| Advances in the management of carotid artery disease: focus on recent evidence and guidelines. | |
| | |
MedLine Citation:
|
PMID: 22221508 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
|
Recent landmark randomized trials and society guidelines have significantly revised the management of carotid artery disease. Duplex ultrasonography is the recommended initial diagnostic test for the assessment of extracranial carotid artery stenosis. Carotid artery imaging is reasonable in select patients scheduled for coronary artery bypass graft (CABG) surgery. Carotid revascularization can be achieved safely and effectively with carotid endarterectomy or carotid artery stenting. Because each procedure has a different risk/benefit profile, the optimal approach is to match the particular patient to the intervention that maximizes outcome benefit. Carotid revascularization is recommended in patients scheduled for CABG surgery when the carotid artery stenosis is symptomatic and/or bilateral. Further trials are required to guide the management of asymptomatic unilateral carotid artery stenosis in patients undergoing CABG surgery. Aggressive medical therapy remains the gold standard for intracranial carotid artery disease because landmark trials have shown no outcome improvement with vascular bypass or percutaneous angioplasty and stenting. A large recent trial showed that local anesthesia, as compared with general anesthesia, for carotid endarterectomy has no major clinical outcome advantage. Although carotid artery stenting is associated with a reduced risk of myocardial ischemia, it still has important risks of stroke and hemodynamic instability that significantly affect clinical outcome. The timing and choice of carotid revascularization technique ultimately depends on multiple clinical factors. |
| | |
Authors:
|
John G T Augoustides |
Related Documents
:
|
19330248 - Effects of cardiopulmonary bypass on propofol pharmacokinetics and bispectral index dur... 12821438 - Porcelain aorta in coronary artery bypass graft operations: an alternative approach. 20085988 - Assessing the cost effectiveness of using prognostic biomarkers with decision models: c... 9205178 - Closed-chest cardiopulmonary bypass and cardioplegia: basis for less invasive cardiac s... 20696738 - Double ecmo in severe ards: report of an outstanding case and literature review. 15582498 - Effects of polyamines on human umbilical artery tone in vitro. |
Publication Detail:
|
Type: Journal Article |
Journal Detail:
|
Title: Journal of cardiothoracic and vascular anesthesia Volume: 26 ISSN: 1532-8422 ISO Abbreviation: J. Cardiothorac. Vasc. Anesth. Publication Date: 2012 Feb |
Date Detail:
|
Created Date: 2012-01-06 Completed Date: - Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 9110208 Medline TA: J Cardiothorac Vasc Anesth Country: United States |
Other Details:
|
Languages: eng Pagination: 166-71 Citation Subset: IM |
Copyright Information:
|
Copyright © 2012 Elsevier Inc. All rights reserved. |
Affiliation:
|
Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: The year in cardiothoracic and vascular anesthesia: selected highlights from 2011.
Next Document: General practitioners' and practice nurses' views and experience of managing depression in coronary ...