Deans' stroke musings: Carotid Endarterectomy for the Treatment of Carotid Near-Occlusion With Recurrent Symptoms

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Thursday, April 28, 2022

Carotid Endarterectomy for the Treatment of Carotid Near-Occlusion With Recurrent Symptoms

In my non-medical opinion I would never do a carotid endarterectomy as long as the Circle of Willis is complete, I would close up the artery preventing clots from being thrown. Way too many complications.

Will your doctor guarantee no complications? Ask your doctor these questions since s/he is supposedly medically trained and I'm not.

Cognitive Dysfunction and Mortality After Carotid Endarterectomy

The latest here:

Carotid Endarterectomy for the Treatment of Carotid Near-Occlusion With Recurrent Symptoms

Jianbin Zhang¹^†,

Jie Chen¹^†,

Xiaojie Xu²^†,

Mingsheng Sun³,

Shu Chen⁴,

Peng Liu¹ and

Zhidong Ye¹^*

¹Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
²Department of Endocrinology, Beijing Jishuitan Hospital, The Fourth Clinical Medical College of Peking University, Beijing, China
³Department of Vascular Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
⁴Department of Interventional Radiology, Affiliated People's Hospital of Inner Mongolia Medical University, Hohhot, China

Objective: Report our preliminary experience of carotid endarterectomy (CEA) for the treatment of carotid near-occlusion (CNO) with recurrent symptoms.

Materials and Methods: Retrospectively analyze the demographics, treatment detail, and outcomes data of 122 patients with CNO from 2014 to 2020. According to whether distal full collapse exists, patients were classified into the full collapse group and the non-full collapse group. The incidence of death, myocardial infarction, stroke, and other variables were compared between the two groups.

Results: A total of 122 patients with CNO and recurrent symptoms were enrolled. The demographics were comparable between the two groups. Thirty-day incidence of primary endpoints was 1.85% in the full collapse group and 4.41% in the non-full collapse group. Twelve-month incidence of primary endpoints was 7.41% in the full collapse group and 4.41% in the non-full collapse group. One re-stenosis occurred in the non-full collapse group 8 months after CEA.

Conclusion: For patients with CNO with recurrent symptoms, CEA is not worse than the results described in historical control groups, despite whether distal full collapse exists. The shunt is important to avoid intraoperative hypoperfusion and postoperative hyperperfusion. The long-term results should be further evaluated.

Introduction

Carotid near-occlusion (CNO), first reported by Lippman et al. in 1970 (1), refers to a distal internal carotid artery (ICA) lumen diameter reduced beyond tight stenosis, which was previously described as pseudo-occlusion, subtotal occlusion, string sign, slim sign, functional occlusion, pre-occlusive stenosis, and critical stenosis (2). CNO is a relatively rare condition accounting for about 3% of symptomatic carotid stenosis (3) and associated with an increased risk of ipsilateral hemispheric stroke (4). CNO with or without distal full collapse is distinguished by whether the distal ICA lumen collapsed due to being thread-like. The natural history and stroke risk of CNO are not yet well-known, patients with symptomatic CNO with full collapse may be associated with a very high risk of stroke recurrence (5).

The optimal treatment strategy for CNO is still controversial. According to the 2017 Clinical Practice Guidelines of the European Society for Vascular Surgery (6), carotid endarterectomy (CEA) or carotid stenting (CAS) is not recommended in patients with symptomatic CNO. This is based on the re-analysis of the North American Symptomatic Carotid Endarterectomy Trial (NASCET) and European Carotid Surgery Trial (ECST) data, which showed that CEA is of less value for patients with CNO than for patients with severe stenosis (7, 8). However, a recent multicenter registry study showed that the risk of early recurrent stroke may be higher in medically treated patients with symptomatic CNO (9). Furthermore, more and more studies achieved good results treating CNO with CEA or CAS (10, 11). So seeking safe and effective management for those patients with CNO is urgent and worthwhile.

We have tried to treat patients with symptomatic CNO with CEA since 2014. This study aims to retrospectively report our preliminary experience of CEA for the treatment of CNO with recurrent symptoms. Then further compare the results based on whether distal full collapse exists