DrVirgo
Forum Hero
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30% stenosis but has it BILATERALLY
-D. Stent or E. carotid endarterectomy?
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| Eagle_303
Forum Elite
Topics: 38
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Carotid stenosis < 50% treatment is aspirin
More than 70% CEA .
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| MAB
Forum Senior
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agree with Eagle as well
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| DrVirgo
Forum Hero
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Posts: 3,515
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What about cases of BILATERAL Stenosis? What are the criteria for endarterectomy then?
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| Eagle_303
Forum Elite
Topics: 38
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CEA is definitely indicated if
- Stenosis is >70%
- Patient is symptomatic
But it is Contraindicated if
- there is ipsilateral stroke (because damage has already been done )
- There is 100% stenosis
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| WaqasQureshi
Forum Senior
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a
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| Destination
Forum Junior
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whats the explanation for answer A
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| ngaybinhyen
Forum Junior
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These are good information for management of carotids stenosis. Any of you know if there is any consensus on management of carotids stenosis.
Thanks
-t.
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| ngaybinhyen
Forum Junior
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* percent stenosis = (1- (minimal diameter)/(post-stenotic diameter)) x 100%.
* Current indications for carotid ENDARTECTOMY
- symptomatic patients with a 70 – 99% stenosis
(The North American Symptomatic Carotid Endarterectomy Trial (NASCET) and the European Carotid Surgery Trial (ECST))
- asymptomatic patients with high grade stenosis (>75%)
(The European asymptomatic carotid surgery trial (ACST))
* For maximum benefit patients should be operated on soon after a TIA or stroke, preferably within the first month.
*** Contraindications
1) Complete internal carotid artery obstruction (because the intraluminal thrombus then extends too far downstream, well into the intracranial portion of the artery, for endarterectomy to be successful).
2) Previous stroke on the ipsilateral side with heavy sequelae, because there is no point in preventing what has already happened.
3) Patient deemed unfit for the operation by the anaesthesiologist.
****** CAROTID STENTING - "interesting stuffs" 
{- Symptomatic with >50% stenosis
or
- Asymptomatic with >80% stenosis }
AND at least one ANATOMIC or CO-MORBID risk factor placing them at high-risk for adverse events from CEA:
{ ANATOMIC: Contralateral carotid occlusion ; Contralateral laryngeal palsy; Post-radiation treatment; Previous CEA recurrent stenosis; High cervical ICA lesions; CCA lesions below the clavicle; Severe tandem lesions
COMORBID: Congestive Heart Failure (Class III/IV), and/or known severe LV dysfunction <30% Open-heart surgery within 6 weeks Recent myocardial infarction (>24 hours and <4 weeks) Unstable angina (CCS class III/IV) Synchronous severe cardiac and carotid disease requiring open heart surgery and carotid revascularization Severe pulmonary disease to include any of the following: Chronic oxygen therapy Resting P02 of < 60 mmHg Baseline hematocrit > 50% FEV1 or DLCO < 50% of normal Abnormal stress test Age greater than 80 years }
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| ngaybinhyen
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The North American Symptomatic Carotid Endarterectomy Trial (NASCET):
Symptomatic patients with less severe carotid occlusion (50 – 69%) had a smaller benefit. In addition, co-morbidity adversely affects the outcome; patients with multiple medical problems have a higher post-operative mortality and hence benefit less from the procedure.
MAYBE JUST ASPIRIN
REGARDLESS UNI- OR BILATERAL
Very good Q. Thanks
-t.
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| ngaybinhyen
Forum Junior
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Posts: 144
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Kaplan LN 2008
Carotid endarterectomy is recommended when an occlusion exceeds 70% of the arterial lumen and the lesion is symptomatic. Endarterectomy may benefit those who are asymptomatic if there is >60% stenosis in men who are <60 years old. The benefit of endoarterectomy is less certain in women because they have a lower risk of stroke. The more severe the disease, the greater the benefit. Carotid stenting is an alternative to endarterectomy
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| nightflight1945
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Thank you ngaybinhyen.
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| ngaybinhyen
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