Long-term Restenosis Rate of Eversion Endarterectomy on the Internal Carotid Artery

Aim. Analysis of long-term results of eversion carotid endarterectomy in patients with atherosclerotic carotid stenosis.Methods. 272 eversion carotid endarterectomy surgeries was performed from June 2008 to December 2014 in the department of cardiac surgery. Long-term results were studied in 198 (73%) patients, with follow-up term ranging from 6 to 48 months. The method of operation serves as a criterion separating Patients were allocated into two groups by the surgery method: in the first group, eversion endarterectomy was performed by Kieny, in the second - by DeBakey.Results. Reconstructed ipsilateral internal carotid artery was passable during the follow-up period in 100% of cases, as confirmed by ultrasonography. In the late period, the mortality in the first group was 2.3% (myocardial infarction and cancer), compared to 1.5% in the second group (myocardial infarction). Acute ischemic stroke occurred in 0.8% of the first group patients and in 1.5% of the second group patients. Restenosis of 50 to 69% were discovered in 3.7% of cases in first group and in 3% in the second group. Restenosis ≥70% were found in 1.5% in both groups of patients.Conclusion. The obtained data confirm that both methods of eversion carotid endarterectomy are safe and reliable in treatment of carotid arteries atherosclerosis and, thus, preventing stroke.

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Comparative analysis of conventional and eversion carotid endarterectomy: Prospective randomized study

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0812590m ◽

2008 ◽

Vol 136 (11-12) ◽

pp. 590-597 ◽

Cited By ~ 2

Author(s):

Dragan Markovic ◽

Lazar Davidovic ◽

Zivan Maksimovic ◽

Ilija Kuzmanovic ◽

Nikola Ilic

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Carotid Endarterectomy ◽

Internal Carotid ◽

Randomized Study ◽

Neurological Complications ◽

Long Term Results ◽

Eversion Endarterectomy ◽

Significant Difference

INTRODUCTION Studies completed in the last decade of the 20th century showed benefits of carotid endarterectomy in the prevention of stroke in patients with a high-grade stenosis of the internal carotid artery. OBJECTIVE The aim of this prospective, randomized study was the comparison of early and long-term results between the conventional and eversion carotid endarterectomy, and literature review. METHOD By the method of random choice, 103 patients were operated on using the eversion carotid endarterectomy and 98 patients using the conventional technique. Operative treatment was carried out under general anaesthesia. Following the clammping of the carotid artery, retrograde blood pressure was determined by a direct puncture of the internal carotid artery above the stenotic lesions. In patients with retrograde pressure below 20 mm Hg intraluminal shunting was routinely performed. Early results were estimated (during the first seven postoperative days) based on mortality, central neurological complications (stroke, TIA) and cranial or cervical nerve lesions. Long-term results were estimated (after at least two years) based on long-term survival rate, central neurological complications (stroke, TIA) and the incidence of haemodynamically significant restenosis of the carotid artery treated by endarterectomy. RESULTS The average time of clamming of the internal carotid artery in the eversion carotid anderectomy group was 5.36 minutes shorter than in the group treated by the conventional technique. Student's t-test showed a statistically highly significant difference in the time needed for clamming of the internal carotid artery between the two groups. The average duration of eversion endarterectomy (82 minutes) was most often 19 minutes shorter than the duration of the conventional endarterectomy (101 minutes). Student's t-test showed a statistically highly significant difference in the average length of surgeries. The distal intimal fixation was more often needed during the conventional carotid endarterectomy (34.7%) compared to eversion endarterectomy (3.9%). ?2-test showed a statistically highly significant difference. CONCLUSION Eversion carotid endarectomy represents a statistically significantly shorter procedure. Distal intimal fixation demanded by this procedure is very rare, clammping of the internal carotid artery is significantly shorter, and it also has a lower rate of the early neurological complications. Based on the results of this study, as well as the opinions of other authors, it can be concluded that the eversion carotid endarterectomy has an advantage over the conventional procedure. We recommend conventional procedure only in cases when retrograde pressure indicates the use of the intraluminal shunting.

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Long-term stability of fusiform dilatation of the internal carotid artery following surgery adjacent to the circle of Willis: report of 2 cases

Journal of Neurosurgery Pediatrics ◽

10.3171/2020.7.peds20469 ◽

2020 ◽

pp. 1-4

Author(s):

Madeline B. Karsten ◽

R. Michael Scott

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Arachnoid Cyst ◽

Pediatric Patients ◽

Internal Carotid ◽

Imaging Finding ◽

Neurological Status ◽

Suprasellar Region

Fusiform dilatation of the internal carotid artery (FDCA) is a known postoperative imaging finding after craniopharyngioma resection. FDCA has also been reported following surgery for other lesions in the suprasellar region in pediatric patients and is thought to be due to trauma to the internal carotid artery (ICA) wall during tumor dissection. Here, the authors report 2 cases of pediatric patients with FDCA. Case 1 is a patient in whom FDCA was visualized on follow-up scans after total resection of a craniopharyngioma; this patient’s subsequent scans and neurological status remained stable throughout a 20-year follow-up period. In case 2, FDCA appeared after resection and fenestration of a giant arachnoid cyst in a 3-year-old child, with 6 years of stable subsequent follow-up, an imaging finding that to the authors’ knowledge has not previously been reported following surgery for arachnoid cyst fenestration. These cases demonstrate that surgery involving dissection adjacent to the carotid artery wall in pediatric patients may lead to the development of FDCA. On very long-term follow-up, this imaging finding rarely changes and virtually all patients remain asymptomatic. Neurointerventional treatment of FDCA in the absence of symptoms or significant late enlargement of the arterial ectasia does not appear to be indicated.

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Long-Term Follow-up of Blister Aneurysms of the Internal Carotid Artery

Neurosurgery ◽

10.1227/01.neu.0000444292.00629.fe ◽

2014 ◽

Vol 74 (3) ◽

pp. E343

Author(s):

&NA;

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Long Term Follow Up

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Eversion endarterectomy in surgery of the internal carotid artery

Cardiovascular Surgery ◽

10.1016/0967-2109(96)82313-1 ◽

1996 ◽

Vol 4 (2) ◽

pp. 190-194 ◽

Cited By ~ 20

Author(s):

L Entz

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Eversion Endarterectomy

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Surgical treatment of internal carotid artery restenosis following eversion endarterectomy

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1210577r ◽

2012 ◽

Vol 140 (9-10) ◽

pp. 577-582

Author(s):

Djordje Radak ◽

Slobodan Tanaskovic ◽

Miloje Vukotic ◽

Srdjan Babic ◽

Nikola Aleksic ◽

...

Keyword(s):

Surgical Treatment ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Surgical Techniques ◽

Minor Stroke ◽

Graft Occlusion ◽

Redo Surgery ◽

Eversion Endarterectomy ◽

Late Morbidity

Introduction. Carotid angioplasty and internal carotid artery stenting is the therapeutic method of choice in the treatment of carotid restenosis, but when it is not technically feasible (expressed tortuosity of supraaortic branches, calcifications, presence of pathological elongation of very long lesions) a redo surgery is indicated. Objective. The aim of our study was to examine the benefits and risks of redo surgery in patients with symptomatic and asymptomatic significant internal carotid artery restenosis and its impact on early and late morbidity and mortality. Methods. The study included 45 patients who were surgically treated for a hemodynamically significant internal carotid artery restenosis from January 2000 to December 2009. Surgical techniques included redo endarterectomy with direct suture, redo anderectomy with a patch plastic and resection with Dacron tubular graft interposition. The patients were followed for postoperative neurological ischemic events (transient ischemic attack (TIA), stroke), local surgical complications and lethal outcome after one month, six months, one year and after two years). Results. In the early postoperative period (up to 30 days) there were no lethal outcomes. TIA was diagnosed in four patients (8.8%), minor stroke in one patient (2.2%) and one patient (2.2%) also had cranial nerve injury. After two years two patients died (4.4%) due to fatal myocardial infarction, three patients (6.5%) had ipsilateral stroke and one patient developed graft occlusion (2%). Conclusion. In the case of symptomatic and asymptomatic carotid restenosis that cannot be treated by carotid percutaneous angioplasty, redo surgical treatment is therapeutic option with an acceptable rate of early and late postoperative complications.

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Long-term Follow-up of Blister Aneurysms of the Internal Carotid Artery

Neurosurgery ◽

10.1227/neu.0000000000000147 ◽

2013 ◽

Vol 73 (6) ◽

pp. 1026-1033 ◽

Cited By ~ 42

Author(s):

M. Yashar S. Kalani ◽

Joseph M. Zabramski ◽

Louis J. Kim ◽

Shakeel A. Chowdhry ◽

George A. C. Mendes ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Scale Score ◽

Glasgow Outcome Scale ◽

Internal Carotid ◽

Radiology Reports ◽

The Mean ◽

Operative Notes

Abstract BACKGROUND: Blister aneurysms of the internal carotid artery (ICA) are uncommon. There is a paucity of data on the long-term outcomes of patients. OBJECTIVE: To review our experience with the treatment of these lesions. METHODS: We retrospectively reviewed all aneurysms treated at our institution between 1994 and 2005. Relevant operative notes, radiology reports, and inpatient/outpatient records were reviewed. RESULTS: Seventeen patients (3 male, 14 female) with 18 blister aneurysms of the ICA were identified. The mean age was 44.6 years (range, 17–72; median, 42 years). Twelve patients (70.6%) presented with aneurysmal subarachnoid hemorrhage. The mean admission Glasgow Outcome Scale score was 4.3 (range, 2–5; median, 5). All patients were initially treated using microsurgical technique with direct clipping (n = 15; 83.3%) or clip-wrapping with Gore-Tex (n = 3, 16.7%). There were 4 cases of intraoperative rupture, all associated with attempted direct clipping; all 4 cases were successfully clipped. Two cases rebled post-treatment. Both rebleeding episodes were managed with endovascular stenting. Follow-up angiography was available for 14 patients and revealed a new aneurysm adjacent to the site of clipping in 1 patient and in-stent stenosis in 2. At the mean follow-up of 74.5 months (median, 73; range, 7–165), the mean Glasgow Outcome Scale score was 4.6 (range, 2–5; median, 5). CONCLUSION: Microsurgical treatment of blister aneurysms of the ICA results in excellent outcome. In the evolution of treating these friable aneurysms, we have modified our clip-wrapping technique and use this technique when direct clipping is not feasible.

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Successful management of bilateral internal carotid artery fusiform giant aneurysms in a patient with intimal fibroplasia using multiple flow diverters: With long-term imaging follow up

Interventional Neuroradiology ◽

10.1177/15910199211049129 ◽

2021 ◽

pp. 159101992110491

Author(s):

Jieun Roh ◽

Seung Kug Baik ◽

Jeong A Yeom ◽

Joo-Young Na ◽

Sang-Won Lee

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Flow Diverter ◽

Giant Aneurysms ◽

The Past ◽

Effective Treatment Modality ◽

Flow Diverters

The authors report a rare case of sequentially developed bilateral internal carotid artery (ICA) fusiform giant aneurysms in a patient with pathologically confirmed intimal fibroplasia. Both ICA fusiform aneurysms were treated with multiple flow diverter insertion and were well-managed over the past 5.5 years of follow-up. The development of aneurysms in this rare disease entity appears to be a lifelong process based on the authors’ observations in serial angiographic follow-up studies. Reconstruction therapy using flow-diverting stents in this unique condition may be a safe and effective treatment modality.

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Surgical Treatment of Proximal Segmental Occlusion of the Internal Carotid Artery

Surgery Research and Practice ◽

10.1155/2019/2976091 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8

Author(s):

Srdjan Babić ◽

Slobodan Tanasković ◽

Mihailo Nešković ◽

Predrag Gajin ◽

Dragoslav Nenezić ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Intracerebral Hemorrhage ◽

Carotid Endarterectomy ◽

Internal Carotid ◽

Long Term Results ◽

Common Symptom ◽

Coronary Syndrome

Purpose. To present the feasibility, safety, and efficacy of carotid endarterectomy in patients with type II internal carotid artery occlusions, including the long-term outcomes. Methods. From March 2008 to August 2015, 74 consecutive patients (48 men with a mean age of 65.1 ± 8.06 years) underwent carotid endarterectomy because of internal carotid artery (ICA) segmental occlusions. These were verified with preoperative carotid duplex scans (CDS) and CT angiography (CTA). Also, brain CT scanning was performed in all these patients. The indication for treatment was made jointly by a vascular surgeon, neurologist, and an interventional radiologist in a multidisciplinary team (MDT) context. After successful treatment, all the patients were followed-up at 1, 3, 6, and 12 months, then every 6 months thereafter. Results. The most common symptom at presentation was transient ischaemic attack (TIA) in 49 patients (66.2%), followed by stroke in the past six months in the 17 remaining patients (23%). Revascularisation of the ICA with endarterectomy techniques was performed successfully in all the patients with an average clamp time of 11.9 min. All the procedures were performed under general anaesthesia in combination with a superficial cervical block. The early complication rate was 8.1% and included two cardiac events (2.7%) (one rhythm disorder and one acute coronary syndrome), three TIAs (4.1%), and one intracerebral hemorrhage (1.3%). Only one patient with the intracerebral hemorrhage died 5 days after surgery giving a postoperative mortality of 1.3% for this series. During the follow-up period (mean 50.4 ± 31.3 months), the primary patency rates at 1, 3, 5, and 7 years were 98.4%, 94.9%, 92.9%, and 82.9%, respectively. Likewise, the survival rates were 98.7%, 96.8%, 89%, and 77.6%, respectively. Ultrasound Doppler controls during follow-up detected 8 ICA restenoses; however, only 3 of these patients required further endovascular treatment. Conclusions. Carotid endarterectomy of internal carotid artery (ICA) segmental occlusion is a safe and effective procedure associated with acceptable risk and good long-term results. Therefore, the current guidelines which do not recommend carotid endarterectomy in this patient group should be reassessed, with the requirement for ongoing large-scale randomized controlled trials to compare CEA with best medical therapy in this patient cohort.

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