By Christopher M. Loftus
Neurovascular methods symbolize a huge element of a surgeon's perform. the hot beneficial result of medical trials on carotid endarterectomy for stroke prevention have led to a transforming into call for for surgeons who practice this approach. Surgeons will be ready to fulfill the call for via studying the elemental ideas, diagnositc standards and operative strategy for carotid endarterectomy. Dr Loftus stocks his perception and broad event during this clinically-oriented quantity. a variety of radiographic examples illustrate the subtleties of choosing the diseased artery, in addition to anatomic adaptations that make analysis and surgical procedure much more hard. The process is illustrated with appealing line drawings observed by way of color images, and the textual content all through is an easy-reading, concise narrative. gains: * encompasses a designated part at the simple ideas underlying carotid endarterectomy * incorporates a part dedicated exclusively to diagnostic concerns with a variety of radiographic reviews illustrating universal and anomalous anatomy * includes 1000's of pictures and drawings demonstrating all facets of the process
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Extra info for Carotid Endarterectomy: Principles and Technique
16 Concurrent Coronary/Carotid Disease It is well established that patients with extracranial carotid artery disease have a higher than normal incidence of coronary disease along with other peripheral vascular problems. Indeed, the risk of perioperative MI exceeds the risk of perioperative stroke in many clinical series of carotid endarterectomy. Several major questions arise when planning treatment for concurrent coronary/carotid disease. First, what is the risk of coronary revascularization in a patient with a high-grade asymptomatic stenosis or bruit?
This degree ofTCD decrease occurred 11 times; however, relevant SSEP changes occurred simultaneously in only six of these patients, and one patient with critical SSEP changes did not have a significant MCA velocity reduction. Of the four patients who had transient neurologic deficits postoperatively, all had both critical MCA reduction and critical SSEP findings. The correlation between intraoperative EEG and TCD monitoring has likewise been evaluated. Schneider et al. 1 in patients with normal intraoperative EEG tracings.
Although the carotid complex is completely exposed, the common and external carotid arteries are not dissected free from their underlying beds in order to prevent postoperative kinking and coiling of these vessels. These arteries are dissected circumferentially only in those areas where silk ties or clamps are placed around them. Copyrighted Material 27 Carotid Endarterectomy Posterior dissection is more extensive in the region of the ICA, where posterior tacking sutures willlater be placed and tied.
Carotid Endarterectomy: Principles and Technique by Christopher M. Loftus