ISSN:0039-2499    

出版商:OVID    

年代:1984

数据来源: OVID

ISSN:0039-2499    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Data from the National Hospital Discharge Survey, the Veterans Administration Hospitals and Armed Forces Hospitals were reviewed to estimate the number of endarterectomies of extracranial vessels of head and neck performed in the United States. The number increased from around 15,000 in 1971 to around 85,000 in 1982. An estimated 2.8% of those operated in non-federal hospitals were discharged dead. Stroke Vol 15, No 6, 1984

ISSN:0039-2499    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

All carotid endarterectomies performed in the greater Cincinnati metropolitan area during 1980 were reviewed. For the 431 procedures performed in 16 hospitals, the operative stroke rate was 8.6% (37 of 431), and the operative mortality rate was 2.8% (12 of 431). The combined morbidity and mortality was 9.5% (41 of 431). Fifty percent of the procedures were done for asymptomatic carotid disease (216 of 431) and 50% were done for symptomatic carotid disease (215 of 431). The stroke rate was 5.6% for the asymptomatic patients and 11.6% for the symptomatic patients (difference significant,P< 0.05). Neuro- surgeons and vascular surgeons had similar surgical morbidity. All of the operative strokes involved the hemisphere ipsilateral to the endarterectomy. Fifty-seven percent of the operative strokes (21 of 37) occurred after a neurologicalty intact interval lasting hours to days. Four occurred following combined endarterectomy-coronary bypass surgery, and one was an intracerebral hemorrhage. The other late strokes (17) occurred without evidence for cardiac embolus or hemorrhage, consistent with a thrombogenic- embologenic operative site, and raising the question of need for adjunctive perioperative medical therapy. Stroke Vol 15, No 6, 1984

ISSN:0039-2499    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Carotid endarterectomy was performed 743 times during 56 months in a community hospi- tal by 24 surgeons. The mortality rate was 2.7% and permanent stroke occurred in 1.8%. Temporary postoperative neurologic deficit occurred in 3.5%. The frequency with which the surgeon performed the procedure did not appear significant in the incidence of postoperative morbidity and mortality. Stroke Vol 15, No 6, 1984

ISSN:0039-2499    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Between 1980 and 1982, 227 consecutive patients with transient ischemic attack (TIA) or ischemic brain infarction (IBI) were evaluated as possible candidates for carotid surgery in the Department of Neurology, University of Helsinki. One hundred and ten patients (mean age 58, range 41-72 years) were selected for surgery; 82 of them had had TIA and 28 IBI as the presenting symptom. After a total of 128 operations (84 unilateral and 18 bilateral endarterectomies, and 8 arterial reconstructions), 16 patients (14.5%) developed neurological deficits. In 7 patients (6.4%), the deficit was severe and 4 of them (3.6%) died within the first four days after surgery. Ten patients had occlusion of the contralateral internal carotid artery and/or severe hypertension. Five of them suffered ischemic brain infarction after the operation and two died. Operation on an occluded internal carotid artery in 7 patients was complicated by hernlparesls in two patients, one of whom died. Patients with surgical complications more often had severe hypertension (P< .001), total occlusion of the contralateral internal carotid artery, (n.s.) and severe angiographic changes (n.s.) compared with patients without complications. During the follow-up the annual rate for IBI was 3.3% and for acute myocardial infarction (AMI) 4.4%. Vascular death occurred with a frequency of 1.7% per year. The results emphasize that patients with TIA or IBI should be carefully evaluated before recommending surgical treatment for prevention of threatened stroke. Patients with severe risk factors may fare better on medical treatment than with surgical intervention. Stroke Vol, 15, No 6, 1984

ISSN:0039-2499    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Asymptomatic cervical bruits with their implication of underlying carotid artery disease, carry an established but low risk of stroke. In spite of the rising numbers of patients subjected to carotid endarterectomy for this condition, there is little evidence that the benefits outweigh the risks. Outcome data from community studies and the current prospective Toronto study of patients with asymptomatic neck bruits indicate that the annual stroke rate is 1-2%, and the annual cardiac death rate is 2-4%. Published data of the results of carotid surgery suggest that surgical risks outweigh any possible benefits, unless a subgroup with spontaneous stroke risk of at least 5% can be identified. Stroke Vol 15, No 6, 1984

ISSN:0039-2499    

出版商:OVID    

年代:1984

数据来源: OVID

ISSN:0039-2499    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

A prospective study was undertaken in March 1980, at the Vascular Surgery Department of the Padua University, Medical School, to establish whether patch graft angioplasty is useful in preventing restenosls after carotid endarterectomy (CE). Seventy-four patients underwent 86 CE (bilateral in 12 cases) for atherosclerotic disease involving the carotid bifurcation. Thirty-eight (51.4%) patients presented TIA's or non hemispheric symptoms of cerebrovascular insufficiency; 30 (40.5%) were asymptomatic and 6 (8.1 %) had partial nonprogressing or fixed strokes. All operations were performed under general anesthe- sia, with pharmacologic hypertension and systemic heparinization; in all cases, continuous EEG monitor- ing and 'stump pressure' measurement were employed. The operation was performed without a temporary intraluminal shunt in the patients showing tolerance to carotid clamping. The protection of the shunt was required only in patients with EEG monitoring changes (17). All carotid arteriotomies were extended into the internal carotid artery to overpass the end of the endarterectomy. Overpass was also used in the proximal edge of the arterlotomy, in the common carotid artery. The distal intima was never fixed with stitches and the arteriotomy was routinely closed with a PTFE patch graft angioplasty. Early results of cerebral protection were excellent. No patient presented permanent or transient postoperative neurological problems and no patient died in the postoperative period for causes related to the operation. This is substantiated by results we achieved during the period 1970–1979 in 192 patients, when all carotid endar- terectomies were routinely performed without a shunt, with figures of 2.5% of postoperative stroke and 1.5% of mortality. Longterm follow-up (from 6 to 36 months) was completed in 51 patients (60 operations). All patients were clinically evaluated and tested for patency of the endarterectomized vessel and the contralateral carotid artery by means of c.w. Dopplersonography and, occasionally, by Duplex scanning. Patency of the endarter- ectomized carotid artery with absence of hemodynamically significant lesions was well detected in all cases. There were 4 late deaths unrelated to cerebrovascular insufficiency. Two patients showed a neurologic deficit. They were investigated with carotidography: both presented intracranial lesions. The absence of carotid restenosis, documented with noninvasive cerebrovascular testing, confirms that the closure with patching effectively delays and prevents this complication by means of a mechanism related to the compen- sation of the volumetrical increase either of the new atherosclerotic plaque or neointimal hyperplasia. The authors believe that-direct closure of the vessel is the primary cause of recurrent stenosis and therefore recommend routine patch graft angioplasty after carotid endarterectomy. Stroke Vol 15, No 6, 1984

ISSN:0039-2499    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Rapid hemodilution in the early phase of ischemic stroke by the combination of venesection (250-650 ml during the first 2 days) and administration of low-molecular weight dextran was evaluated in a prospective controlled trial. Fifty-two patients were randomized to hemodilution therapy and 50 to a control group; the two groups were comparable in important prognostic variables. Mean hemoglobin was reduced from 147 to 127 g/1, hematocrit from 43 to 37% and, in a subsample of patients, whole-blood viscosity at a shear rate of 23 sec'1from 7.0 to 4.3 cps over the first 2 days. Hemodilution was then maintained by repeated dextran infusions. Of the hemodiluted patients, 85% improved in neurological scoring over the first 10 days as compared to 64% of the control patients (P< 0.025). The case fatality rate during the first 3 months was little affected by hemodilution. Among the survivors, 8% of the hemodiluted and 31% of the non-hemodiluted patients were unable to walk at 3 months. The proportion of surviving patients still hospitalized at the 3-month follow-up was 13% in the hemodilution group and 39% in the control group (P< 0.01). The combination of venesection and dextran 40 administration is thus an unsophisticated but effective way to achieve rapid hemodilution in patients with acute cerebral infarction, and it improves the overall clinical outcome over the first 3 months. Stroke Vol 15, No 6, 1984

ISSN:0039-2499    

出版商:OVID    

年代:1984

数据来源: OVID