

The influence of carotid siphon stenosis on short- and long-term outcome after carotid endarterectomy.

PURPOSE: This study was designed to determine whether the presence of ipsilateral carotid siphon stenosis influenced the risk of early and late stroke and death after carotid endarterectomy (CEA). METHODS: The outcomes of patients with moderate (20% to 49%), severe (> 50%), and no siphon stenosis were compared over a 16-year period from April 1976 to February 1992. Complete angiographic data were available in 393 carotid arteries. RESULTS: Siphon stenosis was found ipsilateral to the CEA in 84 (21.4%) of the arteries. Most lesions were in the 20% to 49% diameter-reducing range (77.4%), with the remainder in the greater than 50% range (22.6%). There were no occlusions. The perioperative mortality rate was nearly identical for the groups with and without siphon stenosis, 0.0% versus 0.6%, respectively (p = 0.99). Perioperative stroke morbidity rates (no stenosis, 2.3%; moderate stenosis, 3.1%; > 50% stenosis, 5.3%) were acceptable and were not statistically different (p > 0.38). Late ipsilateral stroke-free rates were similar in the groups with and without siphon stenosis. The 5- and 7-year stroke-free incidences were 88.5% and 83.4% versus 94.9% and 94.9%, respectively (p > 0.20) for the two groups. Long-term ipsilateral stroke-free rates were not significantly different in the subgroups with moderate (20% to 49%) and hemodynamically significant (> 50%) siphon stenosis. The 3- and 5-year ipsilateral stroke-free rates were 96.7% and 87.9% versus 94.6% and 94.6%, respectively (p = 0.69). Late death was more common in the group with siphon stenosis than it was in the group without siphon stenosis, 23.8% versus 12.5% (p = 0.02). Heart disease was responsible for most late deaths, 47% in both groups. Late stroke-related deaths were infrequent: 1.3% in patients with and 0.0% in patients without siphon stenosis. CONCLUSIONS: Although carotid siphon stenosis seemed to be associated with a higher risk of late death, it did not alter the short- and long-term stroke morbidity rates after carotid endarterectomy significantly. We conclude that the presence of carotid siphon stenosis should not influence the decision to perform carotid endarterectomy in patients with the appropriate indications.

Aged↗
PubMed1996

Endarterectomy for moderate symptomatic carotid stenosis: interim results from the MRC European Carotid Surgery Trial.

BACKGROUND: The objective of this study was to assess whether carotid endarterectomy is an appropriate treatment for patients with recent cerebrovascular events in the territory supplied by a moderately stenosed (30-69%) internal carotid artery. Results have previously been reported for severe (70-99%) and mild (0-29%) stenosis. METHODS: A multicentre randomised controlled trial recruited 1599 patients with moderate stenosis treated in 97 hospitals from 15 countries. 60% of patients were allocated to receive and 40% to avoid carotid endarterectomy. The analysis was by intention to treat. FINDINGS: Nine patients were omitted from the analysis because no follow-up data were received. Stroke-free life expectancy (curtailed at 8 years) was shorter in the surgery patients than in the non-surgery control groups (patients with 30-49% stenosis, life expectancy = 6.16 years [controls: 6.63 years]; patients with 50-69% stenosis, life expectancy = 5.93 [6.14] years). It remains possible that patients might derive some benefit from surgery in the very long term; however, our data show that no benefit would be gained over a period of < 4-5 years in patients with 50-69% stenosis and < 6-7 years in patients with 30-49% stenosis. INTERPRETATION: Previous interim results from this study showed that surgery is beneficial in patients with severe stenosis but harmful in those with mild stenosis. With more randomised patients and longer follow-up, the study now shows that endarterectomy is not indicated for most, possibly all, patients with moderate symptomatic carotid stenosis.

Carotid Artery, Internal↗
PubMed1996

Carotid endarterectomy. Results in asymptomatic and symptomatic patients.

Objective evidence of the benefit of carotid endarterectomy in preventing stroke and its significant sequelae has recently been demonstrated by prospective trials. The salutary results depend on meeting strict operative outcome criteria as established by the American Heart Association. We retrospectively analyzed 265 consecutive carotid endarterectomies performed in 248 patients during 1 year at our institution. The perioperative mortality rate was 0; late mortality occurred 6 months postoperatively in 1 of 2 patients who experienced a perioperative stroke. The combined perioperative mortality and stroke rate was 0.8%. The combined mortality and stroke rate in patient subgroups was 0.7% (1/151) for asymptomatic patients, 1.6% (1/64) for symptomatic patients who had presented with a transient ischemic attack, and 0% (0/50) for symptomatic patients who had presented with a completed stroke. We conclude that the objective postoperative benefits of carotid endarterectomy in treating extracranial cerebrovascular disease can be achieved with low perioperative patient morbidity.

Carotid Stenosis↗
PubMed1996

Management options for post carotid endarterectomy stroke.

BACKGROUND: Management of acute thrombosis of the carotid artery has been controversial. This retrospective study reviews the etiology and analyzes the management options of post carotid endarterectomy stroke. METHODS: Diagnosis was made using oculopneumop-lethysmography (OPG/Gee), duplex ultrasound, computed tomography (CT) scanning, and carotid exploration. RESULTS: The cause of stroke was identified as carotid thrombosis in 19/32 patients (59%) and non-carotid thrombosis in 13. Management options included nine patients who underwent selective carotid exploration and all had a thrombosed carotid; mandatory exploration-six were explored and three had a thrombosed carotid artery; and 17 patients had no exploration (medical treatment). Fourteen patients had a positive OPG, 13 were confirmed to have carotid thrombosis. Eight patients had a negative OPG and all were confirmed. The OPG had an overall accuracy of 95% in detecting postoperative thrombosis (89% specificity and 100% sensitivity). Patients with thrombosed carotids and patients with positive OPGs had more severe neurological deficits than those with non-thrombosed carotids. The final neurological status of the 12 patients with carotid thrombosis who underwent thrombectomy and patch angioplasty was improved (7/12) in contrast to the seven patients who did not undergo a thrombectomy (1/7). Seven of nine patients had a complete or good recovery when thrombectomy was done within two hours of the stroke in contrast to 0/3 after two hours. Seven of ten patients with Grade II stroke (moderate) had a good recovery after carotid exploration and thrombectomy in contrast to 0/2 for Grade III (severe) stroke. CONCLUSIONS: Carotid artery thrombosis, the most common cause of post carotid endarterectomy stroke, can be detected by OPG/Gee. Immediate carotid exploration for patients with Grade I or II strokes, when thrombosis is demonstrated, can improve the results of carotid endarterectomy.

Aged↗