Carotid Atherosclerosis

Carotid atherosclerosis plays a striking role in the development of ischemic stroke that is the third leading cause of death, and one of the main causes of disability, in western countries. Atherosclerosis, a chronic and progressive disease of the arterial wall which is preferentially located at the carotid bifurcation and extending into the Internal Carotid Artery (ICA), is complicated by in situ plaque thrombosis and downstream embolism-dependent cerebral ischemia. Treatment of carotid atherosclerosis is based on surgical endarterectomy and endovascular procedures, including transluminal balloon angioplasty or stenting. Carotid endarterectomy is one of the most common non-cardiac vascular operations performed in western countries and is an effective and relatively safe procedure for the treatment of atherosclerotic disease involving carotid bifurcation. The goal of endarterectomy is to remove an obstructing or embolic lesion and reconstruct a durable arterial segment free of flow abnormality. Techniques used for carotid endarterectomy (CEA) include primary closure (PC), patch reconstruction (PR), and eversion (EV). PC and PR employ a longitudinal arteriotomy up the internal carotid artery; EV technique involves the oblique transection of the internal carotid artery at its origin in the carotid bulb, followed by removal of the plaque using the eversion maneuver. A number of studies have shown a decreased incidence of restenosis with patching, as compared to primary closure. AbuRahma et al. randomized a total of 339 CEA into five type of surgery - including primary closure, vein patch, saphenous patch and synthetic patch – and analyzed the long term clinical outcome and the incidence of restenosis. Patch closures resulted associated with a lower rate of perioperative stroke, and were superior in lowering the incidence of restenosis. Naylor et al. enrolled 276 patients who were randomly allocated to vein or thin-walled Dacron patch closure. Patch type had no influence on risk of ipsilateral stroke at 3 years, but Dacron patches were associated with a significantly higher incidence of recurrent restenosis after 3 years of follow up, with most occurring trough 6 to 12 months. A Cochrane systematic review of seven trials including 1127 patients, undergoing 1307 operations, assessed the safety and efficacy of patch angioplasty compared to primary closure. The authors concluded that carotid patch angioplasty, either with a vein or a synthetic patch may reduce the risk of carotid artery restenosis and subsequent ischemic stroke when compared to CEA with PC. It should be taken into account that patch is associated with a higher risk of rupture, infection, or pseudoaneurysm formation. OMICS Group International is an open access online publishing group which has 700+ peer-reviewed journals, organizes 3000+ International Scientific Conferences per year, have around 50,000+ editorial board members and 1000+ Scientific associations. Medical Journals provide a platform for outstanding research around the globe in the field of medicine. These scholarly journals aim to contribute to the progress and application of scientific discoveries, by providing free access to the research information. The published work reaches the general public and the scientific community immediately after publication, thus providing higher citation rates for the author. Medical Journals are supported by 5000 internationally renowned editorial board members and a high quality review board. Medical Journals use online Editorial Manager System for quick and high quality review process. Articles of Medical journals are subjected to peer reviewing and these are included in the standard indexing databases like ISI, Scopus, EBSCO, CAS, HINARI etc. All the articles published in Medical journals are permanently archived in respective peer reviewed journals thus providing unrestricted utilization and requisition of the scientific information.

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Last date updated on September, 2024