The endarterectomy-produced common carotid artery step: A harbinger of early emboli and late restenosis
Purpose: This study analyzes the role of the carotid endarterectomy (CEA)-produced common carotid step or shelf on early and late CEA outcome. A simple method of reconstruction that covers the exposed media and intima of the step and smooths out the flow channel is presented. Methods: Since 1984 int...
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| Veröffentlicht in: | Journal of vascular surgery 1996-05, Vol.23 (5), p.932-939 |
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| description | Purpose: This study analyzes the role of the carotid endarterectomy (CEA)-produced common carotid step or shelf on early and late CEA outcome. A simple method of reconstruction that covers the exposed media and intima of the step and smooths out the flow channel is presented.
Methods: Since 1984 intraoperative geometric measurements were made on 1019 CEA. Duplex scans were made after surgery on 968 (95%); 234 (23%) were monitored for at least 5 years. Of the first 920 CEA, 261 (28%) had a step ≥2 mm. Of the last 99 operations, the 27 (27%) with a step ≥2 mm had inversion plication reconstruction of the step.
Results: Three patients had early post-CEA neurologic events attributed to a common carotid step, two had transient ischemic attacks, and one had a mild stroke. All three had a CEA-produced step ≥2 mm (1.2% of 261,
p = 0.03 when compared with no unexplained early neurologic events in the 659 without a step). Duplex scans were normal in all three except for a common carotid artery step. Six patients had seven reoperations for common carotid artery restenosis at 23 to 104 months (mean 73 months) after CEA. All had a step ≥2 mm at the origin CEA (2.7% of 261,
p = 0.001 when compared with no reoperations for common carotid artery stenosis in the 659 CEA without a step). All but one patient had >75% restenosis. Four were asymptomatic. All seven with restenosis were within 2 mm of the original common carotid end point step. Four restenoses were concentric, two eccentric, and one ulcerated. Six of the seven arteries were originally reconstructed with a greater saphenous vein patch that extended 3 to 6 mm proximal to the step. Early postoperative duplex scans of the 27 recent CEA with step reconstruction demonstrated a tortuous but smooth common carotid artery flow channel.
Conclusion : The CEA-produced common carotid artery step is a potential source of both early postoperative emboli and late restenosis. The incidence is approximately 4% in patients with a CEA step
≥
2 mm. CEA vein patch reconstruction does not prevent restenosis in the region of the step but may lower the incidence. Although not proven, reconstruction techniques directed at covering the exposed step media and intima and smoothing the flow channel may favorably alter outcome. (J Vasc Surg 1996;23:932-9.) |
| doi_str_mv | 10.1016/S0741-5214(96)70260-4 |
| format | Article |
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Methods: Since 1984 intraoperative geometric measurements were made on 1019 CEA. Duplex scans were made after surgery on 968 (95%); 234 (23%) were monitored for at least 5 years. Of the first 920 CEA, 261 (28%) had a step ≥2 mm. Of the last 99 operations, the 27 (27%) with a step ≥2 mm had inversion plication reconstruction of the step.
Results: Three patients had early post-CEA neurologic events attributed to a common carotid step, two had transient ischemic attacks, and one had a mild stroke. All three had a CEA-produced step ≥2 mm (1.2% of 261,
p = 0.03 when compared with no unexplained early neurologic events in the 659 without a step). Duplex scans were normal in all three except for a common carotid artery step. Six patients had seven reoperations for common carotid artery restenosis at 23 to 104 months (mean 73 months) after CEA. All had a step ≥2 mm at the origin CEA (2.7% of 261,
p = 0.001 when compared with no reoperations for common carotid artery stenosis in the 659 CEA without a step). All but one patient had >75% restenosis. Four were asymptomatic. All seven with restenosis were within 2 mm of the original common carotid end point step. Four restenoses were concentric, two eccentric, and one ulcerated. Six of the seven arteries were originally reconstructed with a greater saphenous vein patch that extended 3 to 6 mm proximal to the step. Early postoperative duplex scans of the 27 recent CEA with step reconstruction demonstrated a tortuous but smooth common carotid artery flow channel.
Conclusion : The CEA-produced common carotid artery step is a potential source of both early postoperative emboli and late restenosis. The incidence is approximately 4% in patients with a CEA step
≥
2 mm. CEA vein patch reconstruction does not prevent restenosis in the region of the step but may lower the incidence. Although not proven, reconstruction techniques directed at covering the exposed step media and intima and smoothing the flow channel may favorably alter outcome. (J Vasc Surg 1996;23:932-9.)</description><identifier>ISSN: 0741-5214</identifier><identifier>EISSN: 1097-6809</identifier><identifier>DOI: 10.1016/S0741-5214(96)70260-4</identifier><identifier>PMID: 8667519</identifier><identifier>CODEN: JVSUES</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Biological and medical sciences ; Blood and lymphatic vessels ; Cardiology. Vascular system ; Carotid Artery, Common - diagnostic imaging ; Carotid Artery, Common - surgery ; Carotid Stenosis - diagnostic imaging ; Carotid Stenosis - epidemiology ; Carotid Stenosis - etiology ; Carotid Stenosis - surgery ; Cerebrovascular Disorders - epidemiology ; Cerebrovascular Disorders - etiology ; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous ; Endarterectomy, Carotid - adverse effects ; Endarterectomy, Carotid - methods ; Follow-Up Studies ; Humans ; Incidence ; Intracranial Embolism and Thrombosis - epidemiology ; Intracranial Embolism and Thrombosis - etiology ; Medical sciences ; Postoperative Complications - epidemiology ; Recurrence ; Reoperation ; Time Factors ; Treatment Outcome ; Ultrasonography</subject><ispartof>Journal of vascular surgery, 1996-05, Vol.23 (5), p.932-939</ispartof><rights>1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter</rights><rights>1996 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c436t-9596f9dcbf81321e943135944b2b7fd9a565eaeaf9224b10d7705dd80a7d691b3</citedby><cites>FETCH-LOGICAL-c436t-9596f9dcbf81321e943135944b2b7fd9a565eaeaf9224b10d7705dd80a7d691b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/S0741-5214(96)70260-4$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>309,310,314,780,784,789,790,3550,23930,23931,25140,27924,27925,45995</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=3106051$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/8667519$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Archie, Joseph P.</creatorcontrib><title>The endarterectomy-produced common carotid artery step: A harbinger of early emboli and late restenosis</title><title>Journal of vascular surgery</title><addtitle>J Vasc Surg</addtitle><description>Purpose: This study analyzes the role of the carotid endarterectomy (CEA)-produced common carotid step or shelf on early and late CEA outcome. A simple method of reconstruction that covers the exposed media and intima of the step and smooths out the flow channel is presented.
Methods: Since 1984 intraoperative geometric measurements were made on 1019 CEA. Duplex scans were made after surgery on 968 (95%); 234 (23%) were monitored for at least 5 years. Of the first 920 CEA, 261 (28%) had a step ≥2 mm. Of the last 99 operations, the 27 (27%) with a step ≥2 mm had inversion plication reconstruction of the step.
Results: Three patients had early post-CEA neurologic events attributed to a common carotid step, two had transient ischemic attacks, and one had a mild stroke. All three had a CEA-produced step ≥2 mm (1.2% of 261,
p = 0.03 when compared with no unexplained early neurologic events in the 659 without a step). Duplex scans were normal in all three except for a common carotid artery step. Six patients had seven reoperations for common carotid artery restenosis at 23 to 104 months (mean 73 months) after CEA. All had a step ≥2 mm at the origin CEA (2.7% of 261,
p = 0.001 when compared with no reoperations for common carotid artery stenosis in the 659 CEA without a step). All but one patient had >75% restenosis. Four were asymptomatic. All seven with restenosis were within 2 mm of the original common carotid end point step. Four restenoses were concentric, two eccentric, and one ulcerated. Six of the seven arteries were originally reconstructed with a greater saphenous vein patch that extended 3 to 6 mm proximal to the step. Early postoperative duplex scans of the 27 recent CEA with step reconstruction demonstrated a tortuous but smooth common carotid artery flow channel.
Conclusion : The CEA-produced common carotid artery step is a potential source of both early postoperative emboli and late restenosis. The incidence is approximately 4% in patients with a CEA step
≥
2 mm. CEA vein patch reconstruction does not prevent restenosis in the region of the step but may lower the incidence. Although not proven, reconstruction techniques directed at covering the exposed step media and intima and smoothing the flow channel may favorably alter outcome. (J Vasc Surg 1996;23:932-9.)</description><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Cardiology. Vascular system</subject><subject>Carotid Artery, Common - diagnostic imaging</subject><subject>Carotid Artery, Common - surgery</subject><subject>Carotid Stenosis - diagnostic imaging</subject><subject>Carotid Stenosis - epidemiology</subject><subject>Carotid Stenosis - etiology</subject><subject>Carotid Stenosis - surgery</subject><subject>Cerebrovascular Disorders - epidemiology</subject><subject>Cerebrovascular Disorders - etiology</subject><subject>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</subject><subject>Endarterectomy, Carotid - adverse effects</subject><subject>Endarterectomy, Carotid - methods</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Incidence</subject><subject>Intracranial Embolism and Thrombosis - epidemiology</subject><subject>Intracranial Embolism and Thrombosis - etiology</subject><subject>Medical sciences</subject><subject>Postoperative Complications - epidemiology</subject><subject>Recurrence</subject><subject>Reoperation</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Ultrasonography</subject><issn>0741-5214</issn><issn>1097-6809</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1996</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkUtP3DAQgK2qFV2gPwHJh6oqhxRP4kfcC0KIl4TEAXq2HHsCrpJ4a2eR9t_X-9BeOc1hvnl9Q8gZsF_AQF48M8WhEjXwn1qeK1ZLVvFPZAFMq0q2TH8miwPylRzn_JcxANGqI3LUSqkE6AV5fXlDipO3acaEbo7julqm6FcOPXVxHONEnU1xDp5umTXNMy5_0yv6ZlMXpldMNPYUbRrWFMcuDoHaydPBzkgTFniKOeRT8qW3Q8Zv-3hC_tzevFzfV49Pdw_XV4-V442cKy207LV3Xd9CUwNq3kAjNOdd3aneayukQIu213XNO2BeKSa8b5lVXmromhPyY9e3HPFvVcabMWSHw2AnjKtsVMt4scILKHagSzHnhL1ZpjDatDbAzEaw2Qo2G3tGS7MVbDZ1Z_sBq25Ef6jaGy357_u8zc4OfbKTC_mANcAkE1Cwyx2GRcZ7wGSyCzgV62HzBuNj-GCR_9TTmDA</recordid><startdate>19960501</startdate><enddate>19960501</enddate><creator>Archie, Joseph P.</creator><general>Mosby, Inc</general><general>Elsevier</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>19960501</creationdate><title>The endarterectomy-produced common carotid artery step: A harbinger of early emboli and late restenosis</title><author>Archie, Joseph P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c436t-9596f9dcbf81321e943135944b2b7fd9a565eaeaf9224b10d7705dd80a7d691b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1996</creationdate><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Cardiology. Vascular system</topic><topic>Carotid Artery, Common - diagnostic imaging</topic><topic>Carotid Artery, Common - surgery</topic><topic>Carotid Stenosis - diagnostic imaging</topic><topic>Carotid Stenosis - epidemiology</topic><topic>Carotid Stenosis - etiology</topic><topic>Carotid Stenosis - surgery</topic><topic>Cerebrovascular Disorders - epidemiology</topic><topic>Cerebrovascular Disorders - etiology</topic><topic>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</topic><topic>Endarterectomy, Carotid - adverse effects</topic><topic>Endarterectomy, Carotid - methods</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Incidence</topic><topic>Intracranial Embolism and Thrombosis - epidemiology</topic><topic>Intracranial Embolism and Thrombosis - etiology</topic><topic>Medical sciences</topic><topic>Postoperative Complications - epidemiology</topic><topic>Recurrence</topic><topic>Reoperation</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Ultrasonography</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Archie, Joseph P.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of vascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Archie, Joseph P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The endarterectomy-produced common carotid artery step: A harbinger of early emboli and late restenosis</atitle><jtitle>Journal of vascular surgery</jtitle><addtitle>J Vasc Surg</addtitle><date>1996-05-01</date><risdate>1996</risdate><volume>23</volume><issue>5</issue><spage>932</spage><epage>939</epage><pages>932-939</pages><issn>0741-5214</issn><eissn>1097-6809</eissn><coden>JVSUES</coden><abstract>Purpose: This study analyzes the role of the carotid endarterectomy (CEA)-produced common carotid step or shelf on early and late CEA outcome. A simple method of reconstruction that covers the exposed media and intima of the step and smooths out the flow channel is presented.
Methods: Since 1984 intraoperative geometric measurements were made on 1019 CEA. Duplex scans were made after surgery on 968 (95%); 234 (23%) were monitored for at least 5 years. Of the first 920 CEA, 261 (28%) had a step ≥2 mm. Of the last 99 operations, the 27 (27%) with a step ≥2 mm had inversion plication reconstruction of the step.
Results: Three patients had early post-CEA neurologic events attributed to a common carotid step, two had transient ischemic attacks, and one had a mild stroke. All three had a CEA-produced step ≥2 mm (1.2% of 261,
p = 0.03 when compared with no unexplained early neurologic events in the 659 without a step). Duplex scans were normal in all three except for a common carotid artery step. Six patients had seven reoperations for common carotid artery restenosis at 23 to 104 months (mean 73 months) after CEA. All had a step ≥2 mm at the origin CEA (2.7% of 261,
p = 0.001 when compared with no reoperations for common carotid artery stenosis in the 659 CEA without a step). All but one patient had >75% restenosis. Four were asymptomatic. All seven with restenosis were within 2 mm of the original common carotid end point step. Four restenoses were concentric, two eccentric, and one ulcerated. Six of the seven arteries were originally reconstructed with a greater saphenous vein patch that extended 3 to 6 mm proximal to the step. Early postoperative duplex scans of the 27 recent CEA with step reconstruction demonstrated a tortuous but smooth common carotid artery flow channel.
Conclusion : The CEA-produced common carotid artery step is a potential source of both early postoperative emboli and late restenosis. The incidence is approximately 4% in patients with a CEA step
≥
2 mm. CEA vein patch reconstruction does not prevent restenosis in the region of the step but may lower the incidence. Although not proven, reconstruction techniques directed at covering the exposed step media and intima and smoothing the flow channel may favorably alter outcome. (J Vasc Surg 1996;23:932-9.)</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>8667519</pmid><doi>10.1016/S0741-5214(96)70260-4</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Biological and medical sciences Blood and lymphatic vessels Cardiology. Vascular system Carotid Artery, Common - diagnostic imaging Carotid Artery, Common - surgery Carotid Stenosis - diagnostic imaging Carotid Stenosis - epidemiology Carotid Stenosis - etiology Carotid Stenosis - surgery Cerebrovascular Disorders - epidemiology Cerebrovascular Disorders - etiology Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous Endarterectomy, Carotid - adverse effects Endarterectomy, Carotid - methods Follow-Up Studies Humans Incidence Intracranial Embolism and Thrombosis - epidemiology Intracranial Embolism and Thrombosis - etiology Medical sciences Postoperative Complications - epidemiology Recurrence Reoperation Time Factors Treatment Outcome Ultrasonography |
| title | The endarterectomy-produced common carotid artery step: A harbinger of early emboli and late restenosis |
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