Introdução à Medicina I

2008/2009

Authors:

Bárbara Soeiro; Joana Silva; Jorge Monteiro; Mafalda Barbosa; Marco Assunção; Pedro Tavares; Rodrigo

Monteiro; Rosário Monteiro; Tiago Alves

Adviser:

Prof. Sérgio Sampaio

Class n. 20

Stenosis of the internal carotid artery

• Carotid stenosis is a narrowing of the lumen of the carotid artery, usually caused by atherosclerosis

• Emboli to the cerebral arteries cause transient ischemic attack (TIA) or stroke

Background

Carotid Endarterectomy

• Extraction of the inner lining of the carotid artery if it has become thickened or damaged.

Background

Patch closureEversion

Carotid Stenosis

Background

?Carotid Endarterectomy

• mortality

• neurological morbidity

• risk of restenosis

one year after surgery

Aim

• Compare reports on:

Patch closureEversion

Carotid Endarterectomy

vs

Meta-analysis

Methods

Search Terms carotid endarterectomy, mortality, stroke, transient ischemic attack, restenosis, eversion, patch closure (or equivalent terms).

Query algorithm carotid AND (endarterectomy OR endarterectomies) AND (eversion OR patch OR CEE OR CEER OR CEAP) AND (mortality OR death OR "neurologic morbidity" OR stroke OR "vascular accident" OR "brain vascular accident" OR "cerebrovascular accident" OR CVA OR restenosis OR "transient ischemic attack" OR “transient brainstem ischemia" OR "cerebral ischemia" OR TIA)

Limits Language: EnglishPublished since 1990

Databases PubMedScopusISI Web of Knowledge

MethodsProject Schedule and Gantt Chart

Total number of references: 1254

Pubmed346

Scopus516

ISI Web of Knowledge392

154

181

15

738

166

158

Number of references: 719

Elimination of

repeated references

Search ResultsVenn Diagram

Start

Abstract reviewN=719

The article is a clinical and/or

randomized controlled trial

Excluded

The abstract refers endarterectomy with Dacron patch closure

or eversion

The abstract refers post-operative neurological morbidity

or mortality

The outcomes for both tecniques are

presented separately

Follow-up was higher than 1 year

Division abtracts into 5 groups with 2 revisers each

N=159/160

Yes

Yes

Yes

Included

Yes

Stop

Write the time of follow-up

No

No

No

No

No

Article search on databases

Search on PubMedN=346

Search on Isi Web Knowledge

N=392

Search on ScopusN=516

Exclusion of repetead articles

among the databases

Yes

MethodsSelection of Candidate Studies - Flowchart

Total abstractsn=719

Revision through title and abstract

The study isn't a clinical and/or randomized controlled trial

n=211

The abstract doesn't refer endarterectomy with Dacron patch

closure or eversionn=280

The abstract doesn't refer post-operative neurological morbidity or

mortalityn=37

The outcomes for both techniques aren't presented separately

n=72

Follow-up wasn't higher than 1 yearn=19

Candidate studiesn=100

Review ResultsCandidate studies

1. AbuRahma AF et al. Prospective randomized trial of carotid endarterectomy with polytetrafluoroethylene versus collagen-impregnated dacron (hemashield) patching: Late follow-up. Ann Surg. 2003; 237(6):885-893.

2. AbuRahma AF et al. Prospective controlled study of carotid endarterectomy with hemashield patch: Is it thrombogenic? Vasc Surg. 2001; 35(3):167-174.

3. Ali T et al. Sequential cohort study of Dacron patch closure following carotid endarterectomy. Br J Surg. 2005; 92(3):316-321.

4. Archie JP. Carotid endarterectomy outcome with vein or dacron graft patch angioplasty and internal carotid artery shortening. J Vasc Surg. 1999; 29(4):654-664.

5. Archie Jr JP. Reoperations for carotid artery stenosis: Role of primary and secondary reconstructions. J Vasc Surg. 2001; 33(3):495-503.

6. Asciutto et al. Dacron patch infection after carotid angioplasty. A report of 6 cases. Eur J Vasc Endovasc Surg. 2007; 33(1):55-57.

7. Assadian et al. Homocysteine and early re-stenosis after carotid eversion endarterectomy. Eur J Vasc Endovasc Surg. 2007; 33(2):144-148.

8. Baker WH. Decreased recurrent carotid stenosis by routine patching and intraoperative scanning. Am Surg. 2001; 67(4):328-332.

9. Ballotta et al. Early versus delayed carotid endarterectomy after a nondisabling ischemic stroke: a prospective randomized study. Surgery. 2002; 131(3):287-293.

10. Ballotta et al. Carotid eversion endarterectomy: perioperative outcome and restenosis incidence. Ann Vasc Surg. 2002; 16(4):422-429.

11. Ballotta et al. Carotid endarterectomy contralateral to carotid artery occlusion: analysis from a randomized study. Langenbecks Arch Surg. 2002; 387(5-6):216-221.

ResultsCandidate studies

12. Ballotta E et al. Carotid endarterectomy and patch graft angioplasty vs carotid eversion endarterectomy. Early and long-term follow-up. Chirurgia. 1997; 10(1):62-67.

13. Ballotta E et al. Carotid endarterectomy with patch closure versus carotid eversion endarterectomy and reimplantation: a prospective randomized study. Surgery. 1999; 125(3):271-279.

14. Ballotta E and Da Giau G. Selective shunting with eversion carotid endarterectomy. J Vasc Surg. 2003 ;38(5):1045-1050.

15. Ballotta E et al. Diabetes and asymptomatic carotid stenosis: does diabetic disease influence the outcome of carotid endarterectomy? A 10-year single center experience. Surgery. 2008; 143(4):519-525.

16. Ballotta E et al. Carotid endarterectomy within 2 weeks of minor ischemic stroke: a prospective study. J Vasc Surg. 2008; 48(3):595-600.

17. Ballotta E et al. Long-term survival and stroke-free survival after eversion carotid endarterectomy for asymptomatic severe carotid stenosis. J Vasc Surg. 2007; 46(2):265-270.

18. Ballotta E et al. A prospective randomized study on bilateral carotid endarterectomy: patching versus eversion. Ann Surg. 2000; 232(1):119-125.

19. Balzer et al. Conventional thrombendarterectomy with patch-plasty vs, eversion endarterectomy: Technique, indication and results. Zentralblatt Fur Chirurgie.2000; 125(3):228-238.

20. Bernstein EF. Routine versus selective carotid patching. J Vasc Surg. 1992; 15(5):868-869.

21. Bhattacharya et al. A clinical comparison of Dacron patch closure of small-caliber carotids compared with primary closure of large-caliber carotids after endarterectomy. Am Surg. 1999; 65(4):378-382.

22. Blok JG et al. Vein patch rupture: early complication of carotid endarterectomy. Eur J Surg. 1995; 161(7):519-521.

23. Brothers TE. Initial experience with eversion carotid endarterectomy: absence of a learning curve for the first 100 patients. J Vasc Surg. 2005; 42(3):429-434.

24. Calaitges J et al. Eversion carotid endarterectomy: A safe, advantageous alternative to conventional carotid endarterectomy. A preliminary report. Vascular Surgery. 1996; 30(5):381-385.

ResultsCandidate studies

25. Cao P et al. Eversion versus conventional carotid endarterectomy: a prospective study. Eur J Vasc Endovasc Surg. 1997; 14(2):96-104.

26. Cao P et al. Eversion versus conventional carotid endarterectomy: late results of a prospective multicenter randomized trial. J Vasc Surg. 2000; 31(1 Pt 1):19-30.

27. Cao P et al. A randomized study on eversion versus standard carotid endarterectomy - study design and preliminary results: the Everest Trial. J Vasc Surg. 1998; 27(4):595-605.

28. Cooley DA and Colosimo LR. Eversion technique for carotid endarterectomy. Surg Gynecol Obstet. 1993; 177(4):420-422.

29. Coppi G et al. Carotid endarterectomy using the classical technique and by eversion. [Endoarteriectomia carotidea con tecnica classica e per eversione.] Ann Ital Chir. 1997; 68(4):463-471.

30. Crawford RS et al. Carotid eversion endarterectomy and reimplantation: a safe and simple technique to prevent acute thrombosis-occlusion and/or early and late restenosis. Cardiovasc Surg. 1997; 5(5):473-480.

31. Crawford RS et al. Restenosis after eversion vs patch closure carotid endarterectomy. J Vasc Surg. 2007; 46(1):41-48.

32. Darling RC 3rd et al. Eversion carotid endarterectomy: a technical alternative that may obviate patch closure in women. Cardiovasc Surg. 2003; 11(5):347-352.

33. Darling RC 3rd et al. Eversion endarterectomy of the internal carotid artery: technique and results in 449 procedures. Surgery. 1996; 120(4):635-639.

34. De Syo D et al. Development of carotid endarterectomy at the sestre milosrdnice university hospital, zagreb (1970-1998) - what do we have to do now. Acta Clin Croat. 1998; 37(2):48-58.

35. Deriu G and De Francesco T. Rationale for using a patch graft in carotid endarterectomy. [Razionale dell'uso del patch nell'endoarteriectomia carotidea.]. Ann Ital Chir. 1997; 68(4):473-477.

36. Ecker RD et al. Durability of carotid endarterectomy. Stroke. 2003; 34:2941-2944.  

37. Economopoulos KJ et al. Comparison of carotid endarterectomy using primary closure, patch closure, and eversion techniques. Am J Surg. 1999; 178:505-510.

ResultsCandidate studies

38. Entz L et al. Late results after eversion endarterectomy of the internal carotid artery. Magy Seb. 2001; 54:5-9.

39. Fearn SJ and McCollum CN. Shortening and reimplantation for tortuous internal carotid arteries. J Vasc Surg. 1998; 27:936-939.

40. Friedman SG. Clinical application of eversion carotid endarterectomy. Vasc Endovascular Surg. 2003; 37:239-244.

41. Garofalo M et al. Neurological complications in carotid endarterectomy. Minerva Cardioangiol. 1999; 47:121-126.

42. Gelabert HA et al. Carotid endarterectomy with primary closure does not adversely affect the rate of recurrent stenosis. Arch Surg. 1994; 129:648-654.

43. Goldman KA et al. A comparative study of saphenous vein, internal jugular vein, and knitted dacron patches for carotid artery endarterectomy. Ann Vasc Surg. 1995; 9:71-79.

44. Golledge J et al. Outcome of selective patching following carotid endarterectomy. Eur J Vasc Endovasc Surg. 1996; 11:458-463.

45. Green RM et al. Eversion endarterectomy of the carotid artery: Technical considerations and recurrent stenoses. J Vasc Surg. 2000; 32:1052-1061.

46. Green RM et al. The clinical course of residual carotid arterial disease. J Vasc Surg. 1991; 13:112-120.

47. Grego F et al. Is carotid endarterectomy in octogenarians more dangerous than in younger patients? J Cardiovasc Surg. 2005; 46(5):477-483.

48. Hagmuller GW et al. Operative management of carotid artery stenosis. Z Kardiol. 2004; 11:206-211

49. Hertzer NR and Mascha EJ. A personal experience with coronary artery bypass grafting, carotid patching, and other factors influencing the outcome of carotid endarterectomy. J Vasc Surg. 2006; 43(5):959-968.

50. Hertzer NR et al. Early outcome assessment for 2228 consecutive carotid endarterectomy procedures: the Cleveland Clinic experience from 1989 to 1995. J Vasc Surg. 1997; 26(1):1-10.

51. Hertzer NR. The hidden statistics of carotid patch angioplasty. J Vasc Surg. 1994; 19(3):555-556.

ResultsCandidate studies

52. Hugl B et al. Effect of age and gender on restenosis after carotid endarterectomy. Ann Vasc Surg. 2006; 20(5):602-608.

53. Iseli TA et al. Eversion carotid endarterectomy. ANZ J Surg. 2001; 71(10):570-573.

54. Jacobowitz GR et al. Long-term follow-up of saphenous vein, internal jugular vein, and knitted Dacron patches for carotid artery endarterectomy. Ann Vasc Surg. 2001; 15(3):281-287.

55. Janousek L et al. Comparison of eversion and standard endarterectomy of internal carotid artery. [Srovnani everzni a klasicke endarterektomie a. carotis interna]. Cesk Slov Neurol Neurochir. 2003; 66(3):203-205.

56. Jausseran JM et al. Carotid endarterectomy by the eversion method. One year arteriographical results. [Endarteriectomie carotidienne par eversion: Resultats radiologiques a un an]. J Mal Vasc. 1998; 23(1):7-12.

57. Jausseran JM et al. The advantages of perioperative arteriography in carotid surgery (POAC). Giornale Italiano di Chirurgia Vascolare. 1998; 5(2):90-95.

58. Johnson CA et al. Early recurrent carotid artery stenosis. Current Surgery. 1999; 56(7-8):420-422.

59. Johnson CA et al. The natural history of early recurrent carotid artery stenosis. Am J Surg. 1999; 177(5):433-436.

60. Jokinen JJ et al. Results and future of carotid endarterectomy in a medium-sized Finnish central hospital. Scand J Surg. 2006; 95(1):33-38.

61. Jones CE et al. Technical results from the eversion technique of carotid endarterectomy. Am Surg. 1996; 62(5):361-365.

62. Katras T et al. Durability of eversion carotid endarterectomy: comparison with primary closure and carotid patch angioplasty. J Vasc Surg. 2001; 34(3):453-458.

63. Katz SG and Kohl RD. Does the choice of material influence early morbidity in patients undergoing carotid patch angioplasty? Surgery. 1996; 119(3):297-301.

64. Kieny R et al. Evolution of carotid restenosis after endarterectomy. Cardiovasc Surg. 1994; 2(5):555-560.

65. Koskas F et al. Carotid eversion endarterectomy – short-term and long-term results. Ann Vasc Surg. 1995; 9:9-15.

ResultsCandidate studies

66. Koskas F et al. Carotid eversion endarterectomy: short- and long-term results. Ann Vasc Surg. 1995; 9(1):9-15.

67. Kresowik TF et al. Improving the outcomes of carotid endarterectomy: results of a statewide quality improvement project. J Vasc Surg. 2000; 31(5):918-926.

68. Ladowski JS et al. Factors contributing to recurrent carotid disease following carotid endarterectomy. Am J Surg. 1997; 174(2):118-120.

69. LaMuraglia GM et al. Determinants of carotid endarterectomy anatomic durability: effects of serum lipids and lipid-lowering drugs. J Vasc Surg. 2005; 41(5):762-768.

70. Littooy FN et al. Comparison of standard carotid endarterectomy with Dacron patch angioplasty versus eversion carotid endarterectomy during a 4-year period. Am Surg. 2004; 70(2):181-185.

71. Liu CJ et al. Eversion carotid endarterectomy for carotid stenosis. Zhonghua Wai Ke Za Zhi. 2005; 43:409-411.

72. Marien BJ et al. Bovine pericardium vs dacron for patch angioplasty after carotid endarterectomy: a prospective randomized study. Arch Surg. 2002; 137(7):785-788.

73. Markovic DM et al. Single-center prospective, randomized analysis of conventional and eversion carotid endarterectomy. J Cardiovasc Surg (Torino). 2008; 49(5):619-25.

74. Mazzarolo G et al. Carotid surgery in patients over the age of 80 years: Own experience. Ric Sci 2 Ser Pt 2 Rend [B]. 2001; 22:75-79.

75. Mehta M et al. Eversion technique increases the risk for post-carotid endarterectomy hypertension. J Vasc Surg. 2001; 34(5):839-845.

76. Motyka M et al. Preventive eversion endarterectomy in patients with stenosis of the carotid artery imparing cerebral hemodynamics. Chir Narzadow Ruchu Ortop Pol. 2003; 5:97-102.

77. Naylor R et al. Randomized trial of vein versus dacron patching during carotid endarterectomy: long-term results. J Vasc Surg. 2004; 39(5):985-993.

ResultsCandidate studies

78. Naylor R et al. Randomized trial of vein versus dacron patching during carotid endarterectomy: Long-term results. J Vasc Surg. 2004; 39(5):985-993.

79. Peiper C et al. Eversion endarterectomy versus open thromboendarterectomy and patch plasty for the treatment of internal carotid artery stenosis. Eur J Vasc Endovas Surg. 1999; 18(4):339-343.

80. Perler BA et al. Carotid dacron patch angioplasty: Immediate and long-term results of a prospective series. Cardiovasc Surg. 1995; 3(6):631-636.

81. Pokrovskii AV et al. Comparative analysis of carotid endarterectomy late outcomes related to intervention modality. Angiol Vasc Surg. 2005; 11(1):93-101.

82. Radak DJ et al. Temporal trends in eversion carotid endarterectomy for carotid atherosclerosis: Single-center experience with 5,034 patients. Vascular. 2007; 15(4):205-210.

83. Radak D et al. Single center experience on eversion versus standard carotid endarterectomy: A prospective non-randomized study. Cardiovasc Surg. 2000; 8(6):422-428.

84. Raithel D and Schunn C. Eversion endarterectomy - out? Zentralblatt Fur Chirurgie. 2000; 125(3):239-242.

85. Reigner B et al. Eversion endarterectomy of the internal carotid artery: Midterm results of a new technique. Ann Vascr Surg. 1995; 9(3):241-246.

86. Rockman CB et al. Primary closure of the carotid artery is associated with poorer outcomes during carotid endarterectomy. J Vasc Surg. 2005; 42(5):870-877.

87. Rosenthal D et al. Carotid patch angioplasty: immediate and long-term results. J Vasc Surg. 1990; 12(3):326-333.

88. Rush DS et al. The safety, efficacy, and durability of external carotid endarterectomy. J Vasc Surg. 1992; 16(3):407-413.

89. Schanzer et al. Restenosis after carotid endarterectomy performed with routine intraoperative duplex ultrasonography and arterial patch closure: a contemporary series. Vasc Endovascular Surg. 2007; 41(3):200-205.

ResultsCandidate studies

90. Schneider JR et al. Carotid endarterectomy in women versus men: patient characteristics and outcomes. J Vasc Surg. 1997; 25(5):890-898.

91. Seelig MH et al. Use of intraoperative duplex ultrasonography and routine patch angioplasty in patients undergoing carotid endarterectomy. Mayo Clin Proc. 1999; 74(9):870-876.

92. Shah DM et al. Carotid endarterectomy by eversion technique. Adv Surg. 1999; 33:459-476.

93. Shah DM et al. Carotid endarterectomy by eversion technique: Its safety and durability. Ann Surg. 1998; 228(4):471-478.

94. Skelly CL et al. Routine early postoperative duplex scanning is unnecessary following uncomplicated carotid endarterectomy. Vasc Endovascular Surg. 2002; 36(2):115-122.

95. Szabo A et al. Long-term restenosis rate of eversion endarterectomy on the internal carotid artery. Eur J Vasc Endovasc Surg. 2004; 27(5):537-539.

96. Szabó A et al. Early rise in serum VEGF and PDGF levels predisposes patients with a normal MBL2 genotype to restenosis after eversion endarterectomy. Stroke. 2007; 38(8):2247-2253.

97. Thompson JM et al. Hemodynamics and anatomy after carotid endarterectomy: A comparison between two different surgical approaches. J Vasc Technol. 1998; 22(2):89-94.

98. Verhoeven BAet al. Closure of the arteriotomy after carotid endarterectomy: patch type is related to intraoperative microemboli and restenosis rate. J Vasc Surg. 2005 Dec;42(6):1082-1088.

99. Winkler GA et al.  Comparison of intraoperative completion flowmeter versus duplex ultrasonography and contrast arteriography for carotid endarterectomy. Vasc Endovascular Surg. 2006; 40(6):482-486.

100. Ziaja K et al. Treatment of critical stenosis of internal carotid artery in octogenarians. Chirurgia Polska. 2006; 8(1):27-32.

ResultsCandidate studies

Project Schedule and Gantt Chart

Future Work Plan

Data Collection and Statistical Analysis

Future Work Plan

• descriptive data number of patients subject to the procedure of interest age of patient presence of neurological symptoms

• methodologic datarandomized intervention

• outcome data death stroketransient ischemic attackdegree of stenosis

Statistical Analysis

References

1. Heberer G et al. “Enfermedades oclusivas crónicas de las arterias: Arteria carótida interna”. Enfermedades de la aorta y de las grandes arterias. Barcelona: Editorial Científico-Médica. 1970; 316-324.

2. DeBakey ME et al. Surgical considerations of occlusive disease of innominate, carotid, subclavian and vertebral arteries. Ann Surg 1959; 149:690-710.

3. Sumner DS. “Essential Hemodynamic Principles – Chapter 7”. Vascular Surgery [edited by] Robert B. Rutherford – 5th edition. Volume 1. Pennsylvania: W.B. Saunders Company. 2000; 78-79.

4. Hallett JW et al. “Cerebrovascular Disease – Chapter 11”. Handbook of Patient Care in Vascular Diseases – 4th Edition. Philadelphia: Lippincott Williams & Wilkins. 2001; 131-136.

5. Manuila L et al. Dicionário Médico. Lisboa: Climepsi Editores. 1999.6. Hobson RW et al. Management of atherosclerotic carotid artery disease: Clinical practice guidelines of the

Society for Vascular Surgery. J Vasc Surg 2008; 48:480-486.7. Messina LM and Stoney RJ. “Endarterectomy – Chapter 31”. Vascular Surgery [edited by] Robert B.

Rutherford – 5th edition. Volume 1. Pennsylvania: W.B. Saunders Company 2000; 488-493.8. Zarins CK and Gewertz BL. “Carotid artery surgery – Section I”. Atlas of Vascular Surgery – 2nd edition.

Philadelphia: Elsevier. 2005; 3-13.9. Byrne J et al. Primary closure, routine patching, and eversion endarterectomy: what is the current state of

the literature supporting use of these techniques? Semin Vasc Surg 2007; 20:226-235.

References

10. Cao P et al. A randomized study on eversion versus standard carotid endarterectomy: study design and preliminary results: the Everest Trial. J Vasc Surg 1998; 27:595-605.

11. Senning A. Developments in cardiac surgery in Stockholm during the mid and late 1950s. J Thorac Cardiovasc Surg 1989; 98:825-832.

12. Entz L et al. Comparison of perioperative results obtained with carotid eversion endarterectomy and with conventional patch plasty. Cardiovasc Surg 1997; 5:16-20.

13. Aburahma AF. Patch closure improves results with carotid endarterectomy. Semin Vasc Surg 2004; 17:243-252.

14. Aburahma AF et al. Prospective randomized trial of ACUSEAL (Gore-Tex) vs Finesse (Hemashield) patching during carotid endarterectomy: Long-term outcome. J Vasc Surg 2008; 48:99-103.

15. Ballotta E et al. Carotid endarterectomy with patch closure versus carotid eversion endarterectomy and reimplantation: a prospective randomized study. Surgery 1999; 125:271-279.

16. Crawford RS et al. Restenosis after eversion vs patch closure carotid endarterectomy. J Vasc Surg 2007; 46:41-48.

17. Cao P et al. Eversion versus conventional carotid endarterectomy: late results of a prospective multicenter randomized trial. J Vasc Surg 2000; 31:19-30.