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Sténoses carotidiennes athéromateuses : causes fondamentales et conséquences cliniques

Abstract : The treatment of high-grade carotid stenosis is surgery combined with best medical treatment. We established since 2003, a prospective database including all patients hospitalized in our vascular surgery department for management of carotid stenosis. Since 2012, the clinical database was completed for the establishment of a biological database. We present here the method of setting up such a database, and the results of four original studies on the theme of "high-risk patient" for carotid surgery: the influence of renal function, of the delay between symptoms and surgery and of the contralateral carotid artery on outcome and the proposal of a prognostic score of intolerance to carotid clamping. We have shown that renal failure influenced outcome of carotid surgery in different ways depending on the method of assessment of renal function (serum creatinine, creatinine clearance calculated by Cockcroft-Gault or MDRD formula) ; the hemodynamic status of the contralateral carotid affected the rate of shunt without changing morbidity; that early surgery for symptomatic carotid stenosis was not burdened with excess mortality; and that it is possible to predict the need for establishment of a carotid shunt. Finally, we discuss future projects using biological collection to try to identify atherosclerotic plaques at risk
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Benjamin Kretz. Sténoses carotidiennes athéromateuses : causes fondamentales et conséquences cliniques. Médecine humaine et pathologie. Université de Bourgogne, 2014. Français. ⟨NNT : 2014DIJOMU04⟩. ⟨tel-01805170⟩

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