Background: This study assesses the impact of having a surgical trainee performing a carotid endarterectomy (CEA) procedure on the postoperative rates of stroke and death.
Methods: In this observational retrospective study, consecutive patients, who underwent CEA between May 01, 2016, and July 31, 2022, were entered into a retrospectively collected database. Patients were stratified into 2 categories - consultant-led cases and trainees-led cases. Primary outcomes were 30-day stroke rate, and 30-day morbimortality. A sub analysis was performed after grouping the patients in whether there was a neurological event in the previous 6 months - symptomatic or asymptomatic.
Results/conclusions: Trainees-led cases had significantly longer clamping times and higher rates of stroke in asymptomatic patients compared with consultant-led cases. Patient's safety should be our top priority. Any practice leading to a significantly increased rate of postoperative stroke must be discontinued. Training protocols and adequate supervision must ensure that trainees possess the necessary skills and knowledge to safely and effectively perform CEA procedures, thereby prioritizing patient safety.
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http://dx.doi.org/10.1016/j.avsg.2024.07.098 | DOI Listing |
Front Cardiovasc Med
December 2024
Department of Vascular Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China.
Objective: To develop and validate a new prediction model based on the Lass-logistic regression with inflammatory serologic markers for the assessment of carotid plaque stability, providing clinicians with a reliable tool for risk stratification and decision-making in the management of carotid artery disease.
Methods: In this study, we retrospectively collected the data of the patients who underwent carotid endarterectomy (CEA) from 2019 to 2023 in Nanjing Drum Tower Hospital. Demographic characteristics, vascular risk factors, and the results of preoperative serum biochemistry were measured and collected.
Neuroradiology
December 2024
Department of Neuroradiology, Cerrahpaşa Faculty of Medicine, Istanbul University-, Cerrahpaşa, Istanbul, Türkiye.
Purpose: Patients with contralateral carotid artery occlusion (CCO) represent a subgroup of patients at risk for revascularization procedures. The choice of appropriate revascularization procedure (carotid endarterectomy (CEA) or carotid artery stenting (CAS)) in these patients is controversial. The aim of this study is to share the results of clinical and radiological follow-up after CAS in these patients and to contribute to the literature by evaluating the efficacy and safety of stenting.
View Article and Find Full Text PDFFront Neurol
December 2024
Department of Neurosurgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
Objective: To evaluate postoperative cerebral perfusion changes and their influencing factors in carotid endarterectomy (CEA) patients by integrating multimodal monitoring methods, including cerebral regional oxygen saturation (rSO), carotid ultrasound (CU), computed tomographic angiography (CTA), and computed tomographic perfusion imaging (CTP), with computational fluid dynamics (CFD) assessment.
Methods: We conducted a cohort study on patients with internal carotid artery (ICA) stenosis undergoing CEA at our institution. Pre- and postoperative assessments included CU, CTA, CTP, and rSO monitoring.
Quant Imaging Med Surg
December 2024
Department of Radiology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China.
Background And Objective: Carotid near-occlusion (CNO) is defined as a severe stenosis of the internal carotid artery (ICA) resulting in a reduction in the distal diameter. It is a specific type of carotid stenosis accounting for 34% of the patients with symptomatic carotid stenosis ≥50%. The current guidelines recommend the best medical treatment (BMT) as the treatment of choice.
View Article and Find Full Text PDFJ Vasc Surg
December 2024
Department of Biostatistics, UAB school of Public Health, University of Alabama at Birmingham, Birmingham, AL.
Objective: We assessed if age was an effect modifier in a pooled analysis of two randomized trials comparing CAS and CEA in asymptomatic patients, CREST and ACT I.
Methods: We analyzed data from 2544 patients aged <80 with ≥70% asymptomatic carotid stenosis randomized to CAS or CEA (n=1091; n=1453) who were recruited between 2000 and 2013. Age was considered in four strata (<65, 65-69, 70-74 and 75-79).
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