Carotid endarterectomy: Difference between revisions

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==Adverse effects==
==Adverse effects==
Carotid endarterectomy may both cause<ref  name="pmid15874927">{{cite  journal |author=Nouraei SA, Al-Rawi PG, Sigaudo-Roussel D,  Giussani DA, Gaunt ME |title=Carotid endarterectomy impairs blood  pressure homeostasis by reducing the physiologic baroreflex reserve  |journal=J. Vasc. Surg. |volume=41 |issue=4 |pages=631–7 |year=2005  |month=April |pmid=15874927 |doi=10.1016/j.jvs.2005.01.009 |url=http://linkinghub.elsevier.com/retrieve/pii/S0741521405000315  |issn=}}</ref><ref name="pmid18095499">{{cite journal |author=Azuma  Y, Imai K, Oda K, Niwa F, Makino M, Oshima F |title=[Case  of baroreflex failure after bilateral revascularization of the cervical  carotid artery] |language=Japanese |journal=Rinsho  Shinkeigaku |volume=47 |issue=10 |pages=657–61 |year=2007 |month=October |pmid=18095499 |doi= |url= |issn=}}</ref>and improve<ref  name="pmid8685922">{{cite  journal |author=Hirschl M, Kundi M, Blazek G |title=Five-year  follow-up of patients after thromboendarterectomy of the internal  carotid artery: Relevance of baroreceptor sensitivity |journal=Stroke  |volume=27 |issue=7 |pages=1167–72 |year=1996 |month=July |pmid=8685922  |doi= |url=http://stroke.ahajournals.org/cgi/pmidlookup?view=long&pmid=8685922  |issn=}}</ref><ref  name="pmid10193149">{{cite  journal |author=Akiyama Y, Hashimoto  N, Morimoto M  |title=Orthostatic hypotension improved after bilateral  carotid  endarterectomy--case report |journal=Neurol. Med. Chir. (Tokyo)  |volume=39 |issue=2 |pages=153–6 |year=1999 |month=February  |pmid=10193149 |doi= |url=http://joi.jlc.jst.go.jp/JST.Journalarchive/nmc1959/39.153?from=PubMed  |issn=}}</ref> "vasodepressor-type carotid sinus syndrome caused by compression of the  carotid baroreceptors by atherosclerotic plaques."<ref  name="pmid10193149"/>
Carotid endarterectomy may both cause<ref  name="pmid15874927">{{cite  journal |author=Nouraei SA, Al-Rawi PG, Sigaudo-Roussel D,  Giussani DA, Gaunt ME |title=Carotid endarterectomy impairs blood  pressure homeostasis by reducing the physiologic baroreflex reserve  |journal=J. Vasc. Surg. |volume=41 |issue=4 |pages=631–7 |year=2005  |month=April |pmid=15874927 |doi=10.1016/j.jvs.2005.01.009 |url=http://linkinghub.elsevier.com/retrieve/pii/S0741521405000315  |issn=}}</ref><ref name="pmid18095499">{{cite journal |author=Azuma  Y, Imai K, Oda K, Niwa F, Makino M, Oshima F |title=[Case  of baroreflex failure after bilateral revascularization of the cervical  carotid artery] |language=Japanese |journal=Rinsho  Shinkeigaku |volume=47 |issue=10 |pages=657–61 |year=2007 |month=October |pmid=18095499 |doi= |url= |issn=}}</ref>and improve<ref  name="pmid8685922">{{cite  journal |author=Hirschl M, Kundi M, Blazek G |title=Five-year  follow-up of patients after thromboendarterectomy of the internal  carotid artery: Relevance of baroreceptor sensitivity |journal=Stroke  |volume=27 |issue=7 |pages=1167–72 |year=1996 |month=July |pmid=8685922  |doi= |url=http://stroke.ahajournals.org/cgi/pmidlookup?view=long&pmid=8685922  |issn=}}</ref><ref  name="pmid10193149">{{cite  journal |author=Akiyama Y, Hashimoto  N, Morimoto M  |title=Orthostatic hypotension improved after bilateral  carotid  endarterectomy--case report |journal=Neurol. Med. Chir. (Tokyo)  |volume=39 |issue=2 |pages=153–6 |year=1999 |month=February  |pmid=10193149 |doi= |url=http://joi.jlc.jst.go.jp/JST.Journalarchive/nmc1959/39.153?from=PubMed  |issn=}}</ref> [[orthostatic hypotension]] and "vasodepressor-type carotid sinus syndrome caused by compression of the  carotid baroreceptors by atherosclerotic plaques."<ref  name="pmid10193149"/>


==References==
==References==
<references/>
<references/>

Revision as of 10:33, 27 February 2010

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Carotid endarterectomy.

In medicine, carotid endarterectomy, or CEA, is "excision of the thickened, atheromatous tunica intima of a carotid artery."[1] This is done to prevent a stroke.

Concomitant aspirin may decrease complications.[2][3]

Effectiveness

CEA can benefit patients with[4] and without[5] symptoms according to systematic reviews by the Cochrane Collaboration and the American Academy of Neurology[3].

Stents have less short term effect, but similar intermediate term effect as carotid endarterectomy.[6]

Preoperative assessment

The preoperative care includes assessment for coronary heart disease. In one study, 40% of patients had coronary heart disease, with 18% of the patients (or 48% of those with coronary heart disease) had severe disease (obstruction of the left main or three of the arteries).[7] The strongest predictor of coronary heart disease was the presence of diabetes mellitus. The presence of bilateral carotid disease was not a significant prediction of coronary disease. The presence of cardiac symptoms probably increasess the likelihood of coronary disease.[8]

The role of coronary angiography[9] and myocardial revascularization[10] are not established. A cohort study suggests that [[myocardial revascularization] should be done first as a separate procedure.[11]

Adverse effects

Carotid endarterectomy may both cause[12][13]and improve[14][15] orthostatic hypotension and "vasodepressor-type carotid sinus syndrome caused by compression of the carotid baroreceptors by atherosclerotic plaques."[15]

References

  1. ↑ Anonymous (2024), Carotid endarterectomy (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. ↑ Taylor DW, Barnett HJ, Haynes RB, et al (June 1999). "Low-dose and high-dose acetylsalicylic acid for patients undergoing carotid endarterectomy: a randomised controlled trial. ASA and Carotid Endarterectomy (ACE) Trial Collaborators". Lancet 353 (9171): 2179–84. DOI:10.1016/S0140-6736(99)05388-X. PMID 10392981. Research Blogging.
  3. ↑ 3.0 3.1 Chaturvedi S, Bruno A, Feasby T, et al (September 2005). "Carotid endarterectomy--an evidence-based review: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology". Neurology 65 (6): 794–801. DOI:10.1212/01.wnl.0000176036.07558.82. PMID 16186516. Research Blogging.
  4. ↑ Cina CS, Clase CM, Haynes RB (2000). "Carotid endarterectomy for symptomatic carotid stenosis". Cochrane Database Syst Rev (2): CD001081. DOI:10.1002/14651858.CD001081. PMID 10796411. Research Blogging.
  5. ↑ Chambers BR, Donnan GA (2005). "Carotid endarterectomy for asymptomatic carotid stenosis". Cochrane Database Syst Rev (4): CD001923. DOI:10.1002/14651858.CD001923.pub2. PMID 16235289. Research Blogging.
  6. ↑ Meier P, Knapp G, Tamhane U, Chaturvedi S, Gurm HS (2010). "Short term and intermediate term comparison of endarterectomy versus stenting for carotid artery stenosis: systematic review and meta-analysis of randomised controlled clinical trials.". BMJ 340: c467. DOI:10.1136/bmj.c467. PMID 20154049. Research Blogging.
  7. ↑ Shimada T, Toyoda K, Inoue T, et al (October 2005). "Prediction of coronary artery disease in patients undergoing carotid endarterectomy". J. Neurosurg. 103 (4): 593–6. PMID 16266039. [e]
  8. ↑ Chimowitz MI, Weiss DG, Cohen SL, Starling MR, Hobson RW (April 1994). "Cardiac prognosis of patients with carotid stenosis and no history of coronary artery disease. Veterans Affairs Cooperative Study Group 167". Stroke 25 (4): 759–65. PMID 8160217. [e]
  9. ↑ Massie MT, Rohrer MJ, Leppo JA, Cutler BS (June 1997). "Is coronary angiography necessary for vascular surgery patients who have positive results of dipyridamole thallium scans?". J. Vasc. Surg. 25 (6): 975–82; discussion 982–3. PMID 9201157. [e]
  10. ↑ McFalls EO, Ward HB, Moritz TE, et al (December 2004). "Coronary-artery revascularization before elective major vascular surgery". N. Engl. J. Med. 351 (27): 2795–804. DOI:10.1056/NEJMoa041905. PMID 15625331. Research Blogging.
  11. ↑ Li Y, Walicki D, Mathiesen C, Jenny D, Li Q, Isayev Y et al. (2009). "Strokes after cardiac surgery and relationship to carotid stenosis.". Arch Neurol 66 (9): 1091-6. DOI:10.1001/archneurol.2009.114. PMID 19752298. Research Blogging.
  12. ↑ Nouraei SA, Al-Rawi PG, Sigaudo-Roussel D, Giussani DA, Gaunt ME (April 2005). "Carotid endarterectomy impairs blood pressure homeostasis by reducing the physiologic baroreflex reserve". J. Vasc. Surg. 41 (4): 631–7. DOI:10.1016/j.jvs.2005.01.009. PMID 15874927. Research Blogging.
  13. ↑ Azuma Y, Imai K, Oda K, Niwa F, Makino M, Oshima F (October 2007). "[Case of baroreflex failure after bilateral revascularization of the cervical carotid artery]" (in Japanese). Rinsho Shinkeigaku 47 (10): 657–61. PMID 18095499. [e]
  14. ↑ Hirschl M, Kundi M, Blazek G (July 1996). "Five-year follow-up of patients after thromboendarterectomy of the internal carotid artery: Relevance of baroreceptor sensitivity". Stroke 27 (7): 1167–72. PMID 8685922. [e]
  15. ↑ 15.0 15.1 Akiyama Y, Hashimoto N, Morimoto M (February 1999). "Orthostatic hypotension improved after bilateral carotid endarterectomy--case report". Neurol. Med. Chir. (Tokyo) 39 (2): 153–6. PMID 10193149. [e]
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