scholarly journals Combined Endovascular and Surgical Treatment of Chronic Carotid Artery Occlusion: Hybrid Operation

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Long Yan ◽  
Zhe Wang ◽  
Zhanchuan Liu ◽  
Haoyuan Yin ◽  
Xuan Chen
Keyword(s):  
Surgical Treatment ◽  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Hybrid Surgery ◽  
Failure Group ◽  
Success Group ◽  
Ischemic Events

Objectives. The optimal treatment choice of chronic carotid artery occlusion (CAO) remains inconclusive. This study was aimed at exploring the safety and effectiveness of hybrid surgery in the treatment of CAO and at determining predictors for successful recanalization. Methods. In this study, we enrolled 37 patients with CAO who underwent hybrid surgical treatment during the period 2016–2018. We extracted and analyzed patients’ demographic data, disease characteristics, surgical success rates, perioperative complications, and prognosis. Results. A total of 37 patients with symptomatic CAO underwent hybrid surgical treatment. Thirty cases (81.1%) were successfully recanalized, while seven were not. Blood reflux after carotid endarterectomy occurred in 18 patients (60%) of the success group and 1 (14.3%) of the failure group (OR, 9.0; 95% CI, 0.95-54.5; P = 0.042 ). The rate of distal ICA reconstruction below the clinoid segment was 20 (66.7%) in the success group and 1 (14.3%) in the failure group (OR, 12.0; 95% CI, 1.3-113.7; P = 0.029 ). In patients with successful recanalization, no ischemic events occurred after surgery and during follow-up, but restenosis of >50% was found in one case. In the failure group, two patients experienced recurrent ischemic events during follow-up. Perfusion imaging in successful recanalization cases is significantly improved, preoperative I/C ratio was 1.44 (IQR 1.27-1.55), and postoperative 1.12 (IQR 1.05-1.23). National Institutes of Health Stroke Scale (NIHSS) score of successful recanalization cases was 5.35 (2.26) before surgery and 2.03 (1.40) at 6 months ( P < 0.01 ). Conclusion. Hybrid surgery might be a safe and effective way to treat CAO. Distal internal carotid artery reconstruction to below the clinoid segment and blood reflux after carotid endarterectomy are predictors of successful recanalization.

Contralateral Internal Carotid Artery Occlusion Impairs Early But Not 30-Day Stroke Rate Following Carotid Endarterectomy

Angiology ◽  
2010 ◽  
Vol 61 (7) ◽  
pp. 705-710 ◽  
Author(s):  
Erik Bagaev ◽  
A. Maximilian Pichlmaier ◽  
Theodosios Bisdas ◽  
Mathias H. Wilhelmi ◽  
Axel Haverich ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Internal Carotid ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Internal Carotid Artery Occlusion ◽  
Stroke Rate ◽  
Contralateral Internal Carotid Artery

The importance of internal carotid artery occlusion tolerance test in carotid endarterectomy under locoregional anesthesia

2016 ◽  
Vol 158 (6) ◽  
pp. 1077-1081
Author(s):  
Marcos Dellaretti ◽  
Laura T. de Vasconcelos ◽  
Jules Dourado ◽  
Renata F. de Souza ◽  
Renato R. Fontoura ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Internal Carotid ◽  
Tolerance Test ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Internal Carotid Artery Occlusion ◽  
Locoregional Anesthesia

Abstract T P100: Effect of Carotid Endarterectomy on Cerebral Hemodynamics Using Quantitative Magnetic Resonant Angiography

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Xinjian Du ◽  
Sepideh Amin-Hanjani ◽  
Fady Charbel
Keyword(s):  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Cerebral Artery ◽  
Flow Direction ◽  
Cerebral Arteries ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Cerebral Hemodynamics ◽  
Flow Measurements ◽  
Blood Flow Measurements

Objective: To examine the effect of carotid endarterectomy (CEA) on cerebral hemodynamics using quantitative magnetic resonance angiography (QMRA). Methods: A total of 42 patients with severe carotid artery stenosis were studied (6 patients had asymptomatic stenosis). 6 of 42 patients had contralateral carotid artery occlusion. Pre- and post-op blood flow measurements of major cerebral arteries were performed using QMRA (NOVA,Vasol, Inc.). Results: Patients ranged from 39 to 85 (mean 66) years old, 17 female. Ipsilateral carotid artery flow was significantly increased after CEA, 253 ± 110 ml/min compare to 159 ± 79 ml/min (p<0.001). Middle cerebral artery (MCA) flow was not significantly increased (p=0.11), 127 ± 39 ml/min versus pre-op 115 ± 33 ml/min after CEA. Ipsilateral anterior cerebral artery (ACA) flow direction of 6 patients changed to anterograde, 5 patients’ ipsilatral posterior communicating artery (PCOM) flow direction changed to posterior, 1 patient had both flow direction of Ipilateral ACA and PCOM changed after CEA. Post-op Ipsilateral hemisphere flow (IHF), defined as the sum of MCA, ACA2, and PCA flows, was increased (p=0.05) from 220 ± 45 ml/min to 251 ± 83 ml/min. Conclusions: Carotid stenosis can result in ICA flow compromise, and CEA can increase the flow rate of the ipsilateral carotid artery significantly. However, the collateral capacity of the circle of Willis appears to be the more important determinant of Intracranial ipsilateral MCA flow.

Carotid Artery Occlusion and Ocular Ischemia: Therapy Control with Evoked Potentials

Neurosurgery ◽  
1986 ◽  
Vol 19 (6) ◽  
pp. 1031-1034 ◽  
Author(s):  
Maximilian H. Mehdorn ◽  
Heinz-Eugen Nau ◽  
Michael FÖrster
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Evoked Potentials ◽  
Visual Evoked Potentials ◽  
Internal Carotid ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Therapy Control ◽  
Arterial Bypass

Abstract We present a patient with internal carotid artery occlusion and ischemic oculopathy in whom extracranial-intracranial arterial bypass improved vision. Visual evoked potentials were studied to obtain objective criteria for indication and follow-up evaluation and confirmed that the improved vision was due to improved retinal function. (Neurosurgery 19:1031-1034, 1986)

scholarly journals Dissection-related carotid-cavernous fistula (CCF) following surgical revascularization of chronic internal carotid artery occlusion: a new subtype of CCF and proposed management

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Ao-Fei Liu ◽  
Chen Li ◽  
Wengui Yu ◽  
Li-Mei Lin ◽  
Han-Cheng Qiu ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Internal Carotid Artery Occlusion ◽  
Surgical Removal ◽  
Procedural Success ◽  
Carotid Cavernous Fistulas

Abstract Background The development of carotid-cavernous fistulas (CCFs) during surgical recanalization of chronic internal carotid artery occlusion (ICAO) may be secondary to severe ICA dissection rather than a focal tear of the cavernous ICA seen in typical traumatic CCFs. The purpose of this study is to investigate the causal relationship between the CCFs and severe ICA dissections and to characterize technical outcomes after treatment with stenting. Methods Five patients underwent treatment with self-expanding stents due to intraprocedural CCF and ICA dissection following surgical removal of ICAO plaque. The stents were telescopically placed via true channel of the dissection. Safety of the procedure was evaluated with 30-day stroke and death rate. Procedural success was determined by the efficacy of CCF obliteration and ICAO recanalization with angiography. Results All CCFs were associated with spiral and long segmental dissection from the cervical to cavernous ICA. After stenting, successful dissection reconstruction with TICI 3 was achieved in all patients, with complete (n = 4) or partial CCF (n = 1) obliteration. No patient had CCF syndrome, stroke, or death during follow-up of 6 to 37 months; but one patient had pulsatile tinnitus, which resolved 1 year later. Angiography at 6 to 24 months demonstrated CCF obliteration in all 5 patients and durable ICA patency in 4 patients. Conclusions Intraprocedural CCFs with spiral and cervical-to-cavernous ICA dissection during ICAO surgery are dissection-related because of successful obliteration after stenting for dissection reconstruction. Self-expanding stenting through true channel of the dissection, serving as implanting stent-autograft, may be an optimal therapy for the atypical CCF complication from ICAO surgery.

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