Carotid Artery Surgery. A Problem-based Approach

Table of Contents

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?

Authors

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