Open surgery versus endovascular approach in treatment of extracranial carotid artery aneurysms

BackgroundOpen surgery and the retrograde endovascular approach via the distal left common carotid artery (LCCA) have some limitations in LCCA ostial stenosis treatment. The ‘no touch’ technique used in the renal artery was modified for this situation.MethodsFifteen selective LCCA stenosis patients were treated by the modified ‘no touch’ technique in the antegrade endovascular approach from March 2013 to March 2016. Thirteen underwent the transfemoral approach and the other two had the transbrachial approach due to a ‘bovine aortic arch’. Distal embolic protection devices were used in all cases. Follow-up included a neurological examination, carotid duplex scan, and office interview. Mean follow-up time was 18.2±11.5 months.ResultsThe initial technical success rate was 100%. The average procedure time was 84.0±16.3 min. There were no procedure-related deaths. No clinical neurological complications occurred during the in-hospital stay. No incidence of death or major stroke occurred during the follow-up period; 6.7% (1/15) of patients had a contralateral minor stroke, 66.7% (4/6) of symptomatic patients were relieved of initial symptoms, and the rest showed improvement. No patient developed new ipsilateral neurological symptoms and no in-stent restenosis occurred during the follow-up period. These results were confirmed by ultrasound.ConclusionsThe modified ‘no touch’ antegrade endovascular technique is a feasible method for treating LCCA ostial lesions with a satisfactory initial success rate, acceptable procedure time, and comparable mid- and long-term results. This technique could be considered as a complementary option for LCCA ostial stenosis in addition to open surgery and the retrograde endovascular approach.

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Pseudoaneurysm of the left internal carotid artery following tonsillectomy

VASA ◽

10.1024/0301-1526/a000153 ◽

2011 ◽

Vol 40 (6) ◽

pp. 491-494 ◽

Cited By ~ 4

Author(s):

Vávrová ◽

Slezácek ◽

Vávra ◽

Karlová ◽

Procházka

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Rare Complication ◽

Left Internal Carotid Artery ◽

Acute Tonsillitis ◽

Artery Pseudoaneurysm ◽

Complete Occlusion ◽

Endovascular Approach ◽

Deep Neck Infections

Internal carotid artery pseudoaneurysm is a rare complication of deep neck infections. The authors report the case of a 17-year-old male who presented to the Department of Otorhinolaryngology with an acute tonsillitis requiring tonsillectomy. Four weeks after the surgery the patient was readmitted because of progressive swallowing, trismus, and worsening headache. Computed tomography revealed a pseudoaneurysm of the left internal carotid artery in the extracranial segment. A bare Wallstent was implanted primarily and a complete occlusion of the pseudoaneurysm was achieved. The endovascular approach is a quick and safe method for the treatment of a pseudoaneurysm of the internal carotid artery.

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Surgical management of extracranial carotid artery aneurysms

VASA ◽

10.1024/0301-1526/a000528 ◽

2016 ◽

Vol 45 (3) ◽

pp. 223-228 ◽

Cited By ~ 2

Author(s):

Jan Paweł Skóra ◽

Jacek Kurcz ◽

Krzysztof Korta ◽

Przemysław Szyber ◽

Tadeusz Andrzej Dorobisz ◽

...

Keyword(s):

Carotid Artery ◽

Surgical Management ◽

Minor Stroke ◽

Stroke Rate ◽

Extracranial Carotid Artery ◽

Long Term Follow Up ◽

End To End ◽

Dacron Patch ◽

Major Stroke

Abstract. Background: We present the methods and results of the surgical management of extracranial carotid artery aneurysms (ECCA). Postoperative complications including early and late neurological events were analysed. Correlation between reconstruction techniques and morphology of ECCA was assessed in this retrospective study. Patients and methods: In total, 32 reconstructions of ECCA were performed in 31 symptomatic patients with a mean age of 59.2 (range 33 - 84) years. The causes of ECCA were divided among atherosclerosis (n = 25; 78.1 %), previous carotid endarterectomy with Dacron patch (n = 4; 12.5 %), iatrogenic injury (n = 2; 6.3 %) and infection (n = 1; 3.1 %). In 23 cases, intervention consisted of carotid bypass. Aneurysmectomy with end-to-end suture was performed in 4 cases. Aneurysmal resection with patching was done in 2 cases and aneurysmorrhaphy without patching in another 2 cases. In 1 case, ligature of the internal carotid artery (ICA) was required. Results: Technical success defined as the preservation of ICA patency was achieved in 31 cases (96.9 %). There was one perioperative death due to major stroke (3.1 %). Two cases of minor stroke occurred in the 30-day observation period (6.3 %). Three patients had a transient hypoglossal nerve palsy that subsided spontaneously (9.4 %). At a mean long-term follow-up of 68 months, there were no major or minor ipsilateral strokes or surgery-related deaths reported. In all 30 surviving patients (96.9 %), long-term clinical outcomes were free from ipsilateral neurological symptoms. Conclusions: Open surgery is a relatively safe method in the therapy of ECCA. Surgical repair of ECCAs can be associated with an acceptable major stroke rate and moderate minor stroke rate. Complication-free long-term outcomes can be achieved in as many as 96.9 % of patients. Aneurysmectomy with end-to-end anastomosis or bypass surgery can be implemented during open repair of ECCA.

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Highlights of the Guidelines for Screening of Extracranial Carotid Artery Disease: A Statement for Healthcare Professionals from the Multidisciplinary Practice Guidelines Committee of the American Society of Neuroimaging; Cosponsored by the Society of Vascular and Interventional Neurology

Journal of Endovascular Therapy ◽

10.1583/1545-1550(2007)14[469:hotgfs]2.0.co;2 ◽

2007 ◽

Vol 14 (4) ◽

pp. 469-474 ◽

Cited By ~ 3

Author(s):

Adnan I. Qureshi ◽

Andrei V. Alexandrov ◽

Charles H. Tegeler ◽

Robert W. Hobson ◽

J. Dennis Baker ◽

...

Keyword(s):

Carotid Artery ◽

Practice Guidelines ◽

Healthcare Professionals ◽

Carotid Artery Disease ◽

Extracranial Carotid Artery ◽

Multidisciplinary Practice ◽

Artery Disease ◽

American Society

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Current Management of Extracranial Carotid Artery Disease

Reviews on Recent Clinical Trials ◽

10.2174/157488706778250159 ◽

2006 ◽

Vol 1 (3) ◽

pp. 293-301 ◽

Cited By ~ 4

Author(s):

Rabih Chaer ◽

Brian DeRubertis ◽

Sheela Patel ◽

Stephanie Lin ◽

Craig Kent ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Artery Disease ◽

Current Management ◽

Extracranial Carotid Artery ◽

Artery Disease

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Determining Patient Preference for Treatment of Extracranial Carotid Artery Stenosis: Carotid Angioplasty and Stenting versus Carotid Endarterectomy

Annals of Vascular Surgery ◽

10.1007/s10016-001-0332-0 ◽

2003 ◽

Vol 17 (1) ◽

pp. 15-21 ◽

Cited By ~ 7

Author(s):

Julio A. Warren ◽

William D. Jordan ◽

Gustavo R. Heudebert ◽

David Whitley ◽

Douglas J. Wirthlin

Keyword(s):

Carotid Artery ◽

Carotid Endarterectomy ◽

Patient Preference ◽

Carotid Artery Stenosis ◽

Artery Stenosis ◽

Carotid Angioplasty ◽

Extracranial Carotid Artery ◽

Angioplasty And Stenting ◽

Carotid Angioplasty And Stenting

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Serum Lipids and Lipoproteins Are Less Powerful Predictors of Extracranial Carotid Artery Atherosclerosis Than Are Cigarette Smoking and Hypertension

Mayo Clinic Proceedings ◽

10.1016/s0025-6196(12)61007-6 ◽

1991 ◽

Vol 66 (3) ◽

pp. 259-267 ◽

Cited By ~ 29

Author(s):

DANIEL HOMER ◽

TIMOTHY J. INGALL ◽

HILLIER L. BAKER ◽

W. MICHAEL O'FALLON ◽

BRUCE A. KOTTKE ◽

...

Keyword(s):

Carotid Artery ◽

Cigarette Smoking ◽

Serum Lipids ◽

Extracranial Carotid Artery ◽

Carotid Artery Atherosclerosis ◽

Lipids And Lipoproteins

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Re “Contemporary Outcomes of Open and Endovascular Intervention for Extracranial Carotid Artery Aneurysms: A Single Centre Experience”

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2020.12.017 ◽

2021 ◽

Author(s):

Lazar Davidovic ◽

Filip Petrovic ◽

Andrija Roganovic

Keyword(s):

Carotid Artery ◽

Endovascular Intervention ◽

Single Centre ◽

Extracranial Carotid Artery ◽

Single Centre Experience

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Concomitant origin of the anterior or posterior spinal artery with the feeder of a spinal dural arteriovenous fistula (SDAVF)

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2016-012267 ◽

2016 ◽

Vol 9 (4) ◽

pp. 405-410 ◽

Cited By ~ 10

Author(s):

Yudhi Adrianto ◽

Ku Hyun Yang ◽

Hae-Won Koo ◽

Wonhyoung Park ◽

Sung Chul Jung ◽

...

Keyword(s):

Clinical Outcome ◽

Arteriovenous Fistula ◽

Open Surgery ◽

Dural Arteriovenous Fistula ◽

Spinal Dural Arteriovenous Fistula ◽

Posterior Spinal Artery ◽

Lumbar Level ◽

Scale Scores ◽

Complete Obliteration ◽

Endovascular Approach

Background/objectiveThe concomitant origin of the anterior spinal artery (ASA) or the posterior spinal artery (PSA) from the feeder of a spinal dural arteriovenous fistula (SDAVF) is rare and the exact incidence is not known. We present our experience with the management of SDAVFs in such cases.MethodsIn 63 patients with SDAVF between 1993 and 2015, the feeder origin of the SDAVF was evaluated to determine whether it was concomitant with the origin of the ASA or PSA. Embolization was attempted when the patient did not want open surgery and an endovascular approach was regarded as safe and possible. The outcome of the procedure was evaluated as complete, partial, or no obliteration. The clinical outcome was evaluated by Aminoff–Logue (ALS) gait and micturition scale scores.ResultsNine patients (14%) had a concomitant origin of the ASA or PSA with the feeder. There were two cervical, five thoracic, and two lumbar level SDAVFs. A concomitant origin of the feeder was identified with the ASA (n=7) and PSA (n=2). Embolization was performed in four patients and open surgery was performed in five. Embolization resulted in complete obliteration in three patients and partial obliteration in one. Using the ALS gait and micturition scale, the final outcome improved in six while three cases remained in an unchanged condition over 2–148 months.ConclusionsThe concomitant origin of the ASA or PSA with the feeder occurs occasionally. Complete obliteration of the fistula can be achieved either by embolization or open surgery. Embolization can be carefully performed in selected patients who are in a poor condition and do not want to undergo open surgery.

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