Vascular and endovascular surgery最新文献

{"title":"Carotid Body Tumors: From Basic to Clinical Practice.","authors":"Jiazhi Yu, Wanzhong Yuan, Kangxi Cao, Chaofan Hou, Zhongzheng Wang, Yunfeng Han, Tao Wang","doi":"10.1177/15385744251387662","DOIUrl":"10.1177/15385744251387662","url":null,"abstract":"<p><p><b>Background:</b> Carotid body tumors (CBTs) are rare neoplasms originating from the carotid body. A comprehensive synthesis of the available evidence is essential to enhance the understanding of this condition among clinicians and researchers. <b>Purpose:</b> This review aims to provide a comprehensive overview of CBTs, encompassing their epidemiology, pathophysiology, clinical manifestations, current treatment modalities, and associated complications. <b>Research Design:</b> A narrative literature review was conducted, synthesizing information from relevant studies identified through a systematic search of electronic databases. <b>Study Sample:</b> The review included studies focusing on human subjects with carotid body tumors, encompassing case reports, case series, cohort studies, and relevant review articles. <b>Data Collection and Analysis:</b> The literature search was primarily conducted in the PubMed database. The search strategy utilized a combination of keywords and Medical Subject Headings (MeSH) terms related to \"carotid body tumors,\" \"chemodectoma,\" and \"paraganglioma.\" Retrieved articles were screened based on titles and abstracts, and full texts of relevant studies were reviewed for data extraction. Data on epidemiology, pathogenesis, clinical features, treatments, and complications were then thematically analyzed. <b>Results:</b> Epidemiological data indicate a slight increase in the global incidence of CBTs, although they remain relatively uncommon. The pathogenesis involves factors such as genetic predisposition, chronic hypoxia, and geographical influences. Clinical presentation is variable, commonly featuring neck masses, carotid sinus syndrome, and voice changes, depending on tumor size and location. Primary treatment options include surgical excision, radiotherapy, and embolization, with the choice of modality influenced by patient age, tumor size, and location. While surgery is often the preferred approach, it carries risks of complications such as cranial nerve injury, stroke, and hemorrhage. The review also identifies and discusses rare complications, including baroreceptor reflex failure. <b>Conclusions:</b> A thorough understanding of the multifaceted aspects of CBTs is crucial for refining diagnostic and therapeutic strategies. This integrated knowledge is expected to contribute to improved patient survival and quality of life.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"244-254"},"PeriodicalIF":0.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145350934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Predictive Role of BUN/Creatinine Ratio and Inflammatory Markers in Determining Amputation Risk in Acute Limb Ischemia Patients.","authors":"Alper Yasar, Mustafa Selcuk Ayar, Fatih Caliskan, Semih Murat Yucel","doi":"10.1177/15385744251387753","DOIUrl":"10.1177/15385744251387753","url":null,"abstract":"<p><p>ObjectiveAcute limb ischemia (ALI) is a time-sensitive vascular emergency that often presents to the emergency department and can result in limb loss or mortality if not managed promptly. Identifying simple, cost-effective biomarkers at the time of initial emergency department evaluation could facilitate early risk stratification and guide timely intervention, particularly in resource-limited settings. This study aimed to evaluate the predictive value of three readily available laboratory markers-neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and blood urea nitrogen (BUN)/creatinine ratio-for assessing amputation risk in patients with ALI.MethodsWe conducted a single-center, retrospective cross-sectional study of 138 patients diagnosed with ALI who presented to the emergency department between January 2020 and January 2023. Demographic and laboratory data were collected. ROC analysis was performed to evaluate the predictive performance of NLR, PLR, and BUN/creatinine ratio for amputation risk, and multivariate logistic regression identified independent predictors.ResultsAmong the biomarkers analyzed, the BUN/creatinine ratio demonstrated the highest predictive performance for amputation risk (AUC: 0.727, sensitivity: 69.0%, specificity: 68.8%), although the discriminative ability was only moderate. NLR (AUC: 0.666) and PLR (AUC: 0.647) also showed associations with amputation risk, though with lower predictive values. Female gender emerged as an additional independent predictor of amputation risk (OR: 4.16, 95% CI: 1.47-11.81, <i>P</i> = .007).ConclusionsOur findings suggest that the BUN/creatinine ratio may serve as an accessible biomarker with moderate predictive performance, whose main utility may lie in helping to exclude patients at low risk of amputation. While NLR and PLR also showed potential value, further prospective multicenter studies are required to validate their clinical applicability.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"216-223"},"PeriodicalIF":0.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145305067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Educational Attainment and Outcomes of Hemodialysis Access Creation.","authors":"Nyah Patel, Anna Schneider, Thomas W Cheng, Andrea Alonso, Thomas McNamara, Khuaten Maaneb De Macedo, Elizabeth King, Alik Farber, Jeffrey J Siracuse","doi":"10.1177/15385744251387567","DOIUrl":"10.1177/15385744251387567","url":null,"abstract":"<p><p>ObjectiveHigher education has historically correlated with improved health outcomes, yet its impacts on end-stage renal disease (ESRD) patients undergoing hemodialysis are not well understood. The goal of this study was to characterize patient factors and outcomes associated with initial arteriovenous (AV) access creation by patient education level.MethodsWe performed a single-center retrospective review of patients who underwent initial AV access creation from 2014-2021. Education groups were defined as primary (elementary school), secondary (middle/high school equivalent), and tertiary (college or higher). Univariable, multivariable, and Kaplan-Meier analyses were performed.ResultsWe identified 480 patients with primary (20.2%), secondary (54.6%), or tertiary education levels (25.2%). Patients with primary education were more likely to be of Hispanic ethnicity (58.8% primary vs 17.9% secondary vs 9.9% tertiary; <i>P</i> < 0.0001) or underinsured (Medicaid/uninsured) (62.9% vs 46.2% vs 39.7%; <i>P</i> < .001), but less likely to have English proficiency (27.1% vs 79.4% vs 77.5% tertiary; <i>P</i> < .001).Univariable analysis showed no significant differences in access-related steal or 30-day readmission. On Kaplan-Meier analysis, 2-year survival was 89.5% (primary education), 89.1% (secondary education), and 89.7% (tertiary education) (<i>P</i> = .99). Maturation at 180 days was 80.8%, 75.4%, and 75.3%, respectively (<i>P</i> = .4). On multivariable analysis, neither 30-day index readmission nor loss of primary patency were significantly associated with education level.ConclusionsAlthough education level was not associated with adverse outcomes once patients were undergoing hemodialysis, many of our patients only have primary school education. Earlier attempts at improving healthcare literacy and preventative care should be examined before the deterioration of kidney function.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"193-200"},"PeriodicalIF":0.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145294760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Secondary Prevention after Carotid Stenting in Patients With Atrial Fibrillation.","authors":"Alex D Hanson, Diedo J Ojeda, Arshaq Saleem, Elena Sagues, Andres Gudino, Randall Krug, Edgar A Samaniego","doi":"10.1177/15385744251387547","DOIUrl":"10.1177/15385744251387547","url":null,"abstract":"<p><p>IntroductionThere is no consensus on the optimal secondary stroke prevention regimen for patients with atrial fibrillation undergoing carotid artery stenting (CAS). Our objective is to compare the long-term efficacy and safety of different medical regimens after CAS.MethodsThis retrospective observational study included patients with pre-existing atrial fibrillation who underwent CAS from 2011 to 2024. Patients were divided into three treatment groups: dual antiplatelet therapy (DAPT), single antiplatelet therapy plus oral anticoagulation (AA), and triple therapy (dual antiplatelet therapy plus oral anticoagulation, TT). The primary outcome was the incidence of major bleeding. Secondary outcomes included the incidence of clinically relevant minor bleeding, recurrent stroke, and stent thrombosis.ResultsOf the 1047 patients who underwent CAS, 129 met the inclusion criteria: 31 in the DAPT group, 46 in the AA group, and 52 in the TT group. At 3 months, major bleeding events occurred in 3.2% (1/31) of patients in the DAPT group, 6.5% (3/46) in the AA group, and 7.7% (4/52) in the TT group (<i>P</i> = 0.71). Ischemic stroke after stent placement occurred in 6.4% (2/31) of cases in the DAPT group, compared to 4.3% (2/46) in the AA group and 1.9% (1/52) in the TT group (<i>P</i> = 0.57). Stent thrombosis occurred in 3.2% (1/31) of patients in the DAPT group, 6.5% (3/46) in the AA group, and 1.9% (1/52) in the TT group (<i>P</i> = 0.32).ConclusionOur findings suggest no significant differences in bleeding events or ischemic outcomes among the different antiplatelet and anticoagulation regimens in patients with atrial fibrillation who underwent CAS.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"201-208"},"PeriodicalIF":0.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145310571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular Management of Common Femoral Artery Occlusion Caused by Suture-mediated Vascular Closure Devices: A Single-Center Experience.","authors":"Young Ha Kim, Lee Hwangbo, Jun Kyeung Ko","doi":"10.1177/15385744251387755","DOIUrl":"10.1177/15385744251387755","url":null,"abstract":"<p><p>ObjectiveVascular closure devices (VCDs) are frequently employed to achieve hemostasis at the femoral puncture site, offering an alternative to traditional manual compression. However, a rare yet significant complication is common femoral artery (CFA) occlusion caused by suture-mediated VCDs. The optimal management of this complication remains unclear, with open surgical repair traditionally regarded as the standard of care. This paper aims to share our clinical experience in managing CFA occlusions caused by suture-mediated VCDs and to introduce our preferred endovascular treatment strategy.MethodsAt our institution, approximately 250 femoral artery hemostasis procedures using suture-mediated VCDs are performed annually. Over the past 10 years, we encountered 6 cases of CFA occlusion following the use of such devices. This corresponds to an incidence rate of approximately 0.24%. In all cases, endovascular management was selected as the primary treatment modality over open surgical intervention. Our endovascular approach consisted of initial balloon angioplasty, with adjunctive stenting performed when residual stenosis exceeded 50%.ResultsEndovascular treatment was technically successful in all 6 cases, with no major procedural complications. The mean degree of stenosis prior to balloon angioplasty was 91.9%, including 3 cases of long segmental occlusion. Balloon angioplasty alone was sufficient in 4 cases, while the remaining 2 required additional stenting to address significant residual stenosis. Final angiography demonstrated an average residual stenosis of 25.1%. During the follow-up period (mean duration: 37.8 months), no patients reported symptoms of lower extremity ischemia.ConclusionThis case series highlights the feasibility and efficacy of endovascular management as a first-line approach for CFA occlusion caused by suture-mediated VCDs. When diagnosis is delayed, long segmental occlusion with considerable thrombus burden may limit the effectiveness of balloon angioplasty alone, necessitating adjunctive stenting. Therefore, timely diagnosis and intervention are essential to optimize outcomes in these cases.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"89-96"},"PeriodicalIF":0.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145254465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stent-Graft Malposition Into a False Lumen Causing Occlusion Following Blunt External Iliac Artery Injury: Case Report of a Novel Technique of Endovascular Therapy for Recanalization.","authors":"Ryo Aoki, Akihiro Inoue, Atsuya Hasegawa, Miyuki Kambe, Daisuke Utsunomiya, Zenjiro Sekikawa","doi":"10.1177/15385744251387774","DOIUrl":"10.1177/15385744251387774","url":null,"abstract":"<p><p>IntroductionBlunt trauma to the external iliac artery (EIA) is rare but potentially fatal. Endovascular stent-graft placement is used to control hemorrhage and restore limb perfusion. However, the safety profile and potential complications associated with stent-graft treatment are not well documented. We report a case of EIA injury following blunt trauma complicated by stent-graft deployment into a false lumen, successfully managed with an endovascular rescue technique.Case ReportAn 88-year-old man sustained blunt pelvic trauma with active extravasation from the left EIA. Initially, a covered stent-graft was deployed, which inadvertently caused arterial occlusion due to placement within a false lumen. A rescue procedure was performed using an endovascular approach, where a guidewire was advanced through the perigraft space and snared to establish a pull-through technique. Over this, a second stent-graft was deployed within the perigraft space, restoring flow through the true lumen. Follow-up computed tomography images confirmed successful recanalization and persistent exclusion of the false lumen.ConclusionThis case highlights the potential for stent-graft misplacement in EIA trauma and the importance of ensuring access to the true lumen. Accessing the perigraft space and placing an additional stent-graft represents a new therapeutic approach to achieve recanalization in similar complex vascular injuries.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"154-159"},"PeriodicalIF":0.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145246207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aortic Dissection Following Endovascular Aneurysm Repair - A Systematic Review and Management Algorithm.","authors":"Angus Pegler, Yogeesan Sivakumaran","doi":"10.1177/15385744251387791","DOIUrl":"10.1177/15385744251387791","url":null,"abstract":"<p><p>BackgroundAortic dissection following endovascular aneurysm repair (EVAR) may be iatrogenic or a de-novo event. This study aims to systematically review all cases of dissection following EVAR to identify complications specific to each scenario and develop a management algorithm depending on the clinical presentation.MethodsA comprehensive literature search of MEDLINE, Embase, and CENTRAL databases was performed for all studies relating to dissection following EVAR or fenestrated/branched EVAR (F/BrEVAR). Data collected included timing (differentiating iatrogenic and de-novo events), entry tear location, endograft involved, complications, management, and subsequent outcomes. Due to limited data availability, descriptive data was collected and outcomes compared depending on dissection type and timing. Risk of bias was assessed using a standardised tool for case reports.Results46 patients in 37 studies were included. Complications included endograft compression (52.2%), endoleak (15.2%), and rupture (13.0%). Compression was less likely in endografts with proximal fixation (41.9%), compared to those without (69.2%). Type A dissection after EVAR required cardiac surgery with a high mortality (20.0%). In Type B dissection, 2 cases were diagnosed intra-operatively during F/BrEVAR, 1 died. 8 were diagnosed <4 weeks post-operatively, all managed medically with no complications or mortality. 31 were diagnosed >4 weeks, with mortality of 25.8% and high rates of endograft compression (58.1%), endoleak (16.1%), and rupture (19.4%).ConclusionAortic dissection following EVAR may cause endograft compression, endoleak, or rupture, with significant mortality. Complications are more frequent following Type A dissection and late Type B dissection. Early Type B dissection may be amenable to medical management.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"135-144"},"PeriodicalIF":0.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145254408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing Vascular Surgery Readmission Data in Commonly Used Quality Metric Programs.","authors":"Ahmad Aljobeh, Alisa Khomutova, Ian Winkeler, Sery Pak, Jasper Murphy, Stefanos Giannopoulos, Apostolos Tassiopoulos","doi":"10.1177/15385744251387569","DOIUrl":"10.1177/15385744251387569","url":null,"abstract":"<p><p>BackgroundThirty-day hospital readmissions are a critical healthcare quality metric used to evaluate hospital performance and patient outcomes. Vascular surgery readmission rates are among the highest and most costly. Accurate data on patient readmissions is essential for improving care quality and reimbursement processes. The accuracy of readmission data, often derived from quality metric programs like NSQIP and Vizient, is challenged by misclassification or improper capture of readmissions.MethodsWe conducted a single-institution retrospective analysis using the NSQIP and Vizient registries to identify patients who underwent vascular surgery between 2018 and 2023 and were subsequently readmitted to our institution within 30 days. Demographic, procedural, and readmission data were reviewed to identify factors associated with procedure-related vs non-procedure related readmissions. Logistic regression was employed to determine variables that significantly predicted procedure-related readmissions.ResultsAmong 2375 vascular surgery operations captured by NSQIP and Vizient during the study period, 219 patients (9.2%) were readmitted within 30 days. Of these, 89 (40.6%) were procedure-related and 130 (59.4%) were non-procedure-related. Baseline demographics, comorbidities, and perioperative characteristics were largely similar between groups, although patients with non-procedure-related readmissions were more likely to be functionally dependent (39.2% vs 22.5%, <i>P</i> = 0.009) and current smokers (30.8% vs 20.2%, <i>P</i> = 0.08). In multivariable logistic regression, functional dependence (OR 0.41, 95% CI 0.19-0.88, <i>P</i> = 0.022) and current smoking within 1 year (OR 0.48, 95% CI 0.23-0.99, <i>P</i> = 0.047) were independently associated with lower odds of procedure-related readmission, suggesting that these patients are more likely to return for medical decompensation rather than surgical complications.ConclusionsVascular surgery readmissions are frequent and costly, and factors such as functional health status and pre-existing complications should be considered in prevention strategies. Accurate documentation and coding, combined with targeted transitional care interventions, will be essential to reduce unnecessary readmissions and to ensure fair institutional benchmarking under current quality metric programs.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"108-116"},"PeriodicalIF":0.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145260451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Relationship Between Neutrophil-to-Lymphocyte Ratio and Restenosis in Patients With Femoropopliteal Chronic Total Occlusion Treated With Drug-Coated Balloon Alone Versus Combined Atherectomy and Drug-Coated Balloon.","authors":"Hasan Toz, Yusuf Kuserli, Gülsüm Türkyılmaz, Onur Emre Satılmıs, Ali Aycan Kavala, Saygın Türkyılmaz","doi":"10.1177/15385744251387577","DOIUrl":"https://doi.org/10.1177/15385744251387577","url":null,"abstract":"<p><p>ObjectivesTo evaluate the clinical, hematological, and anatomical outcomes of rotational atherectomy (RA) combined with drug-coated balloon (DCB) angioplasty compared to DCB alone in patients with femoropopliteal arterial disease, with particular emphasis on inflammatory markers and mid-term vessel patency.MethodsThis retrospective, single-center study included patients who underwent endovascular treatment for femoropopliteal lesions using either RA combined with DCB (RA + DCB) or DCB alone. Demographic characteristics, lesion morphology, neutrophil-to-lymphocyte ratio (NLR), and Doppler ultrasonography (DUS) findings were compared between the two groups. Primary outcomes were residual stenosis, ankle-brachial index (ABI), and mid-term vessel patency. Secondary outcomes included postprocedural NLR changes and clinical symptom evolution during follow-up.ResultsA total of 150 patients were included, with 75 treated using RA + DCB and 75 with DCB alone. There were no significant differences in baseline demographics or comorbidities between groups. The RA + DCB group demonstrated a higher prevalence of TASC A lesions and left lower extremity involvement. Postprocedural lymphocyte counts were significantly higher, and NLR values were significantly lower in the RA + DCB group. Additionally, this group exhibited lower residual stenosis rates and significantly higher patency rates at 6 and 12 months. Greater clinical improvement and a higher proportion of asymptomatic patients were observed in the RA + DCB group during follow-up.ConclusionsRA combined with DCB offers superior vascular and clinical outcomes vs DCB alone, likely due to improved lesion preparation and reduced inflammation. NLR may serve as both a prognostic biomarker and indicator of treatment efficacy in peripheral arterial interventions.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":"60 2","pages":"125-134"},"PeriodicalIF":0.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145764886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recurrent Ischaemic Episodes Linked to Carotid Plaque Ulceration: A Multidisciplinary Diagnostic and Management Approach.","authors":"Kausik Chatterjee, Alakendu Sekhar, Allam Harfoush, Michael Babawale, Arun Balakrishnan","doi":"10.1177/15385744251387780","DOIUrl":"10.1177/15385744251387780","url":null,"abstract":"<p><p>BackgroundIdentifying the aetiology of ischemic stroke can be challenging, especially when critical findings are overlooked. Stroke assessment often relies on standardised guidelines, primarily focused on carotid stenosis severity (>50%) as an intervention criterion. However, this approach may neglect high-risk plaque features. This case report highlights the importance of integrating diagnostic findings with clinical presentation to guide management.Case presentationA 68-year-old male presented with sudden-onset transient right arm weakness. Initial imaging, including MRI and CT angiography, revealed a subtle diffusion-weighted imaging (DWI) abnormality in the left hemisphere and moderate carotid atherosclerosis (<50%) that did not meet guideline criteria for endarterectomy. Despite antiplatelet and anticoagulant therapy, the patient experienced multiple recurrent ischemic episodes. Due to the persistence of symptoms, the multidisciplinary team (MDT) recommended advanced vessel wall MRI, which identified intraplaque haemorrhage and plaque ulcerations in the left internal carotid artery-critical findings missed on conventional imaging. This led to a decision to perform carotid endarterectomy. Histology confirmed atheromatous disease with intraplaque haemorrhage. Following surgery, the follow-up scans showed no new infarcts with no clinical recurrence.DiscussionThis case underscores the limitations of relying solely on carotid stenosis degree in stroke management and highlights the importance of identifying high-risk plaque characteristics. Advanced vessel wall imaging proved instrumental in guiding treatment, while MDT collaboration ensured a tailored approach. The findings emphasise the need to prioritise carotid stenosis characteristics over stenosis degree alone when guiding clinical decisions to optimise outcomes in ischemic stroke management.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"170-174"},"PeriodicalIF":0.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145246195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}