Restenosis after microsurgical non-patch carotid endarterectomy in 586 patients

BACKGROUND: Carotid endarterectomy (CEA) reduces the risk of stroke in patients with symptomatic (>50%) and asymptomatic (>60%) carotid artery stenosis. Here we report the midterm results of a microsurgical non-patch technique and compare these findings to those in the literature. METHODS: Fro...

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Autores principales: Reinert, Michael, Mono, Marie-Louise, Kuhlen, Dominique, Mariani, Luigi, Barth, Alain, Beck, Jürgen, Andres, Robert H., Gralla, Jan, Wymann, Rolf, Schmidt, Jürgen, Kauert, Christin, Schroth, Gerhard, Arnold, Marcel, Mattle, Heinrich P., Raabe, Andreas, Fischer, Urs
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Vienna 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3284671/
https://www.ncbi.nlm.nih.gov/pubmed/22113556
http://dx.doi.org/10.1007/s00701-011-1233-9
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author Reinert, Michael
Mono, Marie-Louise
Kuhlen, Dominique
Mariani, Luigi
Barth, Alain
Beck, Jürgen
Andres, Robert H.
Gralla, Jan
Wymann, Rolf
Schmidt, Jürgen
Kauert, Christin
Schroth, Gerhard
Arnold, Marcel
Mattle, Heinrich P.
Raabe, Andreas
Fischer, Urs
author_facet Reinert, Michael
Mono, Marie-Louise
Kuhlen, Dominique
Mariani, Luigi
Barth, Alain
Beck, Jürgen
Andres, Robert H.
Gralla, Jan
Wymann, Rolf
Schmidt, Jürgen
Kauert, Christin
Schroth, Gerhard
Arnold, Marcel
Mattle, Heinrich P.
Raabe, Andreas
Fischer, Urs
author_sort Reinert, Michael
collection PubMed
description BACKGROUND: Carotid endarterectomy (CEA) reduces the risk of stroke in patients with symptomatic (>50%) and asymptomatic (>60%) carotid artery stenosis. Here we report the midterm results of a microsurgical non-patch technique and compare these findings to those in the literature. METHODS: From 1998 to 2009 we treated 586 consecutive patients with CEA. CEA was performed, under general anesthesia, with a surgical microscope using a non-patch technique. Somatosensory evoked potential and transcranial Doppler were continuously monitored. Cross-clamping was performed under EEG burst suppression and adaptive blood pressure increase. Follow-up was performed by an independent neurologist. Mortality at 30 days and morbidity such as major and minor stroke, peripheral nerve palsy, hematoma and cardiac complications were recorded. The restenosis rate was assessed using duplex sonography 1 year after surgery. RESULTS: A total of 439 (75%) patients had symptomatic and 147 (25%) asymptomatic stenosis; 49.7% of the stenoses were on the right-side. Major perioperative strokes occurred in five (0.9%) patients [n = 4 (0.9%) symptomatic; n = 1 (0.7%) asymptomatic patients]. Minor stroke was recorded in six (1%) patients [n = 4 (0.9%) symptomatic; n = 2 (1.3%) asymptomatic patients]. Two patients with symptomatic stenoses died within 1 month after surgery. Nine patients (1.5%) had reversible peripheral nerve palsies, and nine patients (1.5%) suffered a perioperative myocardial infarction. High-grade (>70%) restenosis at 1 year was observed in 19 (3.2%) patients [n = 12 (2.7%) symptomatic; n = 7 (4.7%) asymptomatic patients]. CONCLUSIONS: The midterm rate of restenosis was low when using a microscope-assisted non-patch endarterectomy technique. The 30-day morbidity and mortality rate was comparable or lower than those in recently published surgical series.
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spelling pubmed-32846712012-03-08 Restenosis after microsurgical non-patch carotid endarterectomy in 586 patients Reinert, Michael Mono, Marie-Louise Kuhlen, Dominique Mariani, Luigi Barth, Alain Beck, Jürgen Andres, Robert H. Gralla, Jan Wymann, Rolf Schmidt, Jürgen Kauert, Christin Schroth, Gerhard Arnold, Marcel Mattle, Heinrich P. Raabe, Andreas Fischer, Urs Acta Neurochir (Wien) Clinical Article BACKGROUND: Carotid endarterectomy (CEA) reduces the risk of stroke in patients with symptomatic (>50%) and asymptomatic (>60%) carotid artery stenosis. Here we report the midterm results of a microsurgical non-patch technique and compare these findings to those in the literature. METHODS: From 1998 to 2009 we treated 586 consecutive patients with CEA. CEA was performed, under general anesthesia, with a surgical microscope using a non-patch technique. Somatosensory evoked potential and transcranial Doppler were continuously monitored. Cross-clamping was performed under EEG burst suppression and adaptive blood pressure increase. Follow-up was performed by an independent neurologist. Mortality at 30 days and morbidity such as major and minor stroke, peripheral nerve palsy, hematoma and cardiac complications were recorded. The restenosis rate was assessed using duplex sonography 1 year after surgery. RESULTS: A total of 439 (75%) patients had symptomatic and 147 (25%) asymptomatic stenosis; 49.7% of the stenoses were on the right-side. Major perioperative strokes occurred in five (0.9%) patients [n = 4 (0.9%) symptomatic; n = 1 (0.7%) asymptomatic patients]. Minor stroke was recorded in six (1%) patients [n = 4 (0.9%) symptomatic; n = 2 (1.3%) asymptomatic patients]. Two patients with symptomatic stenoses died within 1 month after surgery. Nine patients (1.5%) had reversible peripheral nerve palsies, and nine patients (1.5%) suffered a perioperative myocardial infarction. High-grade (>70%) restenosis at 1 year was observed in 19 (3.2%) patients [n = 12 (2.7%) symptomatic; n = 7 (4.7%) asymptomatic patients]. CONCLUSIONS: The midterm rate of restenosis was low when using a microscope-assisted non-patch endarterectomy technique. The 30-day morbidity and mortality rate was comparable or lower than those in recently published surgical series. Springer Vienna 2011-11-24 2012 /pmc/articles/PMC3284671/ /pubmed/22113556 http://dx.doi.org/10.1007/s00701-011-1233-9 Text en © The Author(s) 2011 https://creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.
spellingShingle Clinical Article
Reinert, Michael
Mono, Marie-Louise
Kuhlen, Dominique
Mariani, Luigi
Barth, Alain
Beck, Jürgen
Andres, Robert H.
Gralla, Jan
Wymann, Rolf
Schmidt, Jürgen
Kauert, Christin
Schroth, Gerhard
Arnold, Marcel
Mattle, Heinrich P.
Raabe, Andreas
Fischer, Urs
Restenosis after microsurgical non-patch carotid endarterectomy in 586 patients
title Restenosis after microsurgical non-patch carotid endarterectomy in 586 patients
title_full Restenosis after microsurgical non-patch carotid endarterectomy in 586 patients
title_fullStr Restenosis after microsurgical non-patch carotid endarterectomy in 586 patients
title_full_unstemmed Restenosis after microsurgical non-patch carotid endarterectomy in 586 patients
title_short Restenosis after microsurgical non-patch carotid endarterectomy in 586 patients
title_sort restenosis after microsurgical non-patch carotid endarterectomy in 586 patients
topic Clinical Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3284671/
https://www.ncbi.nlm.nih.gov/pubmed/22113556
http://dx.doi.org/10.1007/s00701-011-1233-9
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