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 1,495 records · Page 83Linked to original sources
PubMedDate not supplied

Continuous electroencephalographic monitoring during carotid endarterectomy.

Four hundred and twenty-seven carotid endarteriectomies were performed on 377 patients. The electroencephalogram was used as the sole determinant for the use of a carotid shunt in 386 carotid endarterectomies. With clamping of the internal carotid artery, 51 (13%) had electroencephalographic changes. The most common electroencephalographic change (60%) was rapid, ipsilateral attenuation of background activity. In the 30 day follow up period there were 3 deaths (0.7%) and 11 strokes (2.5%). Two patients (0.5%) had intraoperative strokes. The combined morbidity and mortality was 2.8% (12 of 427). Neurologic complications increased significantly with contralateral carotid occlusion. The electroencephalogram correlated well with neurological deficits occurring in surgery, but stump pressures neither correlated with neurological deficits nor electroencephalographic changes. Continuous electroencephalographic monitoring during carotid endarterectomy is an effective method of determining significant cerebral ischemia and the need for a carotid shunt.

Adult↗
PubMed1988

[Carotid endarterectomies for cerebral ischemia: a follow up study of surgical results and late neurologic complications].

Twenty five carotid endarterectomies were performed in 24 patients with cerebral ischemia due to atherosclerosis. Four of these patients were asymptomatic, 7 suffered from hemispheric TIA (hemispheric attack group), 7 suffered from nonhemispheric TIA (nonhemispheric attack group) and other 6 had previous completed stroke (completed stroke group). The average length of follow-up study was two and half years with a range of 2 months to 6 years. Completed strokes occurred in 1 patient following the operation and in 3 patients during the follow-up period (16.7%). Two patients were reoperated upon because of recurrent carotid stenosis (8.3%). Four patients continued to have neurologic symptoms postoperatively. Ultimately 10 of 24 patients had some neurologic complications even following carotid endarterectomies (41.7%). The first postoperative year was the worst period because almost all late neurologic complications occurred in that time. Kaplan-Meier's analysis demonstrated a relatively favorable result in the hemispheric attack group among these 3 groups. The completed stroke group was followed by that and the nonhemispheric attack group was proved to be the worst, although there was no statistical significance.

Aged↗
PubMedDate not supplied

Local neurological complication during carotid endarterectomy.

In a prospective study of 52 carotid endarterectomies there were 13 temporary cranial nerve injuries in 12 patients (25%); 7 hypoglossal nerve injuries (13.5%), 3 were asymptomatic (5.8%), 2 had mild speech difficulty (3.8%) and 2 had severe difficulty with deglutition and articulation (3.8%). A full recovery was made within 3 months in all 7 patients. Although 10 patients (19.2%) developed a hoarse voice, indirect laryngoscopy only indicated damage to the ipsilateral recurrent laryngeal nerve in 3 patients (5.8%). Both the voice and vocal cord movement returned to normal within 6 months in 2 patients and a 9 months in the third. The marginal mandibular branch of the facial nerve was injured in 3 patients (5.8%) and all recovered completely within 3 months. Following injury to the great auricular and the transverse cervical nerves injury, 13 patients (25%) had persistent irritation and paraesthesia during shaving and in cold weather lasting up to 18 months after operation. Carotid endarterectomy is associated with a much higher incidence of local nerve injury than retrospective surveys would indicate.

Aged↗
PubMed1988

Computed electroencephalographic topographic brain mapping. A new and accurate monitor of cerebral circulation and function for patients having carotid endarterectomy.

To determine the usefulness of computed electroencephalographic (EEG) topographic (CET) brain mapping to monitor neurologic function during carotid endarterectomy (CEA), 46 consecutive patients having CEA were monitored preoperatively, intraoperatively, and immediately postoperatively by CET brain mapping and simultaneous 16-lead EEG. Preoperative studies revealed that 7 of 16 asymptomatic patients, 5 of 11 patients with amaurosis fugax, and 8 of 12 patients with transient ischemic attacks (TIAs) had abnormal CET brain mapping suggestive of previous subclinical stroke. EEG was abnormal in only 8 of the 20 patients with abnormal CET brain mapping. Intraoperatively during carotid cross-clamping, ischemic changes were seen on CET brain mapping in 23 patients whereas EEG detected these changes in only 13 patients. Ischemic changes detected by intraoperative CET brain mapping were more likely to occur in patients with previous stroke (six of seven) than in patients without previous stroke (17 of 39), p less than 0.05. Patients with changes detected by intraoperative CET brain mapping had an average carotid back-pressure of 38 mm Hg, in contrast to 57 mm Hg for patients without CET brain mapping changes, p less than 0.05. After endarterectomy, CET brain mapping revealed new ischemic changes in one patient who awoke with a mild stroke and in one patient who had TIAs and amaurosis fugax within 6 hours of surgery. We conclude that CET brain mapping is a sensitive, accurate, and useful noninvasive monitor of cerebral circulation and function for patients having CEA.(ABSTRACT TRUNCATED AT 250 WORDS)

Blindness↗
PubMed1987

[Coronary endarterectomy (blind and open) associated with bypass. Experience in 143 patients].

From June 1982 until January 1986, 173 coronary endarterectomies (EA) with bypass were performed in 143 patients. The series includes 130 conventional EA and 43 open EA with coronary reconstruction. In 9 cases of open EA the revascularization of the reconstructed coronaries was accomplished with internal mammary artery (AMI). 70 (40.4%) EA were performed on the right coronary artery, 75 (43.3%) on the left anterior descending coronary artery and 28 (20.1%) on the left circumflex coronary artery. The early mortality rate in the entire group was 3.5% (respectively 2.0% for the conventional EA and 7.3% for the open EA) and the rate of perioperative myocardial infarction was 8.4% (7.8% in patients receiving conventional EA and 9.7% in those receiving open EA). With mean follow-up of 18.4 months, most (89.8%) of the surviving patients were either symptoms-free or greatly improved. Coronary endarterectomy is a worth-while procedure and it allows surgical management of otherwise inoperables arteries.

Adult↗
PubMed1987

PTFE grafts to the right coronary artery following endarterectomy.

In ten of 3031 patients undergoing coronary surgery, we used a PTFE graft for bypass to the right coronary artery following endarterectomy. Diffuse calcification was the reason for endarterectomy of the right coronary artery in all cases. We chose a PTFE graft only in those cases where autologous grafts were not available in a sufficient number. After a mean follow-up period of twelve months nine of the ten grafts were patent.--This study demonstrates that under selected circumstances PTFE grafts can be successfully used in coronary surgery if autologous grafts are lacking.

Blood Vessel Prosthesis↗
PubMedDate not supplied

Carotid endarterectomy. Long term follow-up with specific reference to recurrent stenosis, contralateral progression, mortality and recurrent neurological episodes.

This study follows up 292 carotid endarterectomy operations in 256 patients using the colour coded carotid Doppler Imager and oculoplethysmography and reports the rate of ipsilateral restenosis, contralateral progression, late (after 30 days postoperatively) neurological symptoms and mortality in life table form. The restenosis rate was 15% at 5 years. No case of restenosis presented with symptoms and none required reoperation. The contralateral progression rate from less than 50% internal carotid artery stenosis to greater than 50% was 20% over 5 years. Significantly more symptoms were associated with cases of contralateral progression (p = 0.05). The late neurological symptom rate was 14% at 5 years and was associated with widespread intra/extracranial vascular disease rather than restenosis. The late death rate was 12% at 5 years of which 40% were due to myocardial infarction. The overall postoperative death rate over 5 years was the same as an age and sex matched population. A more aggressive approach to coronary artery disease does not appear justified. The value of noninvasive tests in the post-endarterectomy situation is stressed with particular reference to documentation of contralateral progression.

Arteriosclerosis↗
PubMedDate not supplied

Carotid endarterectomy in the community hospital. A continuing controversy.

A retrospective review of 390 carotid endarterectomies performed in two major private hospitals over 78 months by general and neurological surgeons, was conducted. The mortality was 3.1% including five fatal strokes. Permanent neurological deficit was noted in 7.2% of survivors. Use of an intraoperative shunt, or the occurrence of postoperative hypotension did not alter the morbidity. Postoperative hypertension was clearly detrimental, while those with a stable postoperative course fared best. General vascular surgeons were classified as having had additional cardiovascular training, special interest or occasional experience in vascular surgery. Neither training nor case load appeared to affect morbidity. Individual differences within groups were greater than between groups. Improvement of statistics was noted in the second 18 months. It is concluded that the best method to improve results in the moderate sized community with a mixed pool of surgeons is to promote open and ongoing peer review of indications and results of carotid endarterectomy.

Carotid Artery Diseases↗
PubMed1986

Use of carotid endarterectomy in five California Veterans Administration medical centers.

Although carotid endarterectomy is a controversial and frequently performed surgical procedure, little is known about the clinical appropriateness of its use in actual practice. Are the majority of procedures performed for highly accepted clinical reasons? We studied the clinical appropriateness of 107 procedures performed on 95 patients in 1981 in five Veterans Administration teaching medical centers. Standards for judging appropriate use were based on the recommendations of a multidisciplinary panel of nine physicians. Fifty-five percent of the procedures studied were judged clearly appropriate, 32% equivocal, and 13% clearly inappropriate. The rate of serious operative complications was 5.6%. These results suggest that carotid endarterectomy is overutilized within at least some segments of the Veterans Administration population.

Age Factors↗
PubMed1985

The safety of carotid endarterectomy at the time of coronary artery bypass surgery: analysis of results in a high-risk patient population.

From Jan. 1, 1979, to Dec. 31, 1983, 37 patients have undergone simultaneous carotid endarterectomy and myocardial revascularization. There were 27 men and 10 women, and their ages ranged from 45 to 74 years (mean 61.3 years). Unstable angina was present in 61%, significant stenosis in the left main coronary artery in 27%, and either unstable angina or disease of the left main coronary artery in 70% of these patients. All patients had hemodynamically significant stenosis of the carotid artery on the operated side and 14 patients (38%) had bilaterally significant disease; three patients (8%) had a contralateral total occlusion of the carotid artery. There were no deaths resulting from neurologic factors, no permanent, and only one transient (2.7%) neurologic deficits. There were three deaths from cardiac causes (8.1%). Carotid endarterectomy may be performed safely at the time of myocardial revascularization in a patient population with a high incidence of unstable angina and disease of the left main coronary artery. The evolution of and rationale for the combined surgical approach to coexistent carotid and coronary artery disease is discussed and the literature reviewed.

Aged↗
PubMed1985

Evaluation and treatment of cerebral ischemia. Carotid endarterectomy and extracranial-intracranial bypass.

Patients with cerebral ischemia comprise an extremely heterogeneous group that makes analysis of treatment extremely difficult. Given the wide range of findings in the literature, one may select specific reports to justify a predetermined viewpoint. The study of Easton and Sherman has elicited a disproportionate amount of attention. Of the thousands of reported patients in the literature, this study of 228 patients with high postoperative morbidity and mortality has regrettably been cited often as the potential representative of surgical outcome in community hospitals. Undoubtedly, surgical skill varies and may affect results. Not all studies, however, support the contention that such procedures can only be performed adequately by surgeons who frequently do such operations. Most importantly, this study should redraw our attention to the fact that the success of the individual surgeon must be evaluated for any given procedure. With proper selection of patients, both carotid endarterectomy and EC-IC bypass procedures have proved to be safe and effective. In general, technical advances have heralded surgical results that appear to be superior to medical management, or no treatment, in a wide range of patients with cerebrovascular disease. Surgical results can only be evaluated when a procedure is fully developed technically and a large number of cases are accumulated. For carotid endarterectomy, and more recently EC-IC bypass, the necessary information is becoming available. However, the classification of patients to which these procedures should be applied has lagged behind. Given the variability in patients with cerebrovascular disease, this is somewhat understandable. Properly controlled studies would necessarily be unrealistically large. However, the technology and subsequent data that should be developed throughout the next decade will provide us with important information about brain ischemia and metabolism. This new technology should allow us to more completely define the exact nature of ischemic events in the individual patient. This will lead to better classification of patients and, ultimately, will improve patient selection for any methods of treatment, either medical or surgical.

Aged↗
PubMed1985

[The fate of patients with carotid stenosis. Comparative study, based on the literature, of their natural history and evolution under medical treatment or following endarterectomy].

The aim of therapy of carotid artery stenosis is to reduce the number of cerebral ischemic accident complications, but marked uncertainty exists at the present time as to the spontaneous course of these stenotic lesions and the efficacy of the different treatments proposed. After a transient ischemic accident (TIA) there is a 37% risk of a vascular accident (CVA) of a more definite type occurring within 5 years but only 1/4 of these patients die of cerebral complications, death in half of the cases being of coronary origin. Very rapid treatment with anticoagulants after TIA slightly diminishes the number of established cerebral ischemic accidents, but increases the risk of cerebral hemorrhage. Among the anti-aggregant agents, only Aspirin at high dosage (1 to 1.3 g/24 h) appears to be effective in preventing relapses of TIA and/or of CVA and/or on mortality which results from it. Carotid endarterectomy after TIA does not alter long-term survival, dependent on the increased cardiac mortality, but appears to reduce markedly the long-term recurrence rate of TIA and/or CVA. Globally, however, benefits of surgical treatment can be obtained only if post-operative cerebral mortality and morbidity are extremely low, conditions obtained in highly specialized centers only. Spontaneous course of angiographically detected asymptomatic stenosis shows, for a mean 4-year survival, a relatively low level of TIA (3,3 to 19%) and of CVA (0 to 12%) whatever the anatomic type of the stenosis. Prophylactic endarterectomy in practised hands has a low operative mortality (0 to 2%), a limited perioperative cerebral morbidity (1.3 to 4.5%) and a satisfactory later relapse rate of CVA (less than 5% at 4 years). These findings indicate comparable courses for spontaneous and treated cases globally, as well as with respect to cardiac mortality. In the absence of randomized trials it is a controversial point as to whether carotid surgery is superior to a spontaneous course in cases of asymptomatic stenosis.

Anticoagulants↗
PubMedDate not supplied

Improved surgical technique for carotid endarterectomy.

Despite improved results following carotid endarterectomy, a small but significant incidence of neurological deficit may follow the operation. Emphasis has deviated from the importance of the technical details of the operative procedure to consideration of the role of physiological factors (e.g., shunt, stump pressure, EEG vigilance, type of anesthesia). The surgical principles outlined in this report were used in a consecutive series of 214 patients undergoing carotid endarterectomy. A neurological deficit was noted in two patients (0.9%) in whom thrombosis of the repair site was proven.

Carotid Arteries↗
PubMed1986

Staged bilateral carotid endarterectomy.

In a series of 56 staged bilateral carotid endarterectomies, new neurologic symptoms developed in 5% and 20% following the first and second procedure, respectively. All complications were transient or minor. The incidence of postendarterectomy hypertension was significantly higher following the second procedure, when operations were staged less than 3 weeks apart. A correlation between these hypertensive episodes and the occurrence of new neurologic symptoms could not be shown. However, as this correlation has been proved in several other reports, bilateral carotid endarterectomy is advised to be staged at least 3 weeks apart. In addition, a conservative attitude towards contralateral asymptomatic lesions is proposed.

Adult↗
PubMed1986

Carotid endarterectomy in the elderly patient.

Although the segment of the population at the highest risk for cerebral ischemic events is more than 75 years old, there has been hesitancy in performing carotid revascularization in these patients because of an increased risk of perioperative morbidity. Over a period of 54 months, 77 (16 per cent) of 470 carotid endarterectomies performed were upon patients more than 75 years old. There were no differences between age groups with respect to perioperative morbidity or mortality, with three strokes (3.9 per cent) and no deaths in the patients more than 75 years old and 12 strokes (3.1 per cent) and two deaths (0.5 per cent) in the patients less than 75 years old. Postoperative follow-up study ranged from 30 days to five years (a mean of 25 months) in elderly patients. The over-all three and five year survival rate was 78 and 60 per cent, respectively. No patient experienced a stroke during follow-up study. Recurrent symptoms developed in 18 per cent of the elderly patients at three years of follow-up study, and the occurrence was dependent upon the preoperative symptom category (hemispheric 10 per cent and nonhemispheric 33 per cent). We conclude that the low perioperative morbidity and mortality, and subsequent results of carotid endarterectomy in the elderly patient justify operative intervention when significant lesions are encountered.

Actuarial Analysis↗
PubMed1985

Carotid endarterectomy after a completed stroke: reduction in long-term neurologic deterioration.

The merit of carotid endarterectomy for patients who previously have sustained a completed stroke remains controversial. Between January 1976 and December 1983, 118 stroke patients with mild to severe permanent neurologic deficits were evaluated. Fifty-nine patients were managed nonoperatively and 59 operatively. Both cohorts were similar in age and sex distribution, incidence of hypertension (69%), diabetes mellitus (25%), and cardiac disease (39%). In the long-term follow-up (medical cohort average was 44.1 +/- 5.0 months; surgical cohort average, 41.8 +/- 3.7 months) the overall survival rate was comparable, that is, there were nine medical deaths and eight surgical deaths. However, there was a significant difference in the development of new neurologic deficits. Twelve of the 59 unoperated patients had new neurologic deficits and three patients died at 12, 36, and 48 months as a result of a recurrent stroke. New neurologic deficits developed in only two of the 59 surgical patients and there were no stroke-related deaths. When the cumulative probability of remaining free from recurrent deficits was examined in the surviving patients at 6 years, all of the patients in the operated group remained free from recurrent deficits, whereas only 58% of the patients in the unoperated group were free of new neurologic deficits (p = 0.02). These data suggest that stroke patients with fixed mild to moderate neurologic deficits and with carotid lesions may be protected from recurrent neurologic complications by carotid endarterectomy.

Aged↗
PubMed1985

Wound hematomas after carotid endarterectomy.

Wound hematomas, following carotid endarterectomy, are uncommon but potentially lethal complications. The management of 13 patients with this condition is presented. Factors that appeared to predispose to hematoma formation included perioperative use of platelet inhibitory drugs and postoperative hypertension. When the diagnosis of neck wound hematoma is made after carotid endarterectomy, prompt evacuation under local anesthesia is recommended.

Aged↗
PubMed1985

Carotid endarterectomy. One solution to the stroke problem.

Stroke is most often the result of extracranial cerebral artery disease; stroke carries a high initial mortality and morbidity and portends an increased risk of subsequent stroke or myocardial infarction. Stroke is also a preventable disease in more than one half of patients, either by approximate treatment of premonitory transient ischemic attacks or by appropriate evaluation of otherwise asymptomatic carotid bruits. Combined patient education and referring physician awareness should result in a declining incidence of stroke in this country. Two hundred carotid endarterectomies were performed over a 4-year period by senior residents under the direct supervision of the authors. Operative mortality was 1.5 per cent; perioperative stroke, 1.5 per cent; temporary neurologic deficit, 1 per cent; and temporary cranial nerve injury, 1 per cent. Analysis of these patients and of the literature supports an aggressive approach to carotid endarterectomy for patients with focal transient ischemic attacks and a more cautious approach for patients with prior stroke or asymptomatic stenoses.

Adult↗