颈动脉狭窄的显微外科治疗

目的:评价颈动脉内膜剥脱术治疗颅外颈动脉狭窄的疗效,以及经颅多普勒超声(TCD)、微血管多普勒超声(MVD)应用的价值。方法:回顾性分析2012年5月至2013年5月采用颈动脉内膜剥脱术治疗的19例颅外颈动脉狭窄的资料。均伴有不同程度的脑缺血症状。颈动脉狭窄程度2例中度狭窄,17例重度狭窄。同时行颈动脉内膜剥脱术均在显微镜下操作。1例采用补片成形。18例术中采用TCD及MVD监测下完成,1例未采用超声监测。结果:手术成功率为100%,无死亡率。术前脑缺血症状术后患者均有不同程度的恢复。均未发现过度灌注的并发症。结论:颈动脉内膜剥脱术治疗颅外颈动脉狭窄是一种安全、有效的措施;MVD及TCD监测对于显微手术有着重要意义。     

乌司他丁可减轻全麻颈动脉内膜剥脱术患者的脑缺血/再灌注损伤

本研究拟观察乌司他丁减轻全身麻醉下,行颈动脉内膜剥脱术(CEA)的患者脑缺血再灌注损伤的有效性.将40例有症状的重度颈动脉狭窄,于全身麻醉下行单侧标准颈动脉内膜剥脱术的患者随机分为干预组与非干预组,每组20例.干预组在麻醉诱导前经静脉给予乌司他丁5×105 U,非干预组用等量生理盐水.分别于麻醉诱导后、颈动脉夹闭15 min、颈动脉开放15 min,以及术后第1,2,3天抽取患侧颈内静脉球部血液进行肿瘤坏子因子α(TNF-α)、丙二醛(MDA)检测;分别于麻醉诱导后、颈动脉夹闭15 min及开放15 min做动脉及颈内静脉球部血气分析;分别于麻醉诱导后及术后第1,2,3天抽取颈内静脉球部血液进行神经元特异性烯醇化酶(NSE)检测.干预组各时间点的TNF-α浓度均低于非干预组(P0.05),动脉-颈内静脉氧含量差值在颈动脉开放15 min时高于非干预组(P0.05),术后重症监护室驻留时间较非干预组降低38.7%((27.1α15.7)h vs.(44.1α29.6 h),P0.05).两组患者各时间点颈内静脉球部MDA和NSE含量无显著差异(P0.05).预防性给予乌司他丁能够减轻全麻CEA患者术中脑缺血/再灌注损伤性炎性反应,提高脑氧代谢能力,改善术后转归.     

血管内介入治疗颈动脉、椎动脉狭窄的临床疗效和安全性

目的:研究血管内介入治疗颈动脉、椎动脉狭窄的临床疗效和安全性。方法:选择2011年3月~2016年3月在我院进行诊治的210例颈动脉和椎动脉狭窄患者狭窄程度在70%~99%之间,颈、椎动脉直径狭窄率超过70%,所有患者均进行了血管内介入治疗,观察患者的临床表现、DSA和血管超声检查结果和围手术期并发症,并进行随访。结果:经颈部血管听诊发现,有163例(77.62%)患者出现血管杂音,合并高血压103例(49.05%)、高脂血症123例(58.57%)、吸烟76例(36.19%)、糖尿病98例(46.67%)、高同型半胱氨酸血症13例(6.19%);DSA检查发现有126例患者为单纯颅外段颈动脉狭窄,51例患者为单纯椎动脉起始部狭窄,22例患者为颅外段颈动脉合并椎动脉狭窄;术后的颈、椎动脉平均狭窄率为(4.15±7.26)%,明显低于术前的(79.25±6.34)%(P0.05);所有患者均未出现严重神经系统并发症和手术期死亡;术后随访8~36个月,均未出现与支架相关的短暂性脑缺血和新发脑梗死。结论:血管内介入治疗颈动脉、椎动脉狭窄安全有效,具有较高的临床应用价值。     

彩色多普勒超声检查评估老年退行性心脏瓣膜病与颈动脉粥样硬化的相关性研究

目的:应用彩色多普勒超声评估老年退行性心脏瓣膜病(SDHVD)与颈动脉粥样硬化相关性。方法:选择2016年5月-2018年7月中国医科大学航空总医院收治的老年SDHVD患者240例作为观察组,根据心瓣膜钙化程度分级标准将所有患者分为1级组61例、2级组84例以及3级组95例。另取同期于我院住院治疗的非SDHVD患者100例作为对照组。所有患者均接受彩色多普勒超声检查,比较观察组与对照组患者的基础疾病合并情况,对比不同组别患者颈动脉内膜中层厚度(IMT)、颈动脉斑块积分以及颈动脉管腔狭窄程度情况,分析SDHVD与颈动脉粥样硬化相关性。结果:观察组冠心病、糖尿病、高血压以及高脂血症发生率分别为47.08%、50.42%、93.75%、81.67%,均分别高于对照组的24.00%、29.00%、68.00%、52.00%(P0.05)。对照组、1级组、2级组、3级组的IMT以及颈动脉斑块积分比较存在统计学差异,且随着心瓣膜钙化程度分级的逐渐提高,IMT以及颈动脉斑块积分呈逐渐上升趋势(P0.05)。随着心瓣膜钙化程度分级的逐渐升高,颈动脉管腔狭窄程度在50%-70%以及71%-99%中的发生率呈逐渐升高趋势(P0.05)。经Pearson相关性分析显示:SDHVD严重程度与IMT、颈动脉斑块积分以及颈动脉管腔狭窄程度均呈正相关(P0.05)。结论:彩色多普勒超声检查可有效评估SDHVD与颈动脉粥样硬化的严重程度,且SDHVD患者多并发基础疾病,临床应积极预防。     

Hcy, hs-CRP与急性脑梗死患者颈动脉粥样硬化关系的研究

目的:探讨急性脑梗死患者血清同型半胱氨酸(Hcy)、超敏C反应蛋白(hs-CRP)与颈动脉粥样硬化的相关性及临床意义。方法:收集确诊为急性脑梗死患者90例,对患者进行颈动脉超声检查,根据颈动脉狭窄程度将患者分成颈动脉内膜正常组、轻度狭窄组、中-重度狭窄组。比较三组患者斑块检出率、Hcy、hs-CRP水平和IMT厚度,同时对Hcy、hs-CRP与IMT进行相关性分析。结果:中-重度狭窄组斑块检出率为86.4%,显著高于轻度狭窄组和颈动脉内膜正常组(P0.05);颈动脉内膜正常组Hcy、hs-CRP水平以及IMT厚度均显著低于颈动脉轻度狭窄组、中-重度狭窄组(P0.05);hs-CRP与IMT呈正相关(r=0.71,P0.05);Hcy与IMT呈正相关(r=0.79,P0.05)。结论:血清Hcy和hs-CRP水平与颈动脉粥样硬化程度密切相关,Hcy、hs-CRP联合检测对急性脑梗死的早期诊断和预后有着重要临床意义。     

CAS和CEA治疗颈内动脉重度狭窄疗效及对脑血流量、血清miR-145、IGF1R的影响

目的:探讨颈动脉支架植入术(CAS)和颈动脉内膜剥脱术(CEA)治疗颈内动脉重度狭窄疗效及对脑血流量、血清miR-145、胰岛素样生长因子1受体(IGF1R)的影响。方法:回顾性分析2018年1月至2019年12月我院收治的100例颈动脉重度狭窄患者的临床资料,按照手术方式不同分为A组和B组,每组50例,A组给予CAS治疗,B组给予CEA治疗。比较两组围术期情况、脑血流量、血清miR-145、IGF1R、简易精神状态检查表(MMSE)量表、蒙特利尔认知评估量表(MoCA)的变化,并比较术后并发症、再狭窄率及死亡率。结果:两组患者手术时间、术中失血量、术后机械通气时间、ICU停留时间、住院时间比较,差异无统计学意义(P>0.05);术后3个月时,两组脑血流量指标相对达峰时间(rTTP)、相对平均通过时间(rMTT)、相对脑血容量(rCBV)、相对脑血流量(rCBE)、血清miR-145、IGF1R、MMSE量表、MoCA量表评分比较差异均无统计学意义(P>0.05);术后30 d内,两组心动过缓、心肌酶谱升高、高灌注综合征、局部血肿、颈动脉急性闭塞比较差异无统计学意义(P>0.05),A组脑卒中、低血压发生率明显高于B组,B组高血压发生率明显高于A组(P<0.05);术后1年时,两组患者死亡率、再狭窄率比较差异无统计学意义(P>0.05)。结论:CAS和CEA治疗颈内动脉重度狭窄患者的疗效相似,均可有效改善脑血流量,调节血清miR-145、IGF1R水平的表达,促进认知功能恢复,但CAS术后脑卒中、低血压发生率更高,CEA术后高血压发生率更高。     

经颅多普勒超声对脑梗死患者颅内动脉狭窄中的诊断价值研究

目的:研究经颅多普勒超声(TCD)对脑梗死患者颅内动脉狭窄中的诊断价值。方法:选择2014年10月至2016年10月新疆心脑血管病医院神经内科收治的急性脑梗死患者、短暂性脑缺血发作患者及后循环缺血发作患者共140例作为研究对象,对所有患者进行CT血管造影(CTA)及TCD检测。以CTA检查结果为金标准,对比两组颅内动脉狭窄的检测结果,分析TCD的诊断价值以及TCD对双侧大脑的中动脉(MCA)狭窄程度的诊断结果。结果:CTA诊断结果显示140例患者总共检出105例有颅内动脉狭窄,在1155条颅内段的前、后循环血管内,经CTA检测显示狭窄血管249条,TCD检测显示狭窄血管236条。与CTA相比,TCD对患者的诊断一致性较好(Kappa值0.75)。其中TCD对MCA的诊断敏感度和阳性预测值最高,分别为91.26%和93.07%,一致性最好(Kappa值=0.917)。210条MCA血管经CTA诊断结果显示狭窄103条,其中轻度狭窄17条,中度狭窄41条,重度狭窄45条,TCD诊断结果显示狭窄101条,其中轻度狭窄16条,中度狭窄40条,重度狭窄45条。经Kappa检验发现,TCD对MCA狭窄程度的诊断结果与CTA的一致性较好(Kappa值=0.884)。结论:TCD对于脑梗死患者的颅内动脉狭窄具有较高的诊断价值,且与CTA的诊断一致性较好。     

缺血性脑血管疾病患者颈动脉彩超检测的应用价值

在动脉粥样硬化的情况下,颈总动脉至颈内外动脉分叉处容易形成粥样硬化斑块性狭窄及血栓,从而导致一过性脑缺血发作(TIA)或脑卒中。本文应用彩色多普勒超声通过对62例缺血性脑血管疾病患者颈动脉血管的检测,对颈动脉硬化斑块性质及血流受阻程度研究,以探讨缺血性脑血管疾病的早期的发现和预防治疗的措施。     

颈动脉支架置入术后患者认知功能的变化及CT灌注成像技术的疗效评估价值研究

目的:探讨颈动脉狭窄患者在行颈动脉支架置入术后认知功能的变化情况,并分析CT灌注成像(CTP)对手术疗效的评估价值。方法:选取2015年10月到2018年3月在济宁医学院附属日照市人民医院接受治疗的颈动脉狭窄患者80例,其中有症状性颈动脉狭窄患者49例作为有症状组,无症状性颈动脉狭窄患者31例作为无症状组。所有患者均接受颈动脉支架置入手术及CTP检查,采用蒙特利尔认知评估量表(MoCA)、简易智能精神状况量表(MMSE)、搭火柴测验(Stick Test)综合评价颈动脉狭窄患者的术前、术后1周、术后3个月、术后6个月认知功能的变化情况,比较有症状组和无症状组患者的CTP相对灌注参数。结果:术后1周,颈动脉狭窄患者的MoCA总分、视空间/执行能力、注意力、延迟回忆以及MMSE总分、Stick Test总分较术前有所降低(P0.05);术后3个月、术后6个月,颈动脉狭窄患者的MoCA总分、视空间/执行能力、注意力、延迟回忆以及MMSE总分、Stick Test总分较术前有所升高(P0.05)。术前,有症状组的相对血流达峰时间、相对平均通过时间长于无症状组,相对脑血流量低于无症状组(P0.05);术后1周,无症状组的相对血流达峰时间较术前有所缩短,且短于有症状组(P0.05);术后1周,有症状组的相对血流达峰时间、相对平均通过时间较术前有所缩短,相对脑血流量较术前有所升高(P0.05);两组术前、术后1周相对脑血容量比较均无统计学差异(P0.05)。结论:颈动脉支架置入术后患者会出现暂时的、可逆的认知功能恶化,但最终认知功能会得到明显的改善。CTP可发现异常的脑灌注情况,同时能够较好地评价颈动脉支架置入术治疗颈动脉狭窄患者的疗效。     

腰硬联合麻醉对围手术期剖宫产患者皮质醇及血浆D-D水平的影响

目的:探讨腰硬联合麻醉(CSEA)对剖宫产围术期患者围术期皮质醇及血浆D-二聚体(D-D)水平变化的影响。方法:选取2014年3月-2015年5月在我院接受剖宫产手术的患者68例为研究对象。.根据术中采用的麻醉方法不同,将患者分为腰硬联合麻醉组(CSEA组)和连续硬膜外麻醉组(CEA组)。观察并比较两组患者围手术期皮质醇及D-二聚体水平的变化情况。结果:两组患者术中纤维蛋白原、凝血活酶时间及凝血酶原时间间比较,差异均无统计学意义(P0.05);两组患者麻醉后皮质醇及D-D水平均显著高于麻醉前,但CSEA组低于CEA组,差异具有统计学意义(P0.05);两组患者D-D水平在手术结束时、术后24 h较麻醉前均显著升高,差异有统计学意义(P0.05);但CSEA组D-D水平在术后24 h及、术后72 h,CSEA组D-D水平均低于CEA组,差异具有统计学意义(P0.05)。结论:腰硬联合麻醉可以更好的抑制剖宫产患者术中血清皮质醇及术后血浆D-D水平的升高,有利于改善患者术后高凝状态,值得临床推广应用。     

Early identification of patients with the risk for postoperative carotid restenosis development

Multiple randomized trials over the last decade for both symptomatic and asymptomatic carotid stenosis have proven the efficacy of carotid endarterectomy (CEA) in reducing the risk of stroke. The aim of this prospective non-randomizing cohort study was to determine the incidence of carotid arteries restenosis after CEA as well as to ascertain the clinical and etiological characteristics for the development of restenosis. Treatment data from 178 KBC Rijeka patients that had undergone CEA in the period 1. 09. 2005-30. 8. 2009 has been processed. All patients are monitored trough our Neurosonology laboratory algorythm--first Doppler ultrasound examination within the first week after CEA and the following after 1, 3, 6 and 12 months. After this time once a years. The average monitoring time was 21 month (1-36 months). In the stated period 27 restenosis was diagnosed (15.16%). Only four of them were symptomatic (14.81%). Patient survival rate is 98% in the first 12 and 92% in the first 36 months. Carotid restenosis is usually asymptomatic. Non-invasive postoperative carotid arteries color Doppler screening is essential in the early identification of patients with the risk for the development of restenosis.     

Comparison between carotid stenting and carotid endarterectomy in early outcome

Carotid artery stenting (CAS) is a widely used method in prevention of stroke for carotid artery stenosis as an alternative to surgical treatment. Initial studies reveal higher morbidity and mortality rates for CAS than acceptable standards for carotid endarterectomy (CEA). The aim of this study was to compare results in a series of CAS with concurrent risk-matched group of CEA patients. The study included two groups of 50 patients with internal carotid artery stenosis. We compared early outcome (30 days after procedure) in risk-matched groups of patients that underwent these procedures. Post procedural complications were equally frequent in both groups. There was no significant difference in perioperative complication rates (P = 0.871). Comparison of these two methods shows that CAS and CEA are competitive methods for treatment of carotid artery stenosis. Particularly in symptomatic patients with high risk for surgery CAS is alternative treatment.     

Anterior Segment Neovascularization in Diabetic Retinopathy: A Masquerade

Purpose

Anterior segment neovascularization (ASNV) could be a masquerade for ocular ischemic syndrome (OIS) in diabetic patients which misleads diagnosis and treatment. The purpose of our study is to find the relationship between blood flow velocity in carotid siphon and the development of ASNV in diabetic.

Methods

We reviewed 34 eyes of 17 diabetic patients who had Transcranial Color Doppler (TCD) examination with unilateral ASNV. The circulatory parameters of both eyes of each patient were compared and analyzed. In addition, 9 patients with more than 50% stenosis of extracranial internal carotid artery (ICA) and low velocity flow through TCD had been treated by carotid revascularization surgery.

Results

The maximal velocity in systole (Vmax) of carotid siphon (SCA) was lower in the eyes with ASNV than in the eyes without ASNV (P<0.05). ASNV of all the 9 patients regressed totally and BCVA improved significantly (P<0.05). Stenosis of ICA and arm-retina time (ART) decreased significantly (P<0.01) and SCA and ophthalmic artery (OA) increased significantly (P<0.01).

Conclusions

Our study showed ASNV could be a masquerade for OIS in patients with diabetic retinopathy. The decreased blood flow velocity in carotid siphon is related to the development of ASNV. Circulatory parameters screening of SCA by TCD is important to help us to evaluate the blood flow in SCA, the possibility of development of ASNV, and the prognosis of the patient. Interference such as carotid endarterectomy (CEA) or carotid artery stenting (CAS) can be performed if necessary to improve the blood flow in SCA and make ASNV regression.     

Combined surgical approach to carotid and coronary artery disease

The aim of this study was to compare two different surgical approaches to patients with coexistent significant carotid and coronary artery obstruction. Patients were treated with combined operation of carotid endarterectomy and coronary artery bypass grafting (CEA/CABG). The first group of patients underwent the CABG procedure with the cardiopulmonary bypass (CPB) on arrested heart and the second group without the CPB on a beating heart--off pump. Between May 15 1998, and October 9 2003, thirty-five consecutive patients underwent the combined procedure. In both groups there were no cases of transient or permanent perioperative neurological events. Overall, early mortality was 5.6%. The incidence of a perioperative myocardial infarction was 5.5%. In the follow-up period there were no cases of late stroke. According to the presented results in this study, it was found that the combined CEA and CABG is an equally safe and effective procedure performed with or without cardiopulmonary bypass for patients with a severe coexistent carotid and coronary artery disease.     

Symptomatic carotid ischaemic events: safest and most cost effective way of selecting patients for angiography,before carotid endarterectomy.

OBJECTIVE: To determine the safest, least costly, and most effective way to select patients with symptomatic carotid ischaemic events for carotid angiography before carotid endarterectomy. DESIGN: Prospective cohort study. SETTING: University departments of clinical neurosciences and clinical neurology. PATIENTS: 485 Patients with carotid territory transient ischaemic attacks of the brain (n = 224) or eye (n = 162) or retinal infarction (n = 99) were referred to a single neurologist between 1976 and 1986. INTERVENTIONS: Clinical examination by auscultation over the precordium, supraclavicular fossae, and neck vessels (all patients). Cerebral angiography of patients suitable for carotid endarterectomy. MAIN OUTCOME MEASURES: Financial cost and number of disabling strokes after angiography. RESULTS: 296 Patients were investigated by cerebral angiography. Ischaemic symptoms had occurred in the distribution of 298 internal carotid arteries (symptomatic) that were imaged, two patients having bilateral symptoms. The presence or absence of a carotid bruit and the maximum percentage diameter stenosis of the origin of the symptomatic internal carotid artery were correlated. The prevalence of mild disease (diameter stenosis greater than or equal to 25%) of the symptomatic internal carotid artery was 57%, and if an ipsilateral carotid bruit was heard the probability of mild stenosis rose to 92%. The prevalence of moderate disease of the symptomatic internal carotid artery (stenosis greater than or equal to 50%) was 39%, and if a bruit was heard the probability doubled to 78%. The prevalence of severe internal carotid disease (stenosis greater than or equal to 75%) was 22%, and if a bruit was heard the probability was more than double, at 49%. The direct cost to both the NHS and the private health sector of investigating patients with symptomatic carotid ischaemia was estimated for several strategies of carotid artery imaging and expressed in terms of financial cost and number of strokes after angiography incurred in detecting all patients with diameter stenosis of the symptomatic internal carotid artery of greater than or equal to 25%, 50%, or 75%. To detect diameter stenosis of the internal carotid artery of greater than or equal to 25% it is most cost effective to proceed directly to cerebral angiography in patients with a carotid bruit over the symptomatic carotid bifurcation and to screen patients without a carotid bruit by duplex carotid ultrasonography; patients in whom duplex ultrasonography discloses stenosis of greater than or equal to 25% are then referred for cerebral angiography. To detect only more severe internal carotid disease (stenosis of greater than or equal to 50%) the same policy applies, unless the local duplex ultrasonographic service is particularly efficient and reliable, when it is probably most cost effective and safer to screen all patients by this method irrespective of the findings on cervical auscultation. To detect stenosis of 75% or greater it is most cost effective to screen all patients with duplex ultrasonography, whether a carotid bruit is present or not, because this approach reduces the number of angiograms required, is the least expensive, and results in the least number of strokes after angiography. CONCLUSIONS: Patients selection for cerebral angiography before carotid endarterectomy needs to be appropriate and cost effective. Sound clinical evaluation and duplex carotid ultrasound are required. The findings of this study should not be applied to other medical centres without first considering possible differences in the prevalence of carotid artery disease, the efficiency and reliability of duplex ultrasonography, the local complication rates of cerebral angiography, and the local costs of the imaging procedures.     

视网膜静脉阻塞与颈动脉狭窄的相关性研究

目的:探究视网膜静脉阻塞与颈动脉狭窄的相关性研究,并为其临床检测、治疗与预后提供参考。方法:选择我院55例视网膜静脉阻塞患者(55只眼)为研究组,对其裸眼视力、矫正视力、眼压、眼底血管荧光造影(FFA)等检查资料进行分析,并进行多普勒彩超检查,记录其颈动脉狭窄情况,并对两种疾病之间的关系进行分析。同时选取55例健康人作为对照组。结果:研究组55例患者确诊为视网膜静脉阻塞(RVO),多普勒结果显示患者患侧与健侧劲动脉血流动力学各项差异不明显(P0.05);其IMT值较之对照组显著增高(P0.05);其PSV与EDV值有所降低,差异具有统计学意义(P0.05)。结论:视网膜静脉阻塞患者大多存在颈动脉狭窄,因此检测颈动脉血流动力学对于诊断与预防视网膜静脉阻塞有着重要作用。     

The appropriate use of carotid endarterectomy

FOR THE FIRST 30 YEARS AFTER CAROTID ENDARTERECTOMY WAS FIRST DEVELOPED, anecdotal evidence was used to identify patients with internal carotid artery disease for whom this procedure would be appropriate. More recently, the appropriateness of carotid endarterectomy for symptomatic patients and asymptomatic subjects has emerged from 7 randomized trials. Risk of stroke and benefit from the procedure are greatest for symptomatic patients with at least 70% stenosis of the internal carotid artery. Within this group, carotid endarterectomy is most beneficial for the following patients: otherwise healthy elderly patients, those with hemispheric transient ischemic attack, those with tandem extracranial and intracranial lesions and those without evidence of collateral vessels. Risk of perioperative stroke and death is higher in the following groups, although they still benefit: patients with widespread leukoaraiosis, those with occlusion of the contralateral internal carotid artery and those with intraluminal thrombus. Patients with 50% to 69% stenosis experience lesser benefit, and some other groups may even be harmed by carotid endarterectomy, including women and patients with transient monocular blindness only. The procedure is indicated for patients presenting with lacunar stroke and for those with a nearly occluded internal carotid artery, but the benefit is muted. Patients with less than 50% stenosis do not benefit. In the largest randomized trial of asymptomatic subjects, the perioperative risk of stroke and death was very low (1.5%), but the results indicated that a prohibitively high number of subjects (83) must be treated to prevent one stroke in 2 years. The subsequent literature reported higher perioperative risks (2.8% to 5.6%). In asymptomatic individuals nearly half of the strokes that occur may be due to heart and small-vessel disease. These limitations counter any potential benefit. Another trial is in progress and may identify subgroups of asymptomatic subjects who would benefit. Meanwhile, most individuals without symptoms fare better with medical care.The prevention of ischemic stroke by surgical means goes back half a century. After initial endorsement of carotid endarterectomy, confusion arose as to the appropriate selection of patients and the allowable risk from the procedure. In the past 2 decades large randomized trials have been used to evaluate the benefit of the procedure for patients with symptomatic and asymptomatic disease of the internal carotid artery. Sufficient time has now passed since the publication of these trials to analyze their impact on practice and to make recommendations about the application of carotid endarterectomy. There is strong evidence of benefit in some symptomatic patients, whereas other patients will not benefit and may even face harm. There is weak statistical and weaker clinical evidence that asymptomatic subjects will survive longer without experiencing stroke if they undergo endarterectomy than if they do not. The evidence supporting carotid angioplasty and stenting remains anecdotal and conflicting.The purpose of the present report is to provide a clinical roadmap to which symptomatic patients and asymptomatic subjects with carotid stenosis are candidates for endarterectomy. The risks and complications of endarterectomy are also reported. The outlook and benefit for symptomatic patients and asymptomatic subjects are so different that the evidence supporting appropriate use of endarterectomy in these 2 groups will be presented separately.     

The Value of the Serum Neurofilament Protein Heavy Chain as a Biomarker for Peri-operative Brain Injury After Carotid Endarterectomy

This prospective study examined the value of serum neurofilament protein levels for detecting peri-operative brain damage following carotid endarterectomy. An ELISA was used for quantification of neurofilament protein heavy chain (NfH^SMI35) levels from patients undergoing endarterectomy for symptomatic (n = 17) and asymptomatic high-grade internal carotid artery stenosis (n = 30). All patients underwent diffusion-weighted brain imaging before and after the procedure. NfH^SMI35 levels were significantly higher in patients with a symptomatic carotid artery stenosis (0.131 ng/ml) if compared to asymptomatic patients (0.055 ng/ml, P = 0.01). However, serum NfH^SMI35 levels were not related to signs of brain ischemia on routine brain imaging techniques. Our pilot data suggests that raised NfH^SMI35 serum levels in patients with symptomatic carotid artery disease may be a sensitive biomarker for diffuse ischemic damage to the CNS. We conclude that NfH^SMI35 failed to qualify as a biomarker for peri-operative brain injury in CEA and factors that may have compromised the validation of this biomarker are discussed and need to be taken into account for the design of further studies.