scholarly journals Clinical alert: benefit of carotid endarterectomy for patients with high-grade stenosis of the internal carotid artery. National Institute of Neurological Disorders and Stroke Stroke and Trauma Division. North American Symptomatic Carotid Endarterectomy Trial (NASCET) investigators.

Stroke ◽  
1991 ◽  
Vol 22 (6) ◽  
pp. 816-817 ◽  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
North American ◽  
Neurological Disorders ◽  
Internal Carotid ◽  
High Grade ◽  
Symptomatic Carotid

Internal to Common Carotid Artery Peak Systolic Velocity Ratios for Predicting North American Symptomatic Carotid Endarterectomy Trial Stenosis: Derivation/Validation Study Using a Machine Learning Technique

2019 ◽  
Vol 43 (4) ◽  
pp. 182-185
Author(s):  
Alex Polak ◽  
Joseph F. Polak
Keyword(s):  
Machine Learning ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
North American ◽  
Common Carotid Artery ◽  
Internal Carotid ◽  
Velocity Ratio ◽  
Peak Systolic Velocity ◽  
Symptomatic Carotid ◽  
Data Points

The association between internal carotid artery/peak systolic velocity and stenosis severity as measured by the North American Symptomatic Carotid Endarterectomy Trial is known. The association of internal carotid artery peak systolic velocity to common carotid artery peak systolic velocity ratio is less well studied. We use a machine learning algorithm to study this association. We performed a meta-analysis of papers with point data showing graphs of internal carotid artery/peak systolic velocity ratio versus North American Symptomatic Carotid Endarterectomy Trial percent stenosis. We used a neural net algorithm to derive an equation relating internal carotid artery/common carotid artery peak systolic velocity to % stenosis in a derivation group (two thirds of the data points) and applied it to a validation subset (one third of the data points). Model performance was assessed by correlation coefficients and Bland-Altman analyses. We found 4 papers with appropriate data for a total of 775 data points. The mean % stenosis was 53% (26% SD) with a mean internal carotid artery/common carotid artery peak systolic velocity ratio of 3.9 (2.9 SD). The derivation data set (n = 516) showed an association with an r value of 0.76 ( P < .0001) between predicted and measured stenosis. Applying the derived equation to the validation subset (n = 259) showed a similar association ( r = 0.8; P < .0001). A machine learning algorithm gave a good approximation of the association between internal carotid artery/common carotid artery peak systolic velocity ratio and % stenosis on a continuous scale for the aggregate data of 4 published studies. These data could be used to study the accuracy of different cut-points for 50% and 70% stenosis in an unbiased fashion.

“Internal cross-clamping” for symptomatic internal carotid artery thrombus

2007 ◽  
Vol 107 (6) ◽  
pp. 1223-1227 ◽  
Author(s):  
Robert D. Ecker ◽  
Ramachandra P. Tummala ◽  
Elad I. Levy ◽  
L. Nelson Hopkins
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Stent Placement ◽  
Internal Carotid ◽  
Intraluminal Thrombus ◽  
Symptomatic Carotid ◽  
Embolic Protection ◽  
Symptomatic Carotid Stenosis ◽  
The Right

✓Both carotid endarterectomy and carotid artery stent placement with filter embolic protection present a higher risk for patients with internal carotid artery (ICA) lesions containing intraluminal thrombus. Despite the risk associated with intervention, patients with symptomatic intraluminal thrombus who were enrolled in the North American Symptomatic Endarterectomy Trial did better with surgical than medical treatment. We describe the novel use of an endovascular “internal cross-clamping” technique in two patients with symptomatic intraluminal thrombus in the ICA. A 57-year-old woman presented with a history of multiple episodes of left upper-extremity numbness, mild dysarthria, and agraphia occurring over the previous 24 hours. Cranial magnetic resonance imaging revealed a scattered watershed infarction of the right hemisphere and a critical stenosis of the right ICA. An 81-year-old man awoke with hemiplegia and inability to follow commands after undergoing a complicated carotid endarterectomy. Computed tomographic perfusion imaging demonstrated an increased time to peak in the left middle cerebral territory, and emergent angiography demonstrated both intimal flaps and thrombus in the endarterectomy bed. The lesions in both patients were treated with endovascular stent placement using both proximal and distal flow occlusion—a functional “internal cross-clamping”—for embolic protection. To our knowledge, this is the first report of internal trapping and stent placement for symptomatic carotid stenosis containing intraluminal thrombus. This treatment strategy should be added to the armamentarium of endovascular surgeons in selected patients with symptomatic carotid intraluminal thrombus.

Stenting in High-Grade Internal Carotid Artery Stenosis: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Joel M Kaye ◽  
Juan C Mejia-Munne ◽  
Aaron W Grossman ◽  
Peyman Shirani ◽  
Matthew S Smith ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Artery Stenosis ◽  
Carotid Artery Stenting ◽  
Internal Carotid ◽  
Internal Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
High Grade ◽  
Angioplasty And Stenting

Abstract Carotid artery stenosis is implicated in up to 40% of all ischemic strokes. Accordingly, symptomatic, high-grade carotid artery stenosis portends an especially high risk of future stroke. Intervention via open or endovascular approaches drastically reduces this risk. Under the appropriate conditions, carotid artery stenting serves as a safe and effective alternative to carotid endarterectomy. We present the case of a 57-yr-old male with symptomatic, high-grade stenosis of his right internal carotid artery, for whom a history of radiation to the head and neck represented a relative contraindication to carotid endarterectomy, and thus endovascular treatment with angioplasty and stenting was performed. Informed consent was obtained prior to the procedure. Intraprocedurally, stent delivery past the area of stenosis proved somewhat challenging. However, by employing several nuanced maneuvers, we utilized our guiding catheter in a nonconventional manner in order to successfully perform the procedure. As the field of neuroendovascular surgery evolves, each case provides us unique lessons, which in turn expands our interventional capabilities and adds to the armamentarium of neuroendovascular techniques. We present this surgical video both as a means to provide a general overview of carotid artery stenting, and to share a lesson learned through the implementation of an interesting technical nuance.

Histopathological features with angiographic correlates of internal carotid artery pseudo-occlusion: impact of plaque compositions

2011 ◽  
Vol 115 (2) ◽  
pp. 350-358 ◽  
Author(s):  
Yoko Hirata ◽  
Noriyuki Sakata ◽  
Tooru Inoue ◽  
Kotaro Yasumori ◽  
Masahiro Yasaka ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Internal Carotid ◽  
Anterior Communicating Artery ◽  
Collateral Flow ◽  
High Grade ◽  
Severe Stenosis ◽  
Total Occlusion ◽  
Histological Features

Object This study describes clinicopathological characteristics of pseudo-occlusion of the internal carotid artery with regard to its possible mechanisms. Methods The authors retrospectively reviewed 17 patients with pseudo-occlusion and 23 with high-grade stenosis (North American Symptomatic Carotid Endarterectomy Trial criteria ≥ 90%, but no collapsed distal internal carotid artery) who underwent carotid endarterectomy. Atherosclerotic risk factors, clinical presentation, angiographic findings, and histological features of plaque obtained from the carotid endarterectomy were investigated and comparisons were made between groups. Results Plaques obtained in the pseudo-occlusion group were significantly more fibrous and less atheromatous than those in the high-grade stenosis group. Old, organized thrombi were more frequently found in pseudo-occlusion group plaques than in high-grade stenosis group plaques. Plaques acquired in the pseudo-occlusion group had 2 different histological features: the presence or absence of the original lumen. The pseudo-occlusion plaques with total occlusion and recanalization (8 patients) were composed of thrombotic total occlusion with lumen recanalization by large neovascular channels, whereas those with severe stenosis (9 patients) were fibrous or fibroatheromatous and had severe stenosis of the original lumen. In patients with pseudo-occlusion and total occlusion and recanalization, the authors observed a significantly higher incidence of transient ischemic attack and anterior communicating artery–posterior communicating artery collateral flow than those with high-grade stenosis and pseudo-occlusion with severe stenosis. Conclusions Plaques of the pseudo-occlusion group were more fibrous than those of the high-grade stenosis group and had 2 different histological features: pseudo-occlusion with total occlusion and recanalization or pseudoocclusion with severe stenosis. This difference in plaque histology may be related to the clinical features of pseudoocclusion, such as symptoms and collateral flow patterns.

Hybrid Repair of a Common Carotid Pseudoaneurysm and Concomitant Internal Carotid Stenosis With Retrograde Stenting and Carotid Endarterectomy

2021 ◽  
pp. 153857442199293
Author(s):  
Constantinos Zarmakoupis ◽  
George Galyfos ◽  
Grigorios Tsoukalos ◽  
Panagiota Dalla ◽  
Alexandra Triantafyllou ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Common Carotid Artery ◽  
Rare Case ◽  
Internal Carotid ◽  
Covered Stent ◽  
Hybrid Technique ◽  
Hybrid Repair ◽  
Ica Stenosis

This report aims to present a rare case of a common carotid artery (CCA) pseudoaneurysm with a concomitant internal carotid artery (ICA) stenosis that were treated with a hybrid technique. This strategy included the retrograde placement of a CCA covered stent under ICA clamping followed by standardized carotid endarterectomy. The technique will be discussed and compared with other possible treatments.

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