Carotid Stenosis ; surgery ; Endarterectomy, Carotid ; Humans

Carotid Stenosis ; surgery ; Endarterectomy, Carotid ; Humans ; Stents

BACKGROUNDCarotid stenosis is one of the common reasons for patients with ischemic stroke, and the two invasive options carotid endarterectomy (CEA) and carotid artery stenting (CAS) are the most popular treatments. But the relative efficacy and safety of the methods are not clear.

METHODSAbout 521 articles related to CAS and CEA for carotid stenosis published in 1995 - 2011 were retrieved from MEDLINE, Cochrane Library (CL), and China National Knowledge Infrastructure (CNKI) China Journal Full-Test database. Of them, eight articles were chosen. Meta-analysis was used to assess the relative risks.

RESULTSThe eight studies included 3873 patients with symptomatic carotid artery stenosis, including 1941 cases in the carotid stent angioplasty group, and 1932 cases in the carotid endarterectomy group. Fixed effect model analysis showed that within 30 days of incidence of all types of strokes, surgery was significantly highly preferred in CAS patients (CAS group) than the CEA patients (CEA group), and the difference was statistically significant (relative ratio (RR) = 1.80, 95% confidence interval (CI): 1.380 - 2.401, P < 0.0001). But the incidence of death in the two groups is not showed and is not statistically significant after 30 days (RR = 1.52, 95%CI: 0.82 - 2.82, P = 0.18). The rate of cranial nerve injury in the CAS group is lower than the CEA group (RR = 0.14, 95%CI: 0.05 - 0.43, P = 0.0005). The incidence of CAS patients with myocardial infarction is lower than the CEA group after 30 days, but statistically meaningless (RR = 0.22, 95%CI: 0.05 - 1.02, P = 0.05). The stroke or death in CAS patients were higher than the CEA group after 1 year of treatment (RR = 2.58, 95%CI: 1.03 - 6.48, P = 0.04).

CONCLUSIONSCompared to CAS, carotid endarterectomy is still the preferred treatment methodology of symptomatic carotid artery stenosis. Future meta-analyses should then be performed in long-term follow-up to support this treatment recommendation.

Carotid Stenosis ; surgery ; therapy ; Endarterectomy, Carotid ; Humans ; Stents

Carotid Artery, Internal/surgery* ; Carotid Stenosis/surgery* ; Endarterectomy, Carotid ; Humans ; Treatment Outcome

OBJECTIVETo determine the perioperative and late outcomes for carotid endarterectomy (CEA) in treatment of patients with high-grade stenotic lesions of the extracranial internal carotid artery.

METHODSTwenty patients underwent 21 CEAs at the Zhongshan Hospital between May 1993 and June 2000. They were 19 men and 1 woman, with a mean age of 64 +/- 9 years. Seven patients were performed for stroke, 11 for transient ischaemic attacks (TIAs) and 2 for asymptomatic disease. Duplex scan was the primary tool of evaluation prior to surgery. Perioperative digital subtraction angiography and magnetic resonance angiography were done for 19 and 18 patients, respectively. The percentage of stenosis was calculated using NASCET criteria. Of the 21 lesions operated, 19 had a stenosis of 70% or greater, 2 had ulcerative lesions with a stenosis ranging from 60% to 69%. All CEAs were performed under cervical block anaesthesia with selective intraoperative shunting and patch angioplasty. The patients were followed up regularly with duplex scan surveillance.

RESULTSThere was no mortality or stroke during 30 days postoperatively. A TIA occurred in one patient and cranial nerve injury in 2 patients perioperatively. All patients were followed up for a mean interval of 31 +/- 20 months (range: 1 - 63 months). The 2-year survival rate and risk of stroke were 92.3% and 0%, respectively, and the 5-year survival rate and risk of stroke were 79.1% and 12.5%, respectively. Two asymptomatic recurrent stenoses ranging from 50% to 60% were detected on follow-up duplex scan.

CONCLUSIONSFor the patients in this study, CEA is associated with an acceptable perioperative outcome as well as a satisfactory long-term beneficial effect in stroke prevention.

Aged ; Carotid Artery, Internal ; Carotid Stenosis ; surgery ; Endarterectomy, Carotid ; Female ; Humans ; Male ; Middle Aged ; Treatment Outcome

Restoration of cerebral blood flow is particularly important for the treatment of ischemic cerebrovascular disease. It is notable that surgical approaches play a unique role in treating this devastating disease. Among them, mechanical thrombectomy facilitates rapid and effective recanalization of occluded intracranial large vessels causing ischemic stroke, which contributes to improvement of cerebral perfusion in the ischemic penumbra; decompressive craniectomy is an important therapeutic option for acute massive cerebral infarction, and the timing of surgery determines the final clinical outcomes; for carotid endarterectomy in carotid-artery stenosis, individualized surgical plan is important for the safety and effectiveness of the operation; in the surgical revascularization of Moyamoya disease, precise evaluation of clinical and radiological characteristics, optimal surgical strategies and accuracy of intraoperative judgment will yield maximal therapeutic effects; and hybrid surgery is feasible for the therapy of complex ischemic cerebrovascular diseases, such as extracranial/intracranial arteries tandem stenosis and symptomatic chronic total occlusion of carotid artery. This paper reviews recent technical and clinical advances in the surgical treatment of ischemic cerebrovascular disease.
Brain Ischemia ; surgery ; Carotid Artery, Internal ; surgery ; Carotid Stenosis ; surgery ; Endarterectomy, Carotid ; trends ; Humans ; Stroke ; surgery ; Treatment Outcome

Carotid Artery Diseases ; surgery ; Carotid Stenosis ; surgery ; Endarterectomy, Carotid ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Prosthesis Failure ; Stents ; adverse effects

OBJECTIVETo analyze the effectiveness and costs of the eversion carotid endarterectomy (eCEA) and the carotid endarterectomy with patch angioplasty (pCEA) in treating carotid artery stenosis.

METHODSPatients with carotid artery stenosis who underwent the carotid endarterectomy in the vascular surgery department of Peking Union Medical College Hospital from October 2009 to October 2012 were enrolled in this study. According to the two different surgical procedures, the patients were divided into eCEA group and pCEA group.

RESULTSThe two groups were not significantly different in terms of gender ,age ,risk factors, stenosis degree of carotid artery, and the ratio of bilateral lesions (all P>0.05).The ratio of shunt and antibiotics application, operative time, hospitalization cost, and length of hospital stay in the eCEA group were significantly lower than those in pCEA group (P<0.05).The therapeutic effectiveness, complications, surgery-related death, restenosis, and ipsilateral stroke were not significantly different between these two groups (P>0.05).

CONCLUSIONBoth surgical procedures are safe and effective in treating the carotid artery stenosis;however, eCEA has lower cost when compared with pCEA and therefore can be used as the first choice.

Aged ; Carotid Artery, Internal ; surgery ; Carotid Stenosis ; surgery ; Endarterectomy, Carotid ; methods ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies

Ocular ischemic syndrome is a chronic ischemic eye disease including a series of ischemic ocular and brain syndromes caused by carotid artery occlusion or stenosis. Because of the different degrees of ischemia, clinical manifestations of ocular ischemic syndrome are diverse, and it is difficult to diagnose in the initial stage. The main strategy to treat ocular ischemic syndrome is elimination of carotid stenosis. We presented a patient who recovered dramatically after carotid artery stenting. The pre-stenting arm-retinal circulation time of the patient’s left eye was prolonged, and a large amount of microaneurysm appeared at the posterior polar and mid-peripheral aspects of the left retina. The post-stenting arm-retinal circulation time of the left eye decreased to 16.3 seconds, and the microaneurysm almost disappeared.
Angioplasty ; Carotid Arteries ; surgery ; Carotid Stenosis ; surgery ; Female ; Humans ; Ischemia ; diagnosis ; Middle Aged ; Retinal Artery Occlusion ; surgery ; Retinal Diseases ; surgery

OBJECTIVETo analyze risk factors for cerebral hyperperfusion syndrome (CHS) after carotid endarterectomy (CEA).

METHODSFrom September 2010 to September 2012, 183 consecutive patients with carotid artery stenosis who had indications for CEA entered the study. There were 149 male and 34 female patients, aged from 38 to 83 years with an average of (66 ± 9) years. Intracranial blood flow changes were monitored through transcranial Doppler routinely. Pre- and post-operative middle cerebral artery velocity (VMCA) were recorded. CHS was diagnosed by the combination of hyperperfusion syndrome and 100% increase of VMCA after operation compared with pre-operative baseline values. The patients who had CHS during hospitalization were recorded. Pre-operative and operative related factors were analyzed by univariate analysis, followed by Logistic regression model, to identify the risk factors of CHS.

RESULTSOverall, CHS occurred in 15 patients (8.2%) after CEA. The average onset time was (2.6 ± 0.2) days after surgery. By decreasing blood pressure and using dehydration medicine, all the patients with CHS recovered before discharge. None of them developed to intracranial hemorrhage. On univariate analysis, significant risk factors for CHS were history of stoke, symptomatic carotid artery stenosis and shunting during operation. On Logistic regression model, independent risk factor was symptomatic carotid artery stenosis (OR = 6.733, 95%CI: 1.455-31.155, P = 0.015), while shunting during operation (OR = 0.252, 95%CI: 0.067-0.945, P = 0.041) was a protective factor.

CONCLUSIONSSymptomatic carotid artery stenosis is an independent risk factor for CHS after CEA and shunting during operation is a protective factor. Using shunt may be an effective method of preventing CHS after CEA.

Carotid Stenosis ; surgery ; Endarterectomy, Carotid ; Humans ; Middle Cerebral Artery ; Risk Assessment ; Risk Factors