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[PMID]: 29204653
[Au] Autor:Otite FO; Khandelwal P; Malik AM; Chaturvedi S
[Ad] Address:Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida.
[Ti] Title:National Patterns of Carotid Revascularization Before and After the Carotid Revascularization Endarterectomy vs Stenting Trial (CREST).
[So] Source:JAMA Neurol;75(1):51-57, 2018 Jan 01.
[Is] ISSN:2168-6157
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Importance: The Carotid Revascularization Endarterectomy vs Stenting Trial (CREST) showed greater safety of carotid artery stenting (CAS) in patients younger than 70 years and carotid endarterectomy (CEA) in those older than 70 years. It is unknown how the result of CREST has influenced carotid revascularization choices in the United States. Objective: To evaluate national patterns in CAS performance in patients older than 70 years in the post-CREST (2011-2014) compared with the pre-CREST (2007-2010) era. Design, Setting, and Participants: All adults older than 70 years undergoing carotid revascularization in the United States from 2007 to 2014 were retrospectively identified from the 2007-2014 National Inpatient Sample using International Classification of Disease, Ninth Revision procedural codes. From 61 324 882 unweighted hospitalizations contained in the 2007-2014 National Inpatient Sample, 494 733 weighted carotid revascularization admissions in adults older than 70 years were identified using International Classification of Disease, Ninth Revision procedural codes. Main Outcomes and Measures: The proportion of CAS performed in all age groups over time was estimated and multivariable-adjusted models were used to compare the odds of receiving CAS in the pre-CREST with those in the post-CREST era in adults older than 70 years. Results: A total of 41.8% of all patients were women, and mean (SE) age at presentation was 78.1 (0.03) years. A total of 16.3% of CAS and 10.1% of CEA procedures were performed in patients with symptomatic stenosis. The proportion of patients older than 70 years receiving CAS increased from 11.9% in the pre-CREST to 13.8% in the post-CREST era (P = .005). In multivariable models, the odds of receiving CAS increased by 13% in all patients older than 70 years in the post-CREST compared with the pre-CREST period (odds ratio [OR], 1.13, 95% CI, 1.00-1.28, P = .04), including symptomatic women (OR, 1.31, 1.05-1.65, P = .02). Symptomatic stenosis (OR 1.39; 95% CI, 1.27-1.52; P < .001), congestive heart failure (OR, 1.48; 95% CI, 1.35-1.63; P < .001), and peripheral vascular disease (OR, 1.35; 95% CI, 1.27-1.43; P < .001) were associated with higher odds of CAS; comorbid hypertension (OR, 0.70; 95% CI, 0.66-0.74; P < .001), smoking (OR, 0.84; 95% CI, 0.78-0.91; P < .001), and weekend admission (OR, 0.77; 95% CI, 0.68-0.88; P < .001) were negatively associated with the odds of CAS. Conclusions and Relevance: Despite concerns for higher periprocedural complications with CAS in elderly patients, the odds of CAS increased in the post-CREST compared with pre-CREST era in patients older than 70 years, including symptomatic women.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 180311
[Lr] Last revision date:180311
[St] Status:In-Data-Review
[do] DOI:10.1001/jamaneurol.2017.3496

  2 / 18179 MEDLINE  
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[PMID]: 29519202
[Au] Autor:Varetto G; Trevisan A; Barile G; Gibello L; Spalla F; Frola E; Pennica D; PhD PR
[Ad] Address:1 Division of Vascular Surgery, University of Turin, Turin, Italy.
[Ti] Title:Carotid Pseudoaneurysm After Eversion Endarterectomy: A Case Report and Review of the Literature.
[So] Source:Vasc Endovascular Surg;:1538574418761981, 2018 Jan 01.
[Is] ISSN:1938-9116
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Pseudoaneurysm (PA) after carotid endarterectomy (CEA) is a rare and potentially life-threatening complication, with an incidence lower than 1%. Most of the cases described report PAs after carotid patch angioplasty and are associated with infection, often caused by Staphylococci. The management of PAs can be surgical, endovascular, or hybrid. METHODS: We herein present the case of an infected carotid PA 27 days after an eversion CEA. We performed a common to internal carotid bypass with the interposition of great saphenous vein (GSV) associated with specific polyantibiotic therapy for 4 weeks. We searched the PubMed database for reviews and cases reports for patients who developed carotid PA after primary repair CEA in the period between 1969 and 2017. RESULTS: We identified 21 cases of primary closure post-CEA PAs in the literature. In almost 60% of patients, infection was detected. Open surgery was performed in all the cases; in 1 case, an hybrid approach was preferred. In 52% of cases, a vein graft/patch or primary closure was chosen; in 3 cases, ligation was preferred, and in 1 case, a polyester graft was used. CONCLUSION: In our experience and with the evidence observed in the literature, open surgery with GSV interposition is the safest treatment in infected carotid PAs. The endovascular approach must be performed only in proven noninfectious cases. A bridge technique with the insertion of a stent followed by open surgery repair can be an option in emergency cases.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:Publisher
[do] DOI:10.1177/1538574418761981

  3 / 18179 MEDLINE  
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[PMID]: 29518512
[Au] Autor:Fok KC; Chan YC; Law Y; Cheng SW
[Ad] Address:Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Pokfulam Road, Hong Kong.
[Ti] Title:Septic Carotid Endarterectomy Patch as a result of Pre-operative Tooth Extraction.
[So] Source:Ann Vasc Surg;, 2018 Mar 05.
[Is] ISSN:1615-5947
[Cp] Country of publication:Netherlands
[La] Language:eng
[Ab] Abstract:Infected carotid patch are rare. We present a gentleman who had an elective carotid endarterectomy with Dacron patch closure for symptomatic carotid stenosis under regional anaesthesia, and presented one month later with a discharging sinus at the lower aspect of the neck wound. CT scan showed a rim enhancing collection next to the carotid bifurcation. He subsequently underwent patch excision and repair with autologous saphenous vein graft, with good recovery. Of significance was that he had dental extraction for a loose tooth one day before the index operation as advised by the anesthestist. Streptococcus viridans species, which are part of the normal flora of oral cavity, were isolated from tissue culture. This is the first case in the world's literature of a patient who had Streptococcus viridans carotid patch infection which may be related to his pre-operative tooth extraction.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:Publisher

  4 / 18179 MEDLINE  
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[PMID]: 29373658
[Au] Autor:Ali JM; Dunning J; Ng C; Tsui S; Cannon JE; Sheares KK; Taboada D; Toshner M; Screaton N; Pepke-Zaba J; Jenkins DP
[Ad] Address:Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK.
[Ti] Title:The outcome of reoperative pulmonary endarterectomy surgery.
[So] Source:Interact Cardiovasc Thorac Surg;, 2018 Jan 23.
[Is] ISSN:1569-9285
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:OBJECTIVES: Pulmonary endarterectomy (PEA) is the treatment of choice for patients with chronic thromboembolic pulmonary hypertension (PH). Despite excellent outcomes following PEA, a small proportion of patients have residual proximal disease or present with recurrent chronic thromboembolic PH and may benefit from further surgery. The aim of this study was to analyse outcomes following reoperative PEA at a high-volume national tertiary referral centre for the management of chronic thromboembolic PH. METHODS: This retrospective analysis was performed using our prospectively maintained PH database to identify all patients who underwent reoperative PEA surgery between the commencement of the programme in 1997 and January 2017, and the patients' data were collected for analysis. RESULTS: Twelve patients underwent reoperative PEA during the period of study. The mean interval between primary procedure and reoperative procedure was 6.3 years. Significant improvements were observed in pulmonary haemodynamics following reoperative PEA. Mean pulmonary arterial pressure decreased from 46.8 to 29.8 mmHg (P < 0.0001) and pulmonary vascular resistance decreased from 662 to 362 dynescm-5 (P = 0.0007). A significant functional improvement in the 6-min walking test distance was also observed, increasing from 327 to 460 m at 6 months postoperatively (P = 0.0018). Median length of hospital stay was 12 days. In-hospital mortality was 8.3% with 1-year survival of 83.3%. CONCLUSIONS: Reoperative PEA is technically possible and relatively safe, achieving good functional and physiological outcomes. Patients must be carefully selected by a multidisciplinary team, and surgery should be performed in experienced centres.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1801
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:Publisher
[do] DOI:10.1093/icvts/ivx424

  5 / 18179 MEDLINE  
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[PMID]: 29318791
[Au] Autor:Kwon W; Yang JH; Park TK; Chang SA; Jung DS; Cho YS; Kim SM; Kim TJ; Park HY; Choi SH; Kim DK
[Ad] Address:Department of Cardiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
[Ti] Title:Impact of Balloon Pulmonary Angioplasty on Hemodynamics and Clinical Outcomes in Patients with Chronic Thromboembolic Pulmonary Hypertension: the Initial Korean Experience.
[So] Source:J Korean Med Sci;33(4):e24, 2018 Jan 22.
[Is] ISSN:1598-6357
[Cp] Country of publication:Korea (South)
[La] Language:eng
[Ab] Abstract:BACKGROUND: The treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH) is pulmonary endarterectomy (PEA). However, not all patients are eligible for PEA, and some patients experience recurrence of pulmonary hypertension even after PEA. METHODS: Patients who underwent balloon pulmonary angioplasty (BPA) between December 2015 and April 2017 were enrolled from the Samsung Medical Center CTEPH registry. Enrolled patients underwent right heart catheterization, echocardiography, and 6-minute walk distance (6MWD) at baseline, 4 and 24 weeks after their first BPA session. We compared clinical and hemodynamic parameters at the baseline and last BPA session. RESULTS: Fifty-two BPA sessions were performed in 15 patients, six of whom had a history of PEA. BPA resulted in improvements in World Health Organization (WHO) functional class (2.9 0.8 to 1.7 0.6, P = 0.002), 6MWD (387.0 86.4 to 453.4 64.8 m, P = 0.01), tricuspid annular plane systolic excursion (14.1 3.6 to 15.6 4.3 mm, P = 0.03) and hemodynamics, including a decline in mean pulmonary artery pressure (41.1 13.1 to 32.1 9.5 mmHg, P < 0.001) and in pulmonary vascular resistance (607.4 452.3 to 406.7 265.4 dyne.sec.cm⁻5, P = 0.01) but not in cardiac index (2.94 0.79 to 2.96 0.93 L/min/m, P = 0.92). Six cases of complications were recorded, including two cases of reperfusion injury. CONCLUSION: BPA might be a safe and effective treatment strategy for both inoperable CTEPH patients and patients with residual pulmonary hypertension after PEA.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1801
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:In-Process
[do] DOI:10.3346/jkms.2018.33.e24

  6 / 18179 MEDLINE  
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[PMID]: 29300906
[Au] Autor:Verbelen T; Van De Bruaene A; Cools B; Van Raemdonck D; Delcroix M; Rega F; Meyns B
[Ad] Address:Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium.
[Ti] Title:Postoperative left ventricular function in different types of pulmonary hypertension: a comparative study.
[So] Source:Interact Cardiovasc Thorac Surg;, 2018 Jan 02.
[Is] ISSN:1569-9285
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:OBJECTIVES: Left ventricular dysfunction after pulmonary endarterectomy is well described. Left ventricular failure has only been described after lung transplantation for pulmonary arterial hypertension (PAH). We sought to identify factors that contribute to this failure and hypothesized that atrial septostomy before transplantation could prevent this complication. METHODS: From our database, all bilateral lung transplants for PAH (n = 24) and all pulmonary endarterectomies, with a minimal reduction of 800 dyn⋅s⋅cm-5 (n = 27), were selected. Perioperative demographic and echocardiographic data were analysed. RESULTS: In patients with PAH, pulmonary hypertension was diagnosed at a significantly younger age, and time between diagnosis and surgery was significantly longer. Before surgery, right ventricular dimensions were significantly larger and left ventricular wall thicknesses were significantly smaller, but left ventricular diastolic dysfunction was similar. Surgery caused a significant decrease in right ventricular dimensions (less extensive after pulmonary endarterectomy) and caused a significant increase in left ventricular dimensions. Pre-transplant atrial septostomy caused increased left ventricular dimensions, stroke volume and cardiac index. Two patients developed post-transplant left ventricular failure. Compared with other PAH patients, they were younger (<12 years) at diagnosis, time between diagnosis and surgery lasted 2.5 times longer, left ventricular mass was smaller and pre-transplant pulmonary vascular resistance was higher. CONCLUSIONS: In PAH, age at diagnosis is younger and left ventricular preload deprivation lasts longer than that in chronic thromboembolic pulmonary hypertension. Together with lower residual pulmonary vascular resistance and higher increases in preload, this might explain left ventricular failure after lung transplantation. Pre-transplant atrial septostomy might prevent post-transplant left ventricular failure.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1801
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:Publisher
[do] DOI:10.1093/icvts/ivx418

  7 / 18179 MEDLINE  
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[PMID]: 29191852
[Au] Autor:Sheffet AJ; Howard G; Sam A; Jamil Z; Weaver F; Chiu D; Voeks JH; Howard VJ; Hughes SE; Flaxman L; Longbottom ME; Brott TG; CREST Investigators
[Ad] Address:From the Department of Surgery, Rutgers, the State University of New Jersey, Newark (A.J.S., S.E.H., L.F., T.G.B.); Departments of Biostatistics (G.H.) and Epidemiology, School of Public Health (V.J.H.), University of Alabama at Birmingham; Division of Vascular Surgery, Southern Connecticut Vascular
[Ti] Title:Challenge and Yield of Enrolling Racially and Ethnically Diverse Patient Populations in Low Event Rate Clinical Trials.
[So] Source:Stroke;49(1):84-89, 2018 01.
[Is] ISSN:1524-4628
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND AND PURPOSE: We report patient enrollment and retention by race and ethnicity in the CREST (Carotid Revascularization Endarterectomy Versus Stent Trial) and assess potential effect modification by race/ethnicity. In addition, we discuss the challenge of detecting differences in study outcomes when subgroups are small and the event rate is low. METHODS: We compared 2502 patients by race, ethnicity, baseline characteristics, and primary outcome (any periprocedural stroke, death, or myocardial infarction and subsequent ipsilateral stroke up to 10 years). RESULTS: Two hundred forty (9.7%) patients were minority by race (6.1%) or ethnicity (3.6%); 109 patients (4.4%) were black, 32 (1.3%) Asian, 2332 (93.4%) white, 11 (0.4%) other, and 18 (0.7%) unknown. Ninety (3.6%) were Hispanic, 2377 (95%) non-Hispanic, and 35 (1.4%) unknown. The rate of the primary end point for all patients was 10.9%0.9% at 10 years and did not differ by race or ethnicity ( >0.24). CONCLUSIONS: The proportion of minorities recruited to CREST was below their representation in the general population, and retention of minority patients was lower than for whites. Primary outcomes did not differ by race or ethnicity. However, in CREST (like other studies), the lack of evidence of a racial/ethnic difference in the treatment effect should be interpreted with caution because of low statistical power to detect such a difference. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00004732.
[Pt] Publication type:JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Entry month:1712
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[Cl] Clinical Trial:ClinicalTrial
[St] Status:In-Process
[do] DOI:10.1161/STROKEAHA.117.018063

  8 / 18179 MEDLINE  
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[PMID]: 29186602
[Au] Autor:Sen AN; Fridley J; Sebastian S; Duckworth EAM
[Ad] Address:Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.
[Ti] Title:Intraoperative Computed Tomography Angiography: A Novel Completion Imaging Modality for Carotid Endarterectomy.
[So] Source:Oper Neurosurg (Hagerstown);13(6):739-745, 2017 Dec 01.
[Is] ISSN:2332-4260
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Intraoperative computed tomography angiography (ICTA) is a novel completion imaging modality for carotid endarterectomy (CEA). No studies exist in the literature describing ICTA use in CEA. OBJECTIVE: To evaluate the feasibility and efficacy of ICTA as a method of immediately evaluating the technical results of CEA. METHODS: Twenty-three consecutive CEAs were performed by a single neurosurgeon over an 8-month period. Of this series, 12 utilized ICTA for completion imaging, 10 utilized duplex ultrasonography (US), and 1 utilized no intraoperative completion imaging. Electronic medical records were reviewed to assess demographics, CTA results, US results, and need for revisions. RESULTS: Patients included 13 men (62%) and 8 women (38%). All patients had symptomatic internal carotid artery stenosis. Polytetrafluoroethylene (PTFE) patch angioplasty was used in 16 cases (70%). Average operative times were comparable between cases that utilized CTA and US, 180 and 175 min, respectively. Major technical defects were identified in one of the 12 cases utilizing ICTA and none of the 10 cases utilizing intraoperative US. The technical defect was revised without subsequent neurological complication. One patient had a postoperative intracerebral hemorrhage requiring surgical evacuation. Fifteen patients were followed for up to 3 months with no postoperative stroke or transient ischemic attacks. CONCLUSION: ICTA is a potentially safe and effective completion imaging modality compared to traditional alternatives, enabling the identification of technical deficits intraoperatively. While no statistically significant difference in operative times were noted between intraoperative CTA and US use, numerous steps must be taken to maximize the efficiency of ICTA.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1711
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:In-Data-Review
[do] DOI:10.1093/ons/opw036

  9 / 18179 MEDLINE  
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[PMID]: 29286024
[Au] Autor:Stepanenko AB; Charchyan ER; Gens AP; Fedulova SV; Seleznev MN; Shvedov PN
[Ad] Address:Petrovsky Russian Research Center for Surgery, Moscow, Russia.
[Ti] Title:Podkliuchichno-vnutrennesonnoe protezirovanie v lechenii khronicheskoi ishemii golovnogo mozga. [Subclavian-carotid replacement in chronic cerebrovascular insufficiency management].
[So] Source:Khirurgiia (Mosk);(12):4-11, 2017.
[Is] ISSN:0023-1207
[Cp] Country of publication:Russia (Federation)
[La] Language:rus
[Ab] Abstract:AIM: To present own experience of subclavian-carotid replacement for chronic cerebrovascular insufficiency management. MATERIAL AND METHODS: For 12 years 7 subclavian-carotid reconstructions were performed that was 1.2% of all carotid repairs during this period. Great saphenous vein was always used as a graft. Carotid endarterectomy from proximal internal carotid artery was additionally performed if it was necessary. Patients had severe advanced lesion of supra-aortic vessels including bilateral carotid lesion and significant stenosis of ipsilateral proximal common carotid artery. The vast majority of them had cerebrovascular insufficiency grade 3-4. RESULTS: All patients underwent surgery without significant complications despite initially severe state due to advanced lesion of brachiocephalic arteries. Long-term postoperative patency of the grafts was satisfactory within the period from 12 years to 1.5 months. There were no neurological impairment and stroke. CONCLUSION: Subclavian-carotid grafting is an effective alternative for carotid endarterectomy in patients with advanced atherosclerotic lesion of common and internal carotid arteries.
[Pt] Publication type:ENGLISH ABSTRACT; JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 180307
[Lr] Last revision date:180307
[St] Status:In-Process
[do] DOI:10.17116/hirurgia2017124-11

  10 / 18179 MEDLINE  
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[PMID]: 29509372
[Au] Autor:Falkowski A; Goracy I; Kaczmarczyk M; Szemitko M; Bogacki H; Kostka J
[Ad] Address:Department of Interventional Radiology, Pomeranian Medical University, Szczecin, Poland.
[Ti] Title:Lipid derivatives of arachidonic acid used as markers of atherosclerotic plaque instability: a pilot study.
[So] Source:Int Angiol;, 2018 Mar 06.
[Is] ISSN:1827-1839
[Cp] Country of publication:Italy
[La] Language:eng
[Ab] Abstract:BACKGROUND: To compare the results of computer estimation of atherosclerotic plaque with biochemical data and ascertain any relationship with the occurrence of stroke. METHODS: The study involved 20 atherosclerotic plaques causing 70-99% stenosis of internal carotid arteries (ICA). Ultrasonographic examination (USG) images of plaques were analyzed using a computer program. A histogram was obtained for each plaque and a gray scale median (GSM) was determined for each histogram in order to measure the echogenicity of an examined plaque. Then the plaques, collected during endarterectomy, were examined with regard to the concentration of prostaglandins E2 (PGE2), thromboxane A2 (TXA2), and 8 - epi-Prostaglandin F2α. This data was compared with GSM and the occurrence of stroke. RESULTS: The statistical analysis showed significant correlations between low GSM and the occurrence of strokes. Out of 10 plaques with GSM < 35, six (60.0%) were associated with a stroke. In contrast, out of 10 plaques with GSM > 35, only one (10.0%) had a stroke. In addition, there were significant differences in the plaque content of PGE 2, (p<0.05) and (TXA2, p<0.011) between groups. CONCLUSIONS: High levels of PGE2 and TXA2, correlated with the low GSM values, may be the features of unstable plaques and that's may be associated with a risk for stroke.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180306
[Lr] Last revision date:180306
[St] Status:Publisher
[do] DOI:10.23736/S0392-9590.18.03862-2


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