Journal of Clinical Medicine

Journal Browser

► Journal Browser

Special Issue Information

Dear Colleagues,

Carotid endarterectomy has been considered the standard of care for carotid artery stenosis in stroke prevention. In recent years, carotid angioplasty and stenting (CAS) became an important alternative in the treatment of carotid occlusive disease. The evolving technology and the use of advanced generation devices have substantially decreased the morbidity of the procedure, while recent studies have shown comparable long-term effects of both procedures on fatal or disabling stroke. As the experience with carotid stenting grows, the potential of this minimally invasive carotid intervention to become the main treatment option for the high-risk as well as for the average asymptomatic patients has become even more apparent.

The current literature on the value of CAS in stroke prevention has been rapidly growing each year. Given the importance of CAS in the field of medicine and research, the journal JCM is launching this Special Issue.

We encourage you and your co-workers to submit your articles reporting on this topic. Reviews or original articles dealing with the value of CAS on stroke prevention, with the comparison of other treatment modalities such as CEA or conservative management as well as articles providing an up-to-date overview of carotid stenting on carotid stenosis management are particularly welcomed. In addition, we warmly invite you to submit articles reporting on evolving CAS techniques, with a special focus on novel technologies and approaches.

Dr. George N. Kouvelos
Dr. Konstantinos Spanos
Dr. Petroula N. Nana
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

carotid angioplasty
carotid stenosis
CAS
carotid stenting
carotid endarterectomy
carotid
stroke

Published Papers (2 papers)

Download All Papers

Research

12 pages, 2083 KiB

Open AccessArticle

Near-Infrared Spectroscopy-Guided, Individualized Arterial Blood Pressure Management for Carotid Endarterectomy under General Anesthesia: A Randomized, Controlled Trial

by Tina Tomić Mahečić, Branko Malojčić, Dinko Tonković, Mirabel Mažar, Robert Baronica, Snježana Juren Meaški, Andrea Crkvenac Gregorek, Jens Meier and Martin W. Dünser

J. Clin. Med. 2023, 12(15), 4885; https://doi.org/10.3390/jcm12154885 - 25 Jul 2023

Viewed by 958

Abstract

Background: Differences in blood pressure can influence the risk of brain ischemia, perioperative complications, and postoperative neurocognitive function in patients undergoing carotid endarterectomy (CEA). Methods: In this single-center trial, patients scheduled for CEA under general anesthesia were randomized into an intervention group receiving near-infrared spectroscopy (NIRS)-guided blood pressure management during carotid cross-clamping and a control group receiving standard care. The primary endpoint was postoperative neurocognitive function assessed before surgery, on postoperative days 1 and 7, and eight weeks after surgery. Perioperative complications and cerebral autoregulatory capacity were secondary endpoints. Results: Systolic blood pressure (p < 0.001) and norepinephrine doses (89 (54–122) vs. 147 (116–242) µg; p < 0.001) during carotid cross-clamping were lower in the intervention group. No group differences in postoperative neurocognitive function were observed. The rate of perioperative complications was lower in the intervention group than in the control group (3.3 vs. 26.7%, p = 0.03). The breath-holding index did not differ between groups. Conclusions: Postoperative neurocognitive function was comparable between CEA patients undergoing general anesthesia in whom arterial blood pressure during carotid cross-clamping was guided using NIRS and subjects receiving standard care. NIRS-guided, individualized arterial blood pressure management resulted in less vasopressor exposition and a lower rate of perioperative complications. Full article

(This article belongs to the Special Issue Carotid Angioplasty and Stenting: Current State and Future Directions)

► Show Figures

Graphical abstract

15 pages, 5013 KiB

Open AccessArticle

Patient Selection Criteria and Procedural Standardization for Carotid Artery Stenting—A Single Center Experience

by Paolo Calo, Alexander Oberhuber and Hartmut Görtz

J. Clin. Med. 2023, 12(10), 3534; https://doi.org/10.3390/jcm12103534 - 18 May 2023

Viewed by 1213

Abstract

The gold standard for the treatment of carotid artery stenosis is the carotid endarterectomy (CEA). According to current guidelines, carotid artery stenting (CAS) is an alternative. Randomized control trials (RCTs) show significantly higher rates of peri-interventional strokes after CAS compared to CEA. However, these trials were usually characterized by a great heterogeneity in the CAS procedure. In this retrospective analysis from 2012 to 2020, 202 symptomatic and asymptomatic patients were treated with CAS. Patients were carefully pre-selected according to anatomical and clinical criteria. In all cases, the same steps and material were used. All interventions were performed by five experienced vascular surgeons. Primary endpoints of this study were perioperative death and stroke. Asymptomatic carotid stenosis was present in 77% of the patients and symptomatic in 23%. The mean age was 66 years. The average degree of stenosis was 81%. The CAS technical success rate was 100%. Periprocedural complications occurred in 1.5% of cases, including one major stroke (0.5%) and two minor strokes (1%). The results of this study indicate that through a strict patient selection based on anatomical and clinical criteria, CAS can be performed with very low complication rates. Furthermore, standardization of the materials and the procedure itself is crucial. Full article

(This article belongs to the Special Issue Carotid Angioplasty and Stenting: Current State and Future Directions)

► Show Figures