Vertebral Artery to Common Carotid Artery Bypass in Takayasu's Disease with Delayed Cerebral Ischemia

1999 ◽  
Vol 141 (6) ◽  
pp. 655-659 ◽  
Author(s):  
I. M. Ziyal ◽  
L. N. Sekhar ◽  
K. Chandrasekar ◽  
W. O. Bank
2005 ◽  
Vol 103 (1) ◽  
pp. 170-175 ◽  
Author(s):  
Miguel A. Melgar ◽  
Deshdeepak Sahni ◽  
Martin Weinand

✓ Medically refractory positional cerebral ischemia (PCI) and concomitant orthostatic hypotension associated with chronic common carotid artery (CCA) occlusion are rare. In this technical report, the authors describe an extracranial bypass in which the thyrocervical trunk was used as a donor vessel to treat three cases of CCA occlusion with PCI. Postoperatively, although orthostatic hypotension remained, ischemia-related symptoms resolved in all three patients and long-term graft patency was demonstrated. It is possible to treat cerebral ischemia due to CCA occlusion with extracranial bypass surgery. In these patients, the thyrocervical trunk proved to be a suitable donor vessel for the reconstitution of blood flow within the external carotid artery.


Neurosurgery ◽  
2010 ◽  
Vol 67 (6) ◽  
pp. 1783-1789 ◽  
Author(s):  
Ulf Christoph Schneider ◽  
Paul von Weitzel-Mudersbach ◽  
Karl-Titus Hoffmann ◽  
Peter Vajkoczy

Abstract BACKGROUND: Extracranial-intracranial bypass surgery provides blood flow augmentation in patients suffering from intracranial or long-distance conductance artery stenosis or occlusion that otherwise cannot be treated. The standard procedure for these cases is an anastomosis between the superficial temporal and middle cerebral arteries. However, in patients presenting with common carotid artery occlusion, the superficial temporal artery is no longer sufficiently perfused. For these patients, alternative revascularization strategies have to be applied. OBJECTIVE: To describe a novel strategy for revascularization of patients with common carotid artery occlusion, ie, the extracranial posterior communicating artery bypass. METHODS: Two patients with chronic cerebrovascular compromise resulting in transitory ischemic attacks and/or border-zone infarctions caused by common carotid artery occlusion were referred to our institution. A radial artery bypass was established between the third segment of the vertebral artery and an M3 branch of the middle cerebral artery. The vertebral artery was exposed between the vertebral lamina of C1 and occipital bone via a paramedian incision. The bypass was tunneled subcutaneously, conducted intracranially via a tailored extended burr-hole craniotomy, and anastomosed to a recipient M3 vessel. RESULTS: The postoperative course of both patients was uneventful in terms of cerebral ischemia or bleeding complications. In both patients, postoperative angiographic controls revealed an excellent bypass function with markedly improved hemispheric filling of multiple middle cerebral artery branches. The patients were discharged without new neurological symptoms. CONCLUSION: Our extracranial posterior communicating artery bypass using a radial artery transplant from the vertebral artery to the middle cerebral artery is a useful tool to treat patients suffering from hemodynamic cerebrovascular compromise caused by common carotid artery occlusion.


2003 ◽  
Vol 14 (3) ◽  
pp. 1-6 ◽  
Author(s):  
Miguel A. Melgar ◽  
Martin E. Weinand

Medically refractory positional cerebral ischemia and concomitant orthostatic hypotension associated with chronic common carotid artery (CCA) occlusion are rare. The authors detail their experience with three cases treated exclusively by an extracranial bypass in which the thyrocervical trunk was used as the donor vessel. Postoperatively grafts were patent and symptoms resolved in all three patients, although orthostatic hypotension remained. Postural cerebral ischemia due to CCA occlusion can be treated by extracranial bypass surgery. The thyrocervical trunk is a suitable donor for reconstruction of the external carotid artery in these cases.


2018 ◽  
Vol 46 ◽  
pp. 368.e13-368.e17
Author(s):  
Murat Ugurlucan ◽  
Yilmaz Onal ◽  
Didem Melis Oztas ◽  
Cagla Canbay ◽  
Ibrahim Demir ◽  
...  

ISRN Anatomy ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Virendra Budhiraja ◽  
Rakhi Rastogi ◽  
Vaishali Jain ◽  
Vishal Bankwar ◽  
Shiv Raghuwanshi

Variations of the branches of aortic arch are due to alteration in the development of certain branchial arch arteries during embryonic period. Knowledge of these variations is important during aortic instrumentation, thoracic, and neck surgeries. In the present study we observed these variations in fifty-two cadavers from Indian populations. In thirty-three (63.5%) cadavers, the aortic arch showed classical branching pattern which includes brachiocephalic trunk, left common carotid artery, and left subclavian artery. In nineteen (36.5%) cadavers it showed variations in the branching pattern, which include the two branches, namely, left subclavian artery and a common trunk in 19.2% cases, four branches, namely, brachiocephalic trunk, left common carotid artery, left vertebral artery, and left subclavian artery in 15.3% cases, and the three branches, namely, common trunk, left vertebral artery, and left subclavian artery in 1.9% cases.


2018 ◽  
pp. 126-131

Ligadura de arteria carótida común y exsanguinación como modelo experimental de isquemia cerebral focal en ratas Ligation of common carotid artery and exsanguination as experimental model of focal cerebral ischemia in rats  Luz Marina Guerrero Espino Universidad Nacional de Trujillo, Calle Salaverry N⁰545-Trujillo, Perú DOI: https://doi.org/10.33017/RevECIPeru2013.0017/ Resumen La isquemia cerebral   es el proceso fisiopatológico caracterizado por la disfunción de una porción del tejido cerebral secundario a la disminución del flujo en una arteria cerebral concreta.  La mejor herramienta que se dispone hoy para el estudio de la fisiopatología de la isquemia cerebral son los modelos experimentales, que permiten abordar de manera simple el cuidado de esta afección que se caracteriza por su complejidad y heterogeneidad. Considerando que  las investigaciones sobre este campo es ilimitada, no solo por la trascendencia sino por el costo social de la enfermedad  ,el estudio de nuevas metodologías experimentales permitirán alcanzar mejores herramientas con rigor científico para el conocimiento fisiopatológico, terapéutico y preventivo de la enfermedad isquémica cerebral.Por lo que nos propusimos  determinar si la ligadura de arteria carótida común izquierda y exsanguinación     puede ser utilizada como modelo de isquemia cerebral focal en ratas. Se usaron 36 ratas, machos de 8 a 9 semanas de edad, con 200 ± 20gr de peso, que se mantuvieron en condiciones estándar de iluminación, ciclos diarios de 12 horas de luz y 12 de oscuridad, a una temperatura ambiente de 24-25°C, los especímenes fueron distribuidas en dos grupos: Grupo Sham o seudo operado y Grupo Experimental (operado). Se procedió a la sangría por punción cardiaca, y se extrajo de cada rata el 10% del volumen de sangre circulante. Bajo condiciones de asepsia y antisepsia, se realizó una incisión en la línea media del cuello y diseccionó la piel, tejido subcutáneo y músculo hasta lograr identificar la arteria carótida común (ACC) izquierda y se ligó con sutura Nylon 5-0 para interrumpir la circulación sanguínea de manera ipsilateral, se suturó la herida y se administró lidocaína, finalmente se dejó descansar al animal a una temperatura ligeramente mayor a la ambiental en cámaras previamente confeccionadas. Luego de 24 horas de aplicar la cirugía, se sacrificaron los especímenes por sobredosis de anestésico y se realizó la remoción del cerebro y el análisis histopatológico de secciones coronales en tres regiones neocortex, hipocampo y ganglios basales, por ser las áreas más vulnerables a daño en una lesión isquémica. Se encontró que las mayores características neuronales que indican daño celular se manifestaron en el Grupo Experimental con un p‹0.01 y la zona con mayor incidencia de daño es el ganglio basal, p ‹0.01. Se concluyó que la ligadura de arteria carótida común izquierda y ex sanguinación produce daños neuronales localizados y la zona más afectada es el ganglio basal. Descriptores:  isquemia cerebral focal, ligadura arteria carótida común ex sanguinación. Abstract Cerebral ischemia is the pathophysiological process characterized by dysfunction of a portion of brain tissue secondary to decreased flow in specific brain artery. The best tool available today to study the pathophysiology of cerebral ischemia are experimental models, which allow a simple way to address the care of the condition which is characterized by complexity and heterogeneity. Whereas research on this field is unlimited, not only because of the importance but by the social cost of the disease, the study of new experimental methodologies to achieve better tools for scientific rigor in pathophysiological knowledge, treatment and prevention of cerebral ischemic disease. So we set out to determine whether the common carotid artery ligation and ex sanguination left can be used as a model of focal cerebral ischemia in rats. We used 36 male rats of 8 to 9 weeks of age, with 200 ± 20g of weight, were maintained in standard lighting conditions, daily cycles of 12 hours of light and 12 of darkness were used at an ambient temperature of 24-25 ° C, the specimens were divided into two groups: Sham Groups and Experimental Group (operated). We proceeded to the bleeding via cardiac puncture, and extracted from each rat 10% of circulating blood volume. Under aseptic and antiseptic conditions, an incision was made in the midline of the neck and dissected the skin, subcutaneous tissue and muscle to be able to identify the left common carotid artery (CCA) and ligated with 5-0 nylon suture to interrupt circulation way of ipsilateral blood, the wound was sutured and received lidocaine finally allowed to rest the animal at a slightly higher environmental chambers previously made temperature. After 24 hours of surgery applied, the specimens were sacrificed by overdose of anesthetic and removal of the brain and histopathological analysis of coronal sections in three regions neocortex, hippocampus and basal ganglia was performed, being the most vulnerable areas to damage ischemic injury. It was found that the major characteristics that indicate neuronal cell damage demonstrated in the experimental group with p <0.01 and the area with the highest incidence of injury is the basal ganglia, p <0.01. It was concluded that ligation of left common carotid artery and ex sanguinación produces localized neuronal damage and the most affected area is the basal ganglia. Keywords: Focal cerebral ischemia, ligation of left common carotid artery and ex sanguination


2018 ◽  
Vol 53 ◽  
pp. 111-116 ◽  
Author(s):  
Giulio Illuminati ◽  
Giulia Pizzardi ◽  
Francesco G. Calio′ ◽  
Federica Masci ◽  
Rocco Pasqua ◽  
...  

2020 ◽  
Vol 19 (3) ◽  
pp. E301-E302
Author(s):  
Sirin Gandhi ◽  
Claudio Cavallo ◽  
Justin R Mascitelli ◽  
Michael J Nanaszko ◽  
Xiaochun Zhao ◽  
...  

Abstract Extracranial vertebral artery (VA) atherosclerosis is responsible for 14% to 32% of posterior circulation infarctions.1 In the posterior circulation, narrowing of the VA &gt; 30% is significantly associated with strokes. Subclavian artery (SCA) atherosclerosis can produce subclavian steal. Retrograde VA flow around an occluded SCA decreases blood flow to the posterior circulation and causes vertebrobasilar insufficiency (VBI). Flow augmentation to the posterior circulation can be achieved by VA endarterectomy, arterial stenting, VA-common carotid artery (CCA) transposition, or bypass using an interposition graft.2,3 This video illustrates microsurgical revascularization of the proximal VA with VA-CCA transposition. A 58-yr-old man with a prior stroke and chronic right VA occlusion presented with dysarthria and gait instability. Angiographic evaluation confirmed complete midcervical right VA occlusion and left SCA occlusion proximal to VA origin, with subclavian steal. After obtaining patient consent and a failed attempt at endovascular recanalization of the left SCA, a left VA-CCA end-to-side transposition was performed. Neck dissection exposed the left CCA. The thyrocervical trunk served as a landmark to identify the SCA, which was traced proximally to the VA origin. After proximal occlusion, the VA was transected and “fish-mouthed” for end-to-side anastomosis to CCA. An intraluminal, continuous suture technique was used to sew the back walls of this anastomosis. Postoperative computed tomography angiography confirmed bypass patency. Collateral circulation through the thyrocervical and costocervical trunks likely supplied the left arm, and no cerebral, or limb, ischemic symptoms were noted on follow-up. VA-CCA transposition is an uncommon technique for safe and effective revascularization of symptomatic, medically refractory VBI caused by VA occlusion or, as in this case, SCA occlusion with secondary subclavian steal. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.


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