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Giacomelli E, Dorigo W, Sibaldi F, Di Domenico R, Nesi M, Fargion AT, Speziali S, Pulli R. Sex-Related Outcomes in Asymptomatic Carotid Artery Stenosis Undergoing Carotid Endarterectomy. J Surg Res 2025; 305:204-213. [PMID: 39719769 DOI: 10.1016/j.jss.2024.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Revised: 10/14/2024] [Accepted: 11/18/2024] [Indexed: 12/26/2024]
Abstract
INTRODUCTION This study aims to retrospectively analyze the perioperative and long-term outcomes of carotid endarterectomy (CEA) performed in asymptomatic patients, stratifying the results by sex. METHODS Data on CEAs performed from January 2009 to December 2020 at our institution were collected. A neurologic evaluation was conducted 30 d after surgery to assess the occurrence of neurological events. Instrumental evaluations using Doppler ultrasound were performed within the first 3 mo, at 12 mo, and annually thereafter. The primary endpoints were perioperative mortality, major neurological events, and major complications. Secondary endpoints included long-term overall survival, stroke-free survival, absence of neurological symptoms, and absence of significant (>70%) restenosis. RESULTS Two thousand one hundred ninety-four CEAs were performed in asymptomatic patients, with 758 females and 1436 males. There were no differences in perioperative outcomes between the two groups. In the multivariate analysis, female sex was found to be a protective factor for the risk of 30-d stroke (hazard ratio: 0.2; 95% confidence interval: 0.04-0.9; P = 0.05). At a median follow-up of 24 mo, the estimated 10-y overall and stroke-free survival rates were 77.6% in males versus 62.7% in females, P = 0.2 and 70% in males versus 61% in females, P = 0.1, respectively. Also the rates of significant restenosis did not differ between males and females (82.2% versus 87.7%, P = 0.5). CONCLUSIONS This study suggests that female sex, by itself, does not represent a risk factor for adverse outcomes after carotid surgery and it appears to be protective in the first 30 d following surgery.
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Affiliation(s)
- Elena Giacomelli
- Department of Experimental and Clinical Medicine, Chair of Vascular Surgery, University of Florence, Florence, Italy
| | - Walter Dorigo
- Department of Experimental and Clinical Medicine, Chair of Vascular Surgery, University of Florence, Florence, Italy.
| | - Francesca Sibaldi
- Department of Experimental and Clinical Medicine, Chair of Vascular Surgery, University of Florence, Florence, Italy
| | - Rossella Di Domenico
- Department of Experimental and Clinical Medicine, Chair of Vascular Surgery, University of Florence, Florence, Italy
| | - Mascia Nesi
- Department of Experimental and Clinical Medicine, Chair of Vascular Surgery, University of Florence, Florence, Italy
| | - Aaron Thomas Fargion
- Department of Experimental and Clinical Medicine, Chair of Vascular Surgery, University of Florence, Florence, Italy
| | - Sara Speziali
- Department of Experimental and Clinical Medicine, Chair of Vascular Surgery, University of Florence, Florence, Italy
| | - Raffaele Pulli
- Department of Experimental and Clinical Medicine, Chair of Vascular Surgery, University of Florence, Florence, Italy
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Dorigo W, Speziali S, Giacomelli E, Campolmi M, Dolfi L, Fargion AT, Di Domenico R, Coscarelli S, Nesi M, Pratesi C, Pulli R. Cranial nerve injuries post carotid endarterectomy: A 15-year prospective study with routine otolaryngologist and neurological evaluation. J Vasc Surg 2025; 81:158-164. [PMID: 39142450 DOI: 10.1016/j.jvs.2024.07.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 07/31/2024] [Accepted: 07/31/2024] [Indexed: 08/16/2024]
Abstract
OBJECTIVE The aim of this prospective monocentric cohort study was to analyze the risk of otolaryngologist-assessed cranial nerve injuries (CNIs) following carotid endarterectomy (CEA) in our academic center during a 15-year period, and to identify possible risk factors for CNI development. METHODS From January 2007 to December 2022, 3749 consecutive CEAs were performed and their data prospectively recorded in a dedicated database. CNIs were assessed and defined according to a standardized protocol. Instrumental ear, nose, and throat (ENT) evaluations were conducted within 30 days before intervention and before discharge. Preoperative neurological assessments were carried out in all patients with symptomatic carotid stenosis, whereas postoperative neurological evaluations were performed in all patients. Patients with newly onset CNIs underwent follow-up assessments at 30 days and, if necessary, at 6, 12, and 24 months. Perioperative results, including mortality, major central neurological events, and postoperative CNIs, were analyzed. Regression or persistence of lesions during follow-up visits was assessed, and multivariate analysis (binary logistic regression) was conducted to evaluate clinical, anatomical, and surgical technique factors influencing the occurrence of CNIs. RESULTS CEAs were performed more frequently in male patients (2453 interventions; 65.5%) than in females (1296 interventions; 34.5%). The interventions were performed in asymptomatic patients in 3078 cases (82%). In 66 cases, the interventions followed a previous ipsilateral CEA. At preoperative ENT evaluation, no cases of ipsilateral pre-existent CNI were recorded. The 30-day stroke and death rate was 1%. In 113 patients (3%), a postoperative neck bleeding requiring surgical revision and drainage was noted. Pre-discharge ENT evaluations identified 259 motor CNIs, accounting for 6.9% of the entire study group. Eighteen patients had lesions in more than one cranial nerve. ENT and neurological evaluations at 30 days showed the complete resolution of 161 lesions, whereas in 98 cases (2.6%), the CNI persisted. At 1 year, the rate of persistent CNI was 0.4% (10 patients), whereas at 2 years, it was 0.25% (6 cases), in all but one asymptomatic. At multivariate analysis, urgent intervention in unstable patients, secondary intervention, a clamping time >40 minutes, a hematoma requiring revision, and a postoperative stroke were independent predictors of CNIs. CONCLUSIONS Data from this prospective monocentric cohort study showed that the occurrence of CNI following CEA was low, even when an independent multi-specialist evaluation was performed. The percentage of persistent lesions at 2 years was negligible and, in most cases, asymptomatic.
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Affiliation(s)
- Walter Dorigo
- Division of Vascular Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
| | - Sara Speziali
- Division of Vascular Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Elena Giacomelli
- Division of Vascular Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Marco Campolmi
- Division of Vascular Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Lapo Dolfi
- Division of Vascular Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Aaron Thomas Fargion
- Division of Vascular Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Rossella Di Domenico
- Division of Vascular Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Salvatore Coscarelli
- Unit of Phoniatrics and Pathophysiology of Voice and Language, Careggi Teaching Hospital, Florence, Italy
| | - Mascia Nesi
- Stroke Unit, Careggi Teaching Hospital, Florence, Italy
| | - Carlo Pratesi
- Division of Vascular Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Raffaele Pulli
- Division of Vascular Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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BIANCOFIORE B, DE BLASIS S, FALSO R, DOLFI L, PANELLA M, DI DOMENICO R, DORIGO W, PULLI R, PRATESI C. How to improve results in carotid surgery. Analysis of a 20-year case history of more than 7000 operations. ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2023. [DOI: 10.23736/s1824-4777.22.01562-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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Ucci A, de Troia A, D'Ospina RM, Pedrazzi G, Nabulsi B, Azzarone M, Perini P, Massoni CB, Rossi G, Freyrie A. Carotid endarterectomy in asymptomatic octogenarians: Outcomes at 30 days and 5 years. Vascular 2023; 31:98-106. [PMID: 34923864 DOI: 10.1177/17085381211056434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The following study investigated the 30-day and 5-year relative survival rate and freedom from neurological events in asymptomatic carotid stenosis (ACS) octogenarians who had undergone elective carotid endarterectomy (CEA). METHODS Between January 2008 and June 2014, a retrospective review was conducted on ACS patients who had undergone elective CEA. The patients' sample was divided into two groups: Group A (GA) included octogenarians and Group B (GB) included younger patients. The GA patients were subjected to a risk-scoring system and follow-up. The two groups were compared analysing the following primary endpoints: 30-day mortality, stroke, stroke/death and acute myocardial infarction (AMI); GA patients' survival rate and freedom from neurological events at 5 years. The 30-day secondary endpoints included carotid shunting, redo surgical, need for general anaesthesia with preserved consciousness (GAPC) conversion and length of hospital stay. RESULTS We identified 620 patients with ACS, of them 144 (23.2%) belonged to the GA and 476 (76.8%) belonged to the GB. No statistical difference between the two groups was found regarding the primary and secondary endpoints. One hundred nineteen of 144 GA patients (82.6%) underwent the follow-up; the median follow-up was 78.3 months. The GA patients' 5-year survival rate was 62%, while freedom from cerebral events was 94.9%. Analysis regarding GA patients' 5-year survival rate revealed a significantly lower percentage among the patients with a severe risk score compared with those with a moderate risk score (respectively, 29.5% vs 67.7%; p = .005). The multivariate analysis showed that chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD) were independently associated with lower survival. CONCLUSIONS The 30-day outcomes of CEA in octogenarians are comparable to those in younger patients. Comprehensive life expectancy and preoperative score, rather than age alone, should be taken into account before performing CEA on octogenarian patients, considering the short- and long-term efficacy in stroke prevention.
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Affiliation(s)
- Alessandro Ucci
- Department of Medicine and Surgery, 9370University of Parma, Parma, Italy
| | - Alessandro de Troia
- Department of Medicine and Surgery, 9370University of Parma, Parma, Italy.,Department Cardio Thoracic and Vascular Surgery, Unit of Vascular Surgery, 18630University Hospital of Parma
| | | | - Giuseppe Pedrazzi
- Department of Medicine and Surgery, 9370University of Parma, Parma, Italy
| | - Bilal Nabulsi
- Department Cardio Thoracic and Vascular Surgery, Unit of Vascular Surgery, 18630University Hospital of Parma
| | - Matteo Azzarone
- Department of Medicine and Surgery, 9370University of Parma, Parma, Italy.,Department Cardio Thoracic and Vascular Surgery, Unit of Vascular Surgery, 18630University Hospital of Parma
| | - Paolo Perini
- Department Cardio Thoracic and Vascular Surgery, Unit of Vascular Surgery, 18630University Hospital of Parma
| | - Claudio Bianchini Massoni
- Department Cardio Thoracic and Vascular Surgery, Unit of Vascular Surgery, 18630University Hospital of Parma
| | - Giulia Rossi
- Department Cardio Thoracic and Vascular Surgery, Unit of Vascular Surgery, 18630University Hospital of Parma
| | - Antonio Freyrie
- Department of Medicine and Surgery, 9370University of Parma, Parma, Italy.,Department Cardio Thoracic and Vascular Surgery, Unit of Vascular Surgery, 18630University Hospital of Parma
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Bevilacqua S, Pratesi C, Ostuni MF, Pecchioni A, Giacomelli E, Cerillo AG, Stefano P. Outcome analysis of synchronous carotid endarterectomy and cardiac surgery. Comparison of two anesthetic techniques after propensity score-matching. THE JOURNAL OF CARDIOVASCULAR SURGERY 2022; 63:445-453. [PMID: 35848868 DOI: 10.23736/s0021-9509.21.12104-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND The aim of this study was to investigate the outcome of patients undergoing synchronous carotid endarterectomy and coronary and/or other cardiac surgery. The impact of anesthesia on the outcome was examined. METHODS A retrospective single-center observational study was performed, to investigate the outcome of 127 consecutive adult patients submitted to synchronous surgery from 2011 to 2019. Cooperative patient general anesthesia for carotid endarterectomy followed by standard general anesthesia for cardiac surgery and standard general anesthesia for the whole surgery were compared after a propensity score analysis. RESULTS Primary outcomes were 30-day mortality (3.1%), incidence of stroke (3.1%), and myocardial infarction (0.8%). Agitation upon awakening, postoperative cardiac troponin I release, the increase of serum creatinine, the occurrence of acute kidney injury and the need for continuous renal replacement therapy were the secondary outcomes. A binary logistic regression revealed that cardiopulmonary bypass use, standard general anesthesia for the whole surgery and the European risk score II, were the strongest predictors of any severe postoperative complications. After propensity score matching, general anesthesia for the whole surgery was significantly correlated with the occurrence of any severe postoperative complication (P=0.038). CONCLUSIONS Synchronous surgery was performed with acceptable mortality and complication rate even in combination with other than isolated coronary surgery. Cooperative patient general anesthesia during carotid endarterectomy, was not inferior to general anesthesia in this setting.
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Affiliation(s)
- Sergio Bevilacqua
- Department of Anesthesiology and Intensive Care, Careggi University Hospital, Florence, Italy -
| | - Carlo Pratesi
- Department of Cardiothoracic and Vascular Surgery, Careggi University Hospital, Florence, Italy
| | - Michele F Ostuni
- Department of Anesthesiology and Intensive Care, Careggi University Hospital, Florence, Italy
| | - Andrea Pecchioni
- Department of Anesthesiology and Intensive Care, Careggi University Hospital, Florence, Italy
| | - Elena Giacomelli
- Department of Cardiothoracic and Vascular Surgery, Careggi University Hospital, Florence, Italy
| | - Alfredo G Cerillo
- Department of Cardiothoracic and Vascular Surgery, Careggi University Hospital, Florence, Italy
| | - Pierluigi Stefano
- Department of Cardiothoracic and Vascular Surgery, Careggi University Hospital, Florence, Italy
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Lanza G, Orso M, Alba G, Bevilacqua S, Capoccia L, Cappelli A, Carrafiello G, Cernetti C, Diomedi M, Dorigo W, Faggioli G, Giannace V, Giannandrea D, Giannetta M, Lanza J, Lessiani G, Marone EM, Mazzaccaro D, Migliacci R, Nano G, Pagliariccio G, Petruzzellis M, Plutino A, Pomatto S, Pulli R, Reale N, Santalucia P, Sirignano P, Ticozzelli G, Vacirca A, Visco E. Guideline on carotid surgery for stroke prevention: updates from the Italian Society of Vascular and Endovascular Surgery. A trend towards personalized medicine. THE JOURNAL OF CARDIOVASCULAR SURGERY 2022; 63:471-491. [PMID: 35848869 DOI: 10.23736/s0021-9509.22.12368-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND This guideline (GL) on carotid surgery as updating of "Stroke: Italian guidelines for Prevention and Treatment" of the ISO-SPREAD Italian Stroke Organization-Group, has recently been published in the National Guideline System and shared with the Italian Society of Vascular and Endovascular Surgery (SICVE) and other Scientific Societies and Patient's Association. METHODS GRADE-SIGN version, AGREE quality of reporting checklist. Clinical questions formulated according to the PICO model. Recommendations developed based on clinical questions by a multidisciplinary experts' panel and patients' representatives. Systematic reviews performed for each PICO question. Considered judgements filled by assessing the evidence level, direction, and strength of the recommendations. RESULTS The panel provided indications and recommendations for appropriate, comprehensive, and individualized management of patients with carotid stenosis. Diagnostic and therapeutic processes of the best medical therapy, carotid endarterectomy (CEA), carotid stenting (CAS) according to the evidences and the judged opinions were included. Symptomatic carotid stenosis in elective and emergency, asymptomatic carotid stenosis, association with ischemic heart disease, preoperative diagnostics, types of anesthesia, monitoring in case of CEA, CEA techniques, comparison between CEA and CAS, post-surgical carotid restenosis, and medical therapy are the main topics, even with analysis of uncertainty areas for risk-benefit assessments in the individual patient (personalized medicine [PM]). CONCLUSIONS This GL updates on the main recommendations for the most appropriate diagnostic and medical-surgical management of patients with atherosclerotic carotid artery stenosis to prevent ischemic stroke. This GL also provides useful elements for the application of PM in good clinical practice.
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Affiliation(s)
- Gaetano Lanza
- Department of Vascular Surgery, IRCCS MultiMedica, Castellanza Hospital, Castellanza, Varese, Italy
| | - Massimiliano Orso
- Experimental Zooprophylactic Institute of Umbria and Marche, Perugia, Italy
| | - Giuseppe Alba
- Unit of Vascular Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Sergio Bevilacqua
- Department of Cardiac Anesthesia and Resuscitation, Careggi University Hospital, Florence, Italy
| | - Laura Capoccia
- Department of Vascular and Endovascular Surgery, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Alessandro Cappelli
- Unit of Vascular Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Giampaolo Carrafiello
- Department of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Carlo Cernetti
- Department of Cardiology and Hemodynamics, San Giacomo Apostolo Hospital, Castelfranco Veneto, Treviso, Italy
- Cardiology and Hemodynamics Unit, Ca' Foncello Hospital, Treviso, Italy
| | - Marina Diomedi
- Stroke Unit, Tor Vergata Polyclinic Hospital, Tor Vergata University, Rome, Italy
| | - Walter Dorigo
- Department of Vascular Surgery, Careggi Polyclinic Hospital, University of Florence, Florence, Italy
| | - Gianluca Faggioli
- Department of Vascular Surgery, Alma Mater Studiorum University, Bologna, Italy
| | - Vanni Giannace
- Unit of Vascular Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - David Giannandrea
- Department of Neurology, USL Umbria 1, Hospitals of Gubbio, Gualdo Tadino and Città di Castello, Perugia, Italy
| | - Matteo Giannetta
- Department of Vascular Surgery, IRCCS San Donato Hospitals, San Donato Polyclinic Hospital, Milan, Italy
| | - Jessica Lanza
- Department of Vascular Surgery, IRCCS San Martino Polyclinic Hospital, University of Genoa, Genoa, Italy -
| | - Gianfranco Lessiani
- Unit of Vascular Medicine and Diagnostics, Department of Internal Medicine, Villa Serena Hospital, Città Sant'Angelo, Pesaro, Italy
| | - Enrico M Marone
- Vascular Surgery, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Daniela Mazzaccaro
- Department of Vascular Surgery, IRCCS San Donato Hospitals, San Donato Polyclinic Hospital, Milan, Italy
| | - Rino Migliacci
- Department of Internal Medicine, Valdichiana S. Margherita Hospital, USL Toscana Sud-Est, Cortona, Arezzo, Italy
| | - Giovanni Nano
- Department of Vascular Surgery, IRCCS San Donato Hospitals, San Donato Polyclinic Hospital, Milan, Italy
| | - Gabriele Pagliariccio
- Department of Emergency Vascular Surgery, Ospedali Riuniti University of Ancona, Ancona, Italy
| | | | - Andrea Plutino
- Stroke Unit, Ospedali Riuniti Marche Nord, Ancona, Italy
| | - Sara Pomatto
- Department of Vascular Surgery, Sant'Orsola Malpighi Polyclinic Hospital, University of Bologna, Bologna, Italy
| | - Raffaele Pulli
- Department of Vascular Surgery, University of Bari, Bari, Italy
| | | | | | - Pasqualino Sirignano
- Department of Vascular and Endovascular Surgery, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Giulia Ticozzelli
- First Department of Anesthesia and Resuscitation, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Andrea Vacirca
- Unit of Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), IRCSS Sant'Orsola Polyclinic Hospital, University of Bologna, Bologna, Italy
| | - Emanuele Visco
- Department of Cardiology and Hemodynamics, San Giacomo Apostolo Hospital, Castelfranco Veneto, Treviso, Italy
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Bevilacqua S, Ticozzelli G, Orso M, Alba G, Capoccia L, Cappelli A, Cernetti C, Diomedi M, Dorigo W, Faggioli G, Giannace G, Giannandrea D, Giannetta M, Lessiani G, Marone EM, Mazzaccaro D, Migliacci R, Nano G, Pagliariccio G, Petruzzellis M, Plutino A, Pomatto S, Pulli R, Sirignano P, Vacirca A, Visco E, Moghadam SP, Lanza G, Lanza J. Anesthetic management of carotid endarterectomy: an update from Italian guidelines. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE (ONLINE) 2022; 2:24. [PMID: 37386522 PMCID: PMC10245611 DOI: 10.1186/s44158-022-00052-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/12/2022] [Indexed: 07/01/2023]
Abstract
BACKGROUND AND AIMS In order to systematically review the latest evidence on anesthesia, intraoperative neurologic monitoring, postoperative heparin reversal, and postoperative blood pressure management for carotid endarterectomy. The present review is based on a single chapter of the Italian Health Institute Guidelines for diagnosis and treatment of extracranial carotid stenosis and stroke prevention. METHODS AND RESULTS A systematic article review focused on the previously cited topics published between January 2016 and October 2020 has been performed; we looked for both primary and secondary studies in the extensive archive of Medline/PubMed and Cochrane library databases. We selected 14 systematic reviews and meta-analyses, 13 randomized controlled trials, 8 observational studies, and 1 narrative review. Based on this analysis, syntheses of the available evidence were shared and recommendations were indicated complying with the GRADE-SIGN version methodology. CONCLUSIONS From this up-to-date analysis, it has emerged that any type of anesthesia and neurological monitoring method is related to a better outcome after carotid endarterectomy. In addition, insufficient evidence was found to justify reversal or no-reversal of heparin at the end of surgery. Furthermore, despite a low evidence level, a suggestion for blood pressure monitoring in the postoperative period was formulated.
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Affiliation(s)
- Sergio Bevilacqua
- Department of Anesthesia, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | - Giulia Ticozzelli
- Anesthesiology and Intensive Care Unit, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy.
| | - Massimiliano Orso
- Società Italiana di Chirurgia Vascolare ed Endovascolare (SICVE), Roma, Italy
| | - Giuseppe Alba
- Department of Vascular Surgery, University of Siena, Siena, Italy
| | - Laura Capoccia
- Vascular and Endovascular Surgery Division, Policlinico Umberto I La Sapienza University of Rome, Rome, Italy
| | - Alessandro Cappelli
- Vascular Surgery Unit, Policlinico Le Scotte Hospital University of Siena, Siena, Italy
| | - Carlo Cernetti
- Division of Cardiology and and Interventional Hemodynamics, Ca' Foncello Hospital, Azienda USLL2 Marca Trevigiana, Treviso, Italy
| | - Marina Diomedi
- Stroke Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
| | - Walter Dorigo
- Vascular Surgery Unit, University of Florence, Florence, Italy
| | - Gianluca Faggioli
- Vascular Surgery Unit, Policlinico Sant'Orsola, Alma Mater Studiorum University, Bologna, Italy
| | - Giovanni Giannace
- Vascular Surgery Unit, Arcispedale Snata Maria Nuova, Reggio Emilia, Italy
| | - David Giannandrea
- Stroke Unit, Neurology Department, USL Umbria 1, Cittá di Castello, Perugia, Italy
| | - Matteo Giannetta
- Vascular Surgery Unit, IRCCS Policlinico San Donato Hospital University, San Donato Milanese, Italy
| | | | - Enrico Maria Marone
- Vascular Surgery Unit, Department of Policlinico Monaza, Monza, Italy
- Pavia University, Pavia, Italy
| | - Daniela Mazzaccaro
- Vascular Surgery Unit, IRCCS Policlinico San Donato Hospital University, San Donato Milanese, Italy
| | - Rino Migliacci
- Angiology and Internal Medicine, Valdichiana S.Margherita Hospital, Cortona, Italy
| | - Giovanni Nano
- Vascular Surgery Unit, IRCCS Policlinico San Donato Hospital University, San Donato Milanese, Italy
| | | | | | | | - Sara Pomatto
- Vascular Surgery Unit, Policlinico Sant'Orsola, Alma Mater Studiorum University, Bologna, Italy
| | - Raffaele Pulli
- Vascular Surgery Unit, Policlinico Careggi Hospital University, Florence, Italy
| | - Pasqualino Sirignano
- Vascular and Endovascular Surgery Division, Sant'andrea Hospital , "La sapienza" University of Rome, Rome, Italy
| | - Andrea Vacirca
- Vascular Surgery Unit, Policlinico San'Orsola-Alma Mater Studiorum University, Bologna, Italy
| | - Emanuele Visco
- Division of Cardiology and Interventional Hemodynamic, San Giacomo Apostolo Hospital, Azienda ULSS2 Marca Trevigiana, Castelfranco Veneto, Italy
| | | | - Gaetano Lanza
- Vascular Surgery Department, Multimedica Hospital-IRCCS, Castellanza, Italy
| | - Jessica Lanza
- Vascular Surgery Department, IRCSS Ospedale Policlinico, San Martino Genova, Italy
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Ucci A, D'Ospina RM, Perini P, Bianchini Massoni C, De Troia A, Azzarone M, Bridelli F, Bellini V, Bignami E, Freyrie A. Twelve years of experience in carotid endarterectomy with general anesthesia and preserved consciousness. INT ANGIOL 2021; 39:477-484. [PMID: 33440925 DOI: 10.23736/s0392-9590.20.04427-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Carotid endarterectomy (CEA) can be performed both under general anesthesia (GA) or local anesthesia (LA) with good results. General anesthesia with preserved consciousness (GAPC) using remifentanil infusion has been already reported in literature and could potentially merge the advantages of GA and LA overcoming the disadvantages of this last technique. Although the good results of GAPC reported in literature, this technique is not widespread in clinical practice. The aim of this study was to report the perioperative results of CEA under GAPC in a large series of consecutive patients. METHODS This is a retrospective, single center, observational study including all patients treated for CEA under GAPC in our institution between January 2008 and October 2019. Primary endpoints were neurological complications rate, mortality rate in the perioperative period, need to GAPC conversion to GA during surgery and evaluation of the technique with a specific questionnaire regarding patients' satisfaction. Secondary endpoints were myocardial infarction (MI) rate, other perioperative complications rate, rate of intraoperative shunting and need of reintervention in the perioperative period. RESULTS In the considered period 1290 CEA under GAPC were performed and included in this study. Neurological complications rate was 2.01%, mortality rate in the perioperative period was 0.07%, need of GAPC conversion to GA rate during surgery was 0.46% and patients satisfaction regarding the technique were high with a mean vote of 9.1 in a 0 to 10 scale. In the perioperative period MI rate was 0.23%, other perioperative complications rate was 1.39%, intraoperative shunting rate was 7.1% and reintervention rate after surgery was 2.4%. CONCLUSIONS CEA under GAPC may combine the advantages of LA and GA, with a very low rate of conversion to GA during surgery and good patients' satisfaction. Moreover, it does not increase neurological, cardiologic and systemic complications. For these reasons CEA under GAPC could represents a valid alternative to GA or LA.
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Affiliation(s)
- Alessandro Ucci
- Section of Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy -
| | - Rita M D'Ospina
- Section of Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Paolo Perini
- Section of Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Alessandro De Troia
- Section of Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Matteo Azzarone
- Section of Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | | | - Elena Bignami
- ICU Department, Parma University Hospital, Parma, Italy
| | - Antonio Freyrie
- Section of Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy
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Bevilacqua S, Bottari V, Galeotti I. Systematic Application of Rapid Sequence Intubation With Remifentanil During COVID-19 Pandemic. Semin Cardiothorac Vasc Anesth 2020; 25:74-75. [PMID: 32664787 DOI: 10.1177/1089253220941369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In this letter, the authors wonder about the need to apply some of the precautions that have been repeatedly suggested during the recent COVID-19 (coronavirus disease 19) pandemic not only to suspected or documented cases of infection but also to all the new cases entering the hospital. In this regard, orotracheal intubation has been universally recognized as a maneuver with a high risk of viral transmission. On the other hand, rapid sequence induction, which represents the gold standard for limiting the risk of transmission for health care professionals, implies side effects that can be potentially harmful for patients with impaired hemodynamics. In this regard, the authors report a particular type of rapid induction that they are performing in a systematic way during the recent pandemic in cardiac surgery patients. This is performed after the patient reaches a deep analgesic plan, thanks to the unique characteristics of the opioid remifentanil. This type of induction, already tested in vasculopathic patients who underwent carotid surgery, is characterized by great hemodynamic stability and is very advantageous, in the writer's experience, when rapid sequence induction has to be systematically applied to cardiovascular patients, especially if you only want to protect operators.
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Intraoperative Neurological Monitoring With Evoked Potentials During Carotid Endarterectomy Versus Cooperative Patients Under General Anesthesia Technique: A Retrospective Study. J Neurosurg Anesthesiol 2018; 30:258-264. [DOI: 10.1097/ana.0000000000000430] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ucci A, D'Ospina RM, Fanelli M, Rossi G, Persi F, Bridelli F, Tosi M, Bianchini Massoni C, Perini P, Nabulsi B, De Troia A, Tecchio T, Azzarone M, Freyrie A. One-year experience in carotid endarterectomy combining general anaesthesia with preserved consciousness and sequential carotid cross-clamping. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:61-66. [PMID: 29633744 PMCID: PMC6357616 DOI: 10.23750/abm.v89i1.6814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 10/21/2017] [Indexed: 11/23/2022]
Abstract
Background and aim of the work: We report 1-year single-centre experience in carotid endarterectomy (CEA) combining general anaesthesia with preserved consciousness (GAPC) and standardized carotid sequential cross-clamping, for our protocol effectiveness evaluation in reduction of perioperative stroke, death or cardiologic complications. Methods: We considered all patients who underwent CEA in 2016. All patients underwent superficial cervical plexus block and GAPC with Remifentanil. The surgical technique consisted of common carotid artery (CCA) cross-clamping, carotid bifurcation isolation, external (ECA) and internal carotid artery (ICA) cross-clamping. After CCA cross-clamping, we performed a neurological tolerance test (NTT); this allowed selective shunting only for positive NTT. Primary end-points were: transient ischemic attack (TIA)/stroke, myocardial infarction, death in perioperative period. Secondary end-points were: carotid shunting, peripheral cranial nerves injuries (PCNI), GAPC intolerance, other complications, reintervention in perioperative period, length of hospital stay. Results: 104 consecutive patients underwent CEA with this protocol in the considered period. Twenty-seven (25.9%) patients were symptomatic. Mean clamping time was 48±13.5 minutes. Five cases (4.8%) requested internal carotid artery shunting. No TIA/stroke, myocardial infarction or death were recorded in the perioperative period. PCNI were observed in 19 cases (18.2%) in the immediate post-operative period; 16 of them (84.2%) showed complete or partial resolution at discharge. Only one patient (0.9%) showed GAPC intolerance. No other complication occurred. Three patients (2.9%) underwent reintervention for neck haematoma drainage. Mean hospital stay were 3±0.9 days. Conclusions: GAPC associated with sequential carotid cross-clamping appeared to be safe and effective in prevention of major neurological and cardiologic complications during CEA. (www.actabiomedica.it)
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Affiliation(s)
- Alessandro Ucci
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy.
| | - Rita Maria D'Ospina
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy.
| | - Mara Fanelli
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy.
| | - Giulia Rossi
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy.
| | - Federica Persi
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy.
| | - Franca Bridelli
- Anaesthesiology, Intensive Care and Pain Therapy, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy.
| | - Michela Tosi
- Anaesthesiology, Intensive Care and Pain Therapy, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy.
| | - Claudio Bianchini Massoni
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy.
| | - Paolo Perini
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy.
| | - Bilal Nabulsi
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy.
| | - Alessandro De Troia
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy.
| | - Tiziano Tecchio
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy.
| | - Matteo Azzarone
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy.
| | - Antonio Freyrie
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy.
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Rich K, Treat-Jacobson D, DeVeaux T, Fitzgerald K, Kirk L, Thomson L, Foley A, Hill D. Society for Vascular Nursing-Carotid endarterectomy (CEA) updated nursing clinical practice guideline. JOURNAL OF VASCULAR NURSING 2017; 35:90-111. [PMID: 28527733 DOI: 10.1016/j.jvn.2017.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 03/24/2017] [Indexed: 01/22/2023]
Affiliation(s)
| | | | | | | | - Laura Kirk
- University of Minnesota School of Nursing, Minneapolis, Minnesota
| | - Lily Thomson
- Section of Vascular Surgery, Health Sciences Centre, Vascular Research Lab, Winnipeg, Manitoba, Canada
| | - Anne Foley
- Department of Vascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Debbie Hill
- Vascular Health Partners, Community Care Physicians, Albany, New York
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Alilet A, Petit P, Devaux B, Joly C, Samain E, Pili-Floury S, Besch G. Ultrasound-guided intermediate cervical block versus superficial cervical block for carotid artery endarterectomy: The randomized-controlled CERVECHO trial. Anaesth Crit Care Pain Med 2017; 36:91-95. [DOI: 10.1016/j.accpm.2016.03.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 03/04/2016] [Accepted: 03/10/2016] [Indexed: 11/30/2022]
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Yoo Y, Park C, Shin S, Park Y, Lee S, Min K. A comparison of sedation protocols for gastric endoscopic submucosal dissection: moderate sedation with analgesic supplementation vs analgesia targeted light sedation. Br J Anaesth 2015; 115:84-88. [DOI: 10.1093/bja/aeu555] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Ciccozzi A, Angeletti C, Guetti C, Pergolizzi J, Angeletti PM, Mariani R, Marinangeli F. Regional anaesthesia techniques for carotid surgery: the state of art. J Ultrasound 2014; 17:175-83. [PMID: 25177390 DOI: 10.1007/s40477-014-0094-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 04/07/2014] [Indexed: 10/25/2022] Open
Abstract
PURPOSE This review will analyse some aspects of regional anaesthesia (RA) for carotid endarterectomy (CEA), a surgical procedure which requires a strict monitoring of patient's status. RA remains an important tool for the anaesthesiologist. Some debates remain about type and definition of regional anaesthesia, efficacy and safety of the different cervical block techniques, the right dose, concentration and volume of local anaesthetic, the use of adjuvants, the new perspectives: ultrasonography, the future directions. METHODS A literature search was performed for journal articles in English language in the PubMed Embase and in The Cochrane Library database, from January 2000 to December 2013. The electronic search strategy contained the following medical subject headings and free text terms: local anaesthesia versus general anaesthesia for endarterectomy, superficial and deep cervical block, complications of cervical nerve block, ultrasound guidance of superficial and deep cervical plexus block. CONCLUSIONS The gold standard for RA will be achieved after overcoming a number of limitations by a more extensive use of ultrasonography, by combining general and regional anaesthesia, including conscious anaesthesia, by defining the appropriate volume, concentration and dosage of local agents and by addition of adjuvants.
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Affiliation(s)
- Alessandra Ciccozzi
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Via Vetoio 2, 67010 Coppito, L'Aquila, Italy
| | - Chiara Angeletti
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Via Vetoio 2, 67010 Coppito, L'Aquila, Italy
| | - Cristiana Guetti
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Via Vetoio 2, 67010 Coppito, L'Aquila, Italy
| | - Joseph Pergolizzi
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA ; Department of Anesthesiology, Georgetown University School of Medicine, Washington D.C, USA ; Department of Pharmacology, Temple University School of Medicine, Philadelphia, PA USA ; Association of Chronic Pain Patients, Houston, TX USA
| | - Paolo Matteo Angeletti
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Via Vetoio 2, 67010 Coppito, L'Aquila, Italy
| | - Roberta Mariani
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Via Vetoio 2, 67010 Coppito, L'Aquila, Italy
| | - Franco Marinangeli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Via Vetoio 2, 67010 Coppito, L'Aquila, Italy
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Unic-Stojanovic D, Babic S, Neskovic V. General Versus Regional Anesthesia for Carotid Endarterectomy. J Cardiothorac Vasc Anesth 2013; 27:1379-83. [DOI: 10.1053/j.jvca.2012.09.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Indexed: 11/11/2022]
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Abstract
Abstract
Patient satisfaction is an important measure of the quality of health care and is used as an outcome measure in interventional and quality improvement studies. Previous studies have found that there are few appropriately developed and validated questionnaires available. The authors conducted a systematic review to identify all tools used to measure patient satisfaction with anesthesia, which have undergone a psychometric development and validation process, appraised the quality of these processes, and made recommendations of tools that may be suitable for use in different clinical and academic settings. There are a number of robustly developed and subsequently validated instruments, however, there are still many studies using nonvalidated instruments or poorly developed tools, claiming to accurately assess satisfaction with anesthesia. This can lead to biased and inaccurate results. Researchers in this field should be encouraged to use available validated tools, to ensure that patient satisfaction is measured and reported fairly and accurately.
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Comparison of Open and Endovascular Treatments of Post-carotid Endarterectomy Restenosis. Eur J Vasc Endovasc Surg 2013; 45:437-42. [DOI: 10.1016/j.ejvs.2013.01.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 01/18/2013] [Indexed: 11/20/2022]
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Pulli R, Dorigo W, Alessi Innocenti A, Pratesi G, Fargion A, Pratesi C. A 20-year Experience with Surgical Management of True and False Internal Carotid Artery Aneurysms. Eur J Vasc Endovasc Surg 2013; 45:1-6. [DOI: 10.1016/j.ejvs.2012.10.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 10/15/2012] [Indexed: 10/27/2022]
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Tawfic QA, Ismaili MA, Ahmed MA. Prevention of Intra-operative Cerebral Ischemia during Carotid Endarterectomy, Loco-regional versus General Anesthesia. Oman Med J 2012; 27:254-5. [PMID: 22811781 DOI: 10.5001/omj.2012.59] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Accepted: 03/03/2012] [Indexed: 11/03/2022] Open
Abstract
Carotid endarterectomy (CEA), as a prophylactic operation is becoming more popular. It is performed in patients who are at risk of stroke from dislodged atheromatous plaque at the carotid bifurcation. The major concern during CEA is the detection of cerebral hypoperfusion or ischemia during carotid cross clamping. Some studies have shown that the introduction of loco-regional anesthesia has lowered the incidence of major complications compared with general anesthesia since ischemia detection is easier in conscious patient.
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Affiliation(s)
- Qutaiba A Tawfic
- Address correspondence and reprints request to: Qutaiba A. Tawfic, Registrar, Department of Anesthesiology, Sultan Qaboos University Hospital, Sultanate of Oman. E-mail:
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Dorigo W, Pulli R, Nesi M, Alessi Innocenti A, Pratesi G, Inzitari D, Pratesi C. Urgent Carotid Endarterectomy in Patients with Recent/Crescendo Transient Ischaemic Attacks or Acute Stroke. Eur J Vasc Endovasc Surg 2011; 41:351-7. [PMID: 21196126 DOI: 10.1016/j.ejvs.2010.11.026] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Accepted: 11/25/2010] [Indexed: 11/18/2022]
Affiliation(s)
- W Dorigo
- Department of Vascular Surgery, University of Florence, Florence, Italy.
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Early and long-term results of carotid endarterectomy in diabetic patients. J Vasc Surg 2011; 53:44-52. [DOI: 10.1016/j.jvs.2010.08.030] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Revised: 08/10/2010] [Accepted: 08/12/2010] [Indexed: 11/19/2022]
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Yepes Temiño MJ, Lillo Cuevas M. [Anesthesia for carotid endarterectomy: a review]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2011; 58:34-41. [PMID: 21348215 DOI: 10.1016/s0034-9356(11)70695-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Cardiovascular diseases are associated with high rates of morbidity and mortality. Carotid artery stenosis causes between 20% and 25% of ischemic strokes, especially when an embolism is the underlying cause. Carotid endarterectomy is the treatment of choice when stenosis exceeds 60%. It is important to have an understanding of how to manage perioperative factors that can decrease the risk of stroke, infarction, and death. In contrast to the findings of earlier meta-analyses, the recent GALA trial of general versus local anesthesia concluded that the rates of stroke, myocardial infarction, and mortality during or soon after surgery are similar for both types of anesthesia.
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Affiliation(s)
- M J Yepes Temiño
- Departamento de Anestesiología y Reanimación de la Clínica Universidad de Navarra, Clínica Universidad de Navarra, Pamplona.
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Bevilacqua S, Romagnoli S, Ciappi F, Lazzeri C, Pratesi C. Asleep-awake-asleep technique during carotid endarterectomy. J Cardiothorac Vasc Anesth 2010; 25:580-1. [PMID: 20728376 DOI: 10.1053/j.jvca.2010.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Indexed: 11/11/2022]
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Vetrugno L, Di Luca E, Drigo D, Fregonese V, Gonano N, Giordano F. Wake-up test decrease shunts insertion during carotid endarterectomy under general anesthesia. Vasc Endovascular Surg 2010; 44:174-8. [PMID: 20150229 DOI: 10.1177/1538574409359428] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The use of locoregional anesthesia versus general anesthesia (GE) in carotid endarterectomy (CEA) has been a debatable issue in clinical studies for the past several years. In our study, GE with wake-up tests (WUTs) during carotid cross-clamping was used instead of stump pressure (SP) to directly assess the neurological status of the patient to determine whether shunting was needed. Our study assessed the percentage of patients under light sedation and mechanically ventilated needing shunting based on WUT compared to a systolic stump pressure (SPs) cutoff value of <or=40 mm Hg. DESIGN Retrospective, observational study. SETTING University hospital clinic. PARTICIPANTS Three hundred fifty-one patients (American Society of Anesthesiologists physical class II-III) with carotid artery stenosis scheduled for CEA under GE. INTERVENTIONS The WUT was used to assess the neurological status in patients undergoing CEA, which involved the gradual reduction of depth of anesthesia until the patient was capable of responding to a verbal stimulus and provide full collaboration while only receiving remifentanil. A positive WUT indicated that patient was not able to carry out the order. MEASUREMENTS AND MAIN RESULTS Of 343 patients, 20 (5.8%) were shunted due to a positive WUT after cross-clamping in comparison to 45 patients (12.8%) based on the SPs <or=40 mm Hg criteria. CONCLUSION Wake-up test can be used to directly assess the neurological status in patients undergoing CEA to determine whether shunting is required. Our results showed that less patients required shunting based on WUT compared to the SP criteria.
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Affiliation(s)
- Luigi Vetrugno
- Cardiothoracic and Vascular Anesthesia, University-Hospital of Udine, Udine, Italy.
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Troisi N, Dorigo W, Pulli R, Pratesi C. A case of traumatic internal carotid artery aneurysm secondary to carotid shunting. J Vasc Surg 2009; 51:225-7. [PMID: 19879715 DOI: 10.1016/j.jvs.2009.08.057] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Revised: 08/14/2009] [Accepted: 08/15/2009] [Indexed: 11/28/2022]
Abstract
The use of a carotid shunt is a well-accepted method for the prevention of cerebral ischemia during carotid surgery. Although carotid surgeons are familiar with the risks associated with shunt use, few reports have been published detailing the nature, incidence, or severity of shunt-related complications. We report on a patient with dilatation of the distal cervical internal carotid artery at the site of Pruitt-Inahara (LeMaitre Vascular, Inc. Burlington, Mass) shunt balloon inflation. To our knowledge, this complication of shunting during carotid endarterectomy has not been previously described.
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Affiliation(s)
- Nicola Troisi
- Department of Vascular Surgery, University of Florence, Florence, Italy.
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