Journal of vascular surgery · 2013
Selective external endarterectomy in patients with ipsilateral symptomatic internal carotid artery occlusion.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Fokkema Margriet, Reichmann Boudewijn L, den Hartog Anne G, Klijn Catharina J, Schermerhorn Marc L, Moll Frans L, de Borst Gert Jan
Аннотация
BACKGROUND: Selective endarterectomy of external carotid artery (ECA) stenosis has been considered a therapeutic option for patients presenting with symptomatic ipsilateral internal carotid artery (ICA) occlusion to correct cerebral hypoperfusion or eliminate a source of emboli. However, data are scarce, and the long-term benefit of ECA revascularization remains unclear. Our objective was to study the operative results and durability of selective ECA endarterectomy in patients presenting with cerebrovascular symptoms in association with nonacute ipsilateral ICA occlusion.
METHODS: This was a retrospective analysis of 27 consecutive patients who underwent selective ECA endarterectomy in a single center between 2000 and 2010. All patients presented with neurologic symptoms (<6 months of surgery, 78% repeat events) referable to an ipsilateral occlusion of the ICA and concomitant stenosis of the ECA. We assessed the perioperative clinical outcome <30 days and at midterm follow-up (mean, 31.6 months). Patency was defined as freedom of duplex ultrasound detected ≥ 50% restenosis.
RESULTS: Endarterectomy of the ECA was successful in 26 patients (96.3%) with one ECA found occluded at surgery. No perioperative deaths occurred. In the 30 days after surgery, one patient developed an ipsilateral disabling ischemic stroke (3.7%), and one patient (3.7%) had a myocardial infarction. At follow-up, nine patients had died: one of a fatal ischemic stroke, six of non-vascular-related causes, and two of unknown causes. At 3 years, 83% (standard error, 8%) of patients were free from stroke or death, and 80% (standard error, 8%) of the operated-on arteries were patent. Five patients developed restenosis ≥ 50% (n = 2, asymptomatic) or occlusion (n = 3, one symptomatic) ≤ 3 months, and two other patients developed late asymptomatic restenosis.
CONCLUSIONS: Selective endarterectomy of the ECA in symptomatic patients with an ipsilateral occlusion of the ICA is a feasible procedure with an acceptable perioperative risk. Most patients remain stroke-free during follow-up and have a low rate of symptomatic restenosis.
METHODS: This was a retrospective analysis of 27 consecutive patients who underwent selective ECA endarterectomy in a single center between 2000 and 2010. All patients presented with neurologic symptoms (<6 months of surgery, 78% repeat events) referable to an ipsilateral occlusion of the ICA and concomitant stenosis of the ECA. We assessed the perioperative clinical outcome <30 days and at midterm follow-up (mean, 31.6 months). Patency was defined as freedom of duplex ultrasound detected ≥ 50% restenosis.
RESULTS: Endarterectomy of the ECA was successful in 26 patients (96.3%) with one ECA found occluded at surgery. No perioperative deaths occurred. In the 30 days after surgery, one patient developed an ipsilateral disabling ischemic stroke (3.7%), and one patient (3.7%) had a myocardial infarction. At follow-up, nine patients had died: one of a fatal ischemic stroke, six of non-vascular-related causes, and two of unknown causes. At 3 years, 83% (standard error, 8%) of patients were free from stroke or death, and 80% (standard error, 8%) of the operated-on arteries were patent. Five patients developed restenosis ≥ 50% (n = 2, asymptomatic) or occlusion (n = 3, one symptomatic) ≤ 3 months, and two other patients developed late asymptomatic restenosis.
CONCLUSIONS: Selective endarterectomy of the ECA in symptomatic patients with an ipsilateral occlusion of the ICA is a feasible procedure with an acceptable perioperative risk. Most patients remain stroke-free during follow-up and have a low rate of symptomatic restenosis.