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fbtwitterlinkedinvimeoflicker grey 14rssslideshare1
Saedon, Mahmud H.
Languages: English
Types: Doctoral thesis
Subjects: RC

Classified by OpenAIRE into

mesheuropmc: cardiovascular system
Background\ud \ud Transient cerebral microemboli detected by transcranial Doppler (TCD) have been demonstrated to be a reliable biomarker for short term stroke risk in two clinical settings; patients with carotid artery stenosis and those following carotid endarterectomy. Suppressing cerebral microemboli using TCD-directed antiplatelet treatment reduces risk of recurrent stroke. The association between classical cardiovascular risk factors and cerebral microemboli has not been studied. Furthermore, standard TCD method to detect cerebral microemboli is limited by lack of acoustic temporal bone window which is not available in approximately 1 in 7 patients. TCD is the only real-time imaging modality for detecting microemboli. The demonstration of the kinetic of the microemboli is invaluable in assessing the efficacy of antiplatelet agents.\ud Hypotheses\ud \ud 1. Whether Pocock cardiovascular risk score and ABCD2 risk score are able to predict the presence of cerebral microemboli.\ud 2. The feasibility of using transorbital Doppler as an alternative to transcranial Doppler. \ud 3. The effectiveness of Tirofiban in suppressing cerebral microemboli.\ud \ud Methods\ud \ud 1. Pocock score was assessed for the newly developed Carotid Surgery Registry of 670 patients managed between January 2002 and December 2012.\ud 2. ABCD2 score was determined in 206 patients with hyper-acute symptomatic critical carotid artery stenosis in which 102 of these patients were from Registry. A further 104 consecutive patients were recruited between February 2011 and May 2013 within a new prospective observational study.\ud 3. The feasibility of using transorbital Doppler was assessed based on the Registry data. Further new prospective validation study of transorbital Doppler against standard TCD method involving 100 consecutive patients undergoing elective carotid endarterectomies were undertaken.\ud 4. From the Registry, patients who had microembolic signals acutely following carotid surgery were assessed to evaluate the effectiveness of Tirofiban in suppressing microemboli.\ud \ud Findings\ud \ud 1. A high Pocock score (≥ 0.8%) predicts presence of cerebral microemboli acutely following carotid endarterectomy (Area Under Curve (AUC) 0.582 95% CI 0.507 – 0.658, P = 0.038). It also showed a high sensitivity for the presence of microemboli in patients with hyper-acute symptomatic carotid artery disease.\ud 2. The ABCD2 score did not predict presence of cerebral microemboli ((AUC 0.49 95% CI 0.41 – 0.57, P = 0.860), or carotid disease in over one-quarter of patients with symptomatic critical carotid artery stenosis.\ud 3. Transorbital Doppler imaging appears a valid alternative to transcranial Doppler for detecting microembolic signals in patients with no suitable temporal acoustic window (sensitivity 80 %, specificity 86 %. Bland and Altman analysis revealed no significant bias [bias 0.11 microemboli (95% CI: -0.52 to 0.74), P = 0.81]).\ud 4. Tirofiban has been shown to be more effective in treating microemboli in comparison to other most commonly used antithrombotic agents. The time for complete microemboli resolution (Tirofiban 68 minutes (53-94); dextran 113 (79-146); or in controls 53(49-68); P<0.001, KW) were shorter with tirofiban.
  • The results below are discovered through our pilot algorithms. Let us know how we are doing!

    • Risk and mechanism of recurrence stroke...............................................................17
    • Cardiovascular risk factors in carotid disease ..........................................................22
    • ABCD2 risk score in carotid disease..........................................................................28
    • Carotid duplex ultrasound - Measuring carotid stenosis ........................................30
    • Carotid endarterectomy for prevention of recurrent stroke ...................................35 Carotid artery disease associated cerebral microemboli................................................. 40 Establishing the Carotid Surgery Registry........................................................................ 62
    • Background..............................................................................................................62
    • Subjects ...................................................................................................................66
    • Inclusion criteria ......................................................................................................66
    • Ethics .......................................................................................................................66
    • The standard operating procedure (SOP) for data collection ..................................67
    • Preoperative surgical preparation ...........................................................................71
    • Intraoperative - Imaging and surgical methods .......................................................71
    • Post-operative - pharmacological management......................................................75
    • Statistics ..................................................................................................................76 Prospective hyper-acute symptomatic carotid artery stenosis study.............................. 77 5.3.2 Prediction of cardiovascular risk score for microemboli in 206 patients with hyperacute symptomatic carotid artery stenosis ...........................................................................107 5.3.3 ABCD2 risk score to predict presence of cerebral microemboli in hyper-acute symptomatic critical carotid artery stenosis patients ...........................................................113 CHAPTER EIGHT ............................................................................................................................ 161 2. Saedon M, Saratzis A, Lee RW, Hutchinson CE, Imray CH, Singer DR. Registry report
    • carotid endarterectomy. (submitted) 3. Saedon M, Dilshad A, Tiivas C, Virdee D, Hutchinson CE, Singer DR, Imray CH. Prospective
    • cerebral microemboli. Br J Surg. 2014 Nov; 101(12):1551-5. doi: 10.1002/bjs.9634.
    • PubMed PMID: 25224848. 4. Imray C, Buxton P, Saedon M, Hutchinson C, Singer D. Regarding "Intraoperative use of
    • Surg. 2013 Oct; 58(4):1167. doi: 10.1016/j.jvs.2013.05.102. PubMed PMID: 24075115. 5. Saedon M, Singer DR, Pang R, Tiivas C, Hutchinson CE, Imray CH. Registry report on
    • endarterectomy. Stroke. 2013 Jan; 44(1):230-3. doi: 10.1161/STROKEAHA.112.676338.
    • PubMed PMID: 23086672. 6. Saedon M, Imray CH, Singer DR. “Breakthrough pinpoints new stroke treatment”. Daily
    • Express. November 23, 2012 7. Jaipersad TS, Saedon M, Tiivas C, Marshall C, Higman DJ, Imray CH. Perioperative
    • in those patients without a temporal bone acoustic window. Ultrasound Med Biol. 2011
    • May; 37(5):719-22. doi: 10.1016/j.ultrasmedbio.2011.01.018. PubMed PMID: 21458149. 1. Saedon M, Athanasios Saratzis, Ahmed Karim, Steve Goodyear. Endovascular versus
    • and Endovascular Surgery. January 2015 (in press) 2. Saedon M, Mt-Isa S, Saratzis A, Leung E, Mahmood A. Outcome of open versus
    • meta-analysis. Int Angiol. 2014 April. PMID: 24824839. 3. Goodyear SJ, Yow H, Saedon M, Shakespeare J, Hill CE, Watson D, Marshall C, Mahmood
    • cohort study. Perioper Med (Lond). 2013 May 19; 2(1):10. doi: 10.1186/2047-0525-2-10.
    • PubMed PMID: 24472159. 4. *Saratzis A, *Saedon M (Joint 1st authors), Melas N, Kitas GD, Mahmood A. Obesity as an
    • Ann Vasc Surg. 2013 Dec 27. doi: 10.1016/j.avsg.2013.07.008. PubMed PMID: 24378248. 5. Saratzis AN, Goodyear S, Sur H, Saedon M, Imray C, Mahmood A. Acute kidney injury after
    • endovascular repair of abdominal aortic aneurysm. J Endovasc Ther. 2013 Jun; 20(3):315-
    • 30. doi: 10.1583/12-4104MR2.1. PubMed PMID: 23731304. 6. *Saedon H, *Saedon M(Joint 1st authors), Goodyear S, Papettas T, Marshall C. Temporal
    • artery biopsy for giant cell arteritis: retrospective audit. JRSM Short Rep. 2012 Oct;
    • 3(10):73. doi: 10.1258/shorts.2012.012069. PubMed PMID: 23162686
    • 209 7. Saedon H, Salleh S, Balakrishnan A, Imray CH, Saedon M. The role of feedback in
    • Med Educ. 2012 May 2; 12:25. doi: 10.1186/1472-6920-12-25. PubMed PMID: 22551353. 8. Papettas T, Saedon H, Saedon M. Opportunities for learning in the surgical workplace and
    • how they can be exploited: a practical guide. Br J Hosp Med (Lond). 2011 Dec; 72(12):707-
    • 10. PubMed PMID: 22241230. 2. Saedon M, Dishad A, Tiivas C, Hutchinson C, Singer DR, Imray CH. A prospective validation
    • General Meeting, 27 - 29 November 2013, Manchester. Abstract - British Journal of
    • Surgery 2014; 101(S2): 7 - 14 3. Saedon M, Hutchinson CE, Imray CHE, Singer DRJ. Cardiovascular Risk factors for
    • Conference, 28 - 31 May 2013, London. Cerebrovasc Dis 2013; 35 (Supl 3) 1-854 4. Saedon M, Hutchinson CE, Imray CHE, Singer DRJ. ABCD2 risk score does not predict
    • Society - Early Career Investigator Symposium, 13 April 2013, Warwick. Abstract -
    • pending 5. Saedon M, Tiivas C, Hutchinson C, Singer DRJ, Imray CHE. A prospective study comparing
    • carotid endarterectomy. International Surgical Congress, Association of Surgeons of Great 3. Saedon M, Hutchinson CE, Imray CHE, Singer DRJ. Cardiovascular Risk factors for
    • Congress, Association of Surgeons of Great Britain and Ireland (ASGBI), 1 - 3 May 2013.
    • Abstract - British Journal of Surgery 2013; 100(S7): 115 - 225 4. Saedon M, Pang R, Tiivas C, Hutchinson C, Singer DRJ, Imray CHE. Comparison of the
    • tirofiban with the dextran-40 for suppression of cerebral microemboli after elective
    • carotid endarterectomy. UK Stroke Forum 2012, 4 - 6 December 2012, Harrogate.
    • Abstract - Int J of Stroke (2012) 7 (sppl 2) 5. Saedon M, Hutchinson C, Singer DRJ, Imray CHE. Cardiovascular Risk factors for
    • Annual General Meeting, 28 - 30 November 2012, Manchester 6. Saedon M, Hutchinson C, Tiivas C, Singer DRJ, Imray C. A prospective study comparing
    • Clinical Radiology Annual Scientific Meeting 2012, 10th - 12th September 2012, London.
    • Abstract - Clin Radiol 67 2012 S1 - S10 7. Saedon M, Singer DRJ, Pang R, Tiivas C, Hutchinson C, Imray CHE. Comparison of the
    • tirofiban with the dextran-40 for Suppression of Cerebral Microemboli after elective
    • carotid endarterectomy. European Society of Cardiology Congress, 25th - 29th August
    • 2012, Munich, Germany. Abstract - Eur Heart J (2012) 33 (suppl 1): 19-338. 8. Saedon M, Pang R, Tiivas C, Hutchinson C, Singer DRJ, Imray CHE. Cardiovascular risk
    • factors in patients with carotid artery disease and active micro-embolisation. 2nd Joint
    • Meeting of the British and American Microcirculation Societies and 62nd Meeting of the
    • British Microcirculation Society, 4th - 6th July 2012, Oxford. Abstract - Microcirculation
    • (2013) 20: 1 - 68 9. Saedon M, Pang R, Tiivas C, Hutchinson C, Singer DRJ, Imray CHE. Comparison of
    • treatment with tirofiban compared with dextran-40 for suppression of cerebral
    • microemboli after elective carotid endarterectomy. 2nd Joint Meeting of the British and
    • American Microcirculation Societies and 62nd Meeting of the British Microcirculation
    • Society, 4th - 6th July 2012, Oxford. Abstract - Microcirculation (2013) 20: 1 - 68 10. Saedon M, Tiivas C, Hutchinson C, Singer D, Imray C. Report on use of the intravenous
    • endarterectomy. International Surgical Congress, Association of Surgeons of Great Britain 105 120 minutes
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