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Oliveira TF, Centellas CDR, Dalio MB, Joviliano EE. Short term outcomes of carotid surgery: the real-world experience of a single teaching center. J Vasc Bras 2024; 23:e20230033. [PMID: 38433985 PMCID: PMC10903515 DOI: 10.1590/1677-5449.202300332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 11/27/2023] [Indexed: 03/05/2024] Open
Abstract
Background Surgical treatment of symptomatic extracranial carotid stenosis is well established for preventing neurological events and should adhere to optimal quality standards. However, there is growing concern as to whether results of controlled trials are replicable in real-world settings. Objectives To assess a symptomatic carotid stenosis population that underwent surgery and its short-term outcomes in a real-world context at a professional training center. Methods Observational study using data collected from medical records from January 2012 to January 2023. Patients undergoing operations for other carotid diseases and with concomitant heart surgery were excluded. Results A total of 70 patients undergoing angioplasty or carotid endarterectomy were included. Population subsets undergoing angioplasty or endarterectomy were similar. Differences in anesthetic modality and a longer operative time in the carotid endarterectomy subgroup were statistically significant. There were 4 cases of stroke, only 3 of which (2 minor and 1 major) were related to the index lesion. Thus, the rate of major operation-related stroke was 1.43% and the rate of any lesion-related stroke was 4.29%. There was 1 case of AMI in the angioplasty group and there were no deaths in the sample. The overall rate of major adverse cardiovascular events was 5.71%. There were no statistical differences between the endarterectomy and angioplasty groups regarding the main outcomes. Conclusions The rates of outcomes of ischemic stroke, acute myocardial infarction, death, and major adverse cardiovascular events at this center are in line with the rates reported by randomized controlled trials, demonstrating the feasibility of carotid surgery in centers with teaching programs.
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Affiliation(s)
- Tércio Ferreira Oliveira
- Universidade de São Paulo - USP, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brasil.
| | | | - Marcelo Bellini Dalio
- Universidade de São Paulo - USP, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brasil.
| | - Edwaldo Edner Joviliano
- Universidade de São Paulo - USP, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brasil.
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2
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Veraldi GF, Scorsone L, Mastrorilli D, Bruno S, Macrì M, Criscenti P, Onorati F, Faggian G, Bovo C, Mezzetto L. Carotid Endarterectomy with Modified Eversion Technique: Results of a Single Center. Ann Vasc Surg 2020; 72:627-636. [PMID: 33197539 DOI: 10.1016/j.avsg.2020.09.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/14/2020] [Accepted: 09/21/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Carotid endarterectomy (CEA) has a wide range of approaches based on personal expertise and preference. We evaluated our outcome with CEA with modified eversion technique (meCEA) under local anesthesia and whether the surgeon's experience could influence it. METHODS at our Institution, 837 patients underwent CEA across 8 years. Although the surgical technique was standardized, 2 groups were considered further: meCEA performed by a single Senior Operator (Group A) and meCEA performed by 4 young Consultants (Group B). RESULTS A selective shunting policy was needed in 5.1%, together with general anesthesia. Overall operative time was 63.9 ± 15.1 minutes (61.4 ± 12.5 and 66 ± 16.9 minutes in Group A and Group B respectively; P < 0.001) and cross-clamp time 19.3 ± 2.9 minutes (19.0 ± 3.2 vs. 19.5 ± 2.8, P = 0.009). At 30 days, 0.7% TIA and 0.8% strokes were recorded. No differences (p = N.S.) between the 2 study groups in terms of postoperative neurological complications, with postoperative ipsilateral strokes always < 1%. At a median imaging follow-up of 22.5 months, the overall percentage of restenosis was 3.7%, with no difference between the 2 groups (P = 0.954). Twenty-two patients (2.6%) underwent reintervention for significant restenosis, and none of them had an ipsilateral stroke or TIA. Freedom from reintervention for restenosis at 24 months was 97.9% in Group A and 95.9% in Group B, with no between-group difference (P = 0.14). At the median survival follow-up of 37 months, the overall survival rate at 24 months was 97.9%in Group A, and 97.9% in Group B, with no between-group difference (P = 0.070). CONCLUSIONS In our experience, CEA with a modified technique is safe and achieves comparable outcomes to those of other established techniques. The reported short cross-clamp time, also in less experienced hands, is an additional strength.
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Affiliation(s)
- Gian Franco Veraldi
- Department of Vascular Surgery, University Hospital and Trust of Verona, University of Verona - School of Medicine, Verona, Italy
| | - Lorenzo Scorsone
- Department of Vascular Surgery, University Hospital and Trust of Verona, University of Verona - School of Medicine, Verona, Italy.
| | - Davide Mastrorilli
- Department of Vascular Surgery, University Hospital and Trust of Verona, University of Verona - School of Medicine, Verona, Italy
| | - Salvatore Bruno
- Department of Vascular Surgery, University Hospital and Trust of Verona, University of Verona - School of Medicine, Verona, Italy
| | - Marco Macrì
- Department of Vascular Surgery, University Hospital and Trust of Verona, University of Verona - School of Medicine, Verona, Italy
| | - Paolo Criscenti
- Department of Vascular Surgery, University Hospital and Trust of Verona, University of Verona - School of Medicine, Verona, Italy
| | - Francesco Onorati
- Department of Cardiac Surgery, University Hospital and Trust of Verona, University of Verona - School of Medicine, Verona, Italy
| | - Giuseppe Faggian
- Department of Cardiac Surgery, University Hospital and Trust of Verona, University of Verona - School of Medicine, Verona, Italy
| | - Chiara Bovo
- Medical Direction, University Hospital and Trust of Verona, University of Verona - School of Medicine, Verona, Italy
| | - Luca Mezzetto
- Department of Vascular Surgery, University Hospital and Trust of Verona, University of Verona - School of Medicine, Verona, Italy
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Schanzer A, Hoel A, Owens CD, Wake N, Nguyen LL, Conte MS, Belkin M. Restenosis After Carotid Endarterectomy Performed With Routine Intraoperative Duplex Ultrasonography and Arterial Patch Closure: A Contemporary Series. Vasc Endovascular Surg 2019; 41:200-5. [PMID: 17595385 DOI: 10.1177/1538574407301141] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The restenosis rates of 5% to 15% have been reported after carotid endarterectomy (CEA). We undertook this investigation to determine whether the routine practice of carotid artery patch closure and intraoperative completion duplex ultrasonography would result in lower rates of carotid restenosis after CEA. All consecutive carotid endarterectomies performed between 2000 and 2004 at a single institution were reviewed retrospectively. Patients underwent CEA using a longitudinal arteriotomy, followed by routine patching and intraoperative completion duplex ultrasonography. Only patients with at least one postoperative duplex scan performed at a minimum of 180 days after CEA were included. During the 5-year study period, 407 consecutive carotid endarterectomies were performed, with a combined 30-day stroke and mortality rate of 2.5%; 217 patients (53%) had one or more duplex ultrasound examinations performed at least 180 days after CEA. The mean follow-up duration was 692 days. Of the patients who underwent intraoperative intervention based on the results of the completion duplex study, none experienced restenosis, stroke, or death. CEA that is performed with routine patching and intraoperative duplex completion ultrasonography is a safe, durable operation with restenosis rates below those commonly reported.
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Affiliation(s)
- Andres Schanzer
- Department of Vascular Surgery, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
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4
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Abstract
As a common etiology for ischemic stroke, atherosclerotic carotid stenosis has been targeted by vascular surgery since 1950s. Compared with carotid endarterectomy, carotid angioplasty and stenting (CAS) is almost similarly efficacious and less invasive. These advantages make CAS an alternative in treating carotid stenosis. However, accumulative evidences suggested that the long-term benefit-risk ratio of CAS may be decreased or even neutralized by the complications related to in-stent restenosis (ISR). Therefore, investigating the mechanisms and identifying the influential factors of ISR are of vital importance for improving the long-term outcomes of CAS. As responses to intrinsic and extrinsic injuries, intimal hyperplasia and vascular smooth muscle cell proliferation have been regarded as the principle mechanisms for ISR development. Due to the lack of consensus-based definition and consistent follow-up protocol, the reported incidences of ISR after CAS varied widely among studies. These variations made the inter-study comparisons of ISR largely illogical. To eliminate restenosis after CAS, both surgery and endovascular procedures have been attempted with promising results. For preventing ISR, drug-eluting stents and antiplatelets have been proposed as potential solutions.
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Affiliation(s)
- Zhengze Dai
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, China
- Department of Neurology, Pukou Hospital, Nanjing, China
| | - Gelin Xu
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, China
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
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5
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Avgerinos ED, Go C, Ling J, Naddaf A, Steinmetz A, Abou Ali AN, Makaroun MS, Chaer RA. Carotid artery disease progression and related neurologic events after carotid endarterectomy. J Vasc Surg 2016; 64:354-360. [DOI: 10.1016/j.jvs.2016.02.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 02/03/2016] [Indexed: 10/22/2022]
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Budincevic H, Ivkosic A, Martinac M, Trajbar T, Bielen I, Csiba L. Asymptomatic dissecting intimal lesions of common carotid arteries after carotid endarterectomy. Surg Today 2014; 45:1227-32. [PMID: 25160766 DOI: 10.1007/s00595-014-1018-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 08/12/2014] [Indexed: 01/01/2023]
Abstract
PURPOSE Carotid endarterectomy is a standard treatment for symptomatic high-degree internal carotid artery stenosis. The aim of this article is to present possible intimal lesions after carotid endarterectomy. These lesions could be manifested as intimal flaps, intimal steps or dissections with or without occlusion or stenosis of the artery. METHODS The evaluation of the frequency and characteristics of the asymptomatic dissecting intimal lesions of the common carotid arteries was performed in a sample of 100 patients who underwent endarterectomy for symptomatic high-grade stenosis of the internal carotid artery. RESULTS We found five patients with asymptomatic dissecting intimal lesions of the common carotid arteries. CONCLUSION The most common causes of these intimal lesions were shunting and prolongation of the clamping time. Routine carotid ultrasound follow-up exams are necessary because of the potential need for a change in the antithrombotic therapy or due to a need to perform an endovascular treatment.
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Affiliation(s)
- Hrvoje Budincevic
- Stroke and Intensive Care Unit, Department of neurology, University Hospital "Sveti Duh", Sveti Duh 64, 10000, Zagreb, Croatia.
| | - Ante Ivkosic
- Department of surgery, University Hospital "Sveti Duh", Sveti Duh 64, 10000, Zagreb, Croatia
| | - Miran Martinac
- Department of surgery, University Hospital "Sveti Duh", Sveti Duh 64, 10000, Zagreb, Croatia
| | - Tomislav Trajbar
- Department of surgery, University Hospital "Sveti Duh", Sveti Duh 64, 10000, Zagreb, Croatia
| | - Ivan Bielen
- Department of neurology, University Hospital "Sveti Duh", Sveti Duh 64, 10000, Zagreb, Croatia
| | - Laszlo Csiba
- Department of neurology, Medical and Health Science Center, University of Debrecen, Nagyerdei Körút 98, P.O. Box 48, Debrecen, Hungary
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7
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Ackerman PD, Loftus CM. Should we adopt micro-interintimal dissection: a novel and worthwhile advance in carotid surgery technique, but does it prevent restenosis and early neurological deficits? World Neurosurg 2013; 82:e87-9. [PMID: 23459277 DOI: 10.1016/j.wneu.2013.02.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Accepted: 02/22/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Paul D Ackerman
- Department of Neurosurgery, Loyola University Stritch School of Medicine, Maywood, Illinois, USA
| | - Christopher M Loftus
- Department of Neurosurgery, Loyola University Stritch School of Medicine, Maywood, Illinois, USA.
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8
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Ichinose T, Naito K, Tsuruno T. Microsurgical interintimal dissection in carotid endarterectomy. World Neurosurg 2013; 82:e225-8. [PMID: 23321377 DOI: 10.1016/j.wneu.2013.01.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 12/04/2012] [Accepted: 01/11/2013] [Indexed: 01/10/2023]
Abstract
BACKGROUND Safe and complete surgical excision of carotid plaque in carotid endarterectomy (CEA) is essential for preventing postoperative embolic stroke and restenosis. We considered the dissection plane for the plaque according to pathological findings of carotid atherosclerosis. We report our experiences with inner-intimal dissection in CEA. METHODS To obtain complete resection of the plaque with a smooth distal edge and bloodless surface by minimal exposure of the media, the thickened intima was sliced under high-magnification microscopy. The excised specimens were examined pathologically. RESULTS Sixty-three CEAs were performed for 61 patients with carotid stenosis. Complete resection without tacking suture was obtained in all procedures. No mortality was encountered. Minor stroke was recorded in 1 procedure (1.6%). No early restenosis was recorded during follow-up (range, 1-35 months; mean, 15.6 months). Pathological examination revealed interintimal excision of the lesion in each case. CONCLUSION Microsurgical interintimal dissection could accomplish good surgical outcome, including absence of significant early restenosis.
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Affiliation(s)
- Tsutomu Ichinose
- Department of Neurosurgery, Yao Tokushukai General Hospital, Yao, Osaka, Japan.
| | - Kentaro Naito
- Department of Neurosurgery, Yao Tokushukai General Hospital, Yao, Osaka, Japan
| | - Takashi Tsuruno
- Department of Neurosurgery, Yao Tokushukai General Hospital, Yao, Osaka, Japan
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Gürer O, Yapıcı F, Yapıcı N, Özler A, Işık Ö. Comparison Between Local and General Anesthesia for Carotid Endarterectomy: Early and Late Results. Vasc Endovascular Surg 2012; 46:131-8. [DOI: 10.1177/1538574411431345] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The aim of this retrospective study was to compare the results between general and local anesthesia (LA) for carotid endarterectomy (CEA). Methods: Three hundred and twenty-nine patients in whom 365 CEA procedures were performed between January 1990 and September 2001, were included in this study. Results: Operation time, shunt usage rates, hospitalization time ( P < .0001), and permanent stroke rates ( P < .05) were significantly lower in group with LA. For long-term period (121.3 ± 37.45 vs 98.6 ± 28.98 months), no significant difference was observed in these 2 group with respect to restenosis rates, neurological events, and deaths. Conclusions: Despite the lack of significant difference between LA and general anesthesia in terms of restenosis, neurological events, and death in the long-term period; LA is more preferable due its associated advantages including availability of testing the consciousness of the patients by direct contact, reduced use of shunts, shorter hospitalization periods, and less prevalence of permanent stroke in the short-term period.
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Affiliation(s)
- Onur Gürer
- Department of Cardiovascular Surgery, Medicana Hospitals Çamlıca, İstanbul, Turkey
| | - Fikri Yapıcı
- Department of Cardiovascular Surgery, Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey
| | - Nihan Yapıcı
- Department of Anesthesiology, Siyami Ersek Thoracic and Cardiovascular Surgery Center, İstanbul, Turkey
| | - Azmi Özler
- Department of Cardiovascular Surgery, Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey
| | - Ömer Işık
- Department of Cardiovascular Surgery, Medicana Hospitals Çamlıca, İstanbul, Turkey
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10
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Nemes B. New possibilities in the endovascular treatment of supraaortic vessels. Interv Med Appl Sci 2011. [DOI: 10.1556/imas.3.2011.4.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Cerebrovascular disease, including stroke, represents the third-leading cause of death in Hungary and a leading cause of disability among the elderly population. The majority of all strokes are ischemic, mostly secondary to thromboembolic disease of the supraaortic vessels. We investigated new therapeutic methods in the endovascular treatment of these diseases. Surgical revascularization of supraaortic trunk stenosis is associated with high morbidity and mortality rates. Balloon angioplasty has become an increasingly accepted treatment of stenoocclusive supraaortic arterial disease. Natural history data and treatment guidelines do not exist for innominate and proximal common carotid artery lesions. We have confirmed in a large series of innominate artery angioplasties that it is a safe and effective procedure with an excellent initial success rate, with a lower complication rate than the surgical option and with a similar long-term patency rate as for surgery.
In the largest published study on transfemoral angioplasty of ostial and proximal common carotid artery stenosis we have proved that endovascular treatment has high success rate with low stroke/death rate. Carotid stenting (CAS) is an evolving alternative to surgery in the treatment of patients with carotid stenosis. Stent selection is influenced by several factors, including the carotid anatomy and lesion characteristics. We examined the wall adaptability of a new closed-cell carotid stent (NexStent), which was designed for carotid bifurcation treatment. Data obtained from angiographic and computed tomographic images indicate that the stent provides adequate expansion and adaptation to the carotid bifurcation.
There are two types of restenosis after carotid artery interventions: the early restenosis develops mainly within the first 24 months after the revascularization procedure and its pathological background is myointimal hyperplasia; on the other hand late restenosis is rather due to progression of primary atherosclerosis and occurs more than 2 years after carotid endarterectomy (CEA). We compared the early restenosis rate in a consecutive series of CAS versus CEA patients at a single cardiovascular institution. The data suggest that the incidence of restenosis after stenting was less common than after surgery.
Our results may help vascular surgeons and interventional radiologists to consider risk versus benefit when deciding treatment options for supraaortic arterial stenosis.
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Affiliation(s)
- Balázs Nemes
- 1 Heart Center, Semmelweis University, Városmajor u. 68, H-1122, Budapest, Hungary
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Tanaskovic S, Isenovic ER, Radak D. Inflammation as a marker for the prediction of internal carotid artery restenosis following eversion endarterectomy--evidence from clinical studies. Angiology 2011; 62:535-42. [PMID: 21873348 DOI: 10.1177/0003319710398010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The role of inflammation is well established in the pathogenesis of atherosclerosis and an increased level of circulating inflammatory markers may predict the future risk of atherosclerosis progression and plaque rupture. C-reactive protein (CRP) identification by hypersensitive methods (high-sensitivity CRP [hsCRP]) has become a clinical and laboratory inflammation marker. Carotid endarterectomy (CEA) is a well-established procedure for carotid stenosis treatment which can reduce stroke rate. Internal carotid artery (ICA) restenosis reduction may be prevented by the anti-inflammatory effect of statins. This review considers the recent findings on the presence of hsCRP and C3 complement concentration and inflammatory plaque composition as well as their effects on ICA restenosis rate, following eversion CEA with emphasis on human studies.
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Affiliation(s)
- Slobodan Tanaskovic
- Department of Vascular Surgery, Dedinje Cardiovascular Institute, Belgrade University School of Medicine, Belgrade, Serbia
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Tan TW, Weyman AK, Barkhordarian S, Patterson RB. Single Center Experience With Modified Eversion Carotid Endarterectomy. Ann Vasc Surg 2011; 25:87-93. [DOI: 10.1016/j.avsg.2010.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2010] [Revised: 11/17/2010] [Accepted: 11/17/2010] [Indexed: 10/18/2022]
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13
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Hirschberg K, Gombos T, Dósa E, Somorjai A, Szilágyi Á, Szabó G, Füst G, Entz L. Association between estrogen receptor α gene polymorphisms and early restenosis after eversion carotid endarterectomy and carotid stenting. Atherosclerosis 2009; 206:186-92. [DOI: 10.1016/j.atherosclerosis.2009.01.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2008] [Revised: 11/14/2008] [Accepted: 01/19/2009] [Indexed: 10/21/2022]
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Hirschberg K, Entz L, Szabó G, Merkely B. [Restenosis following endovascular interventions: clinical and experimental studies]. Orv Hetil 2009; 150:1307-12. [PMID: 19581159 DOI: 10.1556/oh.2009.28639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Restenosis following endovascular interventions is the main limitation of their long-term success. The incidence of restenosis varies according to the method (stenting, endarterectomy) and the treated vascular region, but the pathomechanism and risk factors are similar. The current article reviews of the author's previous studies in this field. In clinical studies, we compared the restenosis rate after carotid artery stenting and carotid endarterectomy. We also analyzed the complement activation profile after these interventions. In another study, we investigated the role of two polymorphisms of the estrogen receptor alpha in the occurrence of carotid restenosis after either carotid artery stenting or carotid endarterectomy. In an animal model of carotid endarterectomy, we studied the role of the nitrite-oxide-cyclic guanosine monophosphate signaling and the effect of the phosphodiesterase-5 inhibitor therapy in neointimal hyperplasia. Our results suggest that higher incidence of restenosis following carotid endarterectomy can be correlated with the more highly expressed complement activation after this type of carotid intervention. Polymorphisms in the estrogen receptor alpha gene could contribute to the restenosis formation, especially in women. Neointimal hyperplasia can be attenuated by increased cyclic guanosine monophosphate signaling.
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Affiliation(s)
- Kristóf Hirschberg
- Semmelweis Egyetem, Altalános Orvostudományi Kar, Kardiológiai Központ, Budapest Gaál József u. 9. 1122.
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15
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Reply to Dr Dorigo et al. (Letter EJVES3000 Re EJVES2585). Eur J Vasc Endovasc Surg 2006. [DOI: 10.1016/j.ejvs.2005.08.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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16
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Dorigo W, Pulli R, Pratesi C. Re EJVES2585. Concerning factors affecting early restenosis after carotid endarterectomy (CEA). Eur J Vasc Endovasc Surg 2005; 31:108; author reply 108-9. [PMID: 16202629 DOI: 10.1016/j.ejvs.2005.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2005] [Accepted: 08/18/2005] [Indexed: 11/30/2022]
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