The purpose of this study was to determine the impact of intraoperative quality control using arteriography on the conduct and immediate outcome of carotid artery surgery. This retrospective study included 623 carotid artery repair procedures performed between January 1993 and January 2000. There were 427 men and 159 women (37 ...

A major limitation of embolic signal (ES) detection by transcranial Doppler ultrasound is the lack of a reliable automated system. The performance of an automated system needs to be evaluated for different embolic sources on consecutively acquired typical data. We evaluated a new online frequency filtering approach in a total ...

Atherosclerotic lesions of the extracranial cerebral arteries account for ischemic stroke in over half of all cases. The risk of stroke associated with symptomatic carotid artery disease is related to the severity of the stenosis. Results of the two major clinical trials, North American Symptomatic Carotid Endarterectomy Trial (NASCET) and ...

CONTEXT: Total occlusion of the common carotid is rare and the indications and techniques for surgical treatment are still a matter of controversy. OBJECTIVE: To demonstrate the feasibility of retrograde common carotid endarterectomy. DESIGN: Retrospective case report study. SETTING: Tertiary care private hospital. PARTICIPANTS: Three patients underwent ring-stripping retrograde common ...

BACKGROUND: When investigating the degree of formation of intimal hyperplasia (IH) quantification of the extent of the lesion is crucial to its assessment and analysis. The aim of the present study was to establish a new methodology (IH index) for estimating the degree of IH associated with vascular prosthesis implantation. ...

Very few operations have been subject to more scientific scrutiny than carotid endarterectomy (CEA). Since its introduction in the 1950s, CEAs have been performed in great numbers with the goal of preventing ischemic stroke. In the mid 1980s concern about over utilization of CEA and reports of excessive perioperative stroke ...

BACKGROUND AND PURPOSE: The aim of this study was to assess the first multifrequency transcranial Doppler system that was specially developed to automatically detect and discriminate between solid and gaseous cerebral microemboli. METHODS: The multifrequency transcranial Doppler instrumentation insonates simultaneously with 2.5 and 2.0 MHz. Differentiation between solid and gaseous ...

With the perceived high risk of repeat carotid surgery, carotid angioplasty and stenting have been advocated recently as the preferred treatment of recurrent carotid disease following carotid endarterectomy. An experience with the operative treatment of recurrent carotid disease to document the risks and benefits of this procedure is presented. A ...

Carotid endarterectomy is a procedure that has withstood the test of time and scientific scrutiny to remain an important technique for the surgical prevention of stroke. Several aspects of this operation are critical for success, i.e., improving on the natural history of carotid artery stenosis. The procedure is described in ...

OBJECTIVE: To evaluate which velocity, or combination of velocities, from carotid Doppler ultrasonography (DU), achieved the closest agreement with an assessment of suitability for carotid endarterectomy from intra-arterial angiograms (IAA). METHODS: We prospectively collected data from 148 consecutive patients (288 carotids), who had DU and IAA (blinded assessment) before possible ...

A case with a disease triad of an ulcerative lesion in the left internal carotid artery (LICA), severe coronary insufficiency, and an infrarenal abdominal aortic aneurysm (AAA) is presented in whom we performed simultaneous carotid endarterectomy (CEA), coronary artery bypass grafting (CABG), and Y-graft replacement of the AAA. The operative ...

BACKGROUND: Although excellent short- and long-term results have been achieved with surgery in extracranial internal carotid artery stenosis, recurrent stenosis continues to play an important role in post-endarterectomy. Therefore, a close follow-up of patients is warranted. The value of postoperative duplex sonographic evaluations in postoperative follow-up is highly disputed. The ...

BACKGROUND: To evaluate the effect of carotid endarterectomy on ophthalmic artery flow direction and peak systolic flow velocity, the authors examined the ophthalmic artery on 32 patients who had undergone carotid endarterectomy. METHODS: The 32 patients had more than 70% stenosis of the internal carotid artery at its origin on ...

In this article, a patient with extensive cerebrovascular disease who had previously undergone bilateral carotid endarterectomy and subsequent operative revision on the left side is described. The patient developed critical restenosis at the cephalic end of the previous left patch angioplasty as well as a severe stenosis of the left ...

The collateral flow to the cerebral hemisphere after carotid cross clamping during carotid endarterectomy is mainly through the circle of Willis, and the circle is incomplete in the majority of cases. A correlation between the status of the circle of Willis and the necessity of shunting was evaluated in 67 ...

We report a case of carotid endarterectomy and clipping of an ipsilateral internal carotid artery aneurysm in a patient with complete contralateral carotid stenosis. The patient developed an ischaemic electroencephalographic (EEG) tracing on temporary carotid clamping and bypass shunt was contraindicated. We used thiopentone titrated to EEG burst suppression for ...

Recurrence of carotid artery stenosis after primary endarterectomy is a well-known entity. The treatment and optimal management of the disease process, however, is a matter of ongoing debate. We retrospectively reviewed carotid endarterectomies for recurrent disease performed at a community hospital over the past 21 years to evaluate the outcome ...

The aim of this study was to use ultrasonography to assess an experimental carotid arteriotomy followed by end-to-end anastomosis in the lamb. Animals were subjected to an experimental surgical procedure consisting of a right carotid artery arteriotomy and subsequent end-to-end anastomosis with nonpenetrating metallic clips. Left side arteries were used ...

BACKGROUND: Patients with concomitant occlusive disease of coronary and carotid arteries remain at high risk of perioperative stroke and myocardial infarction. Combined coronary artery bypass grafting on cardiopulmonary bypass and carotid endarterectomy has been shown to give good results for this category of patients. In the present study, we analyzed ...

Between January 1, 1985 and December 31, 1998, we performed combined infrarenal aorta and carotid artery reconstruction in 152 consecutive patients. The mean age of these patients was 65.4 +/- 8.6 years (range, 43-88 years). Infrarenal aortic disease involved abdominal aortic aneurysm in 78 patients (44.7%) and occlusive aortoiliac lesions ...

This article reviews the disease process of carotid artery stenosis, its symptomatology, and prognosis for progression to ischemic stroke. Indications for both medical and surgical treatment are reviewed as is criteria for surgical categorization as specified by the American Heart Association guidelines for carotid endarterectomy. Although diagnostic testing, medical treatment ...

Our study objective was to determine if patch angioplasty after carotid endarterectomy decreases the incidence of post-reconstruction technical defects and recurrent stenosis. This was a retrospective review of a prospectively maintained database from February 1980 to February 2000. Main outcome measures included incidence of intraoperative technical defects, residual disease within ...

The North American Symptomatic Carotid Endarterectomy Trial (NASCET) confirmed that carotid endarterectomy (CEA) can significantly cut the risk of stroke in patients with moderate and severe blockage. The standard today is that patients who have internal carotid artery stenosis > 70% with associated symptoms and who are appropriate surgical candidates ...

Endarterectomy reduces the risk of stroke in selected patients with carotid artery stenosis, and the benefit is related to the degree of stenosis. Although the randomized trials demonstrating this benefit measured the degree of stenosis with conventional catheter angiography, many physicians are relying on noninvasive tests to select patients for ...

The authors have developed a double-barreled tack suture procedure for carotid endarterectomy with minimal modification of a conventional needle holder. With this method surgeons can make two stitches simultaneously by using two needles threaded with double-armed suture material, which are held tightly in a parallel fashion in the jaws of ...

Non-penetrating, arcuate-legged titanium clips (VCS) have been utilized successfully over the past five years for a variety of cerebrovascular reconstructions. These applications, including both micro and macrovascular reconstructions, their clinical outcomes and technical considerations are described. Applications include patch angioplasty of cervical carotid endarterectomies, superficial temporal to middle cerebral artery ...

OBJECTIVES: The goal of this study was to determine whether carotid angioplasty and stenting (CAS) is equivalent to carotid endarterectomy (CEA) in patients with symptomatic carotid stenosis >70% by a randomized, controlled trial in a community hospital. BACKGROUND: Carotid angioplasty and stenting has been suggested to be as effective as ...

This is an analysis of restenosis after bilateral carotid endarterectomy (CEA) with saphenous vein patch reconstruction on one side and Dacron patch reconstruction on the other. The possibility that differences in reconstruction geometry between vein and Dacron patched sides effected restenosis outcomes was evaluated as was the value of serial ...

Proper therapy for patients with internal carotid artery stenosis requires a precise pathophysiologic diagnosis that includes characterization and localization of ischemic disease of the brain and knowledge of the arterial disease and the collateral cerebral circulation. Noninvasive techniques such as duplex ultrasound and transcranial Doppler, magnetic resonance angiography, and CT ...

OBJECTIVE: Carotid angioplasty with stent placement is becoming an established treatment modality for patients with high-risk carotid stenosis. Unlike carotid endarterectomy, angioplasty causes direct mechanical dilation of the stenotic carotid artery and bulb. Stimulation of the sinus baroreceptors induces a reflexive response that consists of increased parasympathetic discharge and inhibition ...

Carotid endarterectomy with patch angioplasty is a durable procedure for prevention of recurrent neurological symptoms and stroke. However, no definitive study has demonstrated a clear benefit of one class of the patch material over another. The aim of this study was to evaluate the clinical outcome of carotid endarterectomy with ...

BACKGROUND: Eversion carotid endarterectomy (ECEA) is a technique that obviates the need for traditional longitudinal arteriotomy and patch closure, with low stroke and restenosis rates. The aim of the present study was to report an Australian experience and technique of ECEA. METHODS: All patients who underwent ECEA by the investigating ...

Based on data of recent literature, the most suitable preoperative diagnostic approach to cerebrovascular insufficiency, is evaluated. Correct indications for carotid endarterectomy in symptomatic and asymptomatic carotid stenoses are related to the degree of stenosis. This is also the most important predictive factor of stroke ipsilateral to the stenosis. Arteriography ...

A 56-year-old man had undergone extracranial-intracranial (EC-IC) bypass surgery for occlusion of the right internal carotid artery. Six years later, he complained of transient episodes of numbness in the left arm, occurring periodically over the previous 3 months. Neuroimaging showed the right external carotid artery was severely narrowed and cerebral ...

Controversy exists concerning the best management of patients with coronary artery and carotid artery disease. Between June 1994 and July 2000, 88 patients with coronary artery and carotid artery disease underwent combined coronary artery surgery and carotid endarterectomy. Demographics and perioperative variables of these patients were compared with those of ...

BACKGROUND: As part of a broader effort aimed at improving hospital safety, a large coalition of employers, the Leapfrog Group, will soon require hospitals caring for their employees to meet volume standards for 5 high-risk surgical procedures. We estimated the potential benefits of full nationwide implementation of these volume standards. ...

The objective of this observational study was to determine whether pre-operative transcranial Doppler measurements could identify patients at risk for early cerebral hyperperfusion following carotid endarterectomies. Fifty-five patients (mean age 64.4 years) with symptomatic internal carotid artery stenosis were included. Pre-operative transcranial Doppler measurements included middle cerebral artery blood flow ...

BACKGROUND: The purpose of this study was to investigate the clinical features and management of ocular ischemic syndrome (OIS) and factors influencing its development. METHODS: Ten patients (12 eyes) with OIS underwent detailed medical and ocular histories, complete ophthalmic evaluation including fluorescein angiography, internal carotid artery evaluation by duplex ultrasonography, ...

A 72-year-old man presented with paroxysmal and transient involuntary movements, or "limb shaking". The attacks occurred alternately from one side of the body to the other and ceased spontaneously. Surface EMG study showed synchronous grouping discharges in multiple limb muscles, being compatible with hemiballism-hemichorea. Cerebral angiography demonstrated marked stenosis of ...

A case series is presented demonstrating a unique approach to the treatment of tandem atherosclerotic lesions of the internal carotid artery. Between 1994 and 1999 eight patients with tandem lesions of the internal carotid artery were treated by combined carotid endarterectomy for the proximal lesion and intraoperative angioplasty of the ...

BACKGROUND AND PURPOSE: There has been concern regarding the safety of revascularization procedures of vessels supplying the brain vessels because of the risk of cerebral embolization during the procedure. We have observed a high incidence of hyperintense lesions on diffusion-weighted MR images of the brain after stenting at the carotid ...

The assessment of carotid atherosclerotic disease is an essential pre-requisite for determining a patients suitability for carotid endarterectomy to prevent ischaemic stroke. Catheter angiography is regarded as the most accurate investigative tool for this purpose. However, with its finite morbidity and invasiveness, there is an increasing reliance upon non-invasive methods ...

OBJECTIVES: The purpose of this study was to assess the efficacy of emergency stent implantation for the treatment of perioperative stroke after carotid endarterectomy (CEA). BACKGROUND: Carotid endarterectomy has been proven safe and effective in reducing the risk of stroke in symptomatic and asymptomatic patients with >60% carotid artery stenosis. ...

OBJECTIVE: To study the incidence of wound haematomas and hyperperfusion following carotid endarterectomy and the effect of changes in perioperative management. METHODS: We undertook a prospective audit of the postoperative outcome of 300 consecutive carotid endarterectomies performed for a symptomatic stenosis of the internal carotid artery, under the care of ...

Patients with concomitant carotid and coronary artery disease are at high risk of both cardiac and cerebrovascular complications when they undergo revascularization procedures. The best management strategies for patients with concomitant disease have not been determined for certain. Staged surgical procedures with either coronary artery bypass grafting prior to carotid ...

PURPOSE: Recurrent stenosis after carotid endarterectomy (CEA) is often regarded as an optimal application of carotid artery angioplasty and stenting (CAS). The extended durability of CAS for recurrent carotid artery stenosis after CEA is unknown. We present the intermediate-term surveillance results for all eight CAS procedures performed over a 28-month ...

Endarterectomy is currently the preferred treatment for severe carotid stenosis. The technique of eversion endarterectomy allows correction of severe vessel elongation and kinking. The latter is generally believed to be a relative contraindication for endovascular stent placement. We report successful percutaneous transluminal angioplasty and stenting of a left internal carotid ...

In cardiovascular surgery, the manual continuous suture has often been used for microvascular anastomosis, but the luminal irregularity often causes thrombotic stenosis in the anastomosis sites. The purpose of this study was to examine the feasibility of the combined use of gelatin-resorcin-formaldehyde (GRF) glue and a collagen sheet for the ...

OBJECTIVE: The purpose of this study was to clarify the normal findings of arteries in and around the masseter muscle and to present their pathologic changes with the use of color Doppler sonography. STUDY DESIGN: The vascular appearances were examined for the 4 main arteries feeding the masseter muscle in ...

Endovascular angioplasty and stent placement are rapidly emerging therapeutic modalities for selected patients with carotid arterial occlusive disease. Prospective analyses of several large studies have shown that although carotid endarterectomy is the standard of care for most patients, it is associated with significant morbidity and mortality in high-risk patients. When ...