Document Detail


Carotid atherosclerotic plaque characteristics are associated with microembolization during carotid endarterectomy and procedural outcome.
MedLine Citation:
PMID:  16002764     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: During carotid endarterectomy (CEA), microemboli may occur, resulting in perioperative adverse cerebral events. The objective of the present study was to investigate the relation between atherosclerotic plaque characteristics and the occurrence of microemboli or adverse events during CEA. METHODS: Patients (n=200, 205 procedures) eligible for CEA were monitored by perioperative transcranial Doppler. The following phases were discriminated during CEA: dissection, shunting, release of the clamp, and wound closure. Each carotid plaque was stained for collagen, macrophages, smooth muscle cells, hematoxylin, and elastin. Semiquantitative analyses were performed on all stainings. Plaques were categorized into 3 groups based on overall appearance (fibrous, fibroatheromatous, or atheromatous). RESULTS: Fibrous plaques were associated with the occurrence of more microemboli during clamp release and wound closure compared with atheromatous plaques (P=0.04 and P=0.02, respectively). Transient ischemic attacks and minor stroke occurred in 5 of 205 (2.4%) and 6 of 205 (2.9%) patients, respectively. Adverse cerebral outcome was significantly related to the number of microembolic events during dissection (P=0.003) but not during shunting, clamp release, or wound closure. More cerebrovascular adverse events occurred in patients with atheromatous plaques (7/69) compared with patients with fibrous or fibroatheromatous plaques (4/138) (P=0.04). CONCLUSIONS: Intraoperatively, a higher number of microemboli were associated with the presence of a fibrous but not an atheromatous plaque. However, atheromatous plaques were more prevalent in patients with subsequent immediate adverse events. In addition, specifically the number of microemboli detected during the dissection phase were related to immediate adverse events.
Authors:
B A N Verhoeven; J P P M de Vries; G Pasterkamp; R G A Ackerstaff; A H Schoneveld; E Velema; D P V de Kleijn; F L Moll
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Publication Detail:
Type:  Journal Article; Multicenter Study     Date:  2005-07-07
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  36     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2005 Aug 
Date Detail:
Created Date:  2005-07-28     Completed Date:  2005-12-02     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1735-40     Citation Subset:  IM    
Affiliation:
Department of Vascular Surgery, University Medical Centre, Utrecht, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Atherosclerosis / diagnosis*
Carotid Arteries / pathology*
Carotid Artery Thrombosis / pathology
Carotid Stenosis / pathology*
Collagen / chemistry
Elastin / metabolism
Electroencephalography
Embolization, Therapeutic / adverse effects*,  methods*
Endarterectomy, Carotid / methods*
Female
Hematoxylin / metabolism
Humans
Inflammation
Ischemia
Macrophages / metabolism
Magnetic Resonance Imaging
Male
Microcirculation / pathology
Middle Aged
Muscle, Smooth / cytology
Phenotype
Prospective Studies
Reverse Transcriptase Polymerase Chain Reaction
Stroke / metabolism,  pathology
Tomography, X-Ray Computed
Treatment Outcome
Ultrasonography
Ultrasonography, Doppler, Transcranial / methods*
Wound Healing
Chemical
Reg. No./Substance:
517-28-2/Hematoxylin; 9007-34-5/Collagen; 9007-58-3/Elastin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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