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The risk-reduction from intervention for carotid stenosis (stenting or endarterectomy) is greatest when the indication for intervention is symptoms (i.e., the patient is symptomatic) - typically stroke or TIA. [6] A new generation of double-layer stents is currently being developed to reduce the risk of stroke during or after the procedure.
Carotid endarterectomy is used to reduce the risk of strokes caused by carotid artery stenosis over time. Carotid stenosis can either have symptoms (i.e., be symptomatic), or be found by a doctor in the absence of symptoms (asymptomatic) - and the risk-reduction from endarterectomy is greater for symptomatic than asymptomatic patients.
Carotid artery stenosis can be treated with angioplasty and carotid stenting for patients at high risk for undergoing carotid endarterectomy. [11] Although carotid endarterectomy is typically preferred over carotid artery stenting, stenting is indicated in select patients with radiation-induced stenosis or a carotid lesion not suitable for surgery.
All interventions for carotid revascularization (carotid endarterectomy, carotid stenting, and transcarotid artery revascularization) carry some risk of stroke; however, where the risk of stroke over time from medical management alone is high, intervention may be beneficial. Carotid artery stenting and carotid endarterectomy have been found to ...
Periscope: Like a snorkel, a periscope stent graft provides flow to a visceral vessel, but in a retrograde fashion, with the aortic lumen inferior to the main body of the EVAR device. Stents: Large bare-metal stents have been used to treat proximal endoleaks, as have aortic extension cuffs to treat endograft migration.
Significant complications of the operation include bleeding, heart problems (heart attack, arrhythmias), stroke, infections (often pneumonia) and injury to the kidneys. Three coronary artery bypass grafts, a pedicled LITA to LAD and two saphenous vein grafts – one to the right coronary artery system and one to the obtuse marginal system.
Rates of restenosis differ between devices (e.g., stent-grafts, balloon angioplasty, etc.) and location of procedure (i.e., centrally located in the heart, such as the coronary artery, or in peripheral vessels such as the popliteal artery in the leg, the pudendal artery in the pelvis, or the carotid artery in the neck). [citation needed]
Recovery from this procedure can be complex. Thoracic surgery, CBP and cardioplegia are associated with their own complications and management challenges, as is hypothermia. Specifically, endartectomy is associated with reperfusion pulmonary edema and "pulmonary artery steal".
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