endarterectomy (CEA) is superior to medical therapy in patients with severe carotid artery stenosis. Surgical endarterectomy, however, has several limitations. In the North American Symptomatic Carotid Endarterectomy Trial (NASCET), the risk of stroke or death was 5.8% overall. In high risk patients with significant coronary artery disease, morbidity and mortality as high as 18% has been report...

BACKGROUND Surgical pulmonary endarterectomy is the preferred treatment for chronic thromboembolic pulmonary hypertension. Persistent pulmonary hypertension after pulmonary endarterectomy has been recognized as a major determinant of poor outcome. We tested whether acute vasoreactivity identifies chronic thromboembolic pulmonary hypertension patients prone to develop persistent/recurrent pulmon...

A 59-year old man developed perioperative stroke following left carotid endarterectomy seconday to thrombosis at the endarterectomy site. Transcranial Doppler ultrasonography revealed very frequent microembolization in the left middle cerebral artery territory. The patient was successfully treated with intravenous abciximab with complete neurological recovery.

Methods: Analysis of claims from the Centers for Medicare & Medicaid Services from January 1, 2003, through December 31, 2006. Patients were 65 years or older and had undergone carotid endarterectomy or carotid stenting. The main outcome measures were annual ageadjusted rates of carotid endarterectomy and carotid stenting, factors associated with the use of carotid revascularization, and mortal...

Background—The Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST) found a higher risk of stroke after carotid artery stenting and a higher risk of myocardial infarction (MI) after carotid endarterectomy. Methods and Results—Cardiac biomarkers and ECGs were performed before and 6 to 8 hours after either procedure and if there was clinical evidence of ischemia. In CREST, MI wa...

BACKGROUND AND PURPOSE Whether a history of carotid endarterectomy influences patient compliance with medical treatments and physician attitude toward treatments after ischemic stroke or transient ischemic attack (TIA) is not well known. METHODS We studied the baseline data of 18,467 ischemic stroke and TIA patients from the international REduction of Atherothrombosis for Continued Health (RE...

BACKGROUND AND PURPOSE In 1991, the North American Symptomatic Carotid Endarterectomy Trial (NASCET) reported the benefit of carotid endarterectomy for 659 patients with 70% to 99% stenosis. Follow-up continued until 1997. METHODS The present study examined the risks and causes of ipsilateral stroke in the randomized groups and in those who had delayed endarterectomy or continued on medical t...

The significant risk of fatal myocardial infarction after carotid endarterectomy in patients with coronary disease long has been recognized. In 1,546 consecutive carotid endarterectomies performed in 1,238 patients over the last 10 years, angina pectoris was present in 17% (212/1,238) of patients; a further 32% (396/1,238) of patients were asymptomatic, but had a history of myocardial infarctio...

HYPOTHESIS That alternative methods of cerebral protection, especially routine shunting of all patients undergoing general anesthesia or shunting on the basis of neurologic assessment with the patient awake under cervical plexus block, result in outcomes of carotid endarterectomy comparable with those reported using electroencephalographic monitoring. DESIGN Retrospective review of cases from...

We reviewed demographic data on patients having 2,256 carotid endarterectomies in eight large hospitals in North Carolina to determine the frequency of blacks among these patients. Blacks comprised only 4.6% of the patients having carotid endarterectomy even though they comprised 26% of all patients discharged and 22% of the general population of the state. Data from the National Inpatient Prof...