Carotid endarterectomy: guidelines versus real-world practice

Detalhes bibliográficos
Autor(a) principal: Teixeira,Gabriela
Data de Publicação: 2019
Outros Autores: Pinto,Pedro Sá, Silva,Ivone, Gonçalves,João, Teixeira,Sérgio, Rego,Duarte, Ferreira,Vítor, Antunes,Inês, Veiga,Carlos, Mendes,Daniel, Teles,Paulo, Matos,Arlindo, Almeida,Rui
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-706X2019000200001
Resumo: Introduction: A number of guidelines for the management of carotid disease are available to help clinicians in therapeutic decision and provide useful guidance for the best care of the patients. They stated that carotid endarterectomy (CEA) has some benefit in symptomatic patients with carotid stenosis of 50-69% and is highly beneficial in stenosis of 70-99%, with mortality/ stroke rate less than 6%. The maximum benefit is observed when surgery is performed within two weeks after the cerebrovascular event. CEA in asymptomatic patients should be offered to patients with life expectancy higher than 5 years, stenosis of &gt;70%, and perioperative complications should be less than 3%. The aim of this study is to analyse our clinical practice, review treated patients and referral times and compare the outcomes of our institutional practice with published guidelines. Materials and Methods: Retrospective study of patients undergoing carotid endarterectomy at Centro Hospitalar Universitário do Porto between 2010 and 2015. Results: Between 2010 and 2015, 404 patients underwent CEA, 76% men, and mean age 69 years for both sexes. The degree of stenosis was usually evaluated by ultrasound. The use of complementary study with angio-CT was required in 20% and angiography in 2.2% of the cases. The majority of patients (54.2%) were symptomatic (stroke/ TIA <6 months). In patients with a cerebrovascular event diagnosed at our institution, the time to surgery was 10 days (median). All CEA were performed under general anaesthesia and for arterial closure, a Dacronpatch was systematically used. Shunt was used in 4.6% of cases (n=18). The mean surgery time was 101 minutes and the mean clamping time was 40 minutes. Reversal of antioagulation with protamine was performed in 48.3% patients. Morbimortality: 9 post-operative sequelae events (major stroke), 8 minimal / transient deficit (minor stroke) and 4 deaths. In symptomatic patients (n = 219), the rate of postoperative major stroke was 3.6%. In asymptomatic patients (n = 185), a major and a minor stroke was observed (1.1%). Other complications: haematoma 5.9% (n=24); infection 0.2% (n=1); peripheral nerve dysfunction 8.7% (n=35); false aneurysm 0.5% (n=2). Conclusions: Our results are within the reference values. This study allowed us to know our reality, our ability to give an effective answer for our patients, and to serve as a basis for improving ways of acting.
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spelling Carotid endarterectomy: guidelines versus real-world practiceCarotid disease guidelinesCarotid disease symptomatic and asymptomaticCarotid endarterectomyComplicationsIntroduction: A number of guidelines for the management of carotid disease are available to help clinicians in therapeutic decision and provide useful guidance for the best care of the patients. They stated that carotid endarterectomy (CEA) has some benefit in symptomatic patients with carotid stenosis of 50-69% and is highly beneficial in stenosis of 70-99%, with mortality/ stroke rate less than 6%. The maximum benefit is observed when surgery is performed within two weeks after the cerebrovascular event. CEA in asymptomatic patients should be offered to patients with life expectancy higher than 5 years, stenosis of &gt;70%, and perioperative complications should be less than 3%. The aim of this study is to analyse our clinical practice, review treated patients and referral times and compare the outcomes of our institutional practice with published guidelines. Materials and Methods: Retrospective study of patients undergoing carotid endarterectomy at Centro Hospitalar Universitário do Porto between 2010 and 2015. Results: Between 2010 and 2015, 404 patients underwent CEA, 76% men, and mean age 69 years for both sexes. The degree of stenosis was usually evaluated by ultrasound. The use of complementary study with angio-CT was required in 20% and angiography in 2.2% of the cases. The majority of patients (54.2%) were symptomatic (stroke/ TIA <6 months). In patients with a cerebrovascular event diagnosed at our institution, the time to surgery was 10 days (median). All CEA were performed under general anaesthesia and for arterial closure, a Dacronpatch was systematically used. Shunt was used in 4.6% of cases (n=18). The mean surgery time was 101 minutes and the mean clamping time was 40 minutes. Reversal of antioagulation with protamine was performed in 48.3% patients. Morbimortality: 9 post-operative sequelae events (major stroke), 8 minimal / transient deficit (minor stroke) and 4 deaths. In symptomatic patients (n = 219), the rate of postoperative major stroke was 3.6%. In asymptomatic patients (n = 185), a major and a minor stroke was observed (1.1%). Other complications: haematoma 5.9% (n=24); infection 0.2% (n=1); peripheral nerve dysfunction 8.7% (n=35); false aneurysm 0.5% (n=2). Conclusions: Our results are within the reference values. This study allowed us to know our reality, our ability to give an effective answer for our patients, and to serve as a basis for improving ways of acting.Sociedade Portuguesa de Angiologia e Cirurgia Vascular2019-06-01info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articletext/htmlhttp://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-706X2019000200001Angiologia e Cirurgia Vascular v.15 n.2 2019reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPenghttp://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-706X2019000200001Teixeira,GabrielaPinto,Pedro SáSilva,IvoneGonçalves,JoãoTeixeira,SérgioRego,DuarteFerreira,VítorAntunes,InêsVeiga,CarlosMendes,DanielTeles,PauloMatos,ArlindoAlmeida,Ruiinfo:eu-repo/semantics/openAccess2024-02-06T17:22:54Zoai:scielo:S1646-706X2019000200001Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-20T02:29:23.972140Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv Carotid endarterectomy: guidelines versus real-world practice
title Carotid endarterectomy: guidelines versus real-world practice
spellingShingle Carotid endarterectomy: guidelines versus real-world practice
Teixeira,Gabriela
Carotid disease guidelines
Carotid disease symptomatic and asymptomatic
Carotid endarterectomy
Complications
title_short Carotid endarterectomy: guidelines versus real-world practice
title_full Carotid endarterectomy: guidelines versus real-world practice
title_fullStr Carotid endarterectomy: guidelines versus real-world practice
title_full_unstemmed Carotid endarterectomy: guidelines versus real-world practice
title_sort Carotid endarterectomy: guidelines versus real-world practice
author Teixeira,Gabriela
author_facet Teixeira,Gabriela
Pinto,Pedro Sá
Silva,Ivone
Gonçalves,João
Teixeira,Sérgio
Rego,Duarte
Ferreira,Vítor
Antunes,Inês
Veiga,Carlos
Mendes,Daniel
Teles,Paulo
Matos,Arlindo
Almeida,Rui
author_role author
author2 Pinto,Pedro Sá
Silva,Ivone
Gonçalves,João
Teixeira,Sérgio
Rego,Duarte
Ferreira,Vítor
Antunes,Inês
Veiga,Carlos
Mendes,Daniel
Teles,Paulo
Matos,Arlindo
Almeida,Rui
author2_role author
author
author
author
author
author
author
author
author
author
author
author
dc.contributor.author.fl_str_mv Teixeira,Gabriela
Pinto,Pedro Sá
Silva,Ivone
Gonçalves,João
Teixeira,Sérgio
Rego,Duarte
Ferreira,Vítor
Antunes,Inês
Veiga,Carlos
Mendes,Daniel
Teles,Paulo
Matos,Arlindo
Almeida,Rui
dc.subject.por.fl_str_mv Carotid disease guidelines
Carotid disease symptomatic and asymptomatic
Carotid endarterectomy
Complications
topic Carotid disease guidelines
Carotid disease symptomatic and asymptomatic
Carotid endarterectomy
Complications
description Introduction: A number of guidelines for the management of carotid disease are available to help clinicians in therapeutic decision and provide useful guidance for the best care of the patients. They stated that carotid endarterectomy (CEA) has some benefit in symptomatic patients with carotid stenosis of 50-69% and is highly beneficial in stenosis of 70-99%, with mortality/ stroke rate less than 6%. The maximum benefit is observed when surgery is performed within two weeks after the cerebrovascular event. CEA in asymptomatic patients should be offered to patients with life expectancy higher than 5 years, stenosis of &gt;70%, and perioperative complications should be less than 3%. The aim of this study is to analyse our clinical practice, review treated patients and referral times and compare the outcomes of our institutional practice with published guidelines. Materials and Methods: Retrospective study of patients undergoing carotid endarterectomy at Centro Hospitalar Universitário do Porto between 2010 and 2015. Results: Between 2010 and 2015, 404 patients underwent CEA, 76% men, and mean age 69 years for both sexes. The degree of stenosis was usually evaluated by ultrasound. The use of complementary study with angio-CT was required in 20% and angiography in 2.2% of the cases. The majority of patients (54.2%) were symptomatic (stroke/ TIA <6 months). In patients with a cerebrovascular event diagnosed at our institution, the time to surgery was 10 days (median). All CEA were performed under general anaesthesia and for arterial closure, a Dacronpatch was systematically used. Shunt was used in 4.6% of cases (n=18). The mean surgery time was 101 minutes and the mean clamping time was 40 minutes. Reversal of antioagulation with protamine was performed in 48.3% patients. Morbimortality: 9 post-operative sequelae events (major stroke), 8 minimal / transient deficit (minor stroke) and 4 deaths. In symptomatic patients (n = 219), the rate of postoperative major stroke was 3.6%. In asymptomatic patients (n = 185), a major and a minor stroke was observed (1.1%). Other complications: haematoma 5.9% (n=24); infection 0.2% (n=1); peripheral nerve dysfunction 8.7% (n=35); false aneurysm 0.5% (n=2). Conclusions: Our results are within the reference values. This study allowed us to know our reality, our ability to give an effective answer for our patients, and to serve as a basis for improving ways of acting.
publishDate 2019
dc.date.none.fl_str_mv 2019-06-01
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
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dc.identifier.uri.fl_str_mv http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-706X2019000200001
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dc.language.iso.fl_str_mv eng
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dc.publisher.none.fl_str_mv Sociedade Portuguesa de Angiologia e Cirurgia Vascular
publisher.none.fl_str_mv Sociedade Portuguesa de Angiologia e Cirurgia Vascular
dc.source.none.fl_str_mv Angiologia e Cirurgia Vascular v.15 n.2 2019
reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
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instname_str Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
instacron_str RCAAP
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reponame_str Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
collection Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
repository.name.fl_str_mv Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
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