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This book addresses multiple principles of carotid endarterectomy in terms of cervical anatomy, surgical techniques, practical cases and frequent questions stemming from clinical practice. Carotid endarterectomy (CEA) is an effective way to the treatment of carotid artery stenosis, which significantly reduce the risk of stroke. This book covers the key concepts and common question in CEA. It is a practical book focusing on basic surgical technical techniques, but not covers controversial issues.
Highly illustrated text to aid understanding of best practice in carotid treatment Reflects international best practice Useful in clinical practice and to improve patient care
Assuming little prior knowledge, contributors from the US and UK describe the basic principles, operative technique, patient selection and diagnosis of the procedure that has been shown to significantly reduce the risk of a stroke. Topics of the ten chapters include the pathology of carotid plaque; clinical presentation and natural history; computed imaging and contrast angiography; timing of surgery; anaesthesia; shunting and patching; and post-operative surveillance and re-stenosis. Annotation copyrighted by Book News, Inc., Portland, OR
In the management of vascular disease, there has been an inexorable drive towards less invasive endovascular treatment options. Endovascular treatment of carotid stenosis for stroke is no exception. Several sizeable multicentre trials are running concurrently, which are comparing carotid endarterectomy (CEA), the "gold standard," with the less invasive alternative, carotid stenting (CAS) for low-risk patients with symptomatic carotid stenoses who are considered to be surgical candidates. The endovascular option is in itself a newcomer but state-of-the-art CAS with regards use of all the available technical refinements, to include low-profile monorail dedicated systems with contemporary pharmacological support, is perhaps all but five years old. There is considerable interest from clinicians from a variety of clinical backgrounds and from industry in this technique and, therefore, scope for a contemporary practical guide.
The efficiency of carotid surgery on an asymptomatic carotid artery stenosis and its superiority to conservative treatment was clearly demonstrated in the ACAS study. The stroke risk over a five year follow-up period could be reduced by 55 % and the combined stroke and mortality rate was shown to be a mere 2. 3 %. The efficacy of surgical treatment in also reducing stroke rates in the case of a symptomatic carotid stenosis was proven in the NASCET and ECTS prospective randomized studies. Of extreme importance in these procedures is, however, precise quality control and quality assessment. This is presently a topic of tremendous interest in reconstructive vascular surgery and is constantly being discussed in specialist circles and beyond. Documentation and the possibility of accurate reconstruction of the intraoperative situation are in high demand. Perioperative monitoring of neurological function, particularly the monitoring during carotid surgery, are the aspects underlying constant revision and reassessment to ensure quality control and assurance of a negligeable mortality and morbidity rate. The aim of this book is to discuss the presently available perioperative control methods, examinations, and quality assessments, and the critical consideration of these. We would like to express our thanks to all authors who helped achieve the sense and aim of this book. A special word of thanks to Dr. Kerstin Simons (assistant surgeon) for assisting in the editing of the numerous presentations in this book. Particularly we thank Dr.
The decision for general anesthesia (GA) vs regional anesthesia (RA) for staged carotid endarterectomy (CEA) is an ongoing debate. Should be done on an individual basis.
Since major prospective randomized multicenter studies (NASCET, ECST, ACAS) have assured the significant effect of the carotid reconstruction on stroke prevention, the main interest in carotid surgery focuses on modern radiologic procedures, new aspects in surgical technique, and perioperative region, paricularly of the carotid artery is, therefore, also best treated in an interdisciplinary way involving the neurologist, angioradiologist, and vascular surgeon. These current themes need to be discussed and constantly revised with new developing aspects.