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#28291675   2017/03/14 Save this To Up

Choices of Stent and Cerebral Protection in the Ongoing ACST-2 Trial: A Descriptive Study.

Several plaque and lesion characteristics have been associated with an increased risk for procedural stroke during or shortly after carotid artery stenting (CAS). While technical advancements in stent design and cerebral protection devices (CPD) may help reduce the procedural stroke risk, and anatomy remains important, tailoring stenting procedures according to plaque and lesion characteristics might be a useful strategy in reducing stroke associated with CAS. In this descriptive report of the ongoing Asymptomatic Carotid Surgery Trial-2 (ACST-2), it was assessed whether choice for stent and use or type of CPD was influenced by plaque and lesion characteristics.

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#28234614   2017/02/24 Save this To Up

The use of computer-assisted surgery as an educational tool for the training of orthopedic surgery residents in pedicle screw placement: a pilot study and survey among orthopedic residents.

The training of orthopedic residents in adequate pedicle screw placement is very important. We sought to investigate orthopedic residents' perspectives on the use of computer-assisted surgery (CAS) in a training trial.

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#28124515   2017/01/26 Save this To Up

Anatomic criteria determining high-risk carotid surgery patients.

Based on randomized trials, carotid endarterectomy (CEA) is the standard procedure for patients with a 50-99% symptomatic carotid stenosis and carefully selected patients with an asymptomatic high-grade carotid stenosis. Carotid artery stenting (CAS) is a technical alternative for patients with a high surgical risk or difficult anatomic conditions (e.g., recurrent stenosis). This study aims to provide an overview of anatomic factors associated with a higher risk of CEA complications.

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#27085660   2016/05/31 Save this To Up

SPACE-2: A Missed Opportunity to Compare Carotid Endarterectomy, Carotid Stenting, and Best Medical Treatment in Patients with Asymptomatic Carotid Stenoses.

Because of recent advances in best medical treatment (BMT), it is currently unclear whether any additional surgical or endovascular interventions confer additional benefit, in terms of preventing late ipsilateral carotid territory ischemic stroke in asymptomatic patients with significant carotid stenoses. The aim was to compare the stroke-preventive effects of BMT alone, with that of BMT in combination with carotid endarterectomy (CEA) or carotid artery stenting (CAS) in patients with high grade asymptomatic extracranial carotid artery stenosis.

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#26710804   2015/12/29 Save this To Up

[Clinical analysis of carotid angioplasty stenting for high-grade extracranial carotid artery stenosis combined with severe tortuosity].

To observe the feasibility and safety of carotid angioplasty stenting (CAS) for high-grade extracranial carotid artery stenosis combined with severe tortuosity.

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#23953786   2013/10/21 Save this To Up

Results of carotid angioplasty and stenting are equivalent for critical versus high-grade lesions in patients deemed high risk for carotid endarterectomy.

To examine outcomes of carotid angioplasty and stenting (CAS) in patients with critical carotid stenosis who are deemed high risk for carotid endarterectomy.

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#23634265   2013/05/01 Save this To Up

Risk factors for developing large emboli following carotid artery stenting.

The introduction and development of the embolic protecting device (EPD) has resulted in a decreased rate of stroke after carotid artery stenting (CAS). The authors performed a retrospective study to investigate the risk factors for developing large emboli after CAS which can lead to ischemic events.

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#22466016   2013/01/03 Save this To Up

Complications in endonasal sinus surgery: a 5-year retrospective study of 2,596 patients.

Recent developments should have aided to reduce postoperative complications of endoscopic sinonasal surgery: Computerised tomography (CT) and magnetic resonance imaging (MRI) allow a more precise preoperative view of the anatomic situation and possible variations. The Lund-MacKay-Index provides a tool to assess the extent of the disease, and by introducing microscopic-endonasal and computer-assisted sinunasal surgery (CAS) as well as providing the corresponding training technical progress has been made. We analysed the data of 2,596 patients with acute or chronic rhinosinusitis who underwent surgery between 2000 and 2005 using the procedure of Stammberger. We saw 3.1 % minor complications (minor bleedings, perforation of the lamina papyracea), 0.9 % major complications (severe bleedings, cerebrospinal fluid (CSF) leaks, lesion of the ductus lacrimalis), and one (0.04 %) serious complication (meningitis). When we compared these figures with those of reports from the late 90 s by correlating opacification, type of operation, the surgeon's experience and employing CAS with the outcome we did not find a distinct improvement in the rate of postoperative complications. Serious complications and those resulting in permanent harm such as carotid artery injury, cerebral deficit or death have, however, become very rare. A grading into I (minor), II (major) and III (serious) complications is proposed, to point out this critical grade-III proportion, which should not exceed 0.1 %.

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#21889701   2011/09/05 Save this To Up

Updated Society for Vascular Surgery guidelines for management of extracranial carotid disease.

Management of carotid bifurcation stenosis is a cornerstone of stroke prevention and has been the subject of extensive clinical investigation, including multiple controlled randomized trials. The appropriate treatment of patients with carotid bifurcation disease is of major interest to the community of vascular surgeons. In 2008, the Society for Vascular Surgery published guidelines for treatment of carotid artery disease. At the time, only one randomized trial, comparing carotid endarterectomy (CEA) and carotid stenting (CAS), had been published. Since that publication, four major randomized trials comparing CEA and CAS have been published, and the role of medical management has been re-emphasized. The current publication updates and expands the 2008 guidelines with specific emphasis on six areas: imaging in identification and characterization of carotid stenosis, medical therapy (as stand-alone management and also in conjunction with intervention in patients with carotid bifurcation stenosis), risk stratification to select patients for appropriate interventional management (CEA or CAS), technical standards for performing CEA and CAS, the relative roles of CEA and CAS, and management of unusual conditions associated with extracranial carotid pathology. Recommendations are made using the GRADE (Grades of Recommendation Assessment, Development and Evaluation) system, as has been done with other Society for Vascular Surgery guideline documents.[corrected] The perioperative risk of stroke and death in asymptomatic patients must be <3% to ensure benefit for the patient. CAS should be reserved for symptomatic patients with stenosis of 50% to 99% at high risk for CEA for anatomic or medical reasons. CAS is not recommended for asymptomatic patients at this time. Asymptomatic patients at high risk for intervention or with <3 years life expectancy should be considered for medical management as the first-line therapy.

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#21646237   2011/10/10 Save this To Up

Carotid tortuosity in patients with prior cervical radiation: increased technical challenge during carotid stenting.

Anatomic distortion associated with radiation-induced tissue changes may pose challenges for patients with prior cervical irradiation undergoing carotid stenting. We sought to evaluate the effect of these changes on carotid intervention.

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