Treatment of tandem lesions of the extracranial carotid artery

Abstract The authors present a patient with bihemispheric transient ischemic attacks attributed to stenosis of the left common carotid origin and stenosis and ulceration of the left cervical internal carotid artery. Because of precarious cerebral blood supply secondary to occlusions of the right common carotid and left vertebral arteries, several measures were undertaken perioperatively to provide protection from cerebral ischemia during vessel occlusion. These included Swan-Ganz catheter monitoring to maximize cardiac output and maintain satisfactory hydration, normocarbia, satisfactory oxygenation, and moderate hypertension and barbiturate infusion. With these adjuncts, both lesions were treated together. Retrograde balloon angioplasty under fluoroscopic control of a significant stenosis of the common carotid artery origin was performed before carotid endarterectomy. Postoperative digital subtraction angiography demonstrated a satisfactory technical result. The management of tandem lesions of the extracranial carotid artery is discussed. Balloon angioplasty coupled with extracranial vascular reconstructive procedures may allow the management of lesions not treated safely or effectively by either technique alone.

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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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