[Show abstract][Hide abstract] ABSTRACT: Patients with symptomatic tight carotid stenosis have an increased short-time risk of stroke and an increased long-term risk of ischaemic vascular events compared with the general population. The aim of this study is to assess the safety, efficacy, and limitations of urgent CEA or CAS, in patients with carotid stenosis greater than 70% and clinically characterized by recurrent TIA or brain damage following a stroke (<2.5 cm). This study involved 28 patients divided into two groups. Group A consisted of sixteen patients who had undergone CEA, and group B consisted of twelve patients who had undergone CAS. Primary endpoints were mortality, neurological morbidity (by NIHSS) and postoperative hemorrhagic cerebral conversion, at 30 days. Ten patients (62.5%) of group A experienced an improvement in their initial neurological deficit while in 4 cases (26%) the deficit remained stable. Two cases of neurologic mortality are presented. At 1 month, 9 patients (75%) of group B experienced an improvement in their initial neurological deficit while 3 patients (25%) had a neurological impairment. Urgent or deferred surgical or endovascular treatment have a satisfactory outcome considering the profile in very high-risk patient population. Otherwise in selected patients CEA seems to be preferred to CAS.
Full-text · Article · Mar 2012 · International journal of vascular medicine
[Show abstract][Hide abstract] ABSTRACT: Aim. The aim of the paper is to confirm the validity of color flow Doppler (CFD) in the diagnosis of extracranial carotid artery disease and to assess the diagnostic performance of CFD and magnetic resonance angiography (MRA) compared with the ex vivo intraoperative findings. Methods. Between January and July 2004, 40 outpatients were studied. Preoperative diagnostic imaging in all patients comprised CFD and MRA of the extracranial carotid arteries. Plaques from all patients were evaluated ex vivo after carotid thromboendarterectomy (TEA) to assess the degree of stenosis and structural and surface characteristics of carotid plaques. Results. The intraoperative findings were: 4 stenosis below 60%, 6 from 60% to 70%, 15 from 70% to 80%, 10 from 80% to 90%, 4 preocclusive stenosis, 1 pseudo-occlusion; 10 smooth, 28 irregular, 2 ulcerated surfaces; 8 fibrous, 23 fibrous-calcified, 9 calcified plaques. The CFD data showed: 4 stenosis less than 60%, 6 from 60% to 70%, 14 from 70% to 80%, 12 from 80% to 90%, 3 preocclusive stenosis, 1 pseudo-occlusion; 12 smooth, 26 irregular, 2 ulcerated surfaces; 8 fibrous, 23 fibrous-calcified, 9 calcified plaques. The MRA evaluation evidenced: 3 stenosis less than 60%, 7 from 60% to 70%, 14 from 70% to 80%, 11 from 80% to 90%, 2 preocclusive stenosis, 1 pseudo-occlusion, 1 obstruction; 23 smooth, 16 irregular, 1 ulcerated surfaces; impossibility to define plaque contents. Conclusion. Our study confirms CFD ultrasonography as a reliable imaging modality and the preferred method for mass screening of extracranial carotid artery disease. To confirm doubtful CFD findings MRA can replace digital subtraction angiography (DSA). Intraoperative macroscopical assessment of the arterial plaque provides a standard for assessing objectively the results.
No preview · Article · Sep 2005 · Italian Journal of Vascular and Endovascular Surgery