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

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.

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Anterior communicating artery collateral flow protection against ischemic change during carotid endarterectomy

Journal of Neurosurgery ◽

10.3171/jns.1993.79.3.0379 ◽

1993 ◽

Vol 79 (3) ◽

pp. 379-382 ◽

Cited By ~ 34

Author(s):

Maria V. Lopez-Bresnahan ◽

Lee A. Kearse ◽

Paulino Yanez ◽

Tina I. Young

Keyword(s):

Cerebral Ischemia ◽

Carotid Artery ◽

Carotid Endarterectomy ◽

Cerebral Arteries ◽

Artery Occlusion ◽

Carotid Artery Occlusion ◽

Anterior Communicating Artery ◽

Collateral Flow ◽

Content Type ◽

Carotid Circulation

✓ The purpose of this study was to determine whether preoperative angiographic patterns of collateral cerebral blood flow correlate with protection against intraoperative electroencephalographic (EEG) evidence of cerebral ischemia caused by carotid artery cross-clamping during carotid endarterectomy. Previous studies have shown that contralateral carotid artery occlusion and intracranial stenoses are associated with cerebral ischemia during carotid endarterectomy; however, the angiographic collateral flow patterns associated with cerebral ischemia have not been identified. This paper reports a retrospective study of 67 patients who underwent two- to four-vessel cerebral angiography followed by carotid endarterectomy with 16-channel EEG monitoring. The angiograms were reviewed for extracranial occlusive disease and collateral flow patterns, and the EEG recordings were analyzed for ischemic changes during carotid artery cross-clamping. Statistical analysis was by Fisher's exact test. Cross-filling of the anterior and middle cerebral arteries from the contralateral carotid artery through the anterior communicating artery correlated with a decreased incidence of EEG ischemic changes. Only 21% of patients with this collateral flow pattern showed ischemic changes compared to 50% of patients without this pattern (p < 0.03). Three angiographic findings occurring in combination on the side contralateral to surgery correlated with EEG ischemia: 1) occlusion of the contralateral internal carotid artery (five of seven or 71%, p < 0.03); 2) collateral flow from the external carotid circulation to the internal carotid circulation via the ophthalmic artery; and 3) collateral flow from the posterior circulation to the contralateral anterior circulation via the posterior communicating artery. The data presented here corroborate the correlation between contralateral carotid artery occlusion and cerebral ischemia during carotid endarterectomy. They also demonstrate that cross-filling of the anterior and middle cerebral arteries by the contralateral carotid artery protects against such ischemia. This collateral flow may serve as an indicator of tolerance to carotid artery cross-clamping.

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Two cases of symptomatic common carotid artery occlusion treated by carotid endarterectomy with L-shaped ministernotomy

Surgical Neurology International ◽

10.25259/sni_463_2019 ◽

2020 ◽

Vol 11 ◽

pp. 1

Author(s):

Shotaro Ogawa ◽

Fukutaro Ohgaki ◽

Ryosuke Mizuta ◽

Yasuyuki Furuta ◽

Shigeta Fujitani ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Endarterectomy ◽

Cerebral Artery ◽

Common Carotid Artery ◽

Artery Occlusion ◽

Carotid Artery Occlusion ◽

Partial Sternotomy ◽

Left Limb ◽

The Right ◽

Common Carotid Artery Occlusion

Background: Common carotid artery occlusion (CCAO) is rare. Symptomatic lesions are resistant to medical treatment and revascularization are often required, but there is no consensus on the treatment of CCAO. In this paper, two cases of symptomatic CCAO treated by carotid endarterectomy (CEA) with L-shaped ministernotomy, in which the lesions extended to the beginning part of the CCA, are reported. Case Description: Case 1 involved a 74-year-old man who presented with transient left limb numbness and an abnormal right visual field. Cerebrovascular angiography showed that the right CCA was occluded immediately after its origin and blood was supplied from the posterior circulation. CEA was performed with an L-shaped ministernotomy that allowed exposure of the CCA origin with minimal invasion. There were no complications associated with the sternal incision and he was discharged with a modified Rankin Scale (mRS) score of 0. Case 2 involved a 70-year-old man who presented with left half-blindness. Magnetic resonance imaging showed infarction in the right posterior cerebral artery region and neck echo showed CCA pseudo occlusion just before the carotid bulb. A new infarction in the right middle cerebral artery region developed during hospitalization. CEA with partial sternotomy was performed. The patient was rehabilitated with no deterioration of neurological findings and transferred with an mRS score of 3. Conclusion: There were no complications resulting from partial sternotomy in the two cases presented. CEA with partial sternotomy could be an effective treatment option for CCAO in which the internal carotid artery is patent and thrombus extends to the proximal CCA.

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