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Objective: Carotid angioplasty and stenting (CAS) has challenged carotid endarterectomy (CEA) as the therapy of choice for carotid disease. This meta-analysis aims at summarizing the most current body of evidence. Methods: All prospective, controlled clinical trials comparing CEA versus CAS were included. The outcome measures of interest were relative risk (RR) of 30-day stroke, 30-day stroke/death, long-term risk of stroke, and risk of restenosis. Results: The RR of 30-day stroke for CAS was 1.6 times that of CEA (RR 1.6; 95%CI 1.2-2.0, P = .001). The 30-day RR of stroke/death was 1.5 times higher for CAS (RR 1.5; 95%CI 1.1-2.1, P = .008). There was a higher risk of long-term stroke (RR 1.2; 95%CI 1.0-1.5, P = .043). The risk of restenosis was twice for CAS (RR 1.8; 95%CI 1.1-3.1, P = .04). Conclusion: The 30-day RR of stroke, stroke/death, long-term risk of stroke, and risk of restenosis are consistently higher for carotid artery stenting (CAS). [ABSTRACT FROM PUBLISHER]

Background: It remains controversial whether patients with concomitant carotid and coronary disease should undergo operative repair separately or in combination. Methods: Patients with documented cerebrovascular disease undergoing coronary artery bypass grafting (CABG) alone were matched by propensity scoring with patients undergoing combined carotid endarterectomy (CEA)/CABG procedures and compared for the occurrence of stroke, myocardial infarction (MI), and mortality. Results: Of the 4943 patients undergoing CABG, 908 had known cerebrovascular disease. Among these, 134 underwent concomitant CEA, and these were propensity matched with 134 patients undergoing CABG only. No differences were observed in the perioperative risks of stroke (4% vs 3%, odds ratio [OR] 1.5, 95% confidence interval [CI] 0.4-5.5), MI (0.7% vs 0.7%, not significant [NS]), or combined cardiovascular events (6% vs 10%, OR 0.5, 95% CI [0.2-1.3]), although mortality (1% vs 8%, OR 0.2, 95% CI [0.04-0.8] was higher with CABG only. Discussion: Addition of CEA to CABG did not significantly alter the risk of perioperative stroke relative to propensity-matched patients undergoing CABG alone. [ABSTRACT FROM PUBLISHER]

Introduction: Ambiguity in the literature concerning potential benefits of carotid artery stenting (CAS) as an alternative to carotid endarterectomy (CEA) necessitated a 5-year Delphi-type survey, gauging the changing views over this period of relevant experts undertaking carotid intervention. Methods: Delphi surveys performed in 2004 and 2009 involved 2 rounds of questions combined with feedback of results from the first round between them. The questionnaire was e-mailed to UK vascular surgeons, neurosurgeons, interventional radiologists, and cardiologists. Results: In 2004 and 2009, the second round response rates were 69% and 51%, respectively. Over 5 years, there was a statistically significant reduction in support for ‘‘general anesthesia risk’’ and ‘‘contralateral occlusion’’ as indications for CAS and views that CAS ‘‘increased patient satisfaction’’ and ‘‘decreased the length of hospital stay.’’ Concerning the impact of recent trials on the professionals’ treatment routines for symptomatic and asymptomatic patients with carotid disease, 65.8% and 76.3%, respectively, had not changed their overwhelming non-CAS routines, with 32.9% and 19.7% saying clinical trial results moved them toward CEA. Conclusions: A 2009 survey of vascular experts found no increase in preference for CAS as a treatment option for advanced carotid bifurcation atherosclerosis. This, in combination with the lack of change from and indeed move toward the ‘‘gold-standard’’ CEA, demonstrates a general decline in confidence with CAS. [ABSTRACT FROM PUBLISHER]

Purpose: The aim of the study was to compare the outcome after carotid endarterectomy (CEA) in patients with and without diabetes mellitus. Methods: We prospectively recorded the data from patients who underwent CEA. A patient was considered diabetic when he reported the use of antidiabetic medication. De novo diagnosis of diabetes was defined as the first demonstration of a fasting glucose serum concentration >126 mg/dL or >200 mg/dL after glucose load. An early adverse outcome was defined as the occurrence of ipsilateral minor or major stroke and/or death during the 30-day postoperative period. Results: The stroke and death rate was significantly higher in diabetic patients (n = 380) compared to the controls (n = 971; 4.5% versus 1.5%, P = .002). Multivariate analysis showed a significant association between the presence of diabetes and 30-day stroke and death rate (OR 2.94, CI 1.46-5.97, P = .003). Conclusions: Diabetic patients are at greater risk for perioperative stroke and death. [ABSTRACT FROM PUBLISHER]

Background: Increased carotid restenosis due to revascularization therapy is associated with insulin resistance. We hypothesize that glucose control using acarbose may attenuate intimal hyperplasia in rat carotid endarterectomy model of diet-induced insulin resistance. Methods: Rats were fed low-fat complex carbohydrate (control) or high-fat sucrose (insulin resistance) for 4 months. Three days preoperatively, some high-fat-sucrose rats were on acarbose, remainder of the rats received placebo. Rat carotids were assessed with duplex pre-and postoperatively. Acarbose and placebo continued for 2 weeks. Glucose, insulin, blood flow velocities and intimal hyperplasia were determined. Results: High-fat sucrose plus acarbose attenuated intimal hyperplasia. Postdrug high-fat sucrose glucose decreased. Blood flow velocities postoperatively elevated above baseline. High-fat sucrose increased blood flow velocities postoperatively, which was attenuated with acarbose. Conclusion: Glucose control by acarbose in rat carotid endarterectomy model of diet-induced insulin resistance resulted in attenuation of intimal hyperplasia. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the transition process from conventional carotid endarterectomy (cCEA) to eversion carotid endarterectomy (eCEA). Methods: Patients operated with carotid endarterectomy (CEA; 164 patients, 171 CEA) in 2002-2003 were retrospectively included. Results: In 2002, cCEA was applied in 64 (80%) and eCEA in 16 (20%) patients. There was an inversion on the preponderant surgical technique in 2003 (cCEA in 34 patients [37%] and eCEA in 57 patients [63%]). Perioperative stroke or death occurred in 3 patients (3.8%) in 2002 and 5 (5.5%) in 2003 (P ¼ .78). Perioperative myocardial infarction occurred in 2 patients (2.5%) in 2002 and 2 in 2003 (2.2%, P ¼ 1.00). Median follow-up was 83 (79-86) and 70 (67-74) months for the 2002 and 2003 cohorts, respectively, and there were no differences in survival or ipsilateral stroke between the groups. Conclusions: The transition from cCEA to eCEA is possible without significant changes in morbidity and mortality perioperatively and during follow-up. [ABSTRACT FROM AUTHOR]

Neurological complications and mortality within 30 days following carotid endarterectomy (CEA) alone or with concomitant cardiac surgery/cardiopulmonary bypass (CPB) were assessed in patients with or without contralateral occlusion of the internal carotid artery (CO-ICA). Of 335 patients undergoing CEA, 173 underwent concomitant cardiac surgery with CPB. Group A consisted of 260 patients without CO-ICA and group B of 75 patients with CO-ICA. The neurological complications (peripheral nerve damage, transient ischemic attack [TIA], prolonged reversible ischemic neurological deficit [PRIND], and stroke) and the Rankin index within 24 hours and 30 days postoperatively were compared. Strokes within 24 hours were significantly increased (P = .006) in group B (11%) compared with A (3.1%); TIA and PRIND did not differ (P = .33). The overall neurological complications and in particular for peripheral neurological damage, TIA/PRIND, and stroke did not differ within the 30-day-period postsurgery. A significantly higher stroke rate within 24 hours postsurgery occurred in patients with CO-ICA. [ABSTRACT FROM AUTHOR]