Determination of barometric criteria for rupture of atherosclerotic plaques in the brachiocephalic arteries

2021 ◽  
Vol 23 (1) ◽  
pp. 143-152
Author(s):  
Dmitriy N. Maistrenko ◽  
Alexander S. Ivanov ◽  
Mikhail I. Generalov ◽  
Dmitry N. Nikolaev ◽  
Andrey A. Stanzhevsky ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Hypertensive Crisis ◽  
Significant Risk ◽  
Liquid Component ◽  
Fluid Component ◽  
Eversion Endarterectomy ◽  
Brachiocephalic Arteries

The sequence of determining determination of the critical value of blood pressure for the occurrence of dissection of atherosclerotic intima of the internal carotid artery according to the experimental study. Atherosclerotic lesion of the brachiocephalic arteries was modeled on a vascular silicone phantom of the carotid arteries, in which the surgical material (intact annular area of atherosclerotic intima with plaque), obtained after eversion endarterectomy in a patient with atherosclerotic lesions, was placed and fixed in the region of the mouth of the internal carotid artery. A total of 30 models were created. To determine the critical values of the pressure on the intima with the plaque, at which it ruptures, balloon catheters were used, controlling the pressure with a manometer. The results were compared with the preoperative data of ultrasound and computed tomography examinations of patients. Dissection of the intima in the area of the plaque occurred in 6 cases at a pressure of 150180 mm Hg; in 9 cases at 180200 mm Hg, in 3 cases at a pressure of more than 200 mmHg, in 12 when exposed to more than 300 mm Hg. All patients, whose intima ruptured at a pressure of less than 200 mm Hg, had a fluid component of the plaque on preoperative examination, and in 6 patients, the critical pressure on the plaque was 150 mm Hg., there was also a thinned "cover" of the plaque. In the rest of the cases, the plaques were stable without a liquid component. Dissection of the intima in these cases did not occur when the exposure value was more than 300 mm Hg. The presence of a fluid component in an atherosclerotic plaque of the carotid artery in combination with a thinned cover of the plaque indicates the extreme danger of its destruction and embolism during a hypertensive crisis. The degree of stenosis of the carotid artery was found to be a less significant risk factor for unstable plaque rupture than the presence of a fluid component.

scholarly journals Surgical treatment of internal carotid artery restenosis following eversion endarterectomy

2012 ◽  
Vol 140 (9-10) ◽  
pp. 577-582
Author(s):  
Djordje Radak ◽  
Slobodan Tanaskovic ◽  
Miloje Vukotic ◽  
Srdjan Babic ◽  
Nikola Aleksic ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Surgical Techniques ◽  
Minor Stroke ◽  
Graft Occlusion ◽  
Redo Surgery ◽  
Eversion Endarterectomy ◽  
Late Morbidity

Introduction. Carotid angioplasty and internal carotid artery stenting is the therapeutic method of choice in the treatment of carotid restenosis, but when it is not technically feasible (expressed tortuosity of supraaortic branches, calcifications, presence of pathological elongation of very long lesions) a redo surgery is indicated. Objective. The aim of our study was to examine the benefits and risks of redo surgery in patients with symptomatic and asymptomatic significant internal carotid artery restenosis and its impact on early and late morbidity and mortality. Methods. The study included 45 patients who were surgically treated for a hemodynamically significant internal carotid artery restenosis from January 2000 to December 2009. Surgical techniques included redo endarterectomy with direct suture, redo anderectomy with a patch plastic and resection with Dacron tubular graft interposition. The patients were followed for postoperative neurological ischemic events (transient ischemic attack (TIA), stroke), local surgical complications and lethal outcome after one month, six months, one year and after two years). Results. In the early postoperative period (up to 30 days) there were no lethal outcomes. TIA was diagnosed in four patients (8.8%), minor stroke in one patient (2.2%) and one patient (2.2%) also had cranial nerve injury. After two years two patients died (4.4%) due to fatal myocardial infarction, three patients (6.5%) had ipsilateral stroke and one patient developed graft occlusion (2%). Conclusion. In the case of symptomatic and asymptomatic carotid restenosis that cannot be treated by carotid percutaneous angioplasty, redo surgical treatment is therapeutic option with an acceptable rate of early and late postoperative complications.

Determination of Arterial Diameters, Length and Mass of the Plaque, and Theoretical Volume in the Internal Carotid Artery by Quantitative Vascular Echography

Angiology ◽  
1993 ◽  
Vol 44 (4) ◽  
pp. 314-320 ◽  
Author(s):  
Marco Ciccone ◽  
Domenico di Noia ◽  
Maurizio Liquori ◽  
Liliana di Michele ◽  
Salvatore Novo ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Arterial Diameters

scholarly journals Long-term Restenosis Rate of Eversion Endarterectomy on the Internal Carotid Artery

2004 ◽  
Vol 27 (5) ◽  
pp. 537-539 ◽  
Author(s):  
A. Szabo ◽  
E. Brazda ◽  
E. Dosa ◽  
A. Apor ◽  
Z. Szabolcs ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Restenosis Rate ◽  
Eversion Endarterectomy

Surgical Treatment of Carotid Artery Disease

2020 ◽  
Author(s):  
Wesley S. Moore
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Internal Carotid ◽  
Carotid Artery Disease ◽  
Carotid Bifurcation ◽  
Eversion Endarterectomy ◽  
Artery Disease ◽  
Carotid Arterial

The rationale for operating on patients with carotid artery disease is to prevent stroke. It has been estimated that in 50 to 80% of patients who experience an ischemic stroke, the underlying cause is a lesion in the distribution of the carotid artery, usually in the vicinity of the carotid bifurcation. Appropriate identification and intervention could significantly reduce the incidence of ischemic stroke. Carotid endarterectomy for both symptomatic and asymptomatic carotid artery stenosis has been extensively evaluated in prospective, randomized trials. Surgical reconstruction of the carotid artery yields the greatest benefits when done by surgeons who can keep complication rates to an absolute minimum. The majority of complications associated with carotid arterial procedures are either technical or judgmental; accordingly, this review emphasizes the procedural aspects of planning and operation considered to be particularly important for deriving the best short- and long-term results from surgical intervention. Specifically, this review covers preoperative evaluation, operative planning, operative technique, postoperative care, follow-up, and alternatives to direct carotid reconstruction. Figures show carotid arterial procedures including recommended patient positioning, the commonly used vertical incision, the alternative transverse incision, mobilization of the sternocleidomastoid muscle to identify the jugular vein, palpation of the internal carotid artery, division of the structures between the internal and external carotid arteries to allow the carotid bifurcation to drop down, division of the posterior belly of the digastric muscle to yield additional exposure of the internal carotid artery, a graphic representation of the measurement of internal carotid artery back-pressure, a central infarct zone surrounded by an ischemic zone, shunt placement, open endarterectomy, eversion endarterectomy, repair of fibromuscular dysplasia, and repair of coiling or kinking of the internal carotid artery. This review contains 17 figures, and 25 references Key words: Carotid artery disease; Carotid endarterectomy; Carotid angioplasty with stenting; Eversion endarterectomy; Open endarterectomy; Carotid plaque; TCAR  

Surgical Treatment of Carotid Artery Disease

2020 ◽  
Author(s):  
Wesley S. Moore
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Internal Carotid ◽  
Carotid Artery Disease ◽  
Carotid Bifurcation ◽  
Eversion Endarterectomy ◽  
Artery Disease ◽  
Carotid Arterial

The rationale for operating on patients with carotid artery disease is to prevent stroke. It has been estimated that in 50 to 80% of patients who experience an ischemic stroke, the underlying cause is a lesion in the distribution of the carotid artery, usually in the vicinity of the carotid bifurcation. Appropriate identification and intervention could significantly reduce the incidence of ischemic stroke. Carotid endarterectomy for both symptomatic and asymptomatic carotid artery stenosis has been extensively evaluated in prospective, randomized trials. Surgical reconstruction of the carotid artery yields the greatest benefits when done by surgeons who can keep complication rates to an absolute minimum. The majority of complications associated with carotid arterial procedures are either technical or judgmental; accordingly, this review emphasizes the procedural aspects of planning and operation considered to be particularly important for deriving the best short- and long-term results from surgical intervention. Specifically, this review covers preoperative evaluation, operative planning, operative technique, postoperative care, follow-up, and alternatives to direct carotid reconstruction. Figures show carotid arterial procedures including recommended patient positioning, the commonly used vertical incision, the alternative transverse incision, mobilization of the sternocleidomastoid muscle to identify the jugular vein, palpation of the internal carotid artery, division of the structures between the internal and external carotid arteries to allow the carotid bifurcation to drop down, division of the posterior belly of the digastric muscle to yield additional exposure of the internal carotid artery, a graphic representation of the measurement of internal carotid artery back-pressure, a central infarct zone surrounded by an ischemic zone, shunt placement, open endarterectomy, eversion endarterectomy, repair of fibromuscular dysplasia, and repair of coiling or kinking of the internal carotid artery. This review contains 17 figures, and 25 references Key words: Carotid artery disease; Carotid endarterectomy; Carotid angioplasty with stenting; Eversion endarterectomy; Open endarterectomy; Carotid plaque; TCAR  

Eversion Endarterectomy of the Internal Carotid Artery: Midterm Results of a New Technique

1995 ◽  
Vol 9 (3) ◽  
pp. 241-246 ◽  
Author(s):  
Bruno Reigner ◽  
Philippe Reveilleau ◽  
Muriel Gayral ◽  
Xavier Papon ◽  
Bernard Enon ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
New Technique ◽  
Midterm Results ◽  
Eversion Endarterectomy ◽  
A New Technique
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