The Experts below are selected from a list of 219 Experts worldwide ranked by ideXlab platform
David Bergqvist - One of the best experts on this subject based on the ideXlab platform.
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What is the optimal perioperative antithrombotic regimen? In Naylor R, MacKay W (eds). Carotid Artery Surgery. A problem based approach.
2000Co-Authors: David BergqvistAbstract:What is the optimal perioperative antithrombotic regimen? In Naylor R, MacKay W (eds). Carotid Artery Surgery. A problem based approach.
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Should all patients be patched? If not, how should I select which patients to patch? In Naylor R, MacKay W (eds). Carotid Artery Surgery. A problem based approach.
2000Co-Authors: David Bergqvist, H ParssonAbstract:Should all patients be patched? If not, how should I select which patients to patch? In Naylor R, MacKay W (eds). Carotid Artery Surgery. A problem based approach.
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cranial nerve injuries after Carotid Artery Surgery a prospective study of 663 operations
European Journal of Vascular and Endovascular Surgery, 1995Co-Authors: Claes Forssell, Peter Kitzing, David BergqvistAbstract:Objective: To establish the incidence of cranial nerve injuries caused by Carotid Artery Surgery. Methods: During the years 1982 to 1992, 689 Carotid Artery operations were performed at Malmo General Hospital. Of these 656 were pre- and postoperatively examined at the Department of Phoniatrics concerning the function of the cranial nerves IX, X, and XII. Results: There was injury to one or more of the examined nerves after 75 operations (11.4%). In 70 (10.7%) operations the hypoglossal nerve was injured, in eight (1.2%) the recurrent laryngeal nerve, in two (0.3%) the glossopharyngeal nerve and in two (0.3%) the superior laryngeal nerve. Seven patients complained of postoperative hoarseness, but had no injuries. One hypoglossal and one recurrent nerve injury was permanent. Nerve injury was more frequent in operations performed with a shunt (p = 0.05), with patch closure (p = 0.01) and by a junior surgeon (p = 0.05). Conclusion: In a prospective series, the incidence of cranial nerve injuries after Carotid Surgery was significant but the vast majority were reversible.
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Intraplaque haemorrhage at Carotid Artery Surgery--a predictor of cardiovascular mortality.
Journal of Internal Medicine, 1995Co-Authors: P. Falke, David Bergqvist, Thomas Mätzsch, Nils H. Sternby, Lars StavenowAbstract:OBJECTIVE. To ascertain whether Carotid intraplaque haemorrhage (IH) in patients undergoing Carotid Artery Surgery is a predictor of increased cardiac mortality over a 5.5 year follow-up. DESIGN AND SUBJECTS. Carotid Artery plaques were obtained at Surgery from 47 consecutive patients (41 men, six women), median age 67 (range 48-81) years, with symptoms of Carotid transient ischaemic attacks (TIAs) or Carotid territory minor stroke. As determined at preoperative angiography, the degree of stenosis was 50-99%. Specimens were classified histologically as manifesting severe atherosclerosis, fibrous plaque, IH, or residual IH debris. SETTING. Medical Angiology and Vascular Surgery Units, Malmo General Hospital. INTERVENTION. Carotid endarterectomy. MAIN OUTCOME MEASURE. Correlation between mortality and IH. RESULTS. At follow-up after 5.5 years, mortality was 28% (13/47) overall, 92% (12/13) in the IH subgroup [of stroke (n = 1) or myocardial infarction (n = 11)], but only 3% (1/34), of pancreatic cancer, in the non-IH subgroup (P = 0.0001). Mortality was also significantly higher in the severe atherosclerosis than in the fibrous plaque subgroup, 39% (12/31) vs. 6% (1/16) (P = 0.044), but not significantly increased in any other subgroup (fibrous plaque, residual IH, TIA, minor stroke, or acetylsalicylic acid or anticoagulant treatment). No correlation existed between IH or death and haemoglobin value or platelet count. CONCLUSIONS. Evidence of recent IH seen at Carotid Artery Surgery may be a marker of cardiovascular mortality. As IH was also found in a post-mortem control subgroup, the difference may be due to abnormality in blood components (e.g., coagulation factors) or impaired vessel-wall healing capacity (e.g. endothelial dysfunction). (Less)
M Massucci - One of the best experts on this subject based on the ideXlab platform.
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general anaesthesia versus cervical block and perioperative complications in Carotid Artery Surgery
European Journal of Vascular and Endovascular Surgery, 1997Co-Authors: P Fiorani, E Sbarigia, Francesco Speziale, Mario Antonini, Brenno Fiorani, L Rizzo, M MassucciAbstract:Purpose: To compare the influence of anaesthetic technique on perioperative complications in patients undergoing Carotid endarterectomy. Material and methods: In a retrospective study of 1020 consecutive patients who underwent Carotid Artery Surgery over 10 years, perioperative neurologic and cardiologic complications and the use of an internal Carotid Artery shunt were compared in 337 patients (33%) treated under general anaesthesia and 683 (67%) under cervical block. The two groups had similar characteristics. The most frequent surgical indication was symptomatic Carotid Artery disease (91.5%). The remaining patients had asymptomatic severe internal Carotid lesions (> 70%). Results: The overall perioperative stroke rate was 1.9%, the death-stroke rate 0.7% and the cardiac complication rate 0.8%. The perioperative stroke rate was higher in the general anaesthesia group than in the cervical block group (3.2% vs 1.3%, p = 0.01). Cardiac complication rates were similar in the two groups. A Carotid Artery shunt was used in 75 patients (22%) receiving general anaesthesia and in 92 patients (13%) receiving cervical block ( p = 0.0004). The causes of stroke in the cervical block group were intraoperative embolism (4 cases, 26%), perioperative thromboembolism (7 cases, 58%) and clamping ischaemia (1 case, 16%). Mechanisms causing stroke in the general anaesthesia group remained unidentified or uncertain. Conclusions: Cervical block anaesthesia yields better perioperative results than general anaesthesia probably because it allows more reliable cerebral monitoring, reducing or even eliminating perioperative strokes related to clamping ischaemia. It facilitates detection of the mechanism underlying intraoperative stroke allowing surgical techniques and intraoperative management to be modified accordingly. Cervical block anaesthesia significantly reduces the need for internal Carotid Artery shunting.
Carolyn Blyth - One of the best experts on this subject based on the ideXlab platform.
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superficial and deep cervical plexus block for Carotid Artery Surgery a prospective study of 1000 blocks
Regional Anesthesia and Pain Medicine, 1997Co-Authors: Michael J. Davies, Brendan S. Silbert, David Scott, Russell J Cook, Patricia H Mooney, Carolyn BlythAbstract:Background And Objectives. Cervical plexus blocks are performed for Carotid Surgery to allow neurological assessment of the awake patient. The aim of this study was to establish the frequency of success, complication, and patient acceptance of the technique. Methods. One thousand superficial and deep cervical blocks were performed in 924 patients having Carotid Artery Surgery. Data about the blocks were recorded prospectively and patients were followed up postoperatively by an independent anesthesiologist to assess patient acceptance of the technique. Results. Lidocaine was the most frequently used anesthetic (88%). Surgical supplementation of the blocks was required in 53% of operations. Six blocks (0.6%) had clinical evidence of intravascular injection of local anesthetic. Sedation was required in 66% of operations and conversion to general anesthesia occurred in 25 (2.5%) of operations. Ninety-one percent of patients reported no problems with the block, and 93% stated that they would have the same anesthetic for any future similar Surgery. Conclusions. We conclude that superficial and deep cervical plexus block has a high success rate, low complication rate, and high patient acceptance rate. Caution should, however, be exercised to ensure a low intravascular injection rate which is of most concern with this technique, because blood was aspirated in 30% of patients during performance of the block.
Ethan A Halm - One of the best experts on this subject based on the ideXlab platform.
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risk factors for perioperative death and stroke after Carotid endarterectomy results of the new york Carotid Artery Surgery study
Stroke, 2009Co-Authors: Ethan A Halm, Stanley Tuhrim, Jason J Wang, Caron B Rockman, Thomas S Riles, Mark R ChassinAbstract:Background and Purpose— The benefit of Carotid endarterectomy is heavily influenced by the risk of perioperative death or stroke. This study developed a multivariable model predicting the risk of death or stroke within 30 days of Carotid endarterectomy. Methods— The New York Carotid Artery Surgery (NYCAS) Study is a population-based cohort of 9308 Carotid endarterectomies performed on Medicare patients from January 1998 through June 1999 in New York State. Detailed clinical data were abstracted from medical charts to assess sociodemographic, neurological, and comorbidity risk factors. Deaths and strokes within 30 days of Surgery were confirmed by physician overreading. Multivariable logistic regression was used to identify independent patient risk factors. Results— The 30-day rate of death or stroke was 2.71% among asymptomatic patients with no history of stroke/transient ischemic attack (TIA), 4.06% among asymptomatic ones with a distant history of stroke/TIA, 5.62% among those operated on for Carotid TI...
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association between minor and major surgical complications after Carotid endarterectomy results of the new york Carotid Artery Surgery study
Journal of Vascular Surgery, 2007Co-Authors: Alexander Greenstein, Stanley Tuhrim, Jason J Wang, Caron B Rockman, Thomas S Riles, Mark R Chassin, Ethan A HalmAbstract:Objective Most studies on outcomes of Carotid endarterectomy (CEA) have focused on the major complications of death and stroke. Less is known about minor but more common surgical complications such as hematoma, cranial nerve palsy, and wound infection. This study used data from a large, population-based cohort study to describe the incidence of minor surgical complications after CEA and examine associations between minor and major complications. Methods The New York Carotid Artery Surgery (NYCAS) study examined all Medicare beneficiaries who underwent CEA from January 1998 to June 1999 in NY State. Detailed clinical information on preoperative characteristics and complications ≤30 days of Surgery was abstracted from hospital charts. Associations between minor (cranial nerve palsies, hematoma, and wound infection) and major complications (death/stroke) were examined with χ 2 tests and multivariate logistic regression. Results The NYCAS study had data on 9308 CEAs performed by 482 surgeons in 167 hospitals. Overall, 10% of patients had a minor surgical complication (cranial nerve (CN) palsy, 5.5%; hematoma, 5.0%; and wound infection, 0.2%). Cardiac complications occurred in 3.9% (myocardial 1.1%, unstable angina 0.9%, pulmonary edema 2.1%, and ventricular tachycardia 0.8%). In both unadjusted and adjusted analyses, the occurrence of any minor surgical complication, CN palsy alone, or hematoma alone was associated with 3 to 4-fold greater odds of perioperative stroke or combined risk of death and nonfatal stroke ( P Conclusion Minor surgical complications are common after CEA and are associated with much higher risk of death and stroke. Patient factors, process factors, and direct causality are involved in this relationship, but future work will be needed to better understand their relative contributions.
Mark R Chassin - One of the best experts on this subject based on the ideXlab platform.
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risk factors for perioperative death and stroke after Carotid endarterectomy results of the new york Carotid Artery Surgery study
Stroke, 2009Co-Authors: Ethan A Halm, Stanley Tuhrim, Jason J Wang, Caron B Rockman, Thomas S Riles, Mark R ChassinAbstract:Background and Purpose— The benefit of Carotid endarterectomy is heavily influenced by the risk of perioperative death or stroke. This study developed a multivariable model predicting the risk of death or stroke within 30 days of Carotid endarterectomy. Methods— The New York Carotid Artery Surgery (NYCAS) Study is a population-based cohort of 9308 Carotid endarterectomies performed on Medicare patients from January 1998 through June 1999 in New York State. Detailed clinical data were abstracted from medical charts to assess sociodemographic, neurological, and comorbidity risk factors. Deaths and strokes within 30 days of Surgery were confirmed by physician overreading. Multivariable logistic regression was used to identify independent patient risk factors. Results— The 30-day rate of death or stroke was 2.71% among asymptomatic patients with no history of stroke/transient ischemic attack (TIA), 4.06% among asymptomatic ones with a distant history of stroke/TIA, 5.62% among those operated on for Carotid TI...
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association between minor and major surgical complications after Carotid endarterectomy results of the new york Carotid Artery Surgery study
Journal of Vascular Surgery, 2007Co-Authors: Alexander Greenstein, Stanley Tuhrim, Jason J Wang, Caron B Rockman, Thomas S Riles, Mark R Chassin, Ethan A HalmAbstract:Objective Most studies on outcomes of Carotid endarterectomy (CEA) have focused on the major complications of death and stroke. Less is known about minor but more common surgical complications such as hematoma, cranial nerve palsy, and wound infection. This study used data from a large, population-based cohort study to describe the incidence of minor surgical complications after CEA and examine associations between minor and major complications. Methods The New York Carotid Artery Surgery (NYCAS) study examined all Medicare beneficiaries who underwent CEA from January 1998 to June 1999 in NY State. Detailed clinical information on preoperative characteristics and complications ≤30 days of Surgery was abstracted from hospital charts. Associations between minor (cranial nerve palsies, hematoma, and wound infection) and major complications (death/stroke) were examined with χ 2 tests and multivariate logistic regression. Results The NYCAS study had data on 9308 CEAs performed by 482 surgeons in 167 hospitals. Overall, 10% of patients had a minor surgical complication (cranial nerve (CN) palsy, 5.5%; hematoma, 5.0%; and wound infection, 0.2%). Cardiac complications occurred in 3.9% (myocardial 1.1%, unstable angina 0.9%, pulmonary edema 2.1%, and ventricular tachycardia 0.8%). In both unadjusted and adjusted analyses, the occurrence of any minor surgical complication, CN palsy alone, or hematoma alone was associated with 3 to 4-fold greater odds of perioperative stroke or combined risk of death and nonfatal stroke ( P Conclusion Minor surgical complications are common after CEA and are associated with much higher risk of death and stroke. Patient factors, process factors, and direct causality are involved in this relationship, but future work will be needed to better understand their relative contributions.