scholarly journals Management of Bilateral Carotid Occlusive Disease

2015 ◽  
Vol 4 (3-4) ◽  
pp. 96-103 ◽  
Author(s):  
Ashutosh P. Jadhav ◽  
Andrew F. Ducruet ◽  
Brian T. Jankowitz ◽  
Tudor G. Jovin
Keyword(s):  
Scale Score ◽  
Internal Carotid ◽  
Recurrent Stroke ◽  
Carotid Stenting ◽  
Occlusive Disease ◽  
External Carotid ◽  
Anterior Circulation ◽  
Retrograde Filling ◽  
Bilateral Carotid ◽  
Carotid Occlusive Disease

Background: Symptomatic bilateral internal carotid occlusive disease is a rare but potentially devastating entity. Medical therapy alone is associated with high rates of mortality and recurrent stroke. The optimal management of this disease remains poorly understood. Methods: A retrospective review of a prospectively maintained database was conducted for patients who presented with an acute stroke in the setting of bilateral carotid occlusive disease between May and October 2013. Results: We identified 3 patients. The admission National Institutes of Health Stroke Scale score ranged from 4 to 7. All patients had small- to moderate-sized infarcts in the anterior circulation on presentation. Angiography confirmed bilateral internal carotid occlusions with collateral filling via the posterior communicating artery and retrograde filling via external carotid artery supply to the ophthalmic artery. All patients were initially managed with permissive hypertension and anticoagulation followed by carotid angioplasty and stenting. At 1-year follow-up, all patients demonstrated a modified Rankin scale score of 0-1. Conclusions: Carotid stenting may be a safe and effective therapy for patients presenting with symptomatic bilateral carotid occlusions.

scholarly journals Management of Intracranial Aneurysm in the Anterior Circulation Assosiated with Internal Carotid Occlusive Disease

1988 ◽  
Vol 16 (1) ◽  
pp. 42-46 ◽  
Author(s):  
Tomonao SUZUKA ◽  
Hajime NAGAI ◽  
Mitsuhito MASE ◽  
Hidekazu FUKUOKA ◽  
Takuji TAKAGI
Keyword(s):  
Intracranial Aneurysm ◽  
Internal Carotid ◽  
Occlusive Disease ◽  
Anterior Circulation ◽  
Carotid Occlusive Disease

scholarly journals Concurrent Stenoocclusive Disease of Intracranial and Extracranial Arteries in a Patient with Polycythemia Vera

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Le H. Hua ◽  
Robert L. Dodd ◽  
Neil E. Schwartz
Keyword(s):  
Polycythemia Vera ◽  
Internal Carotid ◽  
Systemic Vasculitis ◽  
Cerebral Arteries ◽  
Occlusive Disease ◽  
External Carotid ◽  
Hematologic Disorders ◽  
Percutaneous Balloon ◽  
Vessel Imaging ◽  
Percutaneous Balloon Angioplasty

Moyamoya disease is a stenoocclusive disease involving the intracranial carotid and proximal middle cerebral arteries. There are rarely any additional extracranial stenoses occurring concurrently with moyamoya. The pathophysiology of moyamoya remains obscure, but hematologic disorders, notably sickle-cell anemia, have been associated in some cases. We describe the novel case of polycythemia vera associated with severe steno-occlusive disease of both intracranial and extracranial large arteries. A 47-year-old woman with polycythemia vera had multiple transient ischemic attacks, and noninvasive vessel imaging revealed steno-occlusive disease of bilateral supraclinoid internal carotid arteries with moyamoya-type collaterals, proximal left subclavian artery, right vertebral artery origin, bilateral renal arteries, superior mesenteric artery, and right common iliac artery. Laboratory workup for systemic vasculitis was negative. She required bilateral direct external carotid to internal carotid bypass procedures and percutaneous balloon angioplasty of her right VA origin stenosis. This case suggests that hematologic disorders can lead to vessel stenoses and occlusion. The pathophysiology may be due to a prothrombotic state leading to repeated endothelial injury, resultant intimal hyperplasia, and progressive steno-occlusion.

scholarly journals Combination of surgical and endovascular treatments for bilateral carotid occlusive disease

Nosotchu ◽  
2005 ◽  
Vol 27 (2) ◽  
pp. 292-298
Author(s):  
Yasuo Inoue ◽  
Takashi Houri ◽  
Satoshi Ueda ◽  
Yasuhiko Osaka ◽  
Hiroshi Tenjin ◽  
...  
Keyword(s):  
Occlusive Disease ◽  
Bilateral Carotid ◽  
Carotid Occlusive Disease

Self-Expanding Stent Placement for Anterior Circulation Intracranial Artery Dissection Presenting With Ischemic Symptoms

Neurosurgery ◽  
2014 ◽  
Vol 76 (2) ◽  
pp. 158-164 ◽  
Author(s):  
Dong Joon Kim ◽  
Byung Moon Kim ◽  
Sang Hyun Suh ◽  
Dong Ik Kim
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Scale Score ◽  
Internal Carotid ◽  
Artery Dissection ◽  
Anterior Circulation ◽  
The Mean ◽  
Severe Degree ◽  
Recurrent Ischemia

ABSTRACT BACKGROUND: The prognosis of ischemic anterior circulation intracranial dissection (AC-ICD) is poor and its optimal management is still controversial. OBJECTIVE: To evaluate the safety and efficacy of a self-expanding stent for ischemic AC-ICD. METHODS: Eight patients (mean age, 36 years) underwent self-expanding stenting for ischemic AC-ICD. Imaging findings of ischemic AC-ICD, the reason for stenting, and the clinical and angiographic outcomes were retrospectively evaluated. RESULTS: AC-ICD involved intracranial internal carotid artery to middle cerebral artery (MCA) in 2, intracranial internal carotid artery alone in 3, and MCA alone in 3 patients. Six AC-ICDs showed complete or near occlusions while 2 had a severe degree of stenosis. Six AC-ICDs showed an intimal flap and 3 had intramural hematomas. Six patients underwent emergent stenting for acute stroke within 6 hours (n = 2) or crescendo-type stroke within 24 hours (n = 4), while 2 patients had stenting for recurrent ischemia on dual antiplatelet and/or anticoagulation after the initial attack. The mean dissection-related stenosis improved from 93.1% to 20.3% after stenting (P < .05). The mean National Institutes of Health Stroke Scale score improved from 7.5 to 1.4 (P < .05). All patients had excellent or favorable outcomes at 3 months: modified Rankin Scale score, 0 in 3, 1 in 3, and 2 in 1 patient(s). No patients had subarachnoid hemorrhage or ischemic symptom recurrence during the clinical follow-up (mean, 27 months). All stented arteries were patent without significant in-stent stenosis on angiographic follow-up (range, 3–12 months). CONCLUSION: Self-expanding stents seem to be safe and effective for AC-ICD presenting with acute/crescendo-type stroke or recurrent ischemia despite adequate medication.

Internal carotid artery stump angioplasty for the treatment of cerebrovascular occlusive disease

1986 ◽  
Vol 65 (4) ◽  
pp. 461-464 ◽  
Author(s):  
Edward C. Benzel ◽  
Kevin M. Sittig ◽  
Mansour Mirfakhraee
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
External Carotid Artery ◽  
Occlusive Disease ◽  
External Carotid ◽  
Content Type ◽  
Cerebrovascular Occlusive Disease ◽  
Intracranial Vasculature ◽  
Fine Print

✓ Nineteen patients underwent a total of 21 stump angioplasty procedures for an occluded internal carotid artery. Indications for surgery included the preparation of the donor vessel for a subsequent extracranial-intracranial bypass procedure, the occurrence of emboli to the intracranial vasculature from the external carotid artery circulation, and the association with symptomatic occlusive disease of the external carotid artery accompanying occlusion of the ipsilateral internal carotid artery. The technique utilized and the results obtained in these 19 patients are presented. In select patients, the removal of an occluded internal carotid artery stump via a stump angioplasty is beneficial in preventing the catastrophic sequela of embolic cerebrovascular disease.

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