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de Athayde Soares R, Câmara Costa Ferreira ZM, Viana Portela MV, Campelo Campos AB, Matielo MF, Pecego CS, Sacilotto R. A Comparative Analysis and Results of Carotid Interventions Based on Duplex Ultrasound as a Single Exam Versus Multiple Diagnose Exams. Ann Vasc Surg 2024; 104:10-17. [PMID: 37356654 DOI: 10.1016/j.avsg.2023.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/10/2023] [Accepted: 06/12/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND To determine the results, safety, and clinical outcomes of carotid interventions performed with duplex ultrasound (DUS) as a single preoperative image for internal carotid artery (ICA) assessment, compared to computed tomography angiography (CTA) and magnetic resonance angiography (MRA). METHODS Prospective, consecutive cohort study of 2 groups of patients submitted to carotid interventions, 1 group of patients with DUS as a sole exam (group DUS) compared to patients with DUS plus CTA or MRA for ICA stenosis diagnosis (group CTA/MRA) regarding clinical outcomes such as major stroke, minor stroke, transient ischemic attack and perioperative mortality. RESULTS Two groups of patients were identified: group DUS with 47 patients and group CTA/MRA plus DUS with 68 patients. The mean age of the patients was 71.67 years in total cohort, and most of them were male (66.1%). Group DUS had higher prevalence of male, dyslipidemia, ischemic heart disease, peripheral artery disease and chronic kidney disease than group CTA/MRA (83% vs. 54.4%, P = 0.001; 93.6% vs. 51.5%, P < 0.001; 36.2% vs. 16.2%, P = 0.009; 29.8% vs. 13.2%, P = 0.019; 14.9% vs. 5.9%, P = 0.007, respectively). We have performed a Kaplan-Meier regarding survival rates: Group DUS had 93.5%% and Group CTA/MRA had 90.3%% at 720 days. P = 0.15, standard error < 10 at 720 days. a Kaplan-Meier analysis regarding primary patency rates showed Group DUS with 92.7% and Group CTA/MRA with 94.7% at 720 days. P = 0.78, standard error < 10 at 720 days. Furthermore, the incidence of postoperative stroke was 2.6% (asymptomatic 1.7%, symptomatic 2.9%), with no differences among DUS and CTA/MRA groups (2.1% vs. 2.9%, P = 0.78, respectively). CONCLUSIONS Independently of the type of carotid intervention (carotid endarterectomy and carotid stenting (CAS)), DUS as an only preoperative carotid image has similar results regarding postoperative outcomes when compared to CTA/MRA for preoperative carotid evaluation.
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Affiliation(s)
- Rafael de Athayde Soares
- Division of Vascular and Endovascular Surgery, Hospital do Servidor Público Estadual de São Paulo, São Paulo, SP, Brazil.
| | | | - Matheus Vegas Viana Portela
- Division of Vascular and Endovascular Surgery, Hospital do Servidor Público Estadual de São Paulo, São Paulo, SP, Brazil
| | - Ana Beatriz Campelo Campos
- Division of Vascular and Endovascular Surgery, Hospital do Servidor Público Estadual de São Paulo, São Paulo, SP, Brazil
| | - Marcelo Fernando Matielo
- Division of Vascular and Endovascular Surgery, Hospital do Servidor Público Estadual de São Paulo, São Paulo, SP, Brazil
| | | | - Roberto Sacilotto
- Division of Vascular and Endovascular Surgery, Hospital do Servidor Público Estadual de São Paulo, São Paulo, SP, Brazil
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Penton A, Driscoll M, Li R, DeJong M, Blecha M. Carotid Endarterectomy for Asymptomatic Stenosis Based on Duplex Ultrasound Alone Achieves Equivalent Perioperative and Long-Term Outcomes Relative to Advanced Imaging Based Endarterectomy. Ann Vasc Surg 2024; 98:44-57. [PMID: 37454891 DOI: 10.1016/j.avsg.2023.07.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 05/08/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND The purpose of this study is to compare both perioperative as well as long-term outcomes of patients undergoing carotid endarterectomy (CEA) for asymptomatic carotid bifurcation stenosis based on duplex ultrasound in isolation relative to a combination of duplex and more advanced imaging. METHODS All CEA in the VQI between January 2003 and May 2022 were queried. We identified 171,816 CEAs in the database. Exclusions were symptomatic carotid lesion (57,742), lack of imaging documentation (908), lack of advanced imaging status (1,816), simultaneous additional arterial intervention in the carotid, coronary, or peripheral arterial system (n = 4,118), and anatomic high-risk status for CEA (n = 4,071). Included patients were then placed into 1 of 2 cohorts: patients undergoing CEA based on duplex imaging alone (n = 33,437) and those undergoing CEA based on advanced imaging (CTA, MRA, or invasive angiography) with or without duplex (n = 69,715). We performed multivariable analysis for the following outcomes utilizing CEA based on duplex in isolation as 1 of the variables: perioperative neurological ischemic event utilizing binary logistic regression; combined 90-day mortality and neurological ischemic event utilizing binary logistic regression; neurological event in long-term follow-up with date of surgery serving as time zero; time dependent Cox regression analysis; mortality in long-term follow-up utilizing time-dependent Cox regression. RESULTS Carotid endarterectomy based on duplex alone and CEA based on advanced imaging had essentially equivalent rates of 90-day mortality (0.9% vs. 1.0%, P = 0.108); combined perioperative neurological event and 90-day mortality (2.0% vs. 2.2%, P = 0.042); and, return to the operating room (1.6% vs. 1.7%, P = 0.154). On multivariable analysis CEA based on advanced imaging was noted to have a slightly higher absolute rate of perioperative neurological event without achieving multivariable significance (1.3% vs. 1.2%, adjusted odds ratio 1.11 (0.98-1.25), P = 0.092. CEA based on advanced imaging had a higher rate of neurological event after index hospital admission relative to duplex in isolation (hazard ratio (HR) 1.44 (1.31-1.60), P < 0.001). However, the absolute percentage difference was just 0.5% (1.6% vs. 2.1%). CEA based on duplex alone was associated with a slightly increased risk of mortality in LTFU (HR 1.16 (1.11-1.21), P < 0.001). At 5 years the absolute risk of mortality was less than 1% different between the cohorts. CONCLUSIONS Performing CEA for asymptomatic bifurcation stenosis based on duplex ultrasound alone is a safe practice which achieves clinically equivalent perioperative and long-term freedom from cerebral ischemia and mortality relative to CEA based on advanced imaging. This has potential implications for health care cost saving as well as avoidance of radiation and iodinated contrast.
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Affiliation(s)
- Ashley Penton
- Loyola University Medical Center Department of Sugery, Maywood, IL
| | - Matthew Driscoll
- Loyola University Chicago Stritch School of Medicine, Maywood, IL
| | - Ruojia Li
- Division of Vascular Surgery and Endovascular Therapy, Maywood, IL
| | - Matthew DeJong
- Loyola University Medical Center Department of Sugery, Maywood, IL
| | - Matthew Blecha
- Division of Vascular Surgery and Endovascular Therapy, Maywood, IL.
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Liver Stiffness Is Associated with the Burden of Carotid and Systemic Atherosclerosis in an Unorganized Cohort of Patients 40-64 Years Old. Diagnostics (Basel) 2022; 12:diagnostics12102336. [PMID: 36292024 PMCID: PMC9600688 DOI: 10.3390/diagnostics12102336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/13/2022] [Accepted: 09/23/2022] [Indexed: 11/17/2022] Open
Abstract
Background: The aim of the study is to research the relationship between the severity of liver fibrosis and the burden of carotid and systemic atherosclerosis. Methods: The study includes 163 patients 40 to 64 years of age without atherosclerotic CVD or liver disease. All patients underwent duplex scanning of the carotid and lower limb arteries. All patients underwent transient liver elastometry using the FibroScan (Echosens, France). Results: Carotid plaque was detected in 110 (67.5%) patients. Based on the results of linear regression analysis, relationships between liver stiffness and carotid total plaque area (r = 0.21; p = 0.025) were found. Significant relationships were established between liver stiffness and atherosclerosis burden score based on the results of linear regression (r = 0.17; p = 0.029). Liver stiffness showed moderate diagnostic performance (AUC 0.666; p = 0.01) with regard to generalized atherosclerosis. An increase in liver stiffness >4.5 kPa was associated with an odds ratio of generalized atherosclerosis of 3.48 (95% CI 1.07−11.3; p = 0.038) after adjusting confounding factors. Conclusion: Among patients 40−64 years of age without established atherosclerotic CVD and liver disease, liver stiffness directly correlates with the burden of carotid and systemic atherosclerosis. Liver stiffness showed moderate diagnostic performance (AUC 0.666; p = 0.01) with regard to generalized atherosclerosis.
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Konstantinova EV, Sagatelyan AA, Bogdanova AA, Pershina ES, Shemenkova VS, Svet AV, Oganesyan AA, Gilyarov MY. Comparative assessment of the signs of instability of atherosclerotic plaques in the carotid arteries in elderly patients with acute coronary syndrome with duplex scanning and computed tomography angiography. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2022. [DOI: 10.15829/1728-8800-2022-3275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Aim. To study the signs of instability of atherosclerotic plaques (ASP) in the carotid arteries in elderly patients with acute coronary syndrome (ACS) in the comparative aspect of duplex ultrasound scanning (DUS) and computed tomography angiography (CT).Material and methods. 27 patients with ACS (75 years and over) were included in the study. The signs of instability of ASP were assessed according to DUS and CT.Results. The signs of instability of ASP according to DUS were detected in 85,7%, according to CT — in 84,6%. The following signs were detected with DUS and CT: the presence of irregular plaque surface including signs of ulceration — 6,4 and 11,6% (p=0,021), positive remodeling — 3,8 and 3,8% (p=0,998), signs of local calcification — 23 and 25,9% (p=0,536), heterogenous structure — 55,1 and 46,8% (p=0,045), hypoechogenic component and low-density areas — 11,5 and 11,6% (p= 0,998). The correlation analysis showed high comparability of DUS and CT: irregular plaque surface with ulceration (K=0,624, p=0,02), positive remodeling (K=1, p<0,001), calcification (K=0,858, p<0,001), heterogenous structure (K=0,754, p<0,001), the presence of hypoechogenic component and low-density areas (K=1, p<0,001).Conclusion. The study of elderly patients with ACS found high comparability of DUS and CT in the definition of the signs of instability of ASP in the carotid arteries. It is possible to use DUS as a routine method for assessing carotid atherosclerosis in patients of this group, which can reduce the risk of complications during CT, shorten the examination time, and minimize economic costs.
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Affiliation(s)
- E. V. Konstantinova
- N. I. Pirogov Russian National Research Medical University;
N. I. Pirogov City Clinical Hospital No. 1 of the Department of Health of Moscow
| | | | - A. A. Bogdanova
- N. I. Pirogov Russian National Research Medical University;
N. I. Pirogov City Clinical Hospital No. 1 of the Department of Health of Moscow
| | - E. S. Pershina
- N. I. Pirogov City Clinical Hospital No. 1 of the Department of Health of Moscow
| | - V. S. Shemenkova
- N. I. Pirogov City Clinical Hospital No. 1 of the Department of Health of Moscow
| | - A. V. Svet
- N. I. Pirogov City Clinical Hospital No. 1 of the Department of Health of Moscow
| | - A. A. Oganesyan
- N. I. Pirogov City Clinical Hospital No. 1 of the Department of Health of Moscow
| | - M. Yu. Gilyarov
- N. I. Pirogov Russian National Research Medical University;
N. I. Pirogov City Clinical Hospital No. 1 of the Department of Health of Moscow
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Komut E, Murat M, Büyükşireci M, Komut S, Kozaci N. Relationship between internal carotid artery stenosis grade and optic nerve sheath diameter measured by transorbital ultrasonography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:724-730. [PMID: 33655575 DOI: 10.1002/jcu.22999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 02/09/2021] [Accepted: 02/16/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE To assess the consequence of the presence, grade, and asymmetry of carotid artery stenoses on the optic nerve sheath diameter (ONSD) measured by ultrasonography. METHODS ONSD was measured with B-mode ultrasonography in 129 patients referred for duplex and color Doppler imaging of the carotid arteries. Internal carotid artery stenosis was graded on the basis of peak systolic flow velocity. RESULTS The mean ONSD was 3.04 ± 0.38 mm in the patients without or with <50% internal carotid artery stenosis and 2.46 ± 0.35 mm in those with >70% stenosis. There was an average difference of 0.58 mm between the ONSD of the patients with <50% and the patients with >70% stenosis. CONCLUSION ONSD is lower in patients with carotid artery stenosis. Carotid arteries should be investigated, especially in patients with cardiovascular risk factors or diseases, before interpreting ONSD values.
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Affiliation(s)
- Erdal Komut
- Faculty of Medicine, Department of Radiology, Hitit University, Çorum, Turkey
| | - Muammer Murat
- Department of Radiology, Erol Olcok Training and Research Hospital, Çorum, Turkey
| | - Mehmet Büyükşireci
- Department of Radiology, Erol Olcok Training and Research Hospital, Çorum, Turkey
| | - Seval Komut
- Faculty of Medicine, Department of Emergency Medicine, Hitit University, Çorum, Turkey
| | - Nalan Kozaci
- Faculty of Medicine, Department of Emergency Medicine, Alaaddin Keykubat University, Antalya, Turkey
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Kaya FS. Carotid disease and retinal optical coherence tomography angiography parameters in patients with non-arteritic anterior ischemic optic neuropathy. Int Ophthalmol 2021; 42:123-131. [PMID: 34406576 DOI: 10.1007/s10792-021-02007-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 08/07/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE In order to analyze the data and retinal microvasculature for non-arteritic anterior ischemic optic neuropathy (NAION), patients were referred to have carotid Doppler ultrasound (CDU) from 2016 to 2020. METHODS In this case-control observational study, 30 NAION patients were evaluated with CDU. Twenty-two NAION patients (at least 3 months after the onset of symptoms) and 9 normal subjects underwent a complete ophthalmic examination including optical coherence tomography (OCT) and optical coherence tomography angiography (OCT-A). NAION eyes and fellow eyes were further divided into two groups based on the presence of carotid stenosis (CS). NAION patients with CS were termed "CS-NAION"; and those without CS were termed "NCS-NAION." Measurements of radial peripapillary capillary vessel density (RPC VD), ganglion cell complex (GCC), retinal nerve fiber layer (RNFL) thicknesses were compared among groups. RESULTS Fourteen of 30 NAION patients referred to have carotid Doppler were positive for CS with each one of such referrals having less than 50% stenosis. RNLF, GCC and RPC VDs were reduced in NAION patients' eyes, when compared to controls and the fellow eyes. RPC VD was significantly lower in the temporal-superior (P = 0.037) and the superior-temporal (P = 0.012) sectors of the NCS-NAION patients than in the CS-NAION patients. No significant differences were found between CS-fellow eyes and NCS-fellow eyes in terms of RPC VDs, RNLF or GCC. CONCLUSION Results of the study highlight the effect of the carotid artery stenosis on ocular perfusion pressure in the pathogenesis of NAION. More extensive studies are necessary.
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Affiliation(s)
- Fatma Selin Kaya
- Ophthalmology Department, Çam and Sakura City Hospital, Başakşehir Olimpiyat Bulvarı Yolu, 34480, Başakşehir, Istanbul, Turkey.
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Wang H, Fei L, Xia H, Zhang Q, Huang Y. Diagnostic significance of transcranial doppler combined with carotid ultrasound in patients with cerebral ischemic stroke. Am J Transl Res 2021; 13:6980-6986. [PMID: 34306452 PMCID: PMC8290762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 02/09/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To explore the diagnostic value of transcranial doppler (TCD) combined with carotid ultrasound (CU) in cerebral ischemic stroke (CIS). METHODS A total of 68 patients with CIS who were treated in our hospital from September 2018 to September 2020 were selected as the research group, and another 68 patients with non-CIS admitted during the same period were selected as the reference group. Both groups underwent TCD and CU examinations to compare their diagnostic values. RESULTS There were no distinct differences concerning clinical data such as gender ratio, age, BMI value, smoking history, residence, and complications between the two groups (P > 0.05). The carotid artery intima-media thickening was reported at a markedly higher rate in the research group compared to the reference group (P < 0.001). It was indicated by the CU examination that the degree of carotid artery stenosis in the research group was more severe compared with the reference group (P < 0.05). The patients in the research group experienced more severe intracranial artery stenosis relative to the reference group by the TCD examination (P < 0.05). The plaque morphology of the research group was predominantly irregular, and the internal echoes were predominantly hypoechoic. The plaque morphology in the reference group was predominantly regular, and the internal echoes were predominantly isoechoic. There was remarkably higher incidence of the research group (78%) with ulcer as compared to the reference group (P < 0.05), and no marked difference was observed in the incidence of calcification (P > 0.05). The combined diagnostic approach was superior to TCD and CUS alone in the terms of accuracy, sensitivity and specificity (P < 0.001). CONCLUSION TCD combined with CU can greatly improve the diagnostic efficiency of CIS, and provide more evidence for clinical therapy. It deserves promotion and use.
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Affiliation(s)
- Huijun Wang
- Department of Ultrasound, Jingzhou Second People's Hospital Jingzhou, Hubei Province, China
| | - Li Fei
- Department of Ultrasound, Jingzhou Second People's Hospital Jingzhou, Hubei Province, China
| | - Hongbo Xia
- Department of Ultrasound, Jingzhou Second People's Hospital Jingzhou, Hubei Province, China
| | - Qian Zhang
- Department of Ultrasound, Jingzhou Second People's Hospital Jingzhou, Hubei Province, China
| | - Youping Huang
- Department of Ultrasound, Jingzhou Second People's Hospital Jingzhou, Hubei Province, China
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Fonseca AC, Merwick Á, Dennis M, Ferrari J, Ferro JM, Kelly P, Lal A, Ois A, Olivot JM, Purroy F. European Stroke Organisation (ESO) guidelines on management of transient ischaemic attack. Eur Stroke J 2021; 6:CLXIII-CLXXXVI. [PMID: 34414299 PMCID: PMC8370080 DOI: 10.1177/2396987321992905] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 01/16/2021] [Indexed: 01/14/2023] Open
Abstract
The aim of the present European Stroke Organisation Transient Ischaemic Attack (TIA) management guideline document is to provide clinically useful evidence-based recommendations on approaches to triage, investigation and secondary prevention, particularly in the acute phase following TIA. The guidelines were prepared following the Standard Operational Procedure for a European Stroke Organisation guideline document and according to GRADE methodology. As a basic principle, we defined TIA clinically and pragmatically for generalisability as transient neurological symptoms, likely to be due to focal cerebral or ocular ischaemia, which last less than 24 hours. High risk TIA was defined based on clinical features in patients seen early after their event or having other features suggesting a high early risk of stroke (e.g. ABCD2 score of 4 or greater, or weakness or speech disturbance for greater than five minutes, or recurrent events, or significant ipsilateral large artery disease e.g. carotid stenosis, intracranial stenosis). Overall, we strongly recommend using dual antiplatelet treatment with clopidogrel and aspirin short term, in high-risk non-cardioembolic TIA patients, with an ABCD2 score of 4 or greater, as defined in randomised controlled trials (RCTs). We further recommend specialist review within 24 hours after the onset of TIA symptoms. We suggest review in a specialist TIA clinic rather than conventional outpatients, if managed in an outpatient setting. We make a recommendation to use either MRA or CTA in TIA patients for additional confirmation of large artery stenosis of 50% or greater, in order to guide further management, such as clarifying degree of carotid stenosis detected with carotid duplex ultrasound. We make a recommendation against using prediction tools (eg ABCD2 score) alone to identify high risk patients or to make triage and treatment decisions in suspected TIA patients as due to limited sensitivity of the scores, those with score value of 3 or less may include significant numbers of individual patients at risk of recurrent stroke, who require early assessment and treatment. These recommendations aim to emphasise the importance of prompt acute assessment and relevant secondary prevention. There are no data from randomised controlled trials on prediction tool use and optimal imaging strategies in suspected TIA.
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Affiliation(s)
- Ana Catarina Fonseca
- Department of Neurosciences and Mental Health (Neurology), Hospital Santa Maria-CHLN, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Áine Merwick
- Department of Neurology, Cork University Hospital & University College Cork, Cork, Ireland
| | - Martin Dennis
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Julia Ferrari
- Department of Neurology, St. John´s of God Hospital, Vienna, Austria
| | - José M Ferro
- Department of Neurosciences and Mental Health (Neurology), Hospital Santa Maria-CHLN, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Peter Kelly
- Stroke Service, Mater University Hospital and HRB Stroke Clinical Trials Network Ireland, University College Dublin, Ireland
| | - Avtar Lal
- Guidelines Methodologist, European Stroke Organisation, Basel, Switzerland
| | - Angel Ois
- Department of Neurology, Hospital del Mar, IMIM, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Jean Marc Olivot
- Acute Stroke Unit, Clinical Investigation Center and Toulouse Neuro Imaging Center, Toulouse University Medical Center, Toulouse, France
| | - Francisco Purroy
- Hospital Universitari Arnau de Vilanova, Institut de Recerca Biomedica de Lleida (IRBLleida), Universitat de Lleida (UdL), Lleida, Spain
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Elías FR, Medina G, Sánchez M, Rios CS, Belmont GDLC, Danés LG. Carotid endarterectomy 20-year experience in a low-volume center. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2020. [DOI: 10.4103/ijves.ijves_24_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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