Carotid Artery Surgery, A Problem-based Approach

Carotid Artery Surgery

A Problem-based Approach

Edited by A. Ross Naylor, MD, FRCS, Consultant, Vascular Surgeon and Honorary Senior Lecturer, Department of Surgery, Leicester Royal Infirmary, Leicester, UK; and William C. Mackey, MD, Professor of Surgery, Tufts University School of Medicine; Chief of Vascular Surgery, New England Medical Center Hospital, Boston, MA


PATIENT SELECTION: 1. The Randomised Trials for Symptomatic Disease: How Should They Influence My Clinical Practice? 2. The Randomised Trials for Asymptomatic Disease: How Should They Influence My Clinical Practice? 3. Is There A Role for Emergency or Urgent Carotid Endarterectomy? 4. When Should I Perform Carotid Endarterectomy after a Complete Stroke? 5. In Patients with Combined Carotid and Coronary Disease, Should I Perform a Staged or Synchronous Procedure? 6. Is there a Role for Carotid Artery Surgery in Patients with Non-hemisopheric or Vertebro-basila Symptoms? 7. Should Cost-effectiveness Influence Patient Selection for Carotid Surgery? EVALUATION AND PRE-OPERATIVE MANAGEMENT:8. Is Duplex Ultrasound Alone Sufficient for Pre-operative Imaging? 9. Is There A Role for Pre-operative Magnetic Resonance Angiography? 10. Which Patients Should Undergo Contrast Angiography? 11. Does Routine Pre-operative CT Scanning Alter Patient Management? 12. Which Patients Require Pre-operative Assessment by a Neurologist? 13. Which Non-cardiac Medical Conditions Alter the Operative Risk? 14. When is Pre-operative Cardiac Evaluation Advisable? 15. What Does Optimal Medical Management Really Entail? OPERATIVE CARE:16. What Evidence is there that Regional Anaesthesia Confers Any Benefit over General Anaesthesia? 17. What Steps Can I take to Minimise Inadvertent Cranial Nerve Injury? 18. What Practical Steps Can I Take if I a) know pre-operatively that the lesion extends very high or b) unexpectedly encounter a high lesion during operation? 19. What is the Optimal Peri-operative Antithrombotic Regimen? 20. Should All Patients Be Shunted: If Not How Will I Predict Which Patients Require a Shunt? 21. How Can I Achieve the Optimal Flow Surface and Distal End-pointing Following Carotid Endarterectomy?22. Should All Patients Be Patched: If Not How Should I Select Which Patients to Patch? 23. When Should I Abandon A Planned Endarterectomy? 24. Is There Any Evidence that Peri-operative Monitoring and Quality Control Assessment Alters Clinical Outcome? 25. Is there a Role for Carotid Angioplasty/Stenting? POST-OPERATIVE MANAGEMENT:26. How Should I Manage A Patient Who Suffers a Peri-operative Neurological Deficit? 27. How Can I Balance Patient Safety and Cost-effectiveness in Planning Early Post-operative Care and Hospital Discharge? 28. Does Serial Post-operative Clinical or Duplex Surveillance Reduce the Long-term Stroke Risk? 29. When Should I Re-operate for Recurrent Carotid Stenosis? 30. How Should I Manage A Patient with an Infected Prosthetic Patch?