Surgical advances for extracranial carotid stenosis.

Neurosurgery

Department of Neurosurgery, Penn State Hershey Medical Center, Hershey, Pennsylvania.

Published: February 2014

Carotid endarterectomy is a commonly performed operation to prevent stroke in patients who have asymptomatic or symptomatic internal carotid artery atherosclerotic stenosis. Carotid angioplasty and stenting has also been advocated for treatment of these patients. In this article, we address a number of questions for which a review of available data will advance our understanding of the role of carotid endarterectomy in stroke prevention. These include the following: Are carotid endarterectomy and carotid angioplasty and stenting equivalent procedures for the treatment of carotid artery disease? Which patients should be deemed at high risk for carotid endarterectomy? Should carotid endarterectomy be an urgent procedure in symptomatic patients with severe internal carotid artery stenosis? Finally, what is the role of carotid endarterectomy in asymptomatic patients? We also review the senior author's personal experience with >2000 consecutive carotid endarterectomies, with special attention to his present approach to this operation. We believe that carotid endarterectomy, in experienced hands, is a minimally invasive operation that remains the procedure of choice for most patients with carotid artery disease who will benefit from invasive treatment.

Download full-text PDF

Source
http://dx.doi.org/10.1227/NEU.0000000000000150DOI Listing

Publication Analysis

Top Keywords

carotid endarterectomy
24
carotid artery
16
carotid
15
stenosis carotid
8
internal carotid
8
carotid angioplasty
8
angioplasty stenting
8
role carotid
8
endarterectomy
6
patients
5

Similar Publications

Aim: Ischemic stroke remains one of the leading causes of death and disability worldwide and ca-rotid stenosis is the leading etiology of ischemic strokes of non-cardiac origin. The chronic inflammatory process and pro-inflammatory state in carotid stenosis seem to be the most im-portant underlying factor in carotid occlusion. In addition to medical therapy and carotid ar-tery stunting (CAS) in the treatment of carotid stenosis, carotid endarterectomy (CEA) is the main surgical treatment of carotid stenosis and its prognosis is the main subject of our study.

View Article and Find Full Text PDF

Background: According to the latest Society for Vascular Surgery (SVS) guidelines, carotid revascularization for asymptomatic individuals should be offered if the perioperative stroke/death rate does not exceed 3%. Heart failure (HF) has been associated with reduced survival rates following carotid revascularization, which may significantly impact the risk-benefit decision of treating asymptomatic patients with HF. This study aimed to evaluate the 30-day postoperative risks in asymptomatic patients with newly diagnosed and/or decompensated HF undergoing carotid endarterectomy (CEA) and carotid artery stenting (CAS).

View Article and Find Full Text PDF

Differentiation of Atherosclerotic Carotid Plaque Components With Dual-Energy Computed Tomography.

Invest Radiol

January 2025

From the Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.A., J.B., T.F., A.A.P., M.E.K.); CARIM, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands (M.A., J.B., M.J.J.G., W.H.M., R.J.v.O., M.E.K.); Department of Pathology, Maastricht University Medical Center, Maastricht, the Netherlands (M.J.J.G.); Department of Medical Biochemistry, Amsterdam Cardiovascular Sciences: Atherosclerosis & Ischemic Syndrome; Amsterdam Infection and Immunity: Inflammatory Diseases; Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands (M.J.J.G.); Department of Neurology, Zuyderland Medical Center, Heerlen, the Netherlands (T.H.C.M.L.S.); Department of Neurology, Zuyderland Medical Center, Sittard, the Netherlands (N.P.v.O.); Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, the Netherlands (J.-W.H.C.D.); Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht, the Netherlands (W.H.M.); Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands (R.J.v.O.); and School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands (A.A.P.).

Objectives: Carotid plaque vulnerability is a strong predictor of recurrent ipsilateral stroke, but differentiation of plaque components using conventional computed tomography (CT) is suboptimal. The aim of our study was to evaluate the ability of dual-energy CT (DECT) to characterize atherosclerotic carotid plaque components based on the effective atomic number and effective electron density using magnetic resonance imaging (MRI) and, where possible, histology as the reference standard.

Materials And Methods: Patients with recent cerebral ischemia and a ≥2-mm carotid plaque underwent computed tomography angiography and MRI.

View Article and Find Full Text PDF

Objective: Carotid artery stenosis, primarily caused by atherosclerosis, is a major risk factor for ischemic stroke. Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are established interventions to reduce stroke risk and restore cerebral blood flow. However, the effect of these treatments on circadian rhythms, and their influence on stroke recovery, remains underexplored.

View Article and Find Full Text PDF

Carotid artery atherosclerotic stenosis is an important annual cause of stroke in the United States. Moreover, the incidence of carotid artery stenosis is significantly increasing due to the widespread popularity of high fat and high salt diets, sedentary lifestyles, and the increasing age of the population. Of major importance to cardiovascular specialists is the fact that individuals with atherosclerotic carotid artery stenosis can have a prevalence of atherosclerotic coronary artery disease as high as 50 to 75%.

View Article and Find Full Text PDF

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!