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Introduction The results of carotid revascularization in octogenarians are not well investigated. Methods The NSQIP based database for CEA and CAS was queried for patients aged u226580' under CEA and CAS between 2012 and 2020. Results A total of 122 and 3,013 patients aged u2265 to 32079, with symptomatic carotid stenosis undergoing CAS and CEA were identified. Patients with CAS were more likely to be over 90 years and have diabetes, were more likely to have diabetes, and were more likely to have high-risk anatomy, but lower ASA scores. An ipsilateral stroke had affected 43 percent of patients with CAS and 44. 7% in CEA patients. Symptom presentation other than ipsilateral stroke was significantly reduced chances of 30-day mortality, according to the report, while older age raised odds significantly. Conclusions From a real world study by a surgical quality registry shows that CEA may have reduced rates of mortality in comparison to CAS among octogenarians.
Source link: https://europepmc.org/article/MED/35863648
After carotid revascularization, we investigated the effect of anterior communicating artery flow on the perioperative hemodynamic state and new ischemic lesions. After temporary ICA occlusion, we also measured the change in regional cerebral oxygen saturation after temporary ICA occlusion. Anterior communicating artery flow was found in 61 patients, but not in 22 patients. With a mean peak systolic velocity of u2265200 cm/s and anterior communicating artery flow, preoperative cerebrovascular reactivity was markedly higher in patients with anterior communicating artery flow. In patients without anterior communicating artery flow, the decrease in mean regional cerebral oxygen saturation was much higher. The multivariate logistic regression report found that anterior communicating artery flow was correlated with new ischemic lesions. Conclusions: After carotid revascularization, the absence of anterior communicating artery flow influenced the perioperative hemodynamic status in patients with carotid stenosis and was associated with an elevated incidence of new ischemic lesions.
Source link: https://europepmc.org/article/MED/35835591
paraphrased artery stenting results prior to the lesion length, according to prior reports, the increased perioperative stroke or death event rate among patients treated with transfemoral carotid artery stenting is strongly related to the lesion length. However, there are studies comparing the effect of lesion length on transcarotid artery revascularization with flow reversal. Patients based on knot with the most prominent inflection were divided into two groups by lesion length 25mm and lesion length u226525mm. The final logistic regression model clustered by center identifier to investigate the relationship between lesion length and in-hospital outcomes stratified by the stent approach was both clinically relevant and statistically significant variables on univariable regression. Patients with long lesions had higher incidence of being symptomatic on both TCAR and TFCAS, and they were more likely to have general anesthesia in TCAR and TFCAS. Compared to short lesions among patients under TCAR or TFCAS, long carotid lesions were associated with elevated risks of stroke, TIA, and stroke/death after adjusting for potential confounders. However, when comparing TCAR versus TFCAS results in patients with long lesions, TCAR was found to be associated with a 30% decrease in stroke/TIA, stroke, and longer stays as a result of long-stays. Conclusions (in this large modern retrospective national survey) Carotid lesion length appears to have a detrimental effect on hospital outcomes for TCAR and TFCAS. These encouraging findings support flow reversal's relative effectiveness in terms of neuroprotection relative to distal embolic protection equipment in terms of neuroprotection.
Source link: https://europepmc.org/article/MED/35835322
We wanted to see if selective coronary revascularization of CEA patients with asymptomatic coronary ischemia could reduce the risk of MACEs, myocardial infarction, and cardiac death after endarterectomy compared to CEA patients receiving standard cardiac evaluation and care. Patients were enrolled in a prospective study of noninvasive preoperative coronary ischemia using coronary computed tomography-based fractional flow reserve to find asymptomatic coronary ischemia with selective postoperative coronary revascularization. matched Control patients with standard preoperative cardiac evaluation and no postoperative coronary revascularization have been identified in Group II. FFR CT u2264 0. 75, 0. 75 percent ischemia in group I was defined as FFR CT u2264 0. 80 distal to coronary stenosis with severe ischemia, which was defined as FFR CT u2264 0. 75. Conclusions Preoperative coronary ischemia with selective coronary revascularization after CEA may reduce the risk of MACEs, cardiac arrest, MI, and CV death during a three-year follow-up compared to CEA patients receiving standard cardiac examination and care.
Source link: https://europepmc.org/article/MED/35667605
Objective The results of transcarotid revascularization have been noninferior to those obtained for carotid endarterectomy, according to the original findings. Hence, TCAR has increasingly been delivered to patients with neck anatomy that is otherwise unobtainable for traditional CEA. Patients undergoing TCAR in de novo anatomy with unviolated surgical planes were found to make a difference between patients receiving TCAR in necks with hostile anatomy relative to those receiving TCAR in necks with hostile anatomic structure. The present study was conducted to see if a difference exists among patients undergoing TCAR in de novo anatomy with unviolated surgical planes compared to those undergoing TCAR in necks with hostile anatomical abnormalities. Methods Two large-volume TCAR companies were captured from December 2015 to December 2021 through a search of two parallel, prospectively hosted, carotid intervention databases at these two health centers. An adversary neck anatomy has been described as a result of recent ipsilateral neck radiation, oncologic dissection, or CEA.
Source link: https://europepmc.org/article/MED/35640859
Seven adult patients underwent two-stage treatment of chronic coarcation, including surgical revascularization of the left subclavian artery to the left common carotid artery and transcatheter covered stent implantation. The majority of patients received a single covered stent. The LSA's surgical revascularization of the LSA to the LCCA can safely plan for covered stent implantation in adult patients with a difficult CoA.
Source link: https://europepmc.org/article/MED/35616926
Objective Age b226580 years is considered as a risk factor for periprocedural stroke after transfemoral carotid artery stenting but not after carotid endarterectomy. Methods All patients in the Vascular Quality Initiative were included, from 50 to 99% carotid artery stenosis, with CEA, TF-CAS, or TCAR in the Vascular Quality Initiative. Using variance and multivariable logistic regression models, we compared the perioperative incidence of ipsilateral stroke or death for CEA vs. TF-CAS vs. TCAR, a TIGER vs. TCAR. Regardless of symptom severity and degree of stenosis, the risk of perioperative stroke/death in TF-CAS remained significant for TF-CAS over CEA. For asymptomatic patients and those with high-grade stenosis, the risk of stroke/death was elevated compared to CEA for asymptomatic patients and those with high-grade stenosis, but not for patients with symptomatic and moderate-grade disease. Compared to CEA overall, the risk of myocardial infarction was reduced with TCAR and TF-CAS.
Source link: https://europepmc.org/article/MED/35643202
The lowest overall stroke rate for any carotid artery stenting procedure is achieved by Transcarotid artery revascularization technique. Methods We compared the 30-day results of a disease and CEA within 14 days of a stroke or transient ischemic attack from January 2016 to February 2020 using the Society for Vascular Quality Initiative carotid artery stenting and CEA databases. Result A total of 1281 symptomatic patients had undergone TCAR, and 13,429 patients had CEA within 14 days of a neurologic event. Although TCAR procedures were shorter and the postoperative length of stay was similar to CEA, the TCAR patients were more likely to be transferred to a hospital other than home. Conclusions: Within 14 days of a neurologic event, there were elevated ipsilateral postoperative stroke rates relative to CEA, particularly when performed within 48 hours after a stroke.
Source link: https://europepmc.org/article/MED/35618193
Methods Adults were found in the 2012-2019 National Inpatient Sample, with carotid endarterectomy or carotid artery stenting. The stenting of carotid endarterectomy and carotid artery stenting was tabulated, and hospitals in the highest and lowest quartiles were classified as high-volume centers and low-volume centers, respectively, according to the respective departments. To determine the correlation of race and insurance status with high-volume center utilization, multivariable logistic models were created. Black, Hispanic, and other non-White patients had reduced risks of undergoing carotid revascularization at high-volume centers compared to White patients following the adjustment. In the same way, Medicaid and a lack of insurance were tied with lower odds of high-volume center utilization relative to private insurance, which was lower than private insurance. Conclusion Patients of color and those with Medicaid or lack of insurance used high-volume centers at lower rates, as did those without insurance. Further systemic efforts to ensure equitable access to specialized centers may reduce observed disparities in carotid revascularization.
Source link: https://europepmc.org/article/MED/35581028
Objective Carotid stenosis is currently treated by carotid endarterectomy, carotid artery stenting, or transcarotid artery revascularization. This study sought to contribute to the literature by presenting real-world evidence comparing the safety and effectiveness of these carotid revascularization procedures used by dual-trained neurosurgeons' dual-trained neurosurgeons' capillarization procedures. Methods The authors of a retrospective review of carotid stenosis databases at two U. S. centers. In both univariable and multivariable regression studies, male sex had significantly reduced odds of 30-day transient ischemic attack or stroke. Patients with 30-day TIA or stroke had a significant risk of 30-day mortality on univariable and multivariable regression. Patients are appropriately selected, according to this real-world experience in two high-volume tertiary care centers, and it suggests that both of the three treatment modalities have similar safety and effectiveness if patients are appropriately selected.
Source link: https://europepmc.org/article/MED/35561689
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