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5.
JAMA ; 325(5): 476-481, 2021 02 02.
Artigo em Inglês | MEDLINE | ID: mdl-33528542

RESUMO

Importance: Carotid artery stenosis is atherosclerotic disease that affects extracranial carotid arteries. Asymptomatic carotid artery stenosis refers to stenosis in persons without a history of ischemic stroke, transient ischemic attack, or other neurologic symptoms referable to the carotid arteries. The prevalence of asymptomatic carotid artery stenosis is low in the general population but increases with age. Objective: To determine if its 2014 recommendation should be reaffirmed, the US Preventive Services Task Force (USPSTF) commissioned a reaffirmation evidence review. The reaffirmation update focused on the targeted key questions on the potential benefits and harms of screening and interventions, including revascularization procedures designed to improve carotid artery blood flow, in persons with asymptomatic carotid artery stenosis. Population: This recommendation statement applies to adults without a history of transient ischemic attack, stroke, or other neurologic signs or symptoms referable to the carotid arteries. Evidence Assessment: The USPSTF found no new substantial evidence that could change its recommendation and therefore concludes with moderate certainty that the harms of screening for asymptomatic carotid artery stenosis outweigh the benefits. Recommendation: The USPSTF recommends against screening for asymptomatic carotid artery stenosis in the general adult population. (D recommendation).


Assuntos
Doenças Assintomáticas , Artérias Carótidas/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Programas de Rastreamento , Acidente Vascular Cerebral/prevenção & controle , Adulto , Estenose das Carótidas/tratamento farmacológico , Estenose das Carótidas/cirurgia , Angiografia por Tomografia Computadorizada , Reações Falso-Positivas , Humanos , Angiografia por Ressonância Magnética , Programas de Rastreamento/efeitos adversos , Medição de Risco , Ultrassonografia
6.
J Stroke Cerebrovasc Dis ; 30(3): 105609, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33429238

RESUMO

The case of a 70-year-old male presenting an ischemic stroke related to COVID-19 infection is described. He was initially admitted to the hospital with respiratory insufficiency syndrome secondary to pneumonia caused by SARS Co2. In the next days, he developed rapid neurological deterioration characterized by drowsiness which progressed to deep coma. D-dimer was elevated. Brain CT scan showed bilateral massive ischemic stroke located in the anterior circulation, CT angiogram showed occlusion in the left internal carotid artery and the right middle cerebral artery. The deterioration of the patient continued and he subsequently died. Large vessel occlusion has been reported in COVID-19 patients, but this clinical presentation is usually unilateral. Cases of bilateral occlusion of large vessels have not been previously reported in COVID-19 patients. This report shows that bilateral massive stroke may occur in COVID-19 cases and it should be suspected in patients who show rapid neurological deterioration without focal deficits.


Assuntos
Arteriopatias Oclusivas/etiologia , /etiologia , Idoso , Encéfalo/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/etiologia , Coma/etiologia , Angiografia por Tomografia Computadorizada , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Infarto da Artéria Cerebral Média/etiologia , Masculino , Doenças do Sistema Nervoso/etiologia , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Trombectomia
7.
Vasc Endovascular Surg ; 55(1): 64-68, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32862800

RESUMO

First bite syndrome (FBS) is a sharp unilateral pain in the vicinity of the angle of the mandible after taking the first bite of a meal that presents typically after surgery in the area of the ipsilateral parapharyngeal space. It is not confirmed what the pathophysiology is that causes this pain, but the proposed mechanism is the iatrogenic damage of sympathetic fibers that extend from the superior cervical ganglion (SCG) to innervate the parotid gland. The presentation of this syndrome has been acknowledged in patients who have undergone head and neck tumor resections, but it has not been documented in the same thorough manner among vascular surgery cases in the parapharyngeal space, possibly because of a higher risk of development in other head and neck surgeries, or to under-reporting of cases. To date, only 5 cases of FBS status post carotid endarterectomy have been documented in the literature. Definitive treatment of FBS has not been established. Some studies have shown improvement with amitriptyline, and carbamazepine as well as botulinum toxin injections. We will present the case of a 75 year old male who developed first bite syndrome after a right carotid endarterectomy with efforts of raising awareness of a potential acute complication of carotid endarterectomy.


Assuntos
Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas/efeitos adversos , Dor Facial/etiologia , Mastigação , Glândula Parótida/inervação , Traumatismos dos Nervos Periféricos/etiologia , Gânglio Cervical Superior/lesões , Idoso , Analgésicos/uso terapêutico , Estenose das Carótidas/diagnóstico por imagem , Dor Facial/diagnóstico , Dor Facial/tratamento farmacológico , Dor Facial/fisiopatologia , Humanos , Masculino , Traumatismos dos Nervos Periféricos/diagnóstico , Traumatismos dos Nervos Periféricos/tratamento farmacológico , Traumatismos dos Nervos Periféricos/fisiopatologia , Resultado do Tratamento
9.
J Stroke Cerebrovasc Dis ; 30(2): 105521, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33310073

RESUMO

INTRODUCTION: Guidelines for antiplatelet therapy administration, during emergent stenting for extra-cranial internal carotid artery (EC-ICA) occlusion in the setting of acute ischemic stroke (AIS) are lacking. Different antiplatelet regimen are used in association to endovascular therapy (EVT) for the treatment of EC-ICA lesions. We aimed to compare the clinical and radiological effects of three intravenous antiplatelet agents used during emergent EC-ICA stenting. MATERIAL AND METHODS: Clinical data were collected from January 2015 to December 2019 in a monocentric prospective registry of AIS patients treated by EVT. All patients who underwent emergent EC-ICA stenting were sorted regarding the intravenous antiplatelet agent used during the procedure. RESULTS: Among 218 patients treated by EVT for an EC-ICA occlusion of the anterior circulation during the study period, 70 underwent an emergent stenting of the EC-ICA. 60 were included in the present study, 9 received intravenous (IV) Cangrelor, 8 IV abciximab and 43 Aspirin. The rate of favorable neurological outcome, defined as modified Rankin Scale (mRS) ≤ 2 at three months were better in the Cangrelor and Aspirin groups (66,7% and 58,1%, respectively) than in the Abciximab group (37,5%), as well as, the rate of any intracranial ICH (22,2% and 37,2% vs 62,5%). The rate of acute stent reocclusion was similar between groups. CONCLUSION: When used as a rescue treatment during emergent stenting of EC-ICA, Cangrelor and Aspirin present a better safety profile than Abciximab, with less intracranial hemorrhages and a higher rate of good clinical outcome. Additional studies are needed to confirm these findings.


Assuntos
Artéria Carótida Interna , Estenose das Carótidas/terapia , Procedimentos Endovasculares/instrumentação , Inibidores da Agregação de Plaquetas/administração & dosagem , Stents , Abciximab/administração & dosagem , Monofosfato de Adenosina/administração & dosagem , Monofosfato de Adenosina/análogos & derivados , Administração Intravenosa , Idoso , Aspirina/administração & dosagem , Artéria Carótida Interna/diagnóstico por imagem , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico por imagem , Esquema de Medicação , Emergências , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , /diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/efeitos adversos , Sistema de Registros , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
10.
J Stroke Cerebrovasc Dis ; 30(2): 105531, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33310593

RESUMO

OBJECTIVES: Acute central retinal artery occlusion (CRAO) is an ophthalmologic emergency that often results in permanent vision loss. Over 25% are associated with acute cerebral ischemia. In the absence of existing Level I treatment options, this study aims to examine institutional practice patterns and review the literature to develop a formalized approach to the treatment of CRAO in the era of ischemic stroke protocols. MATERIALS AND METHODS: This is a retrospective review of institutional practices in the workup and treatment of patients diagnosed with acute non-arteritic (NA) CRAO at a single center from January 2017 to August 2020. RESULTS: Of 91 patients managed for acute NA-CRAO, 62.6% were male and average age was 66.4 years. Only 20.9% of patients presented within 4 h of symptom onset. 12.1% of patients had evidence of acute stroke on MRI, and 27.5% had ipsilateral internal carotid artery stenosis >50%. Half (52.7%) did not receive any acute treatment for CRAO, excluding antiplatelet/anticoagulation. 48.5% of patients undergoing acute medical treatment had improved visual acuity compared to 29.4% without treatment (p=0.14). CONCLUSIONS: There is a lack of clear protocol for the management of NA-CRAO. While not reaching statistical significance, our experience mirrors the literature with patients undergoing medical treatment demonstrating improved visual acuity over those without treatment. Given the presence of acute ischemic stroke, carotid disease, and/or stroke risk factors in over 25% of patients with CRAO, multidisciplinary involvement and modern stroke algorithms should be considered for this disease.


Assuntos
Estenose das Carótidas/terapia , Oclusão da Artéria Retiniana/terapia , Visão Ocular , Idoso , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/epidemiologia , Estenose das Carótidas/fisiopatologia , Tomada de Decisão Clínica , Feminino , Humanos , /epidemiologia , Masculino , Recuperação de Função Fisiológica , Oclusão da Artéria Retiniana/diagnóstico por imagem , Oclusão da Artéria Retiniana/epidemiologia , Oclusão da Artéria Retiniana/fisiopatologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Resultado do Tratamento
11.
No Shinkei Geka ; 48(12): 1157-1163, 2020 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-33353878

RESUMO

An 89-year-old man underwent carotid artery stenting for symptomatic left internal carotid artery stenosis. His postoperative course was uneventful;however, on postoperative day 4, he developed a food allergy rash throughout his body after consuming sushi. He developed right hemiplegia and aphasia the following day, and magnetic resonance imaging revealed left internal carotid artery occlusion. Angiography revealed stent thrombosis, and endovascular thrombectomy achieved partial recanalization;however, right hemiplegia and aphasia persisted. Eosinophilia and increased platelet aggregation suggested allergic stent thrombosis(Kounis syndrome type 3).


Assuntos
Estenose das Carótidas , Hipersensibilidade Alimentar , Trombose , Idoso de 80 Anos ou mais , Artéria Carótida Interna , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/cirurgia , Hipersensibilidade Alimentar/complicações , Humanos , Masculino , Stents/efeitos adversos , Trombose/diagnóstico por imagem , Trombose/etiologia
12.
Semin Vasc Surg ; 33(3-4): 36-46, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33308594

RESUMO

Before the development of the first prototype duplex ultrasound scanner at the University of Washington in the late 1970s, the only noninvasive tests available for extracranial carotid artery disease were indirect methods, such as the periorbital Doppler examination and oculoplethysmography. The duplex scanner combined real-time two-dimensional B-mode imaging and pulsed-Doppler flow detection in a single instrument and provided Doppler spectral waveforms from discrete sites within the vessel lumen. Spectral waveforms allowed characterization of the flow patterns and velocity changes associated with normal and diseased arteries. In a series of validation studies, Dr. D. Eugene Strandness, Jr. and colleagues compared various spectral waveform parameters obtained from internal carotid arteries to independently read carotid arteriograms and established quantitative threshold criteria for classification of carotid artery disease. These criteria were based on peak systolic velocity and end-diastolic velocity, as well as features such as spectral broadening and flow separation. Internal carotid arteries were classified as normal, 1% to 15% diameter reduction, 16% to 49% diameter reduction, 50% to 79% diameter reduction, 80% to 99% diameter reduction, and occluded. Since the 1980s, the University of Washington carotid duplex criteria have been widely used and modified in vascular laboratories throughout the world. Additional clinically relevant criteria have also been developed, such as a threshold for the 70% to 99% North American Symptomatic Carotid Endarterectomy Trial (NASCET) stenosis. Validation of carotid criteria has always depended on comparing spectral waveform parameters to the "gold standard" of contrast arteriography. However, experience has shown that the relationship between velocity and arteriographic stenosis is subject to significant variability. Based on these observations, standardization of carotid duplex criteria should lead to more consistent reporting among vascular laboratories, but it is unlikely to result in improved correlation with arteriography.


Assuntos
Artéria Carótida Interna/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Ultrassonografia Doppler Dupla , Velocidade do Fluxo Sanguíneo , Artéria Carótida Interna/fisiopatologia , Estenose das Carótidas/história , Estenose das Carótidas/fisiopatologia , História do Século XX , História do Século XXI , Humanos , Valor Preditivo dos Testes , Prognóstico , Fluxo Sanguíneo Regional , Índice de Gravidade de Doença , Ultrassonografia Doppler Dupla/história
13.
Semin Vasc Surg ; 33(3-4): 47-53, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33308595

RESUMO

Duplex ultrasound testing after open or endovascular extracranial carotid artery interventions is a clinical practice guideline with a strong recommendation from the Society for Vascular Surgery. Neurologic outcomes are improved by the recognition of repair site stenosis or atherosclerotic disease progression in the unoperated carotid artery. The benefit of surveillance outweighs its risk because duplex testing is free of complications and accurate in the detection of internal carotid artery (ICA) stenosis or occlusion. Surveillance for >70% ICA stenosis is recommended within 30 days of the procedure, then every 6 months for 2 years, and annually thereafter. Repair site and contralateral ICA stenosis classification should be based on angle-corrected pulsed Doppler measurements of peak systolic velocity (PSV), end-diastolic velocity (EDV), and the ratio of PSV at the stenosis to a proximal, nondiseased common carotid artery (CCA) segment (ICA/CCA ratio). Interpretation criteria of PSV >300 cm/s, EDV >125 cm/s, and ICA/CCA ratio >4 predicts >70% repair site stenosis. Endovascular intervention is recommended for a carotid repair site stenosis based on the occurrence of an ipsilateral neurologic event and appropriate anatomy for angioplasty. For asymptomatic restenosis, intervention is based on stenosis progression to elevated PSV and EDV >70% stenosis threshold values and the patient is deemed high risk for stroke due to contralateral ICA occlusion or incomplete functional patency of the circle of Willis.


Assuntos
Artéria Carótida Interna/cirurgia , Estenose das Carótidas/terapia , Endarterectomia das Carótidas , Procedimentos Endovasculares/instrumentação , Stents , Ultrassonografia Doppler Dupla , Velocidade do Fluxo Sanguíneo , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/fisiopatologia , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/fisiopatologia , Endarterectomia das Carótidas/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Humanos , Valor Preditivo dos Testes , Recidiva , Fluxo Sanguíneo Regional , Resultado do Tratamento
16.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2088-2091, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018417

RESUMO

A relationship between ultrasound strain indices in carotid plaque to cognitive domains of executive and language function are studied in 42 symptomatic and 34 asymptomatic patients. The mean and standard deviation of the percentage stenosis were 72.10 ± 15.19 and 77.41 ± 11.20 for symptomatic and asymptomatic patients respectively. Pearson's correlation between axial, lateral and shear strain indices versus executive and language composite scores was performed.. A significant inverse correlation for both executive and language function for symptomatic patients to strain indices was found. On the other hand, for asymptomatic patients only executive function was inversely correlated with the corresponding strain indices. Our hypothesis that microemboli from vulnerable plaque and possible 'silent strokes' may be responsible for decline in executive function for both symptomatic and asymptomatic patients'. Strokes and transient ischemic attacks may be responsible for further cognitive decline in language function for symptomatic patients.


Assuntos
Estenose das Carótidas , Disfunção Cognitiva , Placa Aterosclerótica , Estenose das Carótidas/diagnóstico por imagem , Humanos , Placa Amiloide , Placa Aterosclerótica/diagnóstico por imagem , Ultrassonografia
17.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5810-5813, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019295

RESUMO

Asymptomatic carotid stenosis patients manifest compromised cognitive performance compared to controls. Cerebral perfusion deficit could be an important contributor to cognitive impairment. The relationship between carotid stenosis and cerebral perfusion deficit is not established. If established, this could lead to a more informed selection of ACS patients likely to benefit from carotid revascularization. Perfusion-weighted MR imaging (PWI) is a clinically viable non-invasive technique to quantify cerebral perfusion. However, its impact is limited due to lack of efficient clinical tools to analyze PWI data in different brain regions for characterizing interhemispheric perfusion asymmetry. Development of automated approaches to characterize clinically relevant perfusion deficits is therefore required. Moreover, there is no established evidence of association between perfusion deficit and stenosis severity. In this paper, we propose an approach to quantify interhemispheric perfusion differences in different brain regions using clinical data. Our proposed metrics, based on the PWI mean transit time, for characterizing difference between ipsilateral and contralateral hemispheres demonstrate a very strong relationship with Doppler ultrasound based peak systolic velocity measured at stenosis. Our approach also highlights dependence of perfusion asymmetry on effective collateralization through the cerebral vasculature. In future studies, we plan to extend this method to a larger cohort and refine the methods for validating novel biomarker for risk-stratification of carotid stenosis.


Assuntos
Estenose das Carótidas , Estenose das Carótidas/diagnóstico por imagem , Circulação Cerebrovascular , Humanos , Angiografia por Ressonância Magnética , Perfusão , Ultrassonografia
18.
J Med Vasc ; 45(5): 260-267, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32862983

RESUMO

OBJECTIVE: Carotid endarterectomy has traditionally been the strategy for the surgical management of carotid stenosis. Alongside the usual techniques, this study presents another technique: endarterectomy with systematized resection-anastomosis. MATERIAL AND METHODS: A retrospective study from January 2006 to December 2018, included all patients managed for carotid stenosis at Meaux hospital with the "endarterectomy with systematized resection-anastomosis" technique. The perioperative death and stroke rate were evaluated according to the judgment criterion "homolateral ischemic stroke and any stroke or perioperative death". Statistical analysis of the data was performed using SPSS software. RESULTS: For 415 carotids operated, we identified 240 managed with this technique. The average age was 71.7±9.6 years, 70% men and 30% women. The main cardiovascular risk factor was hypertension (76.7%), 24.2% of patients had an ischemic heart disease history, 43.7% homolateral ischemic stroke and 29% transient ischemic attack. Bilateral lesions were diagnosed in 6.2% of patients and 7.5% had contralateral occlusion. Carotid stenosis was symptomatic in 52.9% of patients. The average stenosis rate observed was 82.9±8.1% on computed tomography angiogram and 83.7±7.7% on magnetic resonance angiogram. The shunt was used in 45.4% of procedures. The average length of stay was 5.9±2.3 days. All patients had satisfactory results in terms of patency and anatomical appearance on the 1st check. In the post-operative period during the first month, complications occurred in 12.5% of patients (1.6% acute coronary syndrome, 0.8% neurological event, 0.8% death, 0.4% infection, 12.1% hematoma, 1.6% recovery for bleeding). The overall perioperative death and stroke rate was 2.6%. Myocardial infarction and sepsis were the causes of death for the 2 patients in the peri operative period. The mean duration of follow-up was 21.2 months, without any restenosis or occurrence of neurological complications. One patient died beyond the 1st month of follow-up without established cause, and the overall mortality rate was 1.3%. CONCLUSION: Thromboendarterectomy with "systematized" anastomosis resection represents an angioplasty method for carotid stenosis surgical management under visual control.


Assuntos
Artérias Carótidas/cirurgia , Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica , Isquemia Encefálica/etiologia , Artérias Carótidas/diagnóstico por imagem , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/mortalidade , Endarterectomia das Carótidas/efeitos adversos , Endarterectomia das Carótidas/mortalidade , Feminino , Humanos , Ataque Isquêmico Transitório/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Fatores de Tempo , Resultado do Tratamento
20.
Cochrane Database Syst Rev ; 9: CD001081, 2020 09 12.
Artigo em Inglês | MEDLINE | ID: mdl-32918282

RESUMO

BACKGROUND: Stroke is the third leading cause of death and the most common cause of long-term disability. Severe narrowing (stenosis) of the carotid artery is an important cause of stroke. Surgical treatment (carotid endarterectomy) may reduce the risk of stroke, but carries a risk of operative complications. This is an update of a Cochrane Review, originally published in 1999, and most recently updated in 2017. OBJECTIVES: To determine the balance of benefit versus risk of endarterectomy plus best medical management compared with best medical management alone, in people with a recent symptomatic carotid stenosis (i.e. transient ischaemic attack (TIA) or non-disabling stroke). SEARCH METHODS: We searched the Cochrane Stroke Group Trials Register, CENTRAL, MEDLINE Ovid, Embase Ovid, Web of Science Core Collection, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP) portal to October 2019. We also reviewed the reference lists of all relevant studies and abstract books from research proceedings. SELECTION CRITERIA: We included randomised controlled trials (RCTs) comparing carotid artery surgery plus best medical treatment with best medical treatment alone.  DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies, assessed risk of bias, and extracted the data. We assessed the results and the quality of the evidence of the primary and secondary outcomes by the GRADE method, which classifies the quality of evidence as high, moderate, low, or very low. MAIN RESULTS: We included three trials involving 6343 participants. The trials differed in the methods of measuring carotid stenosis and in the definition of stroke. Using the primary electronic data files, we pooled and analysed individual patient data on 6092 participants (35,000 patient-years of follow-up), after reassessing the carotid angiograms and outcomes from all three trials, and redefining outcome events where necessary, to achieve comparability. Surgery increased the five-year risk of any stroke or operative death in participants with less than 30% stenosis (risk ratio (RR) 1.25, 95% confidence interval (CI) 0.99 to 1.56; 2 studies, 1746 participants; high-quality evidence). Surgery decreased the five-year risk of any stroke or operative death in participants with 30% to 49% stenosis (RR 0.97, 95% CI 0.79 to 1.19; 2 studies, 1429 participants; high-quality evidence), was of benefit in participants with 50% to 69% stenosis (RR 0.77, 95% CI 0.63 to 0.94; 3 studies, 1549 participants; moderate-quality evidence), and was highly beneficial in participants with 70% to 99% stenosis without near-occlusion (RR 0.53, 95% CI 0.42 to 0.67; 3 studies, 1095 participants; moderate-quality evidence). However, surgery decreased the five-year risk of any stroke or operative death in participants with near-occlusions (RR 0.95, 95% CI 0.59 to 1.53; 2 studies, 271 participants; moderate-quality evidence). AUTHORS' CONCLUSIONS: Carotid endarterectomy reduced the risk of recurrent stroke for people with significant stenosis. Endarterectomy might be of some benefit for participants with 50% to 69% symptomatic stenosis (moderate-quality evidence) and highly beneficial for those with 70% to 99% stenosis (moderate-quality evidence).


Assuntos
Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas , Complicações Pós-Operatórias/prevenção & controle , Acidente Vascular Cerebral/prevenção & controle , Adulto , Fatores Etários , Idoso , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/patologia , Endarterectomia das Carótidas/efeitos adversos , Endarterectomia das Carótidas/mortalidade , Endarterectomia das Carótidas/normas , Feminino , Humanos , Ataque Isquêmico Transitório/etiologia , Masculino , Complicações Pós-Operatórias/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Risco , Fatores Sexuais , Acidente Vascular Cerebral/etiologia , Fatores de Tempo
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