Differences between CAS and Differences between CAS and CEA in the pathophysiological CEA in the pathophysiological mechanism of procedural stroke mechanism of procedural stroke GJ de Borst GJ de Borst Department of Vascular Surgery Department of Vascular Surgery
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Differences between CAS and CEA in the pathophysiological mechanism of procedural stroke GJ de Borst Department of Vascular Surgery.
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Differences between CAS and CEA in Differences between CAS and CEA in the pathophysiological mechanism of the pathophysiological mechanism of
procedural stroke procedural stroke
GJ de BorstGJ de Borst
Department of Vascular SurgeryDepartment of Vascular Surgery
Background
• Most data on CAS vs CEA focused on clinical outcomes
• Few data characterizing the strokes that occur during carotid revascularization (and especially CAS)
• Thus limiting understanding the potential mechanisms of procedural stroke …
Fairman R, et al Ann Surg 2007 / de Borst et al EJVES 2001
Micro-embolisation harmless ??
Timing of procedural stroke
Intra-operative stroke:
1) apparent at awakening
2) intra-procedural symptoms (in the awake patient)
Post-operative stroke:
1) Symptom free interval between awakening and start of symptoms
2) Symptom free interval between procedure and start of symptoms
Etiology (1)
Intra-operative stroke
• Embolisation• spontaneous (instable plaque)• Dissection phase• Shunt insertion• Air embolisation (shunt dysfunction)• Embolisation endarterectomized zone
• Thrombosis• Peri shunt thrombosis• On table carotid thrombosis