Carotid endarterectomy in heart transplant patients

Porcellini, M; D'Armiento, Fp; Di Lella, D; Carbone, F; Russo, A; Mignogna, C; Del Guercio, L

Risultato della ricerca: Article

Abstract

AIM: The aim of this study was to determine the clinical outcome of carotid endarterectomy in heart transplant recipients and morphologic features of atherosclerotic plaques removed during operation. METHODS: Between April 1993 and October 2001 5 heart transplant patients with symptomatic carotid stenosis >70% underwent carotid endarterectomy with regional anesthesia, including a staged bilateral procedure in one patient. Cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol were evaluated in each patient. The plaques ( n=6) underwent histologic analysis after carotid endarterectomy. Carotid artery duplex imaging was added to the routine postoperative evaluation. RESULTS: Carotid plaques resulted to be echolucent on B-mode ultrasound examination. Cholesterol, triglycerides and LDL-cholesterol levels were found to be increased, while HDL-cholesterol were decreased. All patients underwent successful carotid endarterectomy; there were no perioperative deaths, major neurologic or cardiac events. The mean length of stay was 2.2 days. The mean follow-up was 44 months. In 1 case, an asymptomatic restenosis >50% occurred 9 months later and, in 2 other cases, a contralateral mild stenosis was found 12 and 36 months later. One patient had a progressive contralateral stenosis, requiring operation 18 months later. High lipid content and heterogeneous cellular infiltration were observed, including macrophages, T-lymphocytes, neutrophils, and also eosinophils in the rapidly progressing plaque. CONCLUSIONS: Heart transplant patients receiving immunosuppression may successfully undergo carotid endarterectomy, without increased risk, but progression of atherosclerotic disease in the carotid arteries seems to continue, despite lipid-lowering regimen and antiplatelet therapy.
Lingua originaleEnglish
pagine (da-a)267-271
Numero di pagine5
RivistaJournal of Cardiovascular Surgery
Volume46
Stato di pubblicazionePublished - 2005

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Carotid Endarterectomy
Transplants
Carotid Artery Diseases
LDL Cholesterol
HDL Cholesterol
Pathologic Constriction
Triglycerides
Cholesterol
Lipids
Conduction Anesthesia
Carotid Stenosis
Atherosclerotic Plaques
Carotid Arteries
Eosinophils
Immunosuppression
Nervous System
Length of Stay
Neutrophils
Macrophages
T-Lymphocytes

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Porcellini, M; D'Armiento, Fp; Di Lella, D; Carbone, F; Russo, A; Mignogna, C; Del Guercio, L (2005). Carotid endarterectomy in heart transplant patients. Journal of Cardiovascular Surgery, 46, 267-271.

Carotid endarterectomy in heart transplant patients. / Porcellini, M; D'Armiento, Fp; Di Lella, D; Carbone, F; Russo, A; Mignogna, C; Del Guercio, L.

In: Journal of Cardiovascular Surgery, Vol. 46, 2005, pag. 267-271.

Risultato della ricerca: Article

Porcellini, M; D'Armiento, Fp; Di Lella, D; Carbone, F; Russo, A; Mignogna, C; Del Guercio, L 2005, 'Carotid endarterectomy in heart transplant patients', Journal of Cardiovascular Surgery, vol. 46, pagg. 267-271.
Porcellini, M; D'Armiento, Fp; Di Lella, D; Carbone, F; Russo, A; Mignogna, C; Del Guercio, L. Carotid endarterectomy in heart transplant patients. Journal of Cardiovascular Surgery. 2005;46:267-271.
Porcellini, M; D'Armiento, Fp; Di Lella, D; Carbone, F; Russo, A; Mignogna, C; Del Guercio, L. / Carotid endarterectomy in heart transplant patients. In: Journal of Cardiovascular Surgery. 2005 ; Vol. 46. pagg. 267-271.
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abstract = "AIM: The aim of this study was to determine the clinical outcome of carotid endarterectomy in heart transplant recipients and morphologic features of atherosclerotic plaques removed during operation. METHODS: Between April 1993 and October 2001 5 heart transplant patients with symptomatic carotid stenosis >70{\%} underwent carotid endarterectomy with regional anesthesia, including a staged bilateral procedure in one patient. Cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol were evaluated in each patient. The plaques ( n=6) underwent histologic analysis after carotid endarterectomy. Carotid artery duplex imaging was added to the routine postoperative evaluation. RESULTS: Carotid plaques resulted to be echolucent on B-mode ultrasound examination. Cholesterol, triglycerides and LDL-cholesterol levels were found to be increased, while HDL-cholesterol were decreased. All patients underwent successful carotid endarterectomy; there were no perioperative deaths, major neurologic or cardiac events. The mean length of stay was 2.2 days. The mean follow-up was 44 months. In 1 case, an asymptomatic restenosis >50{\%} occurred 9 months later and, in 2 other cases, a contralateral mild stenosis was found 12 and 36 months later. One patient had a progressive contralateral stenosis, requiring operation 18 months later. High lipid content and heterogeneous cellular infiltration were observed, including macrophages, T-lymphocytes, neutrophils, and also eosinophils in the rapidly progressing plaque. CONCLUSIONS: Heart transplant patients receiving immunosuppression may successfully undergo carotid endarterectomy, without increased risk, but progression of atherosclerotic disease in the carotid arteries seems to continue, despite lipid-lowering regimen and antiplatelet therapy.",
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author = "{Porcellini, M; D'Armiento, Fp; Di Lella, D; Carbone, F; Russo, A; Mignogna, C; Del Guercio, L} and Bracale, {Umberto Marcello}",
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T1 - Carotid endarterectomy in heart transplant patients

AU - Porcellini, M; D'Armiento, Fp; Di Lella, D; Carbone, F; Russo, A; Mignogna, C; Del Guercio, L

AU - Bracale, Umberto Marcello

PY - 2005

Y1 - 2005

N2 - AIM: The aim of this study was to determine the clinical outcome of carotid endarterectomy in heart transplant recipients and morphologic features of atherosclerotic plaques removed during operation. METHODS: Between April 1993 and October 2001 5 heart transplant patients with symptomatic carotid stenosis >70% underwent carotid endarterectomy with regional anesthesia, including a staged bilateral procedure in one patient. Cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol were evaluated in each patient. The plaques ( n=6) underwent histologic analysis after carotid endarterectomy. Carotid artery duplex imaging was added to the routine postoperative evaluation. RESULTS: Carotid plaques resulted to be echolucent on B-mode ultrasound examination. Cholesterol, triglycerides and LDL-cholesterol levels were found to be increased, while HDL-cholesterol were decreased. All patients underwent successful carotid endarterectomy; there were no perioperative deaths, major neurologic or cardiac events. The mean length of stay was 2.2 days. The mean follow-up was 44 months. In 1 case, an asymptomatic restenosis >50% occurred 9 months later and, in 2 other cases, a contralateral mild stenosis was found 12 and 36 months later. One patient had a progressive contralateral stenosis, requiring operation 18 months later. High lipid content and heterogeneous cellular infiltration were observed, including macrophages, T-lymphocytes, neutrophils, and also eosinophils in the rapidly progressing plaque. CONCLUSIONS: Heart transplant patients receiving immunosuppression may successfully undergo carotid endarterectomy, without increased risk, but progression of atherosclerotic disease in the carotid arteries seems to continue, despite lipid-lowering regimen and antiplatelet therapy.

AB - AIM: The aim of this study was to determine the clinical outcome of carotid endarterectomy in heart transplant recipients and morphologic features of atherosclerotic plaques removed during operation. METHODS: Between April 1993 and October 2001 5 heart transplant patients with symptomatic carotid stenosis >70% underwent carotid endarterectomy with regional anesthesia, including a staged bilateral procedure in one patient. Cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol were evaluated in each patient. The plaques ( n=6) underwent histologic analysis after carotid endarterectomy. Carotid artery duplex imaging was added to the routine postoperative evaluation. RESULTS: Carotid plaques resulted to be echolucent on B-mode ultrasound examination. Cholesterol, triglycerides and LDL-cholesterol levels were found to be increased, while HDL-cholesterol were decreased. All patients underwent successful carotid endarterectomy; there were no perioperative deaths, major neurologic or cardiac events. The mean length of stay was 2.2 days. The mean follow-up was 44 months. In 1 case, an asymptomatic restenosis >50% occurred 9 months later and, in 2 other cases, a contralateral mild stenosis was found 12 and 36 months later. One patient had a progressive contralateral stenosis, requiring operation 18 months later. High lipid content and heterogeneous cellular infiltration were observed, including macrophages, T-lymphocytes, neutrophils, and also eosinophils in the rapidly progressing plaque. CONCLUSIONS: Heart transplant patients receiving immunosuppression may successfully undergo carotid endarterectomy, without increased risk, but progression of atherosclerotic disease in the carotid arteries seems to continue, despite lipid-lowering regimen and antiplatelet therapy.

KW - carotid endarterectomy; heart transplantation; carotid plaque

UR - http://hdl.handle.net/10447/43511

M3 - Article

VL - 46

SP - 267

EP - 271

JO - Journal of Cardiovascular Surgery

JF - Journal of Cardiovascular Surgery

SN - 0021-9509

ER -