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• W1970564487 endingPage "949" @default.
• W1970564487 startingPage "928" @default.
• W1970564487 abstract "AROTID endarterectomy (CEA) is increasingly performed in the United States and worldwide. In 1992, more than 90,000 CEAs were performed in the United States at an average cost of about $15,000 per procedure. ~ Because this procedure is becoming more common, anesthesiologists can benefit from a review of current practice and controversies in this field that can guide anesthetic strategy. This review discusses the natural history of carotid artery disease, current treatment modalities, and important issues in preoperative evaluation, with an emphasis on the problems posed by the patient with both severe carotid artery disease and severe coronary artery disease. Intraoperative and anestheuc management for CEA, including potential methods of cerebral and myocardial protection and the relative merits of different anesthetic techniques, as well as immediate postoperative management, are considered. DEFINITION, PROGNOSIS, AND TREATMENT OF CAROTID ARTERY DISEASE The most common cause of carotid artery occlusive disease is atherosclerosls, a systemic and progressive disease. It is bilateral in about half of all cases. The atherosclerotic plaque usually develops at the lateral aspect of the carotid artery bifurcation (Fig 1) and extends up into the internal and external carotid arteries (Fig 2). The plaque is composed of both cellular and acellular elements deposited in the subendothelial wall of the artery. Cellular elements principally consist of monocytes, fibrocytes, and smooth muscle cells; acel!ular elements are calcium, collagenous protein, lipids, and cholesterol. A fibrous cap develops at the interface between the blood and the antimal plaque. Disruption of the fibrous cap over a lipid deposiUon can lead to ulceration within the plaque. The embolization of thrombotic material or debris from the plaque can result in stroke or transient neurologic symptoms. The mechanisms of disease progression are not completely understood, but progressive disease is associated with increases in both cellular and acellular components of the plaque." @default.
• W1970564487 created "2016-06-24" @default.
• W1970564487 creator A5009887422 @default.
• W1970564487 creator A5073427760 @default.
• W1970564487 creator A5089616237 @default.
• W1970564487 date "1996-12-01" @default.
• W1970564487 modified "2023-09-26" @default.
• W1970564487 title "Carotid endarterectomy: Perioperative and anesthetic considerations" @default.
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