Current Approaches for Carotid Endarterectomy

Abstract

Permanent neurologic injuries and death following stroke, necessitates more vigorous treatment of carotid disease. Carotid stenting and carotid endarterectomy are treatment options in many centers besides medical treatment. Whether the patient is symptomatic or asymtomatic, indications and management strategies for treatment remain controversial. Despite the debate, carotid endarterectomy is still accepted to be the most efficient intervention to decrease risk of stroke due to carotid artery stenosis.

Keywords

• Endarterectomy, Carotid; Carotid Artery Diseases

Karotis Arter Endarterektomisi ve Güncel Yaklafl›mlar

Abstract

‹nme nedeniyle oluflan kal›c› nörolojik bozukluklar ve ölümler bu hastal›¤›n tedavisinin daha etkin yap›lmas› mecburiyetini getirmifltir. Bu anlay›flla yola ç›k›ld›¤›nda medikal tedavinin yan› s›ra karotis endarterektomisi veya karotis artere stent implantasyonu günümüzde birçok klinikte uygulanmaktad›r. Hasta ister semptomatik isterse asemptomatik olsun uygulanacak tedavilerde ve endikasyonlarda tart›flmalar sürmektedir. Baz› konularda gri alanlar bulunsa da karotis endarterektomisi günümüzde karotis arter darl›¤›na ba¤l› geliflen inme riskini azaltmada en etkin yol olarak göze çarpmaktad›r.

Keywords

• Endarterektomi, Karotis, Karotis Arter Hastal›klar›

References

1. Thom T, Haase N, Rosamond W, Howard VJ, Rumsfeld J,Manolio T, et al. American Heart Association Statistics Com- mittee and Stroke Statistics Subcommittee. Heart disease and stroke statisticsd2006 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2006;113:85-151.
2. Kleindorfer D, Panagos P, Pancioli A, Khoury J, Kissela B, Wo- o D, et al. Incidence and short-term prognosis of transient ische- mic attack in a population-based study. Stroke 2005;36:720-3.
3. White H, Boden-Albala B, Wang C, Elkind MS, Rundek T, Wright CB, et al. Ischemic stroke subtype incidence among whites, blacks, and Hispanics: the Northern Manhattan Study. Circulation 2005;111:1327-31.
4. Bonita R, Stewart A, Beaglehole R. International trends in stroke mortality: 1970e1985. Stroke 1990;21:989-92.
5. Veith FJ,Amor M, Ohki T, Beebe HG, Bell PR, Bolia A, et al. Current status of carotid bifurcation angioplasty and stenting based on a consensus of opinion leaders. J Vasc Surg 2001; 33(2 Suppl):S111-6.
6. Longstreth WT, Jr., Shemanski L, Lefkowitz D, O'Leary DH, Polak JF, Wolfson SK, Jr. Asymptomatic internal carotid ar- tery stenosis defined by ultrasound and the risk of subsequ- ent stroke in the elderly. The Cardiovascular Health Study. Stroke 1998;29(11):2371-6.
7. Fine-Edelstein JS, Wolf PA, O'Leary DH, et al. Precursors of extracranial carotid atherosclerosis in the Framingham Study. Neurology 1994;44(6):1046-50.
8. Mannami T, Baba S, Ogata J. Strong and significant relati- onships between aggregation of major coronary risk factors and the acceleration of carotid atherosclerosis in the general population of a Japanese city: the Suita Study. Arch Intern Med 2000;160(15):2297-303.

9. Wilson PW, Hoeg JM, D'Agostino RB, et al. Cumulative ef- fects of high cholesterol levels, high blood pressure, and ciga- rette smoking on carotid stenosis. N Engl J Med 1997;337(8):516-22.
10. Whisnant J, Cartlidge N, Elveback L. Carotid and verteb- ro-basilar transient ischemic attacks: effect of anticoagulants, hypertension, and cardiac disorders on survival and stroke occurrence a population study. Ann Neurol 1978; 3:107-115. 1111.. Inzitari D, Eliasziw M, Gates P, Sharpe BL, Chan RK, Mel- drum HE et al. The causes and risk of stroke in patients with asymptomatic internal-carotid-artery stenosis. North Ameri- can Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med 2000;342:1693-1700.
11. European Carotid Surgery Trialists’ Collaborative Group. Risk of stroke in the distribution of an asymptomatic carotid artery. Lancet 1995;345:209-212.
12. Norris JW, Zhu CZ, Bornstein NM, Chambers BR. Vascu- lar risks of asymptomatic carotid stenosis. Stroke. 1991;22:1485-1490.
13. Jonathan G. Asymptomatic Carotid Stenosis. Stroke 2007;38;150-5
14. Ballotta E, Da Giau G, Militello C, Barbon B, De Rossi A, Me- neghetti G, et al. High-grade symptomatic and asymptomatic carotid stenosis in the very elderly. A challenge for proponents of carotid angioplasty and stenting. BMC Cardiovasc Disord 2006;6:12-9
15. Reed AB, Gaccione P, Belkin M, Donaldson MC, Mannick JA, Whittemore AD, et al. Preoperative risk factors for carotid endarterectomy: defining the patient at high risk. J Vasc Surg 2003;37:1191-9.
16. Baker WH, Littooy FN, Hayes AC, Dorner DB, Stubbs D. Carotid endarterectomy without a shunt The control series. J Vasc Surg 1984; 1:50-56.
17. Derin GP. Conventional CEA is a safe, effective and durab- le procedure: It is still the gold standard. Trans Montefiore Ve- ith Symposium, New York, NY. November 2002.
18. Bond R, Warlow CP, Naylor AR, Rothwell PM. European Carotid Surgery Trialists’ Collaborative Group. Variation in surgical and anaesthetic technique and associations with operative risk in the European carotid surgery trial: implicati- ons for trials of ancillary techniques. Eur J Vasc Endovasc Surg 2002;23: 117-26.
19. Pluskwa F, Bonnet F, Abhay K, Touboul C, Rey B, Marcan- doro J, et al. Blood pressure profiles during carotid endarte- rectomy. Comparing flunitrazepam/fentanyl/nitrous oxide with epidural anaesthesia (author’s translation). Annales Fran- caisesd’anesthesie et de reanimation 1989;8:26-32.
20. Ballotta E, Da Giau G, Saladini M, Abbruzzese E, Renon L. Toniato A. Carotid endarterectomy with patch closure versus carotid eversion endarterectomy and reimplantation: a pros- pective randomized study. Surgery 1999;125:271-9.
21. Ballotta E, Renon L, Da Giau G, Toniato A, Baracchini C, Abbruzzese E. A prospective randomized study on bilateral carotid endarterectomy: patching versus eversion. Clinical outcome and restenosis. Ann Surg 2000;232:119-25.
22. Balzer K. Eversion versus conventional carotid endarte- rectomy. In: Horsch S, Ktenidis K, editors. Perioperative mo- nitoring incarotid surgery. Darmstadt: Steinkopff Springer; 1998. p. 159-65.
23. Cao P, Giordano G, De Rango P, Zannetti S, Chiesa R, Coppi G, et al and collaborators of the EVEREST Study Gro- up. A randomized study on eversion versus standard carotid endarterectomy: study design and preliminary results: the EVEREST trial. J Vasc Surg 1998;27:595-605.
24. Vanmaele RG, Van Schil PE, DeMaeseneer MG, Meese G, Lehert PH, Van Look RF. Division-endarterectomy-anastomo- sis of the internal carotid artery: a prospective randomized comparative study. Cardiovasc Surg 1994;2:573-81.
25. Gough MJ, Bodenham A, Horrocks M, Colam B, Lewis SC, Rothwell PM, et al. GALA: an international multicentre rando- mized trial comparing general anaesthesia versus local ana- esthesia for carotid surgery. Trials 2008;9:28-36
26. Bond R, Rerkasem K, AbuRahma AF, Naylor AR, Rothwell PM. Patch angioplasty versus primary closure for carotid en- darterectomy. Cochrane Database Syst Rev; 2006:1
27. Mannheim D, Weller B, Vahadim E, Karmeli R. Carotid endar- terectomy with a polyurethane patch versus primary closure: a prospective randomized study. J Vasc Surg 2005;41:403-8.
28. Fowkes FG. Epidemiology of atherosclerotic arterial di- sease in the lower limbs. Eur J Vasc Surg 1988;2:283-91.
29. Newman AB, Siscovick DS, Manolio TA, Polak J, Fried LP, Borhani NO, et al. Ankle-arm index as a marker of atheroscle- rosis in the Cardiovascular Health Study. Cardiovascular He- art Study (CHS) Collaborative Research Group. Circulation 1993;88:37-45.
30. Belch JJ, Topol EJ, Agnelli G, Bertrand M, Califf RM, Cle- ment DL, et al. Critical issues in peripheral arterial disease de- tection and management: a call to action. Arch Intern Med 2003;163:884-92.
31. Simons PC, Algra A, Eikelboom BC, Grobbee DE, van der Graaf Y. Carotid artery stenosis in patients with peripheral ar- terial disease: the SMARTstudy. J Vasc Surg 1999;30:519-25. 3333.. Alexandrova NA, Gibson WC, Norris JW, Maggisano R. 30 Kofluyolu Heart Journal
32. Carotid artery stenosis in peripheral vascular disease. J Vasc Surg 1996;23:645-9.
33. Cina CS, Safar HA, Maggisano R, Bailey R, Clase CM. Pre- valence and progression of internal carotid artery stenosis in patients with peripheral arterial occlusive disease. J Vasc Surg 2002;36: 75-82.
34. Hertzer NR, Young JR, Beven EG, Graor RA, O’Hara PJ, Ruschhaupt 3rd WF, et al. Coronary angiography in 506 pati- ents with extracranial cerebrovascular disease. Arch
35. Intern Med 1985;145:849-52.
36. Urbinati S, Di Pasquale G, Andreoli A, Lusa AM, Carini G, Grazi P, et al. Preoperative noninvasive coronary risk stratifi- cation in candidates for carotid endarterectomy. Stroke 1994; 25:2022-7.
37. Hertzer NR, Loop FD, Beven EG, O’Hara PJ, Krajewski LP. Surgical staging for simultaneous coronary and carotid disea- se: a study including prospective randomization. J Vasc Surg 1989; 9:455-63.
38. Schwartz LB, Bridgman AH, Kieffer RW, Wilcox RA, McCann RL, Tawil MP, et al. Asymptomatic carotid artery ste- nosis and stroke in patients undergoing cardiopulmonary bypass. J Vasc Surg 1995;21:146-53.
39. Naylor AR, Cuffe RL, Rothwell PM, Bell PR. A systematic review of outcomes following staged and synchronous caro- tid endarterectomy and coronary artery bypass. Eur J Vasc Endovasc Surg 2003;25:380-9.
40. SAPPHIRE Investigators (Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy). Pro- tected carotid-artery stenting versus endarterectomy in high- risk patients. N Engl J Med 2004;351:1493-501.