Abstract:
OBJECTIVE:Contralateral stroke is an infrequent cause of perioperative stroke after carotid endarterectomy (CEA). Whereas the risks of ipsilateral stroke complicating CEA have been discriminated, factors that lead to contralateral stroke are poorly defined. The purpose of this study was to identify the risk of perioperative (30-day) contralateral stroke after CEA as well as predisposing preoperative and operative factors. Its specific effect on long-term survival was interrogated. METHODS:The Vascular Study Group of New England (VSGNE) was queried from April 1, 2003, to February 29, 2016, for all CEAs. Duplicated patients and those without complete data were excluded. Patients sustaining contralateral stroke after CEA in the 30-day postoperative period were identified. Demographic, preoperative, and operative factors were analyzed to identify discriminators between those with and those without contralateral stroke. Logistic regression modeling was performed to identify factors independently associated with contralateral stroke. The effect of contralateral stroke on 5-year survival was compared with patients with ipsilateral stroke and no stroke using the Kaplan-Meier method. Log-rank testing compared survival curves. RESULTS:There were 10,837 CEAs performed during the study. Average age was 70.4 ± 9.3 years; 6605 (61%) patients were male, and 40% (n = 4324) were performed for symptoms. Most were current or former smokers (n = 8619 [80%]). Coronary artery disease and congestive heart failure were identified in 31% and 8.6%, respectively. Overall, there were 190 strokes within 30 days of CEA (1.8%); 131 were ipsilateral (1.3%), and 59 (0.5%) patients were identified as having contralateral perioperative stroke. Thirteen patients sustained bilateral stroke (0.1%). Significant univariate associations included urgency (P = .0001), ipsilateral stenosis severity (P = .004), length of operation (P = .0001), CEA with coronary artery bypass graft (P = .0001), CEA with other arterial surgery (P = .01), and CEA with proximal endovascular procedure (P = .03). Contralateral occlusion (P = .06) and degree of contralateral carotid stenosis (P = .14) did not correlate. After logistic regression analysis of significant univariate anatomic and operative factors, length of procedure (odds ratio [OR], 1.08/15 minutes; 95% confidence interval [CI], 1.01-1.15; P = .02), urgency of operation (OR, 2.5; 95% CI, 1.3-4.6; P = .006), and concomitant proximal endovascular intervention (OR, 8.7; 95% CI, 4.5-31.2; P = .001) remained predictors of contralateral stroke after CEA. Occurrence of both ipsilateral (P < .001) and contralateral (P = .023) stroke significantly reduced 5-year survival compared with those without stroke. There was no difference in the negative survival effect based on laterality of stroke (P = .24). CONCLUSIONS:Contralateral stroke after CEA is rare, affecting 0.5% of patients. Traditional risk reduction medical therapy does not affect occurrence. Degree of contralateral stenosis, including contralateral occlusion, does not predict perioperative contralateral stroke. Urgency of operation, length of operation, and performance of concomitant, ipsilateral endovascular intervention predict contralateral stroke risk with CEA. Contralateral stroke affects long-term survival similar to ipsilateral stroke after CEA.
journal_name
J Vasc Surgjournal_title
Journal of vascular surgeryauthors
Clouse WD,Ergul EA,Patel VI,Lancaster RT,LaMuraglia GM,Cambria RP,Conrad MFdoi
10.1016/j.jvs.2017.04.059subject
Has Abstractpub_date
2017-11-01 00:00:00pages
1450-1456issue
5eissn
0741-5214issn
1097-6809pii
S0741-5214(17)31353-8journal_volume
66pub_type
杂志文章abstract:OBJECTIVE:The aim of this study was to identify whether revascularization by percutaneous transluminal angioplasty (PTA) for patients with intermittent claudication improved measures of functional performance including balance. METHODS:A prospective observational study was performed at a single tertiary vascular cente...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2013.05.106
更新日期:2013-12-01 00:00:00
abstract:OBJECTIVE:We placed temporary inferior vena cava filters to prevent pulmonary thromboembolism in patients with deep vein thrombosis (DVT) who were presumed to have an increased risk of pulmonary embolism in the perinatal period. These experiences of using temporary inferior vena cava filters in pregnant women are repor...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2005.01.023
更新日期:2005-04-01 00:00:00
abstract::The LaPlace transform damping (LTD) method of common femoral artery Doppler waveform analysis is a new method for assessing aortoiliac stenosis. A microcomputer was used to analyze the waveform to determine the value of the damping parameter, which is related to inflow stenosis. The study included 60 limbs with arteri...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.1984.avs0010520
更新日期:1984-07-01 00:00:00
abstract::In situ fenestration of aortic stent grafts has the potential to allow for continued perfusion of supra-aortic trunks, without the need for extra-anatomic bypass, and without the need for custom-made devices. Angulation of the target vessel relative to the arch is an obstacle to success with this technique. In this re...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2009.07.088
更新日期:2010-08-01 00:00:00
abstract:OBJECTIVE:Myocardial ischemia and infarction after surgery remain leading causes of morbidity and mortality in patients undergoing major vascular surgery. B-type natriuretic peptide has been shown to predict early postoperative cardiac events in patients undergoing major noncardiac surgery. We aimed to determine if N-t...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2008.05.015
更新日期:2008-10-01 00:00:00
abstract:OBJECTIVE:To evaluate our initial experience with hypogastric artery occlusion using a nitinol vascular plug during endovascular aortic aneurysm repair (EVAR). METHODS:We reviewed the records and images of 23 consecutive patients who underwent transluminal vessel occlusion of the hypogastric artery with a nitinol plug...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2008.06.002
更新日期:2008-11-01 00:00:00
abstract:INTRODUCTION:Acute arterial thrombosis causes endothelial dysfunction due to decreased nitric oxide bioactivity. Increased arginase activity may modulate intracellular L-arginine levels, the substrate for nitric oxide. The purpose of this study was to identify the role of arginase in endothelial dysfunction in cell cul...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2008.02.030
更新日期:2008-08-01 00:00:00
abstract::An 84-year-old female was lost to follow-up after endovascular aneurysm repair at another hospital with known type II endoleak. She later presented with presyncope and hematemesis. A referral center esophagogastroduodenoscopy showed possible duodenal diverticulum. She had recurrent symptoms and repeat computed tomogra...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2011.04.049
更新日期:2011-10-01 00:00:00
abstract:BACKGROUND:Thoracic endovascular aortic repair has transformed the management of blunt traumatic thoracic aortic injuries (BTTAI). Recent studies have suggested that the nonoperative management (NOM) of BTTAI may be a viable alternative. We investigated the NOM of BTTAI by conducting a systematic review and meta-analys...
journal_title:Journal of vascular surgery
pub_type: 杂志文章,meta分析
doi:10.1016/j.jvs.2018.12.045
更新日期:2019-09-01 00:00:00
abstract:PURPOSE:This study evaluated the efficacy of neodymium:yttrium-aluminum-garnet laser welding of flaps in canine arteries and in securing the distal flap during human carotid endarterectomy. METHODS:Endarterectomy flaps were created in both common carotid and both common femoral arteries in 12 dogs. The flaps were repa...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/s0741-5214(95)70085-4
更新日期:1995-07-01 00:00:00
abstract:PURPOSE:The purpose of this study was to use color-flow duplex scanning to identify the anatomic distribution of venous reflux and to quantify venous reflux times in patients with various stages of chronic venous insufficiency (CVI). METHODS:Color-flow-assisted duplex scanning was used to identify the anatomic distrib...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:
更新日期:1993-11-01 00:00:00
abstract::Missile embolism into the cerebral circulation is a very unusual complication of shotgun wounds to the chest or neck. We report a case of an 11-year-old boy who sustained an air gunshot wound and pellet embolism to the intracranial carotid artery. The cerebral artery pellet embolus resulted in contralateral hemiplegia...
journal_title:Journal of vascular surgery
pub_type: 杂志文章,评审
doi:10.1016/j.jvs.2011.07.091
更新日期:2012-02-01 00:00:00
abstract:PURPOSE:The purpose of this study was to present the use of superficial femoral vein (SFV) as an arterial bypass graft when ipsilateral saphenous vein is inadequate. METHODS:Data collected prospectively were reviewed on 24 patients (25 limbs) who had an arterial bypass with SFV performed by the authors between January...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/0741-5214(94)90232-1
更新日期:1994-12-01 00:00:00
abstract:OBJECTIVE:The objective of this study was to acquire insight into the interpretation of intravascular ultrasound images of the abdominal aorta and to assess to what extent this technique can provide useful parameters for the endovascular treatment of patients with abdominal aortic aneurysm. STUDY DESIGN:This was a des...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/s0741-5214(98)70366-0
更新日期:1998-02-01 00:00:00
abstract:OBJECTIVE:To assess the effect of extremity vascular complications (EVCs, including ischemia or vessel trauma) on the outcomes of patients receiving cardiac support devices (CSDs, including ventricular assist device [VAD] and extracorporeal membrane oxygenation [ECMO]). METHODS:Institutional Review Board-approved, ret...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2013.12.014
更新日期:2014-06-01 00:00:00
abstract:INTRODUCTION:Leg ulcers associated with chronic venous insufficiency (CVI) frequently recur after healing. The risk of recurrence has not been well defined for patients in different anatomic and hemodynamic groups. We reviewed the risk of ulcer recurrence on the basis of clinical, etiologic, anatomic, and pathophysiolo...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1067/mva.2002.121128
更新日期:2002-04-01 00:00:00
abstract::Urologic complications related to vascular surgery involving the ureter have been well recognized. These include ureteral compression from aneurysms, congenital anomalies such as retrocaval ureter, obstruction from retroperitoneal fibrosis, iatrogenic injury, and ureteric fistulas. Complications involving the bladder ...
journal_title:Journal of vascular surgery
pub_type: 杂志文章,评审
doi:10.1016/j.jvs.2010.02.261
更新日期:2010-08-01 00:00:00
abstract:OBJECTIVE:The development of in-stent restenosis (ISR) hinders the long-term patency of carotid artery stenting (CAS), yet no optimal treatment has been established. In the present study, we compared the outcomes of redo CAS (rCAS) and carotid endarterectomy (CEA) for ISR. METHODS:A systematic search using the terms "...
journal_title:Journal of vascular surgery
pub_type: 杂志文章,评审
doi:10.1016/j.jvs.2020.07.102
更新日期:2020-08-28 00:00:00
abstract:BACKGROUND:The sandwich technique is an endovascular off-the-shelf solution for patients with thoracoabdominal aortic aneurysms (TAAAs). In a sandwich configuration, the chimney stent runs in the middle of a space created by two or three aortic endografts. METHODS:All patients with TAAAs who were treated with the sand...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2013.12.044
更新日期:2014-06-01 00:00:00
abstract::The cause of hypertension in the immediate postoperative period after carotid endarterectomy is unknown. In order to elucidate the etiology of hypertension following carotid endarterectomy, blood samples were drawn intraoperatively from internal jugular vein and external carotid artery prior to and subsequent to carot...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:
更新日期:1984-09-01 00:00:00
abstract::Distal internal carotid artery exposure can be technically demanding even for experienced vascular surgeons. Although a variety of techniques have been described to facilitate such exposure, temporary mandibular subluxation has emerged as the simplest and least debilitating approach. Current techniques for maintaining...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:
更新日期:1990-09-01 00:00:00
abstract:INTRODUCTION:Racial disparities in open thoracic aortic aneurysm repair have been well documented, with black patients reported to suffer from poor outcomes compared with their white counterparts. It is unclear whether these disparities extend to the less invasive thoracic endovascular aortic repair (TEVAR). This study...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2020.10.087
更新日期:2020-12-02 00:00:00
abstract:OBJECTIVE:Although few studies have reported outcomes after branched or fenestrated endovascular aortic aneurysm repair (FEVAR) of abdominal aortic aneurysms involving visceral vessels (AAA-Vs), no multi-institutional study has compared FEVAR with open surgery (OS) for AAA-Vs. Our objective was to compare 30-day outcom...
journal_title:Journal of vascular surgery
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jvs.2017.04.057
更新日期:2017-12-01 00:00:00
abstract::Connective tissue disorders (CTDs) predispose patients to dilation of the entire aorta, resulting in the development of extensive aneurysms. Aortic reconstruction in CTD patients can be challenging and demands specific approaches to ensure initial success and lasting stability of aortic repair. Herein, we describe tec...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2016.04.044
更新日期:2016-08-01 00:00:00
abstract:OBJECTIVE:The prevalence of significant comorbidities among patients with abdominal aortic aneurysms (AAAs) has contributed to widespread enthusiasm for endovascular AAA repair (EVAR). However, the advantages of EVAR in patients at low risk for open surgical repair (OSR) remain unclear. The objective of this study was ...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2014.05.018
更新日期:2014-11-01 00:00:00
abstract::Injuries of the abdominal visceral vessels are uncommon but devastating entities resulting in extremely high rates of mortality. The most common cause of abdominal vascular injuries is penetrating trauma, accounting for 90% to 95% of these injuries. In contrast, blunt trauma accounts for 5% to 10% of all abdominal vas...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2007.04.041
更新日期:2007-09-01 00:00:00
abstract:OBJECTIVE:This study assessed preliminary results of the Ventana Fenestrated System (Endologix, Irvine, Calif) as an off-the-shelf integrated device for juxtarenal aortic aneurysm (JAA) or pararenal aortic aneurysm (PAA) endovascular repair. METHODS:From November 2010 to April 2012, seven centers enrolled 31 patients ...
journal_title:Journal of vascular surgery
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1016/j.jvs.2012.12.065
更新日期:2013-07-01 00:00:00
abstract:PURPOSE:Neointimal hyperplasia frequently develops after placement of prosthetic vascular grafts and is a major cause of graft failure. This study was an attempt to prevent vascular lesion formation by coating the graft luminal surface with a thin layer of nonporous silicone polymer, and subsequently with an ultrathin ...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/s0741-5214(96)70019-8
更新日期:1996-11-01 00:00:00
abstract::The immunologic competence of 12 patients with advanced and fulminating prosthetic graft infections was studied. Critical deficiencies were noted in the immune status of all the patients. Enhancement of immune responses with accelerated recovery occurred in 8 of the 12 patients who received total parenteral nutritiona...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:
更新日期:1984-01-01 00:00:00
abstract:OBJECTIVE:Central aortic stiffness and chronic obstructive pulmonary disease (COPD) are associated with increased incidence of devastating aortopathies. However, the exact mechanism leading to elevated aortic stiffness in patients with COPD is unknown. The purpose of this study was to quantify flow and shear hemodynami...
journal_title:Journal of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.jvs.2017.06.110
更新日期:2018-07-01 00:00:00