ArticleJournal of neurosurgery. Case lessons2025
To patch or not to patch: is that the real question? The role of hemodynamics in carotid endarterectomy. Illustrative cases.
Article in Journal of neurosurgery. Case lessons, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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5 authors.
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Abstract
backgroundThe utilizationof patches in carotid endarterectomy (CEA) for carotid artery stenosis remains controversial, with conflicting evidence regarding postoperative outcomes. This report accentuates this discourse with two selected representative cases with divergent outcomes. OBSERVATIONS: Computational fluid dynamics analyses of pre- and post-CEA hemodynamics revealed distinct hemodynamic profiles between the two patients. In the nonpatched internal carotid artery (ICA), the vessel retained a cylindrical shape, exhibiting swirling blood flow and higher wall shear stress (WSS)-patterns typical of healthy vasculature. The patched ICA adopted a bulbous shape, akin to the anatomical carotid bulb, and displayed lower WSS and noncoherent disturbed blood flow, which are features associated with atherosclerosis, endothelial dysfunction, and cellular damage. LESSONS: This study suggests that the question may not be "To patch or not to patch?" but rather "Is the restoration of the anatomical bulb shape beneficial or deleterious?" It sheds light on the hemodynamic implications of this procedure and provides insight into the ongoing debate surrounding CEA. Using a patch might not necessarily result in improved flow or more favorable outcomes; thus, restoration of the carotid bulb configuration postendarterectomy might not optimize the hemodynamic profile for patients, but rather, a simple tubular shape, without a patch, might offer the best solution. https://thejns.org/doi/10.3171/CASE24840.
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