Carotid replacement with Dacron graft in 292 patients.

INTRODUCTION: In case of highly atherosclerotic carotid process, carotid graft replacement might be a potential solution for successful procedure. Many studies evaluated the results of vein and polytetrafluorethilen (PTFE) graft usage at the carotid bifurcation, while the experience on the Dacron graft due to extensive atherosclerotic process is missing. The aim of our study was to evaluate 30-day and long-term results of the Dacron graft on carotid artery used in patients with extensive atherosclerotic disease. MATERIAL AND METHODS: This retrospective study analysed early and long-term neurological outcome as well as Dacron graft patency in patients operated with carotid reconstruction. Early results were confirmed by follow-up clinical examination, whereas late results were assessed by follow-up clinical examination as well as duplex sonographic examination at least 1 year after the surgery. As for statistical methods we used descriptive analysis tests, Chi-square test, and logistic regression. RESULTS: Carotid graft replacement was performed in 292 patients, before endarterectomy in 155 (53.09%), or after already attempted unsuccessful eversion endarterectomy in 137 (46.91%). Nineteen (6.5%) patients had a stroke due to ipsilateral and contralateral ischaemia or haemorrhagic in 17 (5.8%), 1 (0.3%) and 1 (0.3%) patients, respectively. Significantly higher rate of strokes occurred when the graft reconstruction was used after the failure of endarterectomy (8.5% vs. 3.5%, p = 0.029). Stroke and death rate was 7.19%. Factors that increased risk of early stroke were the length of plaque in the internal carotid artery measured intraoperatively (p = 0.025) and the surgical tactic to perform graft reconstruction after attempted extensive endarterectomy (p = 0.029). CONCLUSION: Low number of patients with carotid stenosis has extensive atherosclerotic process longer than 4 cm that might jeopardise eversion endarterectomy. Carotid graft replacement with Dacron graft provide early results that are comparable with other conduits; however, in such patients reconstruction should be selected individually based on surgical experience and anatomical distribution of stenotic disease. Due to high risk of stroke, only symptomatic patients with such extensive atherosclerotic disease should be operated.

Female and obese patients might have higher risk from surgical repair of asymptomatic carotid artery stenosis.

BACKGROUND: To investigate the results after carotid endarterectomy performed for asymptomatic carotid stenosis (ACS) in a single high-volume center and define the factors that increase perioperative stroke and mortality rate. METHODS: This observational study that analyzes prospectively collected data includes 1,567 patients with ACS operated in the period between 2007 and 2012. RESULTS: Most patients were male, 1,037 (66.18%), with mean age of 63.6 years. Perioperative death rate was 0.38%. The most frequent causes of death were stroke and myocardial infarction. The total perioperative stroke/transient ischemic attack rate was 2.81%. Logistic regression analysis confirmed that females (P = 0.028) and obese (P = 0.060) patients have higher risk of perioperative stroke after surgical repair of ACS with odds ratio (OR) of 2.008 and 2.342. The early mortality was significantly higher in candidates for coroanary artery bypass grafting (P = 0.018). Stroke and mortality are related to obesity and ischemic heart disease with OR of 2.407 and 2.097, respectively. CONCLUSIONS: According to our results, female and obese patients are prone to stroke after carotid endarterectomy. Further study of the effects of female gender and obesity on surgical outcomes is warranted before medical therapy is considered the preferred treatment for these patients.

Treatment strategies for carotid artery aneurysms.

BACKGROUND: The aim of this paper was to present single centre experience in the treatment of extra cranial carotid artery aneurysms (ECCA) and to analyze results discussing different treatment modalities. METHODS: The study analyzed 60 patients with 62 ECCA treated surgically at the Clinic for vascular and endovascular surgery, Serbian Clinical Center (Belgrade) in the period between 1985 and 2013. Treatment strategy was individually selected and demographic, morphologic, intraoperative and postoperative data were collected. RESULTS: Thirty-day operative mortality was 3.3% and completely stroke related. Besides two fatal strokes one additional was registered making total number of 3 (4.8%) postoperative strokes. Only one (1.6%) early graft thrombosis has been found. The 30-day-patency rate was 98.4%. During the same period seven local complications were found: three (4.8%) hemorrhage and four (6.4%) cranial nerves injuries. In all cases of hemorrhage successful re-intervention was performed without any consequences. Cranial nerves injuries included transient contusions of hypoglossal (2) and superior laryngeal nerve (2). CONCLUSIONS: The etiology, location, and morphology of an ECCA are determining selection of appropriate therapy. Large or tortuous aneurysms, as well as aneurysms involving common carotid or proximal internal carotid artery, are also absolutely indicated to open surgical therapy. Aneurysms which involve the distal internal carotid artery and false anastomotic aneurysms are best managed with endovascular techniques. The ligature is indicated for the treatment of external carotid aneurysms, mycotic aneurysms with local infection and in ruptured ECCA with uncontrolled bleeding.

Simultaneous Endovascular Treatment of Tandem Internal Carotid Lesions: Case Report and Review of Literature.

The incidence of concomitant extracranial carotid artery stenosis and ipsilateral intracranial carotid aneurysm has been reported to vary between 2.8% and 5%. These complex lesions may present a challenge for treatment decision-making. This case report describes an asymptomatic male patient with severe carotid bifurcation stenosis, coupled with an unruptured supraclinoid internal carotid aneurysm. Both lesions were treated simultaneously. Patient underwent carotid stenting followed by aneurysm coiling in the same setting without any complication.