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PubMed1989

Influence of contralateral carotid artery on neurologic outcome after carotid endarterectomy.

The discrepancy in the literature about the immediate results after carotid endarterectomy in the presence of occluded or seriously stenotic contralateral carotid artery, has encouraged a retrospective study on 230 patients subjected to 255 carotid endarterectomies. 63 operations (group 1) were carried out in the presence of occluded contralateral carotid artery (40 operations) or of seriously stenotic contralateral carotid artery (23 operations). In the remaining 192 operations (group 2) the contralateral carotid artery was normal or not significantly stenotic (less than 60% of diameter reduction). The indication for surgery and age and sex distribution were similar in the two groups. No operations were performed during acute stroke. Patients with previous stroke underwent surgery only after at least 1 month from the onset of symptoms, in stable neurological conditions. All the patients were operated on under general anesthesia and with systemic heparinization; the indication for intraluminal shunt was made on the basis of clinical evaluation, of back pressure value and, in 106 operated cases of somatosensory cortical evoked potentials. At the end of every operation, ultrasonographic and/or angiographic instrumental controls were carried out. No statistically significant difference was evidenced in the incidence in groups 1 and 2 of postoperative transitory neurological insufficiency (both 3.2%, P greater than 0.8), of permanent neurological insufficiency (0% and 1%, P greater than 0.9), of mortality because of neurological (3.2% and 1%, P greater than 0.5) and non neurological causes (1.6% and 0%, P greater than 0.1).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

[Treatment of transient ischemic attack by carotid endarterectomy].

Fourty-five patients with transient ischemic attack (TIA) were treated by carotid endarterectomy. All of them had typical manifestation of TIA and stenosis of extracranial carotid artery verified by angiography. After operation most of them were uneventful, but 2 experienced TIA, 2 contralateral reversible weakness and 1 mild hoarseness. There was no mortality. The role of carotid endarterectomy in the prevention and treatment of TIA, and some technical factors including anesthesia, intraoperative monitoring, management of stenosis of high subcranial internal carotid artery and postoperative care, were discussed.

Adult↗
PubMed1989

[Perioperative complications in carotid endarterectomy with respect to the stage of the cerebrovascular disease].

Records of perioperative complications following 407 consecutive carotid endarterectomies performed in 366 patients in the 18-year period have been presented. The complications are categorized according to the clinical stage of vascular disease, that is, according to the indications for the surgery. Out of the total number, 46 (11.3%) operations were done in the 1st, asymptomatic stage of disease, for the haemodinamically significant stenoses and ulcerated plaques; 173 (42.5%) in the 2nd clinical stage for hemispheral and nonhemispheral transient ishemic attacks (TIA) and reversible neurologic deficits (RIND); 3 (0.7%) in the 3rd stage which is a progressive cerebrovascular stroke and 185 (45.5%) in the 4th clinical stage of the disease, in patients with previous cerebral infarction and a permanent neurologic deficit. The rate of a temporary and permanent neurologic deficit, as well as mortality in the first stage of the disease equals zero. In the second stage of the disease, the rate of a temporary neurologic postoperative morbidity increases to 1.7%, of a permanent neurologic morbidity to 1.2%, while the rate of mortality is 1.2%. In the 3rd and 4th stage, those rates amount to 66.7%, 0% and 33.3%, and 1.1%, 3.8% and 1.6%, respectively. The rates of perioperative morbidity and mortality are in proportion to the scope of preoperative brain dysfunction. Results of this work suggest the necessity of categorization of patients, candidates for carotid endarterectomy, according to the clinical stage of the disease, which will enable a better comparison with other authors' results, give a more reliable view on the efficacy of the surgical treatment and justify the surgeons' attitude towards indications.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Carotid endarterectomy (CE) of the internal carotid artery (ICA) with and without patch angioplasty: comparison of hemodynamical and morphological parameters.

The aim of this study was to show, if patch angioplasty or direct closure of the blood vessel following carotid endarterectomy of the ICA resulted in any hemodynamical or morphological differences. Studies were carried out in eighteen and twenty patients, respectively within an average postoperative period of twenty-six month. All patients were examined with continuous-wave Doppler ultrasound, multi-channel pulse Doppler ultrasound and Duplex ultrasonography scanning. Comparing the two groups, differences are predominantly found at or near the site of the endarterectomized segment. Patients who received PTFE (Gore-Tex) patch angioplasty to close the arteriotomy, show in about 50% of all cases a dilatation--pantaloon effect (10)--at the carotid bifurcation (lumina greater than 1.1 cm) when investigating the vessel lumen with duplex sonography. This results in a statistical significant increase in turbulent flow disturbances at the bulb and the origin of the ICA. Furthermore, ICA flow velocity patterns after the endarterectomy point are still within the normal range when compared with patients not receiving a patch plasty, but still significantly elevated. Changes of the vessel wall, as such as intima elevation and intraluminal deposits are more frequently found distal to the endarterectomized segment and do obviously reduce the lumen. However, changes of flow volumina were not quantifiable. Atherosclerotic patients who underwent surgical treatment show as a characteristic finding due to atherosclerosis, a less laminar flow-pattern within the whole extracranial area, when compared with a normal healthy population.

Aged↗
PubMedDate not supplied

The syndrome of inappropriate secretion of antidiuretic hormone following carotid endarterectomy. A case report and review of the literature.

The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) has not been reported as a complication of carotid endarterectomy. We present a case of SIADH in a patient who underwent carotid endarterectomy four weeks after a completed stroke with good recovery. The presence of this syndrome was associated with the development of a neurological deficit.

Carotid Artery Diseases↗
PubMed1989

[Carotid endarterectomy. Risks and benefits of treatment].

From 1980 to 1985, 210 endarterectomies of the carotid artery were performed in 187 patients (50 female, 127 male). In 55 cases there were asymptomatic filiform stenoses with concomitant high grade stenosis or occlusion of the contralateral artery. 155 stenoses of the carotid artery of mostly the highest degree were symptomatic. Patients were examined by means of the direct CW-doppler ultrasound immediately postoperatively and every six months up to six years. In 9 cases (4.3%) there was a perioperative (central) neurologic incident, which in 5 (2.3%) cases was followed by permanent neurologic deficits. Three of these incidents were caused by an early occlusion of the reconstruction. The stroke rate (including perioperative stroke rate) determined by life table analysis for the whole group after 6 years was 5.6%. The rate of TIA's was 4.5%. The rate of local recurrence (stenosis greater than 50% or occlusions) after six years was 15.3%. Except for the above mentioned early occlusions only one recurrent stenosis was symptomatic. We believe that asymptomatic, non multimorbid patients with doublesided high grade stenoses and symptomatic patients profit from an endarterectomy of the carotid artery, as long as the perioperative stroke rate and mortality do not exceed 3-4%.

Adult↗
PubMed1989

[A case of recurrent internal carotid stenosis, after carotid endarterectomy, due to strangulation by scarring].

A case of recurrent internal carotid stenosis, one year after carotid endarterectomy, due to strangulation by scarring composed of digastric muscle, hypoglossal nerve and a branch of external carotid artery (ECA) is reported in this paper. A 34-year-old male suddenly became nauseated and developed right hemiplegia and dysphasia. He was admitted to a hospital, and the symptoms and signs improved gradually during a period of several weeks. A left carotid angiography, performed in another hospital, revealed a stenosis and wall irregularity around the highly-situated carotid bifurcation. He was transferred to our clinic with a view to being operated on. On admission, neurological examination disclosed a mild right motor weakness and motor dysphasia. A right carotid angiography revealed good cross circulation to the opposite. An EEG monitoring under the Matas test showed no outbreaks. With diagnosis of an embolism arising from carotid atheromatous plaque, a carotid endarterectomy was performed successfully. A postoperative angiography revealed good patency without stenosis nor wall irregularity around the carotid bifurcation. The postoperative and out-clinic condition was uneventful. However, one year after the operation, a left carotid angiography revealed recurrent internal carotid stenosis in a high degree. A second operation was performed and the operative findings showed an internal carotid stenosis due to strangulation by scarring composed of digastric muscle, hypoglossal nerve, a branch of ECA and connective tissue. The scarring was decompressed and a postoperative angiography revealed an improvement of the stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Intraoperative assessment of carotid endarterectomy.

In our experience intraoperative arteriography in carotid endarterectomy is very effective in detecting residual small lesions after surgery. There were no neurosurgical complications due to arteriography. The interpretation of the surgical results is objective since the criteria are the same as those used to assess preoperative arteriography. Different intraoperative assessment methods to control carotid endarterectomy are also analysed.

Angiography↗
PubMedDate not supplied

Pseudoaneurysm after carotid endarterectomy.

An unusual case of recurrent infected pseudoaneurysm seven years following carotid endarterectomy is described. The initial pseudoaneurysm was treated with resection and Dacron patch angioplasty. Recurrence one year later was caused by infection of the patch. Treatment with resection and autologous saphenous vein patch angioplasty resulted in cure. Pseudoaneurysm formation after carotid endarterectomy is unusual and can generally be traced to technical factors. Of the fifty reported cases, only seven (14%) resulted from or were associated with local infection. Avoidance of prosthetic patch material may help prevent this complication. If it does occur, management should include precise angiographic diagnosis, vascular control through previously unoperated areas, complete debridement of all necrotic and infected pseudocapsule, and, if necessary, reconstruction with autologous vein.

Aged↗
PubMed1986

[Femoro-popliteal endarterectomy using a pneumatic oscillator].

In patients with severe ischaemia from femoro-popliteal thrombosis, but without suitable vein for bypass, a synthetic or bioprosthesis is usually installed. This is a costly method giving statistically mediocre results. An alternative method is femoro-popliteal endarterectomy performed with rings that are made to oscillate by a pneumatic motor. The procedure requires 3 arteriotomies: one at each end and one in-between to insert rings of a different caliber. Arteriography is mandatory at the end of the operation. This type of endarterectomy is feasible only when blood flow is adequate upstreams, when the femoro-popliteal axis is not calcified and when at least one artery of the leg remains patent. The method is less expensive, and its early results apparently better than those of prostheses extending beyond the knee.

Endarterectomy↗
PubMed1988

Carotid endarterectomy. Where do we stand?

The small number of carotid endarterectomies performed in our country is a cause for concern, since we fear that a good number of excellent candidates are denied this operation based on fears from previous experience. The world literature as well as our recent experience over the last 18 months lead us to believe that carotid endarterectomy is a very safe procedure with excellent short and long term results, and is associated with a very low morbidity and mortality.

Aged↗
PubMed1986

[Coronary endarterectomy associated with by-pass. A series of 111 patients controlled angiographically].

Out of 2 638 patients undergoing coronary bypass surgery at the Arnault Tzanck Centre from 1973 to September 1984, 305 (12%) also required coronary endarterectomy. One hundred and eleven of these patients had control angiographies at the Centre and were the object of this study. Endarterectomy was carried out on a totally occluded artery in 38% of cases and was performed out of necessity in the other cases. One hundred and twenty-nine disobliterations were performed in these 111 patients. The average number of bypass grafts per patient was 2.8. The overall hospital mortality was 6% (19 out of 305) which was higher than for bypass surgery alone. The postoperative myocardial infarction rate was 10%. The 117 control angiographies were performed on average during the 8th month after surgery; these controls were routine in 99 cases (84.5%) in Stage I of the NYHA classification and for recurrent angina in 18 cases (15.5%). The endarterectomised vessel was patent in 72% of cases, which was less than the patency rate of the bypass grafts. Considering the indications of necessity, this result is satisfactory and is compared which those of other reported series.

Adult↗
PubMed1988

Carotid endarterectomy in patients with territorial transient ischemic attacks.

Results are presented of a retrospective analysis of 651 carotid endarterectomies in 605 patients with carotid territorial transient ischemic attacks (TIAs). All operations were performed by the same surgeon in a community hospital from 1963 to 1986. Arteriographic findings consisted of carotid stenosis of 50% or greater in 88.5% of patients and stenosis less than 50% and/or an ulcerated plaque in the remaining 11.5%. Medical risk factors were detected in 92% of patients; hypertension, peripheral vascular disease, and coronary atherosclerosis were most prevalent. All operative procedures were conducted with the patients under general anesthesia, routine shunting, and arterial closure without a patch. The perioperative stroke rate was 1.5% (10 patients); the morality rate was 0.8% (three deaths from myocardial infarction and two from stroke) for a combined stroke and mortality rate of 2.0% (13 of 605 patients). Follow-up (mean 61.8 months) was possible in 570 (96%) of the patients surviving operation without a perioperative stroke. The cumulative probability of late stroke (i.e., cerebral infarct ipsilateral to the operated artery) was 2.5% at 5 years and 8.1% at 10 years. When the perioperative stroke-mortality rate (2.0%) is combined with the data for late ipsilateral stroke, the 5- and 10-year probabilities of ipsilateral stroke were 4.5% and 9.9%, respectively (mean 1% per year for 10-year period). Coronary atherosclerosis accounted for 43% of late deaths and 16% of strokes. The perioperative stroke-mortality rate of 2.0% in this group of patients falls within the acceptable range for carotid endarterectomy in patients with TIA.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1988

Carotid endarterectomy after reversible ischemic neurologic deficit or stroke: is it of value?

The benefit of carotid endarterectomy (CE) in preventing recurrent stroke and improving survival in the patient who has sustained a reversible ischemic neurologic deficit (RIND) or stroke is still controversial. To determine the long-term benefits and value of CE in these patients, a 10-year review of 253 patients who suffered a RIND or stroke was conducted. All patients had CT brain scans, as well as arch, extracranial, and intracranial arteriography; any patients without demonstrated carotid bifurcation disease were excluded from the study. On the basis of clinical symptoms and CT scan findings, 66 patients were categorized as having sustained a RIND and 187 a stroke. One hundred fifty-one patients who suffered a RIND or stroke had CE, whereas 102 patients with RIND or stroke did not have CE and served as a control group. All endarterectomies were performed with a temporary indwelling shunt. Postoperative complications included two deaths (1%), six strokes (4%), and 10 transient neurologic deficits (7%). In follow-up extending to 10 years the cumulative incidence of recurrent stroke was only 7% (11 patients) in the operated group, whereas 18% of patients in the nonoperated control group (18) sustained a recurrent stroke (p less than 0.05). As anticipated, the leading cause of death during follow-up was cardiac related; although CE did not significantly improve long-term survival, there was more than a twofold decrease in the incidence of recurrent stroke as a cause of death in the group having CE.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1988

Coronary endarterectomy: the long-term local effects.

The chronic effects of manual endarterectomy of coronary arteries are described. Nine male patients (age, 58-70 years) had undergone right coronary endarterectomy and bypass grafting 6-9 years prior to death and autopsy. One of the nine endarterectomized arteries had thrombosed soon after the procedure, while the other eight had maintained blood flow for up to eight years. These patent arteries had variable myofibrointimal proliferation ranging from mild to marked, the latter with significant stenosis. Recurrent atherosclerosis was present focally in two endarterectomized arteries. Death had occurred from causes unrelated to pathology in the endarterectomized vessels and provided a unique opportunity to assess the variable long-term effects of this form of arterial injury.

Aged↗
PubMedDate not supplied

Arterial assessment before carotid endarterectomy: current practice in Great Britain and Ireland.

A survey of the management of patients with putative carotid artery disease by 245 vascular and neurosurgeons in Great Britain and Ireland was conducted with a 96 per cent response. Ninety-six (41%) surgeons performed at least one carotid endarterectomy in 1984 and a total of 1374 such operations were carried out in that year. Of the 40 surgeons who performed more than ten operations in 1984, 95 per cent generally employed a screening technique which was less invasive than conventional angiography in their management. Techniques based on ultrasonography were more popular than those based on digital subtraction angiography (DSA) in this respect. If carotid endarterectomy were to be undertaken, 63 per cent of surgeons required pre-operative conventional angiograms. Of the 38 per cent who did not routinely use conventional angiography, all but one used digital subtraction angiography. Ultrasonography and DSA have had a significant impact on the management of carotid artery disease in Great Britain and Ireland and their individual places in such management are becoming clear.

Carotid Arteries↗
PubMed1988

Retrograde dissection of the left main coronary artery after endarterectomy: a rare complication.

The case of a 72-year-old woman who died after bypass grafting and endarterectomy of the left anterior descending coronary artery is described. At autopsy a large intramural dissection of the left anterior descending artery that extended proximally to the left main ostium from the endarterectomy site was found. The dissection was associated with clotting of the false lumen and of the graft, and with a myocardial infarct that precipitated this woman's intraoperative death.

Aged↗