Randomised controlled trials (RCT) have demonstrated a net benefit of carotid endarterectomy (CEA) in stroke prevention for patients with severe carotid artery stenosis as compared to best medical treatment. Results in routine clinical practice must not be inferior to those in the RCTs. The carotid arteries are clamped during CEA which may impair the cerebral perfusion.The aim of this thesis was to assess population-based outcomes from CEA, investigate risk factors for perioperative complications/late mortality and to evaluate effects of carotid clamping during CEA. In the Swedish vascular registry 6182 CEAs were registered during 1994-2003. Data on all CEAs were retrieved, analysed and validated…
Contents
Introduction
Background
Definitions of neurological events
Symptomatic versus asymptomatic carotid artery stenosis
Imaging
CEA of symptomatic carotid artery stenosis
CEA of asymptomatic carotid artery stenosis
Technical considerations of CEA
Tolerance of carotid clamping
Cerebral ischaemia and reperfusion during CEA
Inflammation
Coagulation and fibrinolysis
Swedvasc
Aims
Subjects and methodology
Papers I-III
Swedvasc validation
Swedvasc definitions
Definitions in the papers
Statistics
Papers IV-V
CEA
Measurements
Statistics
Results
Paper I-III
Paper I
Case-control study
Paper II
Paper III
Validation results (papers I-III)
Comments to papers I-III
Papers IV-V
Paper IV
Transit time volume blood flow
Cerebral oximetry
Measurement associations
Comments to paper IV
Paper V
Levels of biomarkers
Comments to paper V
General discussion
CEA for symptomatic stenosis
Timing of CEA
CEA for asymptomatic stenosis
Plaque morphology
Registry data
Risk factors
Gender
Age
Contralateral carotid artery occlusion
Carotid shunt indications
Cerebral ischemia
Conclusions
Summary in Swedish
Bakgrund
Syfte
Delarbeten 1-5
Sammanfattning
Acknowledgements
References
Author: Kragsterman, Björn
Source: Uppsala University Library
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