By Michel Henry, Takao Ohki, Antonio Polydorou, Kyriakos Strigaris, Dimitrios Kiskinis

Even if carotid endarectomy (CEA) has lengthy been thought of the superior approach, contemporary stories document that brief- and long term effects with carotid angioplasty and stenting(CAS) are resembling people with CEA in an important variety of instances. protecting medical evaluation, strategies and units, scientific therapy, and extra, Angioplasty and Stenting of the Carotid and Supra-Aortic Trunks studies the cutting-edge in CAS.

The editors have drawn jointly a panel of specialists to supply an updated photograph that summarizes present, correct wisdom approximately endovascular interventional treatment for carotid sickness. They current a large evaluate of ways and strategies, a dialogue of safeguard units and power pitfalls, and insurance of tips on how to decrease capability problems, pick out and amplify symptoms, and enhance brief- and long term effects. A record from the vanguard of clinical technology, this source provides the state of the art info you want to make sure while it really is acceptable to exploit CAS.

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May overlap with healed plaque ruptures. †Occasionally referred to as type VII lesion. ‡May further progress with healing (healed erosion). §May further progress with healing (healed rupture).  Which patient will benefit from a surgical intervention? 2). 2 Gross and microscopic plaque characteristics in symptomatic and symptomatic patients undergoing carotid endarterectomy. 06 Necrotic core 84 72 ns Ulceration 11 8 ns Calcified nodule 7 7 ns Thrombus 63 80 ns SMC­rich area 5 0 ns Eccentric shape 68 64 ns 8 Modified from Carr et al.

Initial Progression Early plaques Type 1: microscopic detection of lipid droplets in intima and small Intimal thickening groups of macrophage foam cells None Type II: fatty streaks visible on gross inspection, layers of foam Intimal xanthoma cells, occasional lymphocytes and mast cells None Type III (intermediate): extracellular lipid pools present among layers of smooth­muscle cells Thrombus (erosion) Intermediate plaque Type IV: well­defined lipid core; may develop surface disruption Fibrous cap atheroma (fissure) Thrombus (erosion)‡ Late lesions Thin fibrous cap atheroma Thrombus (rupture) haemorrhage/fibrin§ Type Va: new fibrous tissue overlying lipid core (multilayered fibroatheroma)* Healed plaque rupture, erosion Repeated rupture or erosion with or without total occlusion Type Vb: calcification† Fibrocalcific plaque (with or without necrotic core) Type Vc: fibrotic lesion with minimal lipid (could be result of organized thrombi) Miscellaneous/ complicated features Type Vla: surface disruption Type Vlb: intraplaque haemorrhage Type VIc: thrombosis Calcified nodule Thrombus (usually non­occlusive) Pathological intimal thickening Adapted from data published in Refs 2–4.

If the three named precarious (type 7). Anastomoses of the extracranial vessels ECA­ECA anastomoses Anastomoses between the external carotid arteries are transversal and involve bilateral homologous arterial branches which join across the middle line.  There is no cervi cal anastomosis between the internal external carotid arteries, unless a variant occipital artery arises from the internal carotid artery or the ophthalmic artery has an anastomosis with the external carotid artery. 5).  Usually these risk factors have a multiplier effect (rather than an additive effect).

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