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1. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, Vol. 1, 2005 , , ,

The CA impairment is associated with increased risk of stroke in carotid occlusions and with poor prognosis in cerebral infarctions and subarachnoid hemorhages.The autoregulation of the cerebral arteries is improved after carotid endarterectomy or stenting.
CA and VMR are impaired in patients with carotid stenoses and occlusions, in recent and subcortical cerebral infarctions, arteriovenous malformations, subarachnoid hemorhages, traumatic brain injuries, in orthostatic intolerance. The CA impairment is associated with increased risk of stroke in carotid occlusions and with poor prognosis in cerebral infarctions and subarachnoid hemorhages.The autoregulation of the cerebral arteries is improved after carotid endarterectomy or stenting.
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Effect of carotid endarterectomy or stenting on impairment of dynamic cerebral autoregulation.
Reinhard M, Roth M, Muller T, Guschlbauer B, Timmer J, Czosnyka M, Hetzel A. Effect of carotid endarterectomy or stenting on impairment of dynamic cerebral autoregulation.
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Cerebral hemodynamics in asymptomatic and symptomatic patients with high – grade carotid stenosis undergoing carotid endarterectomy.
Sonnie L, Helenius J, TatlisumakT, Saimanen E, Salonen O, Lindsberg PJ, Kaste M. Cerebral hemodynamics in asymptomatic and symptomatic patients with high – grade carotid stenosis undergoing carotid endarterectomy.
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2. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 1, 2005, No. 2 , , ,

The standard surgical treatment, carotid endarterectomy, has been widely used.
The standard surgical treatment, carotid endarterectomy, has been widely used. Carotid artery angioplasty with stenting is the second choice and is currently being used on selected patients who are at high risk for surgery and in controlled clinical trials.
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Carotid Endarterectomy (CEA)
Carotid Endarterectomy (CEA)
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Symptomatic Carotid Endarterectomy Trial (NASCET), have shown that CEA, when performed with low surgical morbidity and mortality, reduces the risk of stroke in patients with high-grade carotid stenosis [7, 8].
Symptomatic Carotid Endarterectomy Trial (NASCET), have shown that CEA, when performed with low surgical morbidity and mortality, reduces the risk of stroke in patients with high-grade carotid stenosis [7, 8]. Both studies showed that approximately 8 patients with more then 70% stenosis would have to be treated to prevent one ipsilateral stroke in a five-year period after surgery.
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В Европа се провеждат няколко проучвания SPACE (Stent protected Angioplasty versus Carotid Endarterectomy), EVA-3S and ICSS (International Carotid Stenting Study-CAVATAS-2), които набират пациенти за рандомизация между КЕ и КАС.
210 с асимптомни каротидни стенози) [13]. Проучването предполага, че стентирането с протекция е не по-малко ефективен метод и дори може да превъзхожда КЕ в случаите, когато се оценява рискът от мозъчен инсулт, миокарден инфаркт и смърт. В Северна Америка е инициирано клиничното проучване CREST (Carotid Revascularisation Endarterectomy versus Stent Trial), което цели да рандомизира 1200–1600 симптомни пациенти. В Европа се провеждат няколко проучвания SPACE (Stent protected Angioplasty versus Carotid Endarterectomy), EVA-3S and ICSS (International Carotid Stenting Study-CAVATAS-2), които набират пациенти за рандомизация между КЕ и КАС. Планира се в SPACE да се включат 1200 болни до края на 2005 г. Първите междинни анализи и резултати се очакват да бъдат публикувани до края на 2006 г.
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Carotid and Vertebral Artery Transluminal Angioplasti Study (CAVATAS) showed no difference in major outcome events between endovascular treatment and carotid endarterectomy, but 30-day death and stroke rate of carotid surgery was higher than desirable – 10% versus 9.9% of CEA [12].
To better define the indications for CAS versus CEA several randomized prospective trials have been designed. Carotid and Vertebral Artery Transluminal Angioplasti Study (CAVATAS) showed no difference in major outcome events between endovascular treatment and carotid endarterectomy, but 30-day death and stroke rate of carotid surgery was higher than desirable – 10% versus 9.9% of CEA [12]. This study also reported that high grade carotid restenosis was more frequent one year after CAS then after carotid surgery. In SAPPHIRE (Stenting and Angioplasty with Protection in Patients at High Risk for Endearterectomy) study, 334 patients were included (96 symptomatic and 219 asymptomatic) [13]. This trial suggested that stenting with protection is not inferior and may be superior to CEA in terms of a combined end point including stroke, myocardial infarction and death.
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In Europe, three ongoing trials, SPACE (Stent protected Angioplasty versus Carotid Endarterectomy), EVA-3S and ICSS (International Carotid Stenting Study-CAVATAS-2), are recruiting symptomatic patients for randomization between CEA and CAS.
In North America, the CREST (Carotid Revascularisation Endarterectomy versus Stent Trial) protocol has been initiated. Its randomization goal is 1200 to 1600 symptomatic patients. In Europe, three ongoing trials, SPACE (Stent protected Angioplasty versus Carotid Endarterectomy), EVA-3S and ICSS (International Carotid Stenting Study-CAVATAS-2), are recruiting symptomatic patients for randomization between CEA and CAS.
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Cost-effectiveness of Diagnostic Strategies Prior to Carotid Endarterectomy.
U-King-Im JM, Hollingworth W, Trivedi RA, Cross JJ, Higgins NJ, Graves MJ et al. Cost-effectiveness of Diagnostic Strategies Prior to Carotid Endarterectomy.
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North American Symptomatic Carotid Endarterectomy Trialist’s Collaborative Group.
North American Symptomatic Carotid Endarterectomy Trialist’s Collaborative Group. The final results of the NASCET
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Rothwell PM, Eliasziw M, Gutnikov SA, Warlow CP, Barnett HJM, for the Carotid Endarterectomy Trialists Collaboration.
Rothwell PM, Eliasziw M, Gutnikov SA, Warlow CP, Barnett HJM, for the Carotid Endarterectomy Trialists Collaboration. Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery.
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North American Symptomatic Carotid Endarterectomy Trial Collaborators.
North American Symptomatic Carotid Endarterectomy Trial Collaborators. Benefical effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis.
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Benefical effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis.
North American Symptomatic Carotid Endarterectomy Trial Collaborators. Benefical effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis.
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3. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 2, 2006, No. 2 , , ,

[8] used L-arginine as a vasodilatory agent for pre and post-surgical evaluations of VMR in patients with severe carotid stenosis undergoing carotid endarterectomy (CEA).
Although the exact mechanisms by which Diamox acts as a vasodilatory agent and increases the CBF remain controversial, it is most probable that these effects are stimulated by metabolic acidosis and by the direct effect of intravenous administration of 1000 mg acetazolamide on cerebral vessels. Dahl et al. [5] noted that a dose at least 15 mg/kg body weight (corresponding to 1200 mg in a patient weighing 80 kg) is needed for obtaining the maximal vasodilatory effect. In 1999, Micieli et al. [8] used L-arginine as a vasodilatory agent for pre and post-surgical evaluations of VMR in patients with severe carotid stenosis undergoing carotid endarterectomy (CEA). L-arginine induces the vasodilation of resistance vessels, a process which is mediated by nitric oxide (NO) at the endothelial level. Intravenous infusion of L-arginine at a dose of 500 mg/kg/30min significantly increases BFV as measured by TCD. Vasodilatory response can be calculated as:
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4. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 3, 2007, No. 2 , , ,

When carotid endarterectomy is considered, antiplatelet therapy should always be started before surgery.
ing the 2-year follow-up in ESPS2 2, NNT=33). The results of a multicenter study ESPRIT [8] confimed the results of ESPS2 about the superiority of ASA+DP over ASA alone. Clopidogrel may be a suitable alternative for those who can not tolerate aspirin or dipyridamole. In a Cochrane analysis [10], antiplatelet therapy during and after CEA reduced the outcome of stroke. When carotid endarterectomy is considered, antiplatelet therapy should always be started before surgery. ASA should be given before, during and following endarterectomy [11]. Clopidogrel should be terminated 5 days before surgery. A combination of clopidogrel plus Aspirin should be initiated prior to carotid stenting and continued for 3 months
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Antiplatelet therapy for preventing stroke and other vascular events after carotid endarterectomy.
Engelter S, Lyrer P. Antiplatelet therapy for preventing stroke and other vascular events after carotid endarterectomy.
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Low-dose acetylsalicylic acis for patients undergoing carotid endarterectomy: a randomised controlled trial.
Taylor DW, Barnett HJM, Haynes RB, Feguson GG, Sackett DL, Thorpe KE, et al. Low-dose acetylsalicylic acis for patients undergoing carotid endarterectomy: a randomised controlled trial.
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Can recurrent stenosis after carotid endarterectomy be prevented by low-doseacetylsalicylic acid?
Hansen F, Lindblad B, Persson NH, Bergqvist D. Can recurrent stenosis after carotid endarterectomy be prevented by low-doseacetylsalicylic acid? A double-blind, randomised and placebo-controlled study.
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North American Symptomatic Carotid Endarterectomy Trial Collaborators.
North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med
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Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis.
North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med
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5. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 4, 2008, No. 1 , , ,

Evaluation of the Possibilities of Ultrasound Diagnostics in Carotid Stenosеs and Carotid Endarterectomy
Evaluation of the Possibilities of Ultrasound Diagnostics in Carotid Stenosеs and Carotid Endarterectomy
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Evaluation of the Possibilities of Ultrasound Diagnostics in Carotid Stenosеs and Carotid Endarterectomy
Evaluation of the Possibilities of Ultrasound Diagnostics in Carotid Stenosеs and Carotid Endarterectomy
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carotid endarterectomy, chronic arterial insufficiency of the limbs, color duplex,
carotid endarterectomy, chronic arterial insufficiency of the limbs, color duplex,
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to study the possibilities for application of ultrasound diagnostics – color duplex and transcranial Doppler sonography (TCD) in patients with asymptomatic and symptomatic carotid stenosis and multifocal arteriosclerosis (MFA) chronic arterial insufficiency of the limbs (CAIL) or ischemic condition of the heart (ICH), undergone to carotid endarterectomy (CEA).
to study the possibilities for application of ultrasound diagnostics – color duplex and transcranial Doppler sonography (TCD) in patients with asymptomatic and symptomatic carotid stenosis and multifocal arteriosclerosis (MFA) chronic arterial insufficiency of the limbs (CAIL) or ischemic condition of the heart (ICH), undergone to carotid endarterectomy (CEA).
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Ultrasound Diagnostics in Carotid Stenosеs and Carotid Endarterectomy
Ultrasound Diagnostics in Carotid Stenosеs and Carotid Endarterectomy
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Ultrasound Diagnostics in Carotid Stenosеs and Carotid Endarterectomy
Ultrasound Diagnostics in Carotid Stenosеs and Carotid Endarterectomy
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Ultrasound Diagnostics in Carotid Stenosеs and Carotid Endarterectomy
Ultrasound Diagnostics in Carotid Stenosеs and Carotid Endarterectomy
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В едно от най-големите мултицентрови изследвания – North American Symptomatic Carotid Endarterectomy Trial (NASCET) [19,21] са изследвани 658 пациента със СКС от 70% до 99%.
В едно от най-големите мултицентрови изследвания – North American Symptomatic Carotid Endarterectomy Trial (NASCET) [19,21] са изследвани 658 пациента със СКС от 70% до 99%. Ранните и късните резултати по безпорен начин доказват ефективността и превантивния ефект на КЕ при СКС над 70%. Комулативният риск от исхемичен мозъчен инсулт за две годишен
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Ultrasound Diagnostics in Carotid Stenosеs and Carotid Endarterectomy
Ultrasound Diagnostics in Carotid Stenosеs and Carotid Endarterectomy
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L. Proposed new duplex classification for threshold stenoses used in various symptomatic and asymptomatic carotid endarterectomy trials.
L. Proposed new duplex classification for threshold stenoses used in various symptomatic and asymptomatic carotid endarterectomy trials.
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Correlation of North American Symptomatic Carotid Endarterectomy Trial (NASCET) angiographic definition of 70% to 99% internal carotid artery stenosis with duplex scanning.
Moneta GL, Edwards JM, Chitwood RW, Taylor LM Jr, Lee RW,. Correlation of North American Symptomatic Carotid Endarterectomy Trial (NASCET) angiographic definition of 70% to 99% internal carotid artery stenosis with duplex scanning.
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Guidelines for carotid endarterectomy: a multidisciplinary consensus statement from the Ad Hoc Committee, American Heart Association.
Moore WS, Barnett HJ, Beebe HG, Bernstein EF, Brener BJ, Brott T, Caplan LR, Day A, Goldstone J, Hobson RW II, Kempczinski RF, Matchar DB, Mayberg MR, Nicolaides AN, Norris JW, Ricotta JJ, Robertson JT, Rutherford RB, Thomas D, Toole JF, Trout HH III, Wiebers DO. Guidelines for carotid endarterectomy: a multidisciplinary consensus statement from the Ad Hoc Committee, American Heart Association.
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North American Symptomatic Carotid Endarterectomy Trial collaborators.
North American Symptomatic Carotid Endarterectomy Trial collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis.
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Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis.
North American Symptomatic Carotid Endarterectomy Trial collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis.
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6. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 4, 2008, No. 2 , , ,

Efficacy of Carotid Endarterectomy
Efficacy of Carotid Endarterectomy
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Efficacy of Carotid Endarterectomy
Efficacy of Carotid Endarterectomy
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carotid endarterectomy, Color Doppler, TCD
carotid endarterectomy, Color Doppler, TCD
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To study the effect of carotid endarterectomy (CE) in the treatment of asymptomatic carotid stenosis.
To study the effect of carotid endarterectomy (CE) in the treatment of asymptomatic carotid stenosis.
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Microsurgical carotid endarterectomy.
Bailes JE, Spetzler FR. Microsurgical carotid endarterectomy. Lippincott-Raven, 1995.
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Carotid endarterectomy and prevention of cerebral ischemia in symptomatic carotid stenosis.
Cooperative Studies Program 309 Trialist Group. Carotid endarterectomy and prevention of cerebral ischemia in symptomatic carotid stenosis.
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A comparison of quality control methods applied to carotid endarterectomy.
Gaunt ME, Smith JL, Ratliff DA, Bell PRF, Naylor AR. A comparison of quality control methods applied to carotid endarterectomy.
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Efficasy of Carotid Endarterectomy for Asymptomatic Carotid Stenosis.
B. Wright, for Veterans Affairs Cooperative Study Group. Efficasy of Carotid Endarterectomy for Asymptomatic Carotid Stenosis.
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Wong Guidelines for the use of carotid endarterectomy: current recommendation from the Canadian Neurosurgical Society.
M. C. Wallace, and J. H. Wong Guidelines for the use of carotid endarterectomy: current recommendation from the Canadian Neurosurgical Society.
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Guidelines for Carotid Endarterectomy.
Donald Easton, MD; Harold P. Adams, Jr, MD; Lawrence M. Brass, MD; Robert W. Hobson, II, MD; Thomas G. Brott, MD; Linda Sternau, MD. Guidelines for Carotid Endarterectomy.
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Transcranial Doppler evaluation of cerebral hyperperfusion syndrome after carotid endarterectomy.
Magee TR, Davies AH, Horrocks M. Transcranial Doppler evaluation of cerebral hyperperfusion syndrome after carotid endarterectomy.
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Mayberg MR, Wilson SE, Yatsu F, Weiss DG, Messina L, Hershey LA, Colling C, Eskridge J, Deykin D, Winn HR, for the Veterans Affairs Mayo Asymptomatic Carotid Endarterectomy Study Group.
Mayberg MR, Wilson SE, Yatsu F, Weiss DG, Messina L, Hershey LA, Colling C, Eskridge J, Deykin D, Winn HR, for the Veterans Affairs Mayo Asymptomatic Carotid Endarterectomy Study Group. Results of a randomized controlled trial of carotid endarterectomy for asymptomatic carotid stenosis.
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Results of a randomized controlled trial of carotid endarterectomy for asymptomatic carotid stenosis.
Mayberg MR, Wilson SE, Yatsu F, Weiss DG, Messina L, Hershey LA, Colling C, Eskridge J, Deykin D, Winn HR, for the Veterans Affairs Mayo Asymptomatic Carotid Endarterectomy Study Group. Results of a randomized controlled trial of carotid endarterectomy for asymptomatic carotid stenosis.
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Guidelines for carotid endarterectomy: a multidisciplinary consensus statement from the Ad Hoc Committee, American Heart Association.
Moore WS, Barnett HJ, Beebe HG, Bernstein EF, Brener BJ, Brott T, Caplan LR, Day A, Goldstone J, Hobson RW II, Kempczinski RF, Matchar DB, Mayberg MR, Nicolaides AN, Norris JW, Ricotta JJ, Robertson JT, Rutherford RB, Thomas D, Toole JF, Trout HH III,Wiebers DO. Guidelines for carotid endarterectomy: a multidisciplinary consensus statement from the Ad Hoc Committee, American Heart Association.
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Carotid endarterectomy: practice guidelines.
Moore WS, Mohr JP, Najafi H, Robertson JT, Stoney RJ, Toole JF. Carotid endarterectomy: practice guidelines. Report of the Ad Hoc Committee to the Joint Council of the Society for Vascular Surgery and the North American Chapter of the International Society for Cardiovascular Surgery.
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Seizures following carotid endarterectomy in patients with severely compromised cerebral circulation.
Nielsen TG, Sillesen H, Schroeder TV. Seizures following carotid endarterectomy in patients with severely compromised cerebral circulation.
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North American Symptomatic Carotid Endarterectomy Trial (NASCET) Group.
North American Symptomatic Carotid Endarterectomy Trial (NASCET) Group. Long-term prognosis and effect of endarterectomy in patients with symptomatic severe carotid stenosis and contralateral carotid stenosis or occlusion: results from NASCET.
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North American Symptomatic Carotid Endarterectomy Trial Collaborators.
North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy symptomatic patients with high-grade carotid stenosis.
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Beneficial effect of carotid endarterectomy symptomatic patients with high-grade carotid stenosis.
North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy symptomatic patients with high-grade carotid stenosis.
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for the Carotid Endarterectomy Trialists Collaboration.
Rothwell PM, Eliasziv M. et all. for the Carotid Endarterectomy Trialists Collaboration. Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery.
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carotid atherosclerosis, carotid endarterectomy, therapy
carotid atherosclerosis, carotid endarterectomy, therapy
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Surgical treatment (carotid endarterectomy) decreases also the frequency of ischemic stroke.
The update strategies for complex treatment of carotid atherosclerosis are reviewed. They include drug and surgical therapy in cases with progression of carotid stenosis over 60-70%. Drug therapy includes antiplatelet therapy and reduction of the risk factors for atherosclerosis. It decreases the frequency of ischemic stroke and vascular dead. Surgical treatment (carotid endarterectomy) decreases also the frequency of ischemic stroke. It is successful when includes preand postoperative drug therapy. The article presents the complex treatment of 205 patients with carotid atherosclerosis. The good early and late results are based on the combination of drug and surgical treatment. Algorithm for therapeutic strategy in patients with carotid atherosclerosis is discussed.
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Aspirin resistance among long-term aspirin users after carotid endarterectomy and controls.
Assadian A, Lax J, Meixner-Loicht U, Hagmuller GW. Aspirin resistance among long-term aspirin users after carotid endarterectomy and controls.
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Perioperative statine and diuretic use influence the presentation of patients undergoing carotid endarterectomy: Results of a large single – institution case study.
Brooke B, M McGirt, G Woodworth. Perioperative statine and diuretic use influence the presentation of patients undergoing carotid endarterectomy: Results of a large single – institution case study.
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How Good Is the Management of Vascular Risk after Stroke, Transient Ischaemic Attack or Carotid Endarterectomy?
Johnson P, Rosewell M, James MA. How Good Is the Management of Vascular Risk after Stroke, Transient Ischaemic Attack or Carotid Endarterectomy?
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AHA Updates Guidelines for Carotid Endarterectomy.
Morey SS. AHA Updates Guidelines for Carotid Endarterectomy.
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Beneficial effects of Clopidogrel combined with Aspirin in reducing cerebral emboli in patients undergoing carotid endarterectomy.
Payne D, C Jones, P Hayes. Beneficial effects of Clopidogrel combined with Aspirin in reducing cerebral emboli in patients undergoing carotid endarterectomy.
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Резултатите от проучването North American Symptomatic Carotid Endarterectomy Trial (NASCET)* сочат, че при симптомните пациенти с каротидни стенози над 70% рискът от ипсилатерален мозъчен инфаркт в следващите две години е 26%.
Резултатите от проучването North American Symptomatic Carotid Endarterectomy Trial (NASCET)* сочат, че при симптомните пациенти с каротидни стенози над 70% рискът от ипсилатерален мозъчен инфаркт в следващите две години е 26%. Проучването ECST** от своя страна показва, че коронарната сърдечна смърт при такива болни достига до 30% за период от 10 години.
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* North American Symptomatic Carotid Endarterectomy Trial (NASCET) Group.
* North American Symptomatic Carotid Endarterectomy Trial (NASCET) Group. Long-term prognosis and effect of endarterectomy in patients with symptomatic severe carotid stenosis and contralateral carotid stenosis or occlusion: results from NASCET. J Neurosurg 83, 1995: 778–782.
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7. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 4, 2008, No. 2 , , ,

Bulgarian experience in carotid endarterectomy.
Bulgarian experience in carotid endarterectomy.
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8. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 6, 2010, No. 1 , , ,

Двуизмерната рентгенова сянка не може да покаже това толкова добре, колкото ултразвуковото изследване, което включва морфологични и хемодинамични критерии.Конвенционалната ангиография обаче е посочена като златен стандарт, защото това е бил методът на избор, когато през 90-те години на миналия век са проведени мащабни проучвания относно симптоматичните каротидни ендартеректомии (NASCET – North American Symptomatic Carotid Endarterectomy Trial).
При конвенционална ангиография е видно, че профилактичният ефект на каротидните операции корелира със степента на каротидната стеноза. Патогенетичен субстрат е плаката и нейният хемодинамичен ефект чрез намаляване на площта и/или нарушение на повърхностната структура. Двуизмерната рентгенова сянка не може да покаже това толкова добре, колкото ултразвуковото изследване, което включва морфологични и хемодинамични критерии.Конвенционалната ангиография обаче е посочена като златен стандарт, защото това е бил методът на избор, когато през 90-те години на миналия век са проведени мащабни проучвания относно симптоматичните каротидни ендартеректомии (NASCET – North American Symptomatic Carotid Endarterectomy Trial). Никой няма да поеме отговорността и огромните разходи да повтори подобно проучване за да докаже, че резултатите от ултразвуковото изследване са същите. Нещо повече, това няма да бъде възможно и от етична гледна точка. Намаляването на диаметъра на съда при конвенционалната ангиография е следствие от развиващата се патогенна плака, която се установява и с цветно В-скениране и измерване на стойностите на кръвния ток. Двата метода представят параметри, които се базират до известна степен на различни биологични показатели, така че пълно съответствие не е възможно. Все още е открит въпросът кой от тези два метода представя по-добре естеството на плаката, вземайки под внимание всички комплексни въздействия върху крайния ултразвуков резултат, вкл.
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North American Symptomatic Carotid Endarterectomy Trialists’ Collaborative Group.
North American Symptomatic Carotid Endarterectomy Trialists’ Collaborative Group. The final results of the NASCET trial.
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9. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 7, 2011, No. 1 , , ,

When a free-floating cloth in carotid artery is established in most cases an operation is recommended – urgent carotid endarterectomy (CEA) or embolectomy because of the great risk of repeating embolic IS [1].
In our clinical cases we excluded any cardiogenic cause for the embolic IS. Patients did not have any previous heart disease and had normal echocardiographies. In both patients FFT were formed by ruptured ulcerated atherosclerotic plaques, which were found intraoperatively. We used CDS and CT of the supraaortal arteries to diagnose FFT. Duplex ultrasound provides a sensitive and specific evaluation of plaque morphology and mobile structures in the carotid artery lumen which is a significant advantage over other neuroimaging methods [3]. When a free-floating cloth in carotid artery is established in most cases an operation is recommended – urgent carotid endarterectomy (CEA) or embolectomy because of the great risk of repeating embolic IS [1]. In rare cases treatment only with anticoagulants is considered [1, 5, 13 ]. Endovascular therapy is extremely rare in patients with prior carotid endarterectomy, due to a very high risk of embolization during the procedure [1, 2]. In both our cases we preferred surgical removal of thrombus and ulcerated atherosclerotic plaque aiming prevention of recurrence of IS, an anticoagulant treatment during hospitalization and long-term double antiplatelet therapy.
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Endovascular therapy is extremely rare in patients with prior carotid endarterectomy, due to a very high risk of embolization during the procedure [1, 2].
In both patients FFT were formed by ruptured ulcerated atherosclerotic plaques, which were found intraoperatively. We used CDS and CT of the supraaortal arteries to diagnose FFT. Duplex ultrasound provides a sensitive and specific evaluation of plaque morphology and mobile structures in the carotid artery lumen which is a significant advantage over other neuroimaging methods [3]. When a free-floating cloth in carotid artery is established in most cases an operation is recommended – urgent carotid endarterectomy (CEA) or embolectomy because of the great risk of repeating embolic IS [1]. In rare cases treatment only with anticoagulants is considered [1, 5, 13 ]. Endovascular therapy is extremely rare in patients with prior carotid endarterectomy, due to a very high risk of embolization during the procedure [1, 2]. In both our cases we preferred surgical removal of thrombus and ulcerated atherosclerotic plaque aiming prevention of recurrence of IS, an anticoagulant treatment during hospitalization and long-term double antiplatelet therapy.
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Assessment of the hemispheric dominance of language before carotid endarterectomy is another important application of fMRI [73].
Assessment of the hemispheric dominance of language before carotid endarterectomy is another important application of fMRI [73].
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Functional Magnetic Resonance Imaging to Determine Hemispheric Language Dominance Prior to Carotid Endarterectomy.
Smits M, Wieberdink RG, Bakker SL, Dippel DW. Functional Magnetic Resonance Imaging to Determine Hemispheric Language Dominance Prior to Carotid Endarterectomy.
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carotid pathology, carotid endarterectomy, consensus, drugs, endovascular treatment, ultrasound diagnosis
carotid pathology, carotid endarterectomy, consensus, drugs, endovascular treatment, ultrasound diagnosis
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Резултатите от проучването North American Symptomatic Carotid Endarterectomy Trial (NASCET)
Резултатите от проучването North American Symptomatic Carotid Endarterectomy Trial (NASCET)
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„дистален”, използван в North American Symptomatic Carotid Endarterectomy Trial (NASCET) – съотношение между диаметъра на остатъчния лумен в стенотичния участък към дисталния диаметър на артерията.
„дистален”, използван в North American Symptomatic Carotid Endarterectomy Trial (NASCET) – съотношение между диаметъра на остатъчния лумен в стенотичния участък към дисталния диаметър на артерията. Използва се от Европейската организация за мозъчен инсулт за определяне на степента на каротидна стеноза. За критична се приема стеноза ≥70%, при която е показана реваскуларизация.
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North American Symptomatic Carotid Endarterectomy Trial (NASCET) Group.
North American Symptomatic Carotid Endarterectomy Trial (NASCET) Group. Long-term prognosis and effect of endarterectomy in patients with symptomatic severe carotid stenosis and contralateral carotid stenosis or occlusion: results from NASCET.
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10. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 8, 2012, No. 1 , , ,

Carotid Endarterectomy
Carotid Endarterectomy
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Early Proximal Common Carotid Artery Dissection after Carotid Endarterectomy
Early Proximal Common Carotid Artery Dissection after Carotid Endarterectomy
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Carotid endarterectomy (CEA) and endovascular dilatation followed by stenting are leading non-pharmacological methods in the treatment of significant carotid pathology.
Carotid endarterectomy (CEA) and endovascular dilatation followed by stenting are leading non-pharmacological methods in the treatment of significant carotid pathology. Although rarely found, carotid dissections are serious postoperative complication after CEA, puncture and stenting of the cervical arteries and veins. They result from traumatic splitting of the vessel wall due to penetration of blood between its layers the stratification of intima and media leads to the formation of "false" lumen or intramural thrombus, and invasion of blood between the media and tunica adventicia predisposes to the formation of pseudoaneurysm [6]. The most commonly dissection is spread distaly, but depending on the hemodynamic gradient between the "real" and the "false" lumen, it can spread proximally. The initial dissection dynamically changes over time
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Carotid endarterectomy is associated with different types of periprocedure and postoperative complications fluctuation in blood pressure, stroke, venous thrombembolism, infections, restenosis, cranial nerves lesions or death.
Carotid endarterectomy is associated with different types of periprocedure and postoperative complications fluctuation in blood pressure, stroke, venous thrombembolism, infections, restenosis, cranial nerves lesions or death. Their frequency and etiology differ in individual studies. Some of the incidents are from emboli of the synthetic patch [8]. According to Archie and Rosenthal two/thirds of the postoperative cerebral events (stroke and transient ischemic attacks) after CEA are due to dissections, intimal fleps or vessel wall damage by clamps, detected by ultrasound in 27% of the patients during CEA [11]. Dissections occur most frequently in the first hours after blood flow restoration following the eversion CEA, they appear distally to CEA and often are symptomatic – cause lesions of the cranial nerves (58%), stroke (8%) or death (2%) [6, 7, 8, 10]. Proximal dissections are rare complication after CEA with shunt [9].
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Emergency stenting to treat neurological complications occurring after carotid endarterectomy.
Carlino M, Pagnotta P, Mario CD, Sheiban I, Magnani G, Jannello A, Melissano G, Chiesa R, Colombo A. Emergency stenting to treat neurological complications occurring after carotid endarterectomy.
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Microsurgical carotid endarterectomy.
Bailes J, Spetzler R. Microsurgical carotid endarterectomy. Lippincott-Raven, 1995:128.
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Proximal shunt dissection: a potential problem in carotid endarterectomy.
Calhoun TR, Kitten CM. Proximal shunt dissection: a potential problem in carotid endarterectomy.
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11. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 9, 2013, No. 2 , , ,

Diagnostic Role of Color-Coded Duplex Sonography in Following-up after Carotid Endarterectomy in Men.
Diagnostic Role of Color-Coded Duplex Sonography in Following-up after Carotid Endarterectomy in Men.
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To a lesser degree, TCD has also been used to evaluate cerebral autoregulatory capacity, monitor cerebral circulation during cardiopulmonary bypass and carotid endarterectomy, to diagnose brain death and for monitoring of cerebral hemodynamics in neurotrauma.
It has been frequently employed for the clinical evaluation of cerebral vasospasm following subarachnoid hemorrhage (SAH). To a lesser degree, TCD has also been used to evaluate cerebral autoregulatory capacity, monitor cerebral circulation during cardiopulmonary bypass and carotid endarterectomy, to diagnose brain death and for monitoring of cerebral hemodynamics in neurotrauma.
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DIAGNOSTIC ROLE OF COLOR-CODED DUPLEX SONOGRAPHY IN FOLLOWING-UP AFTER CAROTID ENDARTERECTOMY
DIAGNOSTIC ROLE OF COLOR-CODED DUPLEX SONOGRAPHY IN FOLLOWING-UP AFTER CAROTID ENDARTERECTOMY
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carotid endarterectomy, color-coded duplex ultrasound.
carotid endarterectomy, color-coded duplex ultrasound.
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12. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 10, 2014, No. 2 , , ,

Improvement of the investigated with BOLD –MRI impaired VMR in patients with high-grade stenoses after carotid endarterectomy is reported [10].
It is found that the measurement of the VMR could be used for evaluation of the therapeutic interventions in patients with carotid disease. Improvement of the investigated with BOLD –MRI impaired VMR in patients with high-grade stenoses after carotid endarterectomy is reported [10]. In similar patients the subgroup with reduced VMR in the MCA is the only independent risk factor for new ischemic accident after carotid stenting [18]. A study in patients with subarachnoid hemorrhage shows that the abnormal VMR after СО
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Carotid endarterectomy improves cerebrovascular reserve capacity preferentially in patients with preoperative impairment as indicated by asymmetric BOLD response to hypercapnia.
Goode SD, Altaf N, Auer DP, MacSweeney ST. Carotid endarterectomy improves cerebrovascular reserve capacity preferentially in patients with preoperative impairment as indicated by asymmetric BOLD response to hypercapnia.
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13. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 12, 2016, No. 1 , , ,

Recent randomized clinical trials show that best medical therapy (BMT) is better than carotid endarterectomy (CEA) or carotid artery stenting (CAS) in preventing stroke.
Recent randomized clinical trials show that best medical therapy (BMT) is better than carotid endarterectomy (CEA) or carotid artery stenting (CAS) in preventing stroke. On the contrary guidelines of practice should remain unchanged. Current recommendations indicate that only ‘highly-selected‘patients should undergo CEA/CAS.
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Carotid endarterectomy for asymptomatic carotid stenosis.
Chambers BR, Donnan GA. Carotid endarterectomy for asymptomatic carotid stenosis.
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Antiplatelet therapy for preventing stroke and other vascular events after carotid endarterectomy.
Engelter S, Lyrer P. Antiplatelet therapy for preventing stroke and other vascular events after carotid endarterectomy.
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Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial.
Halliday A, Mansfield A, Marro J, Peto C, Peto R, Potter J, Thomas D; MRC Asymptomatic Carotid Surgery Trial (ACST) Collaborative Group. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial.
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Carotid artery stenting vs carotid endarterectomy: meta-analysis and diversity-adjusted trial sequential analysis of randomized trials.
Bangalore S, Kumar S, Wetterslev J, Bavry AA, Gluud C, Cutlip DE, Bhatt DL. Carotid artery stenting vs carotid endarterectomy: meta-analysis and diversity-adjusted trial sequential analysis of randomized trials.
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patients with asymptomatic internal-carotid-artery stenosis: North American Symptomatic Carotid Endarterectomy Trial Collaborators.
patients with asymptomatic internal-carotid-artery stenosis: North American Symptomatic Carotid Endarterectomy Trial Collaborators.
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Carotid artery stenting has increased rates of post-procedure stroke, death and resource utilization than does carotid endarterectomy in the United States, 2005.
McPhee JT, Schanzer A, Messina LM, Eslami MH. Carotid artery stenting has increased rates of post-procedure stroke, death and resource utilization than does carotid endarterectomy in the United States, 2005.
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Carotid artery stenting versus carotid endarterectomy: a comprehensive meta-analysis of short-term and long-term outcomes.
Economopoulos KP, Sergentanis TN, Tsivgoulis G, Mariolis AD, Stefanadis C. Carotid artery stenting versus carotid endarterectomy: a comprehensive meta-analysis of short-term and long-term outcomes.
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14. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 12, 2016, No. 2 , , ,

To a lesser degree, TCD has also been used to evaluate cerebral autoregulatory capacity, monitor cerebral circulation during cardiopulmonary bypass and carotid endarterectomy, to diagnose brain death and for monitoring of cerebral hemodynamics in neurotrauma.
Transcranial Doppler (TCD) is a relatively new, non-invasive tool, allowing for bedside monitoring to determine flow velocities indicative of changes in vascular caliber. It has been frequently employed for the clinical evaluation of cerebral vasospasm following subarachnoid hemorrhage (SAH). To a lesser degree, TCD has also been used to evaluate cerebral autoregulatory capacity, monitor cerebral circulation during cardiopulmonary bypass and carotid endarterectomy, to diagnose brain death and for monitoring of cerebral hemodynamics in neurotrauma. TCD is a suitable bedside method for daily assessment of the changes of intracranial pressure (ICP) by continuous monitoring of the changes of blood flow velocities and pulsatility index (PI), reflecting decreases in cerebral perfusion pressure due to increases in ICP. Growing body of literature demonstrates the usefulness of transbulbar B-mode sonography of the optic nerve for detecting increased ICP in patients requiring neurocritical care. TCD findings compatible with the diagnosis of brain death include systolic spikes without diastolic flow or with diastolic reversed flow, and no demonstrable flow in a patient in who flow had been clearly documented on a previous examination. Assessment of cerebral autoregulation using TCD blood flow velocity has been previously validated to be predictive of outcome following traumatic brain injury. The commonly used bedside methods of determining the status of autoregulation include the transient hyperemic response test, the leg-cuff deflation test and reaction to spontaneous blood pressure fluctuations.
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15. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 14, 2018, No. 2 , , ,

Clopidogrel load for emboli reduction in patients with symptomatic carotid stenosis undergoing urgent carotid endarterectomy.
Tsivgoulis G, Kerasnoudis A, Krogias C, Vadikolias K, Meves SH, Heliopoulos I, Georgakarakos E, Piperidou C, Alexandrov AV. Clopidogrel load for emboli reduction in patients with symptomatic carotid stenosis undergoing urgent carotid endarterectomy.
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Detection of cerebral microemboli by means of transcranial Doppler monitoring before and after carotid endarterectomy.
Van Zuilen EV, Moll FL, Vermeulen FE, Mauser HW, van Gijn J, Ackerstaff RG. Detection of cerebral microemboli by means of transcranial Doppler monitoring before and after carotid endarterectomy.
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Recent calculations have suggested that the stroke risk with intensive medical therapy is lower or similar compared with that of carotid endarterectomy or carotid artery stenting in ACAS patients.
There have been contradictions regarding the optimal treatment of patients with asymptomatic severe internal carotid artery stenosis (ACAS). From the one hand previous studies proved benefit from carotid intervention in ACAS patients, from the other hand due to the development of modern medical therapy there has been a significant reduction in stroke incidence in patients with only medical treatment. Recent calculations have suggested that the stroke risk with intensive medical therapy is lower or similar compared with that of carotid endarterectomy or carotid artery stenting in ACAS patients. Therefore, carotid reconstruction for the most patients with asymptomatic severe internal carotid artery stenosis has not been suggested recently. However, some special subgroups with high stroke risk were shown to benefit from carotid surgery. High-risk patients are characterised by poor collateral circulation with exhausted cerebrovascular reserve capacity, or by unstable plaque with cerebral microembolisation. The present article summarizes the use of transcranial Doppler in selection of high-risk ACAS patients who may benefit from carotid intervention.
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Efficacy of carotid endarterectomy for asymptomatic carotid stenosis.
Hobson RW, 2nd, Weiss DG, Fields WS, et al. Efficacy of carotid endarterectomy for asymptomatic carotid stenosis. The Veterans Affairs Cooperative Study Group.
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Mayo Asymptomatic Carotid Endarterectomy Study Group.
Mayo Asymptomatic Carotid Endarterectomy Study Group. Results of a randomized controlled trial of carotid endarterectomy for asymptomatic carotid stenosis.
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Results of a randomized controlled trial of carotid endarterectomy for asymptomatic carotid stenosis.
Mayo Asymptomatic Carotid Endarterectomy Study Group. Results of a randomized controlled trial of carotid endarterectomy for asymptomatic carotid stenosis.
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carotid endarterectomy, carotid stenting, color coded duplex sonography
carotid endarterectomy, carotid stenting, color coded duplex sonography
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The microembolic signals are accepted surrogate marker for future stroke risk and have been used to show treatment efficacy in different clinical conditions (TIA, carotid stenosis, carotid endarterectomy, coronary bypass surgery and during some intravascular interventions).
Transcranial Doppler (TCD) is also useful for evaluation of the efficacy of pharmacotherapy not only in subarachnoid bleeding but also in ischemic stroke risk patients. The microembolic signals are accepted surrogate marker for future stroke risk and have been used to show treatment efficacy in different clinical conditions (TIA, carotid stenosis, carotid endarterectomy, coronary bypass surgery and during some intravascular interventions). The randomized trials successfully evaluated the effect of different anticoagulants (e.g. heparin vs. LMWH), mono vs dual antiplatelet therapy in stroke or stroke risk patients.
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16. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 15, 2019, No. 1 , , ,

The evolution of the clinical symptoms, the ophthalmic status, and the change in sonographic findings before and after carotid endarterectomy were followed up.
A 66-year-old man with a history for ischemic stroke in the left middle cerebral artery (MCA) territory in the past and sudden visual loss of the left eye was examined. He was investigated in the first 7 days after the onset of the symptoms using multimodal ultrasound (color duplex, B-Flow and 3D/4D imaging), computed tomography (CT), and magnetic resonance imaging (MRI). The evolution of the clinical symptoms, the ophthalmic status, and the change in sonographic findings before and after carotid endarterectomy were followed up.
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Carotid endarterectomy with complete recanalization of the left internal carotid artery was performed two months later.
Two-three hours after the onset the patient was able to recognize some light and hand movements. Fundoscopy showed pale left optic papilla, “cherry red” spot symptom of the macula, ischemic signs of the retina and attenuated arterioles. Multimodal ultrasound discovered severe (80%) stenosis of the left ICA, moderate (60%) stenosis of the right ICA, positive Doppler ophthalmic test on the left side and typical sings of CRAO – a small round hyperechoic artefact within the left optic nerve 14 mm behind the optic disc, increased vascular resistance of the left ophthalmic artery (OA) and increased venous flow within the CRAO territory. Collateral blood flow through ciliary artery branches and normalization of ophthalmic venous blood flow were recorded in the following days. These changes correlated with a mild subjective vision improvement. Carotid endarterectomy with complete recanalization of the left internal carotid artery was performed two months later. One month after the operation a persistent hyperechoic artefact in the left optic nerve and increased proximal vascular resistance in the left retinal artery were established with slightly progressive improvement in the vision.
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Two months after the disease onset, carotid endarterectomy with complete recanalization of the left ICA was performed.
The patient was treated with medications. Two months after the disease onset, carotid endarterectomy with complete recanalization of the left ICA was performed.
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Two months later carotid endarterectomy with complete recanalization of the left internal carotid artery was performed (Fig. 6).
artery (branches of the aa. ciliares) and normalization of ophthalmic venous flow were recorded [8]. The changes correlated with a slightly intermittent subjective improvement in vision. One month after the symptoms’ onset local reperfusion in the left retinal pool was observed (Fig. 5). Two months later carotid endarterectomy with complete recanalization of the left internal carotid artery was performed (Fig. 6). One month after the operation a persistent hyperechoic artefact in the left optic nerve, proximally increased vascular resistance in the left ophthalmic artery and left retinal reperfusion, associated with emerging light perception temporally and silhouette recognition were detected.
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The invasive treatment method includes procedures aim the recanalization of the internal carotid artery (carotid endarterectomy, endovascular stenting and/or mechanical thrombectomy) [12, 15] and the ophthalmic artery through selective intra-arterial thrombolysis.
The invasive treatment method includes procedures aim the recanalization of the internal carotid artery (carotid endarterectomy, endovascular stenting and/or mechanical thrombectomy) [12, 15] and the ophthalmic artery through selective intra-arterial thrombolysis. In treatment with intra-arterial thrombolysis there is a 60-70% visual acuity improvement [19]. In some cases the use of anterior chamber paracentesis followed by aspiration of a small amount of fluid is recommended. Nd YAG laser (Neodymium: yttrium-aluminum-garnet laser) embolectomy and pars plana vitrectomy are not routinely used because of the high risk for vitreous hemorrhage. Late effects occur in 18% of patients with acute thrombosis: neovascularization of the optic papilla (usually between weeks 2 and 16 after the symptoms
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Aneurysms of the extracranial carotid arteries can be due to atherosclerosis, traumatic injury, local infection or complication after carotid endarterectomy.
Aneurysms of the extracranial carotid arteries can be due to atherosclerosis, traumatic injury, local infection or complication after carotid endarterectomy. These aneurysms are extremely rare, compared with atherosclerotic occlusive disease with the same localization and with aneurysms of the intracranial carotid arteries and their branches, their incidence being between 0.8% and 18% [6, 17]. The exact frequency of aneurysms of the extracerebral carotid arteries is unknown and their treatment accounts for 1% to 1.5% of all procedures for extracranial cerebrovascular disease in major reference centers. The true frequency of extracranial carotid aneurysms is actually less than 1% of all carotid diseases [6, 12, 17].
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