Hemodynamic Compromise During Carotid Angioplasty and Stenting

Modern surgical treatment of arterial disease is moving towards minimally invasive procedures, as the benefits are numerous. However, one area that is resisting this trend is the treatment of carotid artery disease. For the past number of decades carotid endarterectomy surgery has been referred to as the “gold standard” in the treatment of carotid artery disease. However, in recent year’s carotid angioplasty and stenting (CAS) has emerged to challenge carotid endarterectomy surgery (CES) as a viable alternative for the prevention of strokes. However uptake of this procedure has been hindered due to the peri-operative complications associated with the treatment. During this procedure blood flow in one of the internal carotid arteries supplying blood to the brain is interrupted for a period of time. However, it has been shown that not all patients can accommodate this interruption. Qureshi et al. suggests that ischemic neurological deficits occur in 3 to 13% of patients as a result of hemodynamic compromise.

Surgical Advances for Extracranial Carotid Stenosis

Neurosurgery ◽

10.1227/neu.0000000000000150 ◽

2014 ◽

Vol 74 (suppl_1) ◽

pp. S83-S91 ◽

Cited By ~ 1

Author(s):

Robert E. Harbaugh ◽

Akshal Patel

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Carotid Endarterectomy ◽

Internal Carotid ◽

Carotid Artery Disease ◽

Carotid Angioplasty ◽

Artery Disease ◽

Abstract Carotid endarterectomy is a commonly performed operation to prevent stroke in patients who have asymptomatic or symptomatic internal carotid artery atherosclerotic stenosis. Carotid angioplasty and stenting has also been advocated for treatment of these patients. In this article, we address a number of questions for which a review of available data will advance our understanding of the role of carotid endarterectomy in stroke prevention. These include the following: Are carotid endarterectomy and carotid angioplasty and stenting equivalent procedures for the treatment of carotid artery disease? Which patients should be deemed at high risk for carotid endarterectomy? Should carotid endarterectomy be an urgent procedure in symptomatic patients with severe internal carotid artery stenosis? Finally, what is the role of carotid endarterectomy in asymptomatic patients? We also review the senior author's personal experience with >2000 consecutive carotid endarterectomies, with special attention to his present approach to this operation. We believe that carotid endarterectomy, in experienced hands, is a minimally invasive operation that remains the procedure of choice for most patients with carotid artery disease who will benefit from invasive treatment.

Pro: Has Carotid Angioplasty and Stenting Replaced Carotid Endarterectomy as the Treatment of Choice for Carotid Artery Disease?

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2009.01.024 ◽

2009 ◽

Vol 23 (2) ◽

pp. 245-247 ◽

Cited By ~ 1

Author(s):

Christopher J. Kwolek

Keyword(s):

Carotid Artery ◽

Carotid Endarterectomy ◽

Carotid Artery Disease ◽

Carotid Angioplasty ◽

Artery Disease ◽

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 ◽

Carotid Surgery Is the Gold Standard for High-Risk (HRP) Carotid Artery Intervention: Five-Year Cost-Effectiveness and Quality Stroke-Free Survival Comparison Between Carotid Endarterectomy (CEA), Carotid Angioplasty, and Stenting Technique (CAST), and Optimal Medical Therapy (OMT)

Journal of Vascular Surgery ◽

10.1016/j.jvs.2010.11.085 ◽

2011 ◽

Vol 53 (2) ◽

pp. 558

Author(s):

Niamh Hynes ◽

Sherif Sultan

Keyword(s):

Cost Effectiveness ◽

High Risk ◽

Carotid Artery ◽

Carotid Endarterectomy ◽

Gold Standard ◽

Carotid Surgery ◽

Carotid Angioplasty ◽

Free Survival ◽

Technique and clinical evidence of neuroprotection in carotid artery stenting

VASA ◽

10.1024/0301-1526/a000336 ◽

2014 ◽

Vol 43 (2) ◽

pp. 100-112 ◽

Cited By ~ 1

Author(s):

Rainer Knur

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenting ◽

Clinical Evidence ◽

Carotid Artery Disease ◽

Balloon Occlusion ◽

Protection Devices ◽

Artery Disease ◽

Distal Filter ◽

Carotid artery stenting has been advocated as an effective alternative to carotid endarterectomy. Periprocedural embolization of debris during endovascular treatment of carotid artery disease may result in neurological deficit. Different strategies are being developed and evaluated for their ability to minimize the clinical embolic risk. Distal filter devices, proximal and distal balloon occlusion systems are increasingly used in carotid artery stenting, because they seem to be safe and effective in preventing distal embolization, according to several uncontrolled studies. However the use of embolic protection devices is a subject of controversy and no data on their benefit are available from randomized controlled multi-center trials. The technique and clinical evidence of cerebral protection systems during carotid angioplasty and stenting for stroke prevention are reviewed.

Hyperperfusion Syndrome: Toward a Stricter Definition

Neurosurgery ◽

10.1227/01.neu.0000088738.80838.74 ◽

2003 ◽

Vol 53 (5) ◽

pp. 1053-1060 ◽

Cited By ~ 126

Author(s):

◽

Shelagh B. Coutts ◽

Michael D. Hill ◽

William Y. Hu ◽

Garnette R. Sutherland

Keyword(s):

Carotid Artery ◽

Intracerebral Hemorrhage ◽

Carotid Endarterectomy ◽

Clinical Presentation ◽

Imaging Techniques ◽

Neurological Deficits ◽

Acute Hemorrhage ◽

Motor Weakness ◽

Hyperperfusion Syndrome ◽

Angioplasty And Stenting

Abstract OBJECTIVE Hyperperfusion syndrome is a rare and potentially devastating complication of carotid endarterectomy or carotid artery angioplasty and stenting. With the advent of new imaging techniques, we reviewed our experience with this phenomenon. METHODS This report is a retrospective review of 129 consecutive cases of carotid endarterectomy performed between June 1, 2000, and May 31, 2002, and 44 consecutive cases of carotid artery angioplasty and stenting performed between January 1, 1997, and May 31, 2002. We specifically searched for examples of patients who developed postprocedural nonthrombotic neurological deficits that typified the hyperperfusion syndrome. RESULTS Seven cases of hyperperfusion syndrome occurred, four after endarterectomy (3.1% of carotid endarterectomy cases) and three after stenting (6.8% of stenting cases). The cases of hyperperfusion were classified as presenting with 1) acute focal edema (two cases with stroke-like presentation, attributable to edema immediately after revascularization), 2) acute hemorrhage (two cases of intracerebral hemorrhage immediately after stenting and one case immediately after endarterectomy), or 3) delayed classic presentation (two cases with seizures, focal motor weakness, and/or late intracerebral hemorrhage at least 24 hours after endarterectomy). CONCLUSION Hyperperfusion syndrome may be more common and more variable in clinical presentation than previously appreciated.

The Current Status of Carotid Endarterectomy: The “Gold Standard” Treatment for Carotid Artery Disease

Journal of Vascular and Interventional Radiology ◽

10.1016/s1051-0443(97)70014-9 ◽

1997 ◽

Vol 8 (1) ◽

pp. 16-19

Author(s):

Bruce A. Perler

Keyword(s):

Carotid Artery ◽

Carotid Endarterectomy ◽

Gold Standard ◽

Standard Treatment ◽

Carotid Artery Disease ◽

Current Status ◽

Artery Disease

Transcarotid Artery Revascularization and Advances in Vascular Surgery for Carotid Artery Disease

Surgical Technology Online ◽

10.52198/21.sti.39.cv1484 ◽

2021 ◽

Author(s):

James Hu ◽

◽

Andy Sohn ◽

Justin George ◽

Rajesh Malik ◽

...

Keyword(s):

Carotid Artery ◽

Vascular Surgery ◽

Carotid Endarterectomy ◽

Surgical Management ◽

Carotid Artery Stenosis ◽

Carotid Artery Stenting ◽

Carotid Artery Disease ◽

Artery Stenosis ◽

Cerebrovascular Accidents ◽

Artery Disease

Carotid artery atherosclerotic disease impacts over 2 million Americans annually. Since the advent of the carotid endarterectomy by Debakey in 1953, the surgical management of carotid artery stenosis has prevented cerebrovascular accidents. The technology utilized to manage carotid artery stenosis continued to evolve with the utilization of carotid artery stenting in 1989 and more recently transcarotid artery revascularization (TCAR). This review discusses the modern management of carotid artery stenosis with an emphasis on transcarotid artery revascularization (TCAR) and reversal of flow for reversal of flow for embolic protection.

Concomitant Surgical Treatment of Symptomatic Carotid Artery Disease With a Coexisting Shamblin I Carotid Body Tumor

Vascular and Endovascular Surgery ◽

10.1177/1538574416689430 ◽

2017 ◽

Vol 51 (2) ◽

pp. 103-107 ◽

Cited By ~ 2

Author(s):

Carlos A. Hinojosa ◽

Javier E. Anaya-Ayala ◽

Hugo Laparra-Escareno ◽

Adriana Torres-Machorro ◽

Rene Lizola ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Body ◽

Carotid Artery Disease ◽

Duplex Ultrasound ◽

Neurological Deficits ◽

Symptomatic Carotid ◽

Carotid Body Tumors ◽

Carotid Artery Endarterectomy ◽

Artery Disease ◽

Dissection Technique

Symptomatic carotid artery atherosclerotic disease is an indication for carotid artery endarterectomy. The coexistence of carotid body tumors (CBTs) with symptomatic carotid disease is rarely encountered and adds significant challenges to vascular surgeons, with a reported overall mortality for patients who undergo endarterectomy and tumor excision of 8.8%, as opposed to the 2% for those who had CBT excision only. We describe the case of a 79-year-old female who experienced an acute cerebrovascular accident in the left hemisphere; duplex ultrasound revealed high-grade carotid stenosis in the left side and the presence of a Shamblin I CBT. The risks and benefits of the planned operation were reviewed, and the decision was made to proceed with early carotid endarterectomy and concomitant surgical resection of the tumor using the retrocarotid dissection technique. The patient recovered well, and at 11 months from the combined procedure, her neurological deficits improved significantly.