Efficacy of the Carotid Endarterectomy in Asymptomatic and Symptomatic Carotid Stenosis and in Patients with Multifocal Atherosclerosis
Aim. The aim of the research was to study the effect of carotid endarterectomy (CEA) at patients with asymptomatic and symptomatic carotid stenosis, also in the patients with multifocal atherosclerosis (MFA): carotid stenosis in patients with peripheral arterial disease (PAD) of the limbs and ischemic heart disease (IHD).
Material and methods. Colour Duplex Doppler was used for screening of carotid pathology in 1104 patients with PAD, IHD, transitory ischemic attacks and an ischemic stroke. The group of 205 patients who had stenosis of a. carotis interna >60%, were divided into three subgroups - patients with asymptomatic carotid stenosis (ACS), patients with symptomatic carotid stenosis (SCS) and patients with multifocal atherosclerosis MFA.
Results. All 205 patients were subjected to CEA, conducted by a patch or shunt, which was successful performed at 201 patients (98%). Significant improvement of hemodynamic of the regional carotid as well as intracranial arteries on the side of the surgery was determined using Colour Duplex and Transcranial Doppler Sonography (TDS). At a second stage, after the successful CEA, a vascular reconstruction was carried out or an aorto-coronary bypass created in the case of patients with MFA.
Conclusion. CEA in the case of patients with asymptomatic and symptomatic carotid stenosis and a concurrent MFA is an efficient curative method of removing the carotid pathology with a minimum percentage of vascular complications.
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Dokova K Stoeva K Kirov Ph at al. Public understanding of the causes of high stroke risk in northeast Bulgaria. Eur J Public Health. 2005;15(3):313-316. doi:10.1093/eurpub/cki086 PMID:15941746
Manchev I Mineva P Hadjiev D. Prevalence of Stroke Risk Factors and Their Outcomes: A Population-based Longitudinal Epidemiological Study. Cerebrovasc Dis. 2001;12:303-307. doi:10.1159/000047725 PMID:11721099
Thom T Haase N Rosamond W at al. Heart Disease and Stroke Statistics—2006 Update: A Report from the American heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2006;113: e85-e151. doi:10.1161/CIRCULATIONAHA.105.171600 PMID:16407573
Wardlaw JM Keir SL and Dennis MS. The impact of delays in computed tomography of the brain on the accuracy of diagnosis and subsequent management in patients with minor stroke. J Neurol Neurosurg Psychiatry. 2003;74:77-81. doi:10.1136/jnnp.74.1.77 PMID:12486271
Diringer NM Edwards DF Mattson DT at al. Predictors of Acute Hospital Costs for Treatment of Ischemic Stroke in an Academic Center. Stroke. 1999; 30(4):724-728. PMID:10187869
Taylor T Davis P Torner J at al. Lifetime Cost of Stroke in the United States. Stroke. 1996;27(9):1459-1466. PMID:8784113
Oddone E Waters K. Endarterectomy for asymptomatic carotid artery stenosis. JAMA. 1995;273:1421-8. doi:10.1001/jama.273.18.1421 PMID:7723155
Barnett HJM Haines SJ. Carotid endarterectomy for asymptomatic carotid stenosis. N Engl J Med. 1993;328:276-9. doi:10.1056/NEJM199301283280410 PMID:8418409
Carroccio A. Commentary on "Randomized Clinical Trials: Impact on Clinical Practice for Symptomatic and Asymptomatic Extracranial Carotid Occlusive Disease". Perspect Vasc Surg Endovasc Ther. 2007;19:220-221. doi:10.1177/1531003507306550 PMID:17911542
Carotid surgery versus medical therapy in asymptomatic carotid stenosis. CASANOVA Study Group. Stroke. 1991;22(10):1229-35. PMID:1926232
European Carotid Surgery Trialists' Collaborative Group. Endarterectomy for moderate symptomatic carotid stenosis: interim results from the MRC European Carotid Surgery Trial. Lancet. 1996;347(9015):1591-3. PMID:8667868
Mayberg MR Wilson SE Yatsu F Weiss DG Messina L Hershey LA et al. Carotid endarterectomy and prevention of cerebral ischemia in symptomatic carotid stenosis. JAMA. 1991;266:3289-94. doi:10.1001/jama.266.23.3289 PMID:1960828
Abbruzzese TA Cambria RP. Contemporary Management of Carotid Stenosis: Carotid Endarterectomy Is Here to Stay. Perspect Vasc Surg Endovasc Ther. 2007;19:248. doi:10.1177/1531003507304454 PMID:17911549
Antiplatelet Trialists' Collaboration. Collaborative overview of Asymptomatic Study Executive Committee. Endarterectomy for asymptomatic carotid artery stenosis. JAMA. 1995; 273:1421-8. doi:10.1001/jama.273.18.1421 PMID:7723155
Bergeron P. Symptomatic carotid artery stenosis: the dilemma for a reasonable selection of carotid stenting or endarterectomy. Eur Heart J. 2008;29:7-9. doi:10.1093/eurheartj/ehm530 PMID:18167365
MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70-99%) or with mild (0-29%) carotid stenosis. European Carotid Surgery Trialists' Collaborative Group. Lancet. 1991;337(8752):1235-43. doi:10.1016/0140-6736(91)92916-P PMID:1674060
Gasecki AP Eliasziw M Ferguson GG at al. Long-term prognosis and effect of endarterectomy in patients with symptomatic severe carotid stenosis and contralateral cartoid stenosis or occlusion: results from NASCET. J Neurosurg. 1995;83:778-82. PMID:7472542
Gasecki AP Ferguson GG Eliasziw M Clagett GP Fox AJ Hachinski V et al. Early endarterectomy for severe carotid artery stenosis after a nondisabling stroke: results from the North American Symptomatic Carotid Endarterectomy Trial. J Vasc Surg. 1994;20(2):288-95. PMID:8040954
Gasecki AP Eliasziw M Ferguson GG at al. North American Symptomatic Carotid Endarterectomy Trial (NASCET) Group. Long-term prognosis and effect of endarterectomy in patients with symptomatic severe carotid stenosis and contralateral carotid stenosis or occlusion: results from NASCET. J Neurosurg. 1995; 83(5):778-782. PMID:7472542
Gaunt ME Smith JL Ratliff DA at al. A comparison of quality control methods applied to carotid endarterectomy. Eur J Vasc Endovasc Surg. 1996;11:4-11. doi:10.1016/S1078-5884(96)80128-6 PMID:8564485
Gerraty RP Gates PC Doyle JC. Carotid stenosis and perioperative stroke risk in symptomatic and asymptomatic patients undergoing vascular or coronary surgery. Stroke. 1993;24(8):1115-8. PMID:8342182
Goldstein LB Hasselblad V Matchar DB at al. Comparison and meta-analysis of randomized trials of endarterectomy for symptomatic carotid artery stenosis. Neurology. 1995;45(11):1965-1970. PMID:7501142
Halliday A Mansfield A Marro J. MRC Asymptomatic Carotid Surgery Trial (ACST) Collaborative Group et al. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial. Lancet. 363(9420):1491-502. PMID:15135594
Hobson RW Weiss DG Fields WS et al. Veterans Affairs Cooperative Study Group: efficacy of carotid endarterectomy for asymptomatic carotid stenosis. N Engl J Med. 1993;328:221-7. doi:10.1056/NEJM199301283280401 PMID:8418401
Hobson RW Weiss DG Fields WS Goldstone J Moore WS Towne JB et al. The Veterans Affairs Cooperative Study Group. Efficacy of carotid endarterectomy for asymptomatic carotid stenosis. N Engl J Med. 1993;328:221-7. doi:10.1056/NEJM199301283280401 PMID:8418401
Hobson R W II. Randomized Clinical Trials: Impact on Clinical Practice for Symptomatic and Asymptomatic Extracranial Carotid Occlusive Disease. Perspect Vasc Surg Endovasc Ther. 2007;19:215-219. doi:10.1177/1531003507305267 PMID:17911541
Mayo Asymptomatic Carotid Endarterectomy Study Group. Results of a randomized controlled trial of carotid endarterectomy for asymptomatic carotid stenosis. Mayo Clin Proc. 1992;67(6):513-8. PMID:1434877
Bower TC Merrel SW Cherry KJ Jr et al. Advanced carotid disease in patients requiring aortic reconstruction. Am J Surg. 1993;166(2):146-51. doi:10.1016/S0002-9610(05)81046-3 PMID:8352406
Naylor AR Mehta Z Rothwell PM et al. Carotid artery disease and stroke during coronary artery bypass: a critical review of the literature. Eur J Vasc Endovasc Surg. 2002;23:283-94. doi:10.1053/ejvs.2002.1609 PMID:11991687
Sila CA. Neurologic complications of vascular surgery. Neurol Clin. 1998;16:9-20. doi:10.1016/S07338619(05)70364-9 PMID:9421538
Fields WS Maslenikov V Meyer JS at al. Joint study of extracranial arterial occlusion. V. Progress report of prognosis following surgery or nonsurgical treatment for transient cerebral ischemic attacks and cervical carotid artery lesions. JAMA. 1970;211:1993-2003. doi:10.1001/jama.211.12.1993 PMID:5467158
Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med. 1991;325(7):445-53. PMID:1852179
Ennix CL Jr Lawrie GM Morris GC Jr et al. Improved results of carotid endarterectomy in patients with symptomatic coronary disease: an analysis of 1546 consecutive carotid operations. Stroke. 1979;10(2):122-5. PMID:312551
Zakhariev T. Surgical Strategy in Multifocal Arteriosclerosis. Doctoral thesis. 2001.
Moore WS Barnett HJ Beebe HG at al. Guidelines for carotid endarterectomy: a multidisciplinary consensus statement from the Ad Hoc Committee American Heart Association. Circulation. 1995; 91(2):566-579. PMID:7805271
Wolman RL Nussmeier NA Aggarwal A et al. Cerebral injury after cardiac surgery: Identification of a group at extraordinary risk. Multicenter Study of Perioperative Ischemia Research Group and the Ischemia Research Education Foundation (IREF) Investigators. Stroke. 1999;30(3):514-22. PMID:10066845
Gurm HS Nallamothu BK Yadav J. Safety of carotid artery stenting for symptomatic carotid artery disease: a meta-analysis. Eur Heart J. 2008;29:113-119. doi:10.1093/eurheartj/ehm362 PMID:17881346
Yadav JS Whole MH Kuntz RE et al. Protected carotid-artery tenting versus endarterectomy in high-risk patients. N Engl J Med. 2004;351:1493-501. doi:10.1056/NEJMoa040127 PMID:15470212