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Perioperative Challenges During Carotid Artery Revascularization

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Essentials of Neurosurgical Anesthesia & Critical Care

Abstract

Carotid stenosis is an important cause of ischemic stroke. About 10–15% of patients with carotid territory strokes and transient ischemic attacks (TIA) have a carotid stenosis >50%. On best medical treatment, these patients have a high risk of further, potentially disabling, cerebral ischemic events of up to 10% in the first week, and 15% in the first month after the initial event. Urgent treatment of the carotid stenosis to prevent recurrent strokes is therefore mandatory.

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Suggested Further Reading

  • Adams HP, Adams RJ, Brott T, del Zoppo GJ, Furlan A, Goldstein LB, et al. Guidelines for the early management of patients with ischemic stroke. A scientific statement from the Stroke Council of the American Stroke Association. Stroke. 2003;34:1056–83.

    Article  PubMed  Google Scholar 

  • Adams HP, Adams RJ, Del Zoppo GJ, Goldstein LB. Guidelines for the early management of patients with ischemic stroke. 2005 guidelines update. A scientific statement from the Stroke Council of the American Heart Association/American Stroke Association. Stroke. 2005;36:916–23 (The last two papers give a good overview over current recommended management of ischemic stroke).

    Article  PubMed  Google Scholar 

  • Arnold M, Fischer U, Schroth G, Nedeltchev K, Isenegger J, Remonda L, et al. Intra-arterial thrombolysis of acute Iatrogenic intracranial arterial occlusion attributable to neuroendovascular procedures or coronary angiography. Stroke. 2008;39:1491–5 (i.a. thrombolysis after angiography associated stroke may be helpful).

    Article  PubMed  Google Scholar 

  • Chambers BR, Donnan G. Carotid endarterectomy for asymptomatic carotid stenosis. Cochrane Database Syst Rev 2005, 4. Art. No. CD001923. (Cochrane review of carotid endarterectomy in asymptomatic stenosis.)

    Google Scholar 

  • Dangas G. Editorial comment–hypotension after carotid revascularization. Stroke. 2003;34:2581–2 (Editorial to Reference 7).

    Article  PubMed  Google Scholar 

  • Howell SJ. Carotid endarterectomy. Br J Anaesth. 2007;99:119–31 (Review of carotid endarterectomy with a specific view to anesthetic problems).

    Article  PubMed  CAS  Google Scholar 

  • International Carotid Stenting Study investigators. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid STenting Study): an interim analysis of a randomised controlled trial.

    Google Scholar 

  • Mantese VA, Timaran CH, Chiu D, Begg RJ, Brott TG. CREST Investigators. The Carotid Revascularization Endarterectomy versus Stenting Trial (CREST): stenting versus carotid endarterectomy for carotid disease. Stroke. 2010;41(10 Suppl):S31–4.

    Google Scholar 

  • McKevitt FM, Sivaguru A, Venables GS, et al. Effect of treatment of carotid artery stenosis on blood pressure: a comparison of hemodynamic disturbances after carotid endarterectomy and endovascular treatment. Stroke. 2003;34:2576–82 (Trial investigating cardiovascular changes after CEA and CAS. Associated editorial with a good review in Dangas G. See 2 references above).

    Article  PubMed  CAS  Google Scholar 

  • Ricotta JJ, Malgor RD. A review of the trials comparing carotid endarterectomy and carotid angioplasty and stenting. Perspect Vasc Surg Endovasc Ther. 2008;20:299–308 (Review of the currently available trials comparing carotid endarterectomy and stenting).

    Article  PubMed  Google Scholar 

  • Rothwell PM, Eliasziw M, Gutnikov SA, et al. Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet. 2003;361:107–16 (Individual patient data meta-analysis of the carotid endarterectomy trials for symptomatic stenosis).

    Article  PubMed  CAS  Google Scholar 

  • van Mook WNKA, Rennenberg RJMW, Schurink GW, van Oostenbrugge RJ, Mess WH, Hofman PAM, et al. Cerebral hyperperfusion syndrome. Lancet Neurol. 2005;4:877–88. Good review of cerebral hyperperfusion syndrome.

    Article  PubMed  Google Scholar 

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Correspondence to Ursula Schulz MD, D.Phill .

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© 2012 Springer Science+Business Media, LLC

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Schulz, U., Rothwell, P. (2012). Perioperative Challenges During Carotid Artery Revascularization. In: Brambrink, A., Kirsch, J. (eds) Essentials of Neurosurgical Anesthesia & Critical Care. Springer, New York, NY. https://doi.org/10.1007/978-0-387-09562-2_35

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  • DOI: https://doi.org/10.1007/978-0-387-09562-2_35

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-09561-5

  • Online ISBN: 978-0-387-09562-2

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