Carotid Bypass: Insights from a Real World Multicentre French Cohort
Audrey Besutti1, Matthieu Besutti2, Benjamin Hentgen3
1Department of Endovascular and Vascular Surgery, Besançon Regional University Hospital Centre, Besançon, France.
Summary
Carotid bypass surgery is used for complex cases, but carries risks, especially for asymptomatic patients. Symptomatic patients may have acceptable outcomes, warranting careful selection for this procedure.
Area of Science:
- Vascular Surgery
- Cerebrovascular Disease
- Surgical Outcomes
Background:
- Carotid bypass surgery is an option for complex carotid artery disease.
- Real-world data on its outcomes are essential for clinical decision-making.
Purpose of the Study:
- To evaluate the utilization and early/midterm outcomes of carotid bypass surgery.
- To analyze risk factors associated with adverse events following the procedure.
Main Methods:
- Retrospective analysis of 459 patients undergoing carotid bypass across 12 French centers (2010-2023).
- Primary endpoint: 30-day composite of stroke and/or death.
- Secondary endpoints: complications, midterm patency, and ipsilateral ischemic stroke.
Main Results:
- The 30-day composite endpoint occurred in 5.8% of patients.
- Prosthetic graft use and diabetes were associated with increased risk; statin therapy showed protection.
- Midterm primary patency rates were high (97.1% at 5 years).
Conclusions:
- Carotid bypass is reserved for complex cases, often as a bailout or when standard revascularization is not feasible.
- The procedure may pose an unacceptable risk in asymptomatic patients.
- Outcomes in symptomatic patients might be acceptable but require careful case selection.
Related Concept Videos
01:26Atherosclerosis III: Management
Management of atherosclerosis involves an integrated strategy encompassing pharmacological treatment, surgical interventions, lifestyle changes, and nutrition therapy to address the multifactorial nature of the disease.Pharmacological TherapyA cornerstone of atherosclerosis management is the use of pharmacological agents. Statins, such as atorvastatin, are pivotal in inhibiting HMG-CoA reductase, an enzyme that catalyzes an initial step in cholesterol synthesis in the liver. This reduction in...
01:21Aneurysm II: Clinical Manifestations and Diagnostic Studies
Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...
01:21Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation
Clinical manifestationsPeripheral Arterial Disease (PAD) manifests through a range of symptoms, from the characteristic intermittent claudication to atypical presentations and severe complications in advanced stages. Intermittent claudication, a hallmark symptom of PAD, presents as exercise-induced muscle pain that typically resolves within minutes of rest. This pain is reproducible and stems from inadequate blood flow, leading to the accumulation of lactic acid produced during anaerobic...
01:30Acute Coronary Syndrome III: Diagnostic Studies
Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
01:30Coronary Artery Disease I: Introduction
Coronary Artery Disease (CAD): An Overview with Scientific InsightsCoronary Artery Disease (CAD), often referred to as C-A-D, is a prevalent blood vessel disorder classified under the broader category of atherosclerosis. Atherosclerosis is a pathological process characterized by the hardening and narrowing of arteries due to the accumulation of atherosclerotic plaques. These plaques are composed of cholesterol, fatty substances, inflammatory cells, calcium, and fibrin, reducing blood flow to...