scholarly journals Rupture of aneurysm of the middle cerebral artery along with stenosis of the internal carotid and coronary arteries

2020 ◽  
Vol 24 (2) ◽  
pp. 109
Author(s):  
A. N. Kazantsev ◽  
R. S. Tarasov ◽  
K. P. Chernykh ◽  
R. Yu. Leader ◽  
N. E. Zarkua ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Coronary Arteries ◽  
Postoperative Period ◽  
Conflict Of Interest ◽  
Internal Carotid ◽  
Intracerebral Hematoma ◽  
Satisfactory Condition ◽  
Microsurgical Clipping ◽  
Stage 1

<p>This article presents the results of treatment of a patient with rupture of a giant intracerebral aneurysm of the left middle cerebral artery (MCA), hemodynamically significant stenosis of the internal carotid artery on the left and the trunk of the left coronary artery with multiple lesions of the coronary arteries (anterior descending artery, diagonal branch, right coronary artery). A phased surgical correction was performed, with the time period between stages being 2 months, as follows:<br />Stage 1 — open microsurgical clipping of the aneurysm of the left MCA and removal of intracerebral hematoma. The usage of the standard treatment volume in the form of 3H therapy (hypertension, haemodilution and hypervolemia), as well as slow calcium channel blockers in the postoperative period, was associated with a high risk of developing cardiovascular complications due to the presence of occlusal–stenotic lesions of the coronary and brachiocephalic channels. In the postoperative period, the patient received antiplatelet therapy (acetylsalicylic acid 100 mg at lunch), lipid-lowering therapy (rosuvastatin 20 mg in the evening) and anti-hypertensive therapy (bisoprolol 2.5 mg in the morning; perindopril 2.5 mg in the evening; spironolactone 25 mg in the morning; torasemide 10 mg in the morning; valparin XP 500 mg 2 times a day). On day 14, the patient was transferred from the intensive care unit, and on day 20, the patient was discharged from the hospital in satisfactory condition.<br />Stage 2 — a combined operation in the amount of carotid endarterectomy (CEE) with plastic surgery of the biological patch on the left with plastic reconstruction of the reconstruction zone with a patch from the xenopericardium and coronary bypass grafting (CABG). Tactics were confirmed as optimal, taking into account the stratification of the risk of complications in the postoperative period when applying the new interactive program ‘Program support for the decision-making process for choosing a surgical re-vascularisation strategy for multifocal atherosclerosis’ (certificate of registration of a computer program RU 2017619457). Brain protection during CEE was achieved by invasive measurement of retrograde pressure (60 % of systemic blood pressure (BP)) and intraoperative increase in blood pressure to 180/90 mm Hg. CABG was performed using cardiopulmonary bypass. An epiaortic ultrasound scan was used to select the position of the implantation of a venous shunt into the aortic wall. Intraoperative flowmetry was used to regulate the quality of the implanted shunts.<br />The patient was discharged 10 days after the surgery from the hospital in satisfactory condition. Conservative therapy, initiated after stage 1 of re-vascularisation, was continued.<br />Clipping of intracerebral arterial aneurysm during its rupture and reconstructive interventions on the internal carotid artery and coronary arteries could be performed combined with the possibility of endovascular correction. However, due to the presence of an unstable atherosclerotic plaque, the possibility of interventional correction of the internal carotid artery was excluded, and the condition of the coronary bed at the time of stage 1 remained unknown. An additional argument in favour of open microsurgical clipping of the aneurysm was the need for the removal of intracerebral hematoma.<br />The treatment strategy chosen here was found to be safe and effective. Satisfactory outcome of the surgery was achieved due to a complete range of perioperative examinations. The implemented tactics prevented the development of complications. The data obtained here would form the basis for the development of recommendations for selecting the optimal tactics of re-vascularisation in combined lesions of intracranial, extracranial and coronary arteries.</p><p>Received 21 April 2020. Revised 27 April 2020. Accepted 28 April 2020.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />Conception and design: А.N. Kazantsev, R.S. Tarasov<br />Literature review: K.P. Chernykh, N.E. Zarkua, R.Y. Leader, G.Sh. Bagdavadze<br />Drafting the article: А.N. Kazantsev<br />Illustrations: А.N. Kazantsev, K.P. Chernykh, N.E. Zarkua, R.Y. Leader, G.Sh. Bagdavadze<br />Critical revision of the article: N.E. Zarkua, R.S. Tarasov, Y.P. Linets<br />Final approval of the version to be published: А.N. Kazantsev, R.S. Tarasov, K.P. Chernykh, N.E. Zarkua, R.Y. Leader, <br />G.Sh. Bagdavadze, Y.P. Linets</p>

scholarly journals The combined use of proximal and distal protection devices uring carotid stenting: A case report

2019 ◽  
Vol 23 (2) ◽  
pp. 73
Author(s):  
D. U. Malaev ◽  
D. A. Redkin ◽  
V. I. Baystrukov ◽  
A. A. Prokhorikhin ◽  
A. A. Boykov ◽  
...  
Keyword(s):  
Blood Flow ◽  
Informed Consent ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Conflict Of Interest ◽  
Internal Carotid ◽  
Carotid Stenting ◽  
Protection System ◽  
Combined Use ◽  
Proximal Protection

<p>Despite the development of modern medical technologies, cerebrovascular disease remains a major health and social issue. Among all the cases of ischemic stroke, approximately 20% are attributable to stenotic lesions in the carotid artery. The main drawback of carotid stenting is the risk of embolic complications during the procedure. To resolve this problem, various devices that protect against embolism have been developed. In this clinical case, we describe the ability to minimize the risk of operative stroke through a combined application of the distal and proximal protection systems in carotid stenting.</p><p>In our patient, a 65-year-old woman, angiography of the carotid arteries revealed an ulcerated atherosclerotic plaque of the right internal carotid artery, with stenosis of the lumen of up to 95%. Considering the high risk of distal embolism, the Mo MaUltra (Italy) proximal protection system was used. When evaluating the installation of the Mo MaUltra system, the preserved blood flow through the superior thyroid artery and, therefore, the antegrade blood flow in the internal carotid artery was revealed. Considering the identified risk and the anatomy of the plaque surface, we decided on the additional use of the distal SpiderFX (USA) protection device.</p><p>The combined use of proximal protection system and distal protective device for carotid stenting is technically possible and may reduce the risk of embolic complications.</p><p>Received 23 January 2019. Revised 18 March 2019. Published 23 April 2019.</p><p><strong>Informed consent:</strong> The patient’s informed consent to use the records for medical purposes is obtained.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p>

scholarly journals Emergency glomus-saving autotransplantation of the internal carotid artery in the acute period of ischemic stroke

2021 ◽  
Vol 22 (3) ◽  
pp. 38-47
Author(s):  
A. N. Kazantsev ◽  
K. P. Chernykh ◽  
S. V. Artyukhov ◽  
L. V. Roshkovskaya ◽  
M. O. Janelidze ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Postoperative Period ◽  
Internal Carotid ◽  
External Carotid ◽  
Computer Data ◽  
Acute Period ◽  
Atherosclerotic Lesions ◽  
The City

Purpose. Analysis of the immediate results of emergency glomus-sparing auto-transplantation of the internal carotid artery (ICA) in the acute period of ischemic stroke, developed on the basis of the City Alexandrovskaya Hospital, St. Petersburg.Material and methods. In this prospective, single-center study from January 2017 to August 2020. 49 patients were included in the acute period of ischemic stroke with hemodynamically significant extended atherosclerotic lesions of the ICA. All patients underwent glomus-sparing ICA autotransplantation, developed on the basis of the City Alexandrovskaya Hospital, St. Petersburg (Kazantsev A. N., Zarkua N. E., Chernykh K. P. et al. Аrteries with extended atherosclerotic lesions of the internal carotid artery. Patent application No. 202.013.4151/14 (062595), filing date 10/16/2020). Glomus-sparing ICA autotransplantation, developed on the basis of the City Alexandrovskaya Hospital, St. Petersburg, was performed as follows. On the inner edge of the external carotid artery (ECA), adjacent to the carotid sinus, 2–3 cm above the orifice, depending on the spread of atherosclerotic plaque (ASB), arteriotomy was performed with the transition to the common carotid artery (CCA) (also 2–3 see below the mouth of the NSA). The ICA was cut off at the site formed by the sections of the wall of the NSA and the CCA. Then the ICA was cut off as distally as possible in front of the hypoglossal nerve, so that the artery was completely resected. In view of the presence of an intact carotid glomus on the resected area of the ICA, which connects it to the wound, endarterectomy from the ICA was performed inside the operating field by its complete eversion. Then, open endarterectomy from ECA and CCA was performed. At the next stage, the ICA was implanted in its previous place with the creation of proximal and distal end-to-end anastomoses, so that the continuing ASB above the endarterectomy zone was fixed with a circular vascular suture.Results. There were no complications in the postoperative period. No cases of restenosis / thrombosis of the reconstruction zone were identified in all the sample according to the color duplex scanning data. On the 7th day after the operation, all patients were diagnosed with regression of neurological symptoms according to the National Institute of Health Stroke Scale: on admission, the mean score was 10.5±3.5; at the moment of the control point — 6.5±1.5; p=0.001. This reflects the effectiveness of the chosen treatment strategy. According to the data on the dynamics of systolic blood pressure, stable systolic parameters were observed in the postoperative period against the background of antihypertensive therapy taken before the operation.Conclusion. Carotid endarterectomy in the acute period of ischemic stroke is safe in the presence of mild neurological deficits (up to 25 points on the National Institute of Health Stroke Scale) and the diameter of the ischemic focus in the brain not exceeding 2.5 cm according to the computer data. tomography. Glomussparing ICA autotransplantation, developed on the basis of the Aleksandrovskaya Hospital, St. Petersburg, does not require the use of a patch and is not characterized by the risk of developing ICA thrombosis as a result of intimal detachment behind the endarterectomy zone. Preservation of the carotid glomus during reconstructive intervention on the ICA prevents the development of labile arterial hypertension and hemorrhagic transformation in the postoperative period.

scholarly journals Emergency Carotid Endarterectomy for Internal Carotid Artery Thrombosis in the Course of COVID-19

2021 ◽  
Vol 10 (3) ◽  
pp. 477-483
Author(s):  
A. N. Kazantsev ◽  
S. V. Artyukhov ◽  
K. P. Chernykh ◽  
A. R. Shabaev ◽  
G. Sh. Bagdavadze ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Local Anesthesia ◽  
Internal Carotid ◽  
Complete Regression ◽  
Fatty Tissue ◽  
Pulmonary Barotrauma ◽  
Satisfactory Condition

A case of successful emergency carotid endarterectomy (CEE) in the acute period of ischemic stroke (within an hour after the onset of symptoms) in a patient with acute occlusive thrombosis of the internal carotid artery in the course of moderate-severe COVID-19 with a positive result of the polymerase chain reaction of the nasopharyngeal smear for SARS-CoV-2. The diameter of the ischemic focus in the brain according to multispiral computed tomography did not exceed 2.5 cm. The course of ischemic stroke was characterized by mild neurological deficit (score 5 according to National Institute of Health Stroke Scale). It was demonstrated that the severity of the patient’s condition was associated with bilateral, polysegmental, viral penvmonia with 65% damage to the lung tissue, a decrease in SpO2 to 93%. Laboratory noted coagulopathy with an increase in D-dimer (2837.0 ng/ml), prothrombin according to Quick (155.3%), fibrinogen (14.5 g/l) and signs of a “cytokine storm” with leukocytosis (28.4 10E9/l), an increase in C-reactive protein (183.5 mg/l), ferritin (632.8 ng/ml), interleukin-6 (176.9 pg/ml). The patient underwent glomus-sparing eversional CEE. The intervention was performed under local anesthesia due to the high risk of developing pulmonary barotrauma when using mechanical ventilation. To prevent the development of acute hematoma, a double active drainage was used into the paravasal space and subcutaneous fatty tissue (SFT). In case of thrombosis of one of the drainages, the second could serve as a spare. Also, upon receipt of hemorrhagic discharge from the drainage located in the SFT, the patient would not need to be transported to the operating room. Removal of skin sutures with revision and stitching of the bleeding source could be performed under local anesthesia in a dressing room. The postoperative period was uneventful, with complete regression of neurological symptoms. Used anticoagulant (heparin 5 thousand units 4 times a day s/c) and antiplatelet therapy (acetylsalicylic acid 125 mg at lunch). The patient was discharged from the hospital on the 12th day after CEE in satisfactory condition.

scholarly journals Results of using the modified technique of eversion carotid endarterectomy in patients with extended atherosclerotic disease of bifurcation of common carotid artery

2021 ◽  
Vol 9 (3) ◽  
pp. 415-424
Author(s):  
V.A. Panfilov ◽  
◽  
A.O. Virganskiy ◽  
K.V. Romanenko ◽  
◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Atherosclerotic Plaque ◽  
Postoperative Period ◽  
Internal Carotid ◽  
Early Postoperative Period ◽  
Modified Technique ◽  
Results Of Treatment

BACKGROUND: Eversion carotid endarterectomy is one of the most frequently used methods of carotid endarterectomy. This is primarily due to the relative ease of surgical techniques, reduction in the risk of hemodynamic disorders in the reconstruction zone and the absence of the need to use synthetic material. The main disadvantage of eversion carotid endarterectomy is poor visualization of the distal edge of the atherosclerotic plaque and the lack of control of the unfixed edge of intima in common atherosclerotic lesion of the internal carotid artery. The use of a modified technique of eversion carotid endarterectomy avoids these disadvantages and preserves its advantages. AIM: to analyze the results of the use of modified eversion carotid endarterectomy in patients with extended disease to the internal carotid artery. MATERIALS AND METHODS: The study is based on the analysis of the results of treatment of patients with chronic cerebrovascular insufficiency due to extended atherosclerotic disease of the internal carotid artery, in whom eversion carotid endarterectomy was performed using a modified technique in the conditions of the Department of Vascular Surgery in Vinogradov City Hospital. The presence of an atherosclerotic plaque extending over a distance of more than 2.5 cm from the bifurcation was considered a common damage to the internal carotid artery. The assessment of intraoperative parameters, early postoperative period, as well as treatment results after 3, 6 and 12 months from the moment of surgery was carried out. RESULTS: The results of treatment of 60 patients in the early postoperative and long-term periods were analyzed. The average operation time was 71.37 ± 8.87 minutes. The average time for clamping the ICA was 18.35 ± 3.9 minutes. Transient ischemic attack in the early postoperative period occurred in 1 (1.7%) patient. Restenosis of the internal carotid artery (≥40%) on the side of the performed reconstruction developed in 3 (5.2%) patients. CONCLUSION: The risk of development of neurological disorders in the early postoperative period, as well as of restenosis of the area of surgical intervention in the long-term period when using the modified technique of eversion carotid endarterectomy, correspond to the data of modern world literature.

scholarly journals Evaluation of Surgical Clipping and Endovascular Coiling on Oculomotor Nerve Palsy Caused by Internal Carotid Artery Aneurysm

2020 ◽  
Vol 11 ◽  
Author(s):  
Zhenqing Sun ◽  
Xueqiang Yan ◽  
Xiaolong Li ◽  
Jie Wu
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Recovery Rate ◽  
Nerve Palsy ◽  
Internal Carotid ◽  
Oculomotor Nerve ◽  
Oculomotor Nerve Palsy ◽  
Endovascular Coiling ◽  
Surgical Clipping ◽  
Microsurgical Clipping

Objectives: Internal carotid artery (ICA) aneurysm often leads to oculomotor nerve palsy (ONP) that impairs eye movement. Currently, microsurgical clipping and endovascular coiling are the two major options to treat ONP. The purpose of the current study is to compare the clinical outcomes of the two methods in patients with ONP caused by ICA aneurysm.Patients and Methods: In the present study, we assessed the prognostic factors and recovery outcomes of a total of 90 ICA aneurysm-induced ONP patients, where 50 of them were treated with microsurgical clipping and 40 of them were treated with endovascular coiling. Within the endovascular coiling group, 20 of the patients were treated with balloon-assisted coiling and the other 20 were treated with stent-assisted coiling.Results: Overall, we achieved a 59% (53 out of 90) full recovery rate. Both surgical clipping and endovascular coiling treatment methods achieved similar recovery outcomes in the tested patients. However, within the endovascular coiling group, balloon-assisted coiling treatment demonstrated a significantly higher full recovery rate (17 out of 20) compared to stent-assisted coiling treatment (eight out of 20).Conclusion: In general, no significant difference was identified between the surgical and coiling treatments, and both procedures were considered as beneficial for ICA aneurysm-induced ONP.

Balloon-assisted microvascular clipping of paraclinoid aneurysms

2004 ◽  
Vol 100 (4) ◽  
pp. 713-716 ◽  
Author(s):  
William Thorell ◽  
Peter Rasmussen ◽  
John Perl ◽  
Thomas Masaryk ◽  
Marc Mayberg
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Direct Result ◽  
Parent Vessel ◽  
Content Type ◽  
Complex Aneurysms ◽  
Microsurgical Clipping ◽  
Paraclinoid Aneurysms ◽  
Fine Print

✓ Paraclinoid aneurysms represent a significant surgical challenge. Multiple techniques have been developed to maximize the effectiveness and safety of excluding these aneurysms from the cerebral circulation. Endovascular balloons have been used for proximal control of parent arteries during the treatment of aneurysms. In this report the authors describe the technique of navigating an endovascular balloon across the neck of paraclinoid aneurysms in four patients to gain proximal control, improve the accuracy of clip placement, and reduce the risk of distal embolization of intraluminal thrombus. Six consecutive patients with giant or complex aneurysms of the ophthalmic or paraclinoid internal carotid artery that were not amenable to endovascular obliteration were retrospectively analyzed. In all six patients, the aneurysm was exposed and dissected for microsurgical clipping, and attempts were made to navigate a nondetachable, compliant silicone balloon across the neck of the aneurysm. If successfully placed, the balloon was inflated during clip placement. In four patients, the balloon was successfully navigated across the neck of the aneurysm and was inflated during clip application. Internal carotid artery tortuosity precluded navigation of the balloon into the intracranial circulation in two patients. All aneurysms were completely excluded from the parent vessel according to postoperative angiography studies. No complication occurred as a direct result of the endovascular portion of the procedure. Endovascular balloon stenting of complex paraclinoid aneurysms during microvascular clipping may provide an adjunctive therapy that facilitates safe and accurate clip placement.

scholarly journals Prophylaxis of complications in postoperative period in patients, suffering stenosis of carotid arteries

2020 ◽  
Vol 87 (1-2) ◽  
pp. 11-14
Author(s):  
I. S. Pulyaeva ◽  
V. A. Prasol ◽  
Yu. V. Ivanova
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Postoperative Period ◽  
Carotid Arteries ◽  
Conservative Therapy ◽  
Internal Carotid ◽  
Perioperative Period ◽  
Neurological Complications ◽  
Results Of Treatment ◽  
Carotid Arteries Stenosis

Objective. To analyze the surgical treatment results in patients, suffering carotid arteries stenosis, using endarterectomy in combination with conservative therapy. Materials and methods. Results of treatment were analyzed in 58 patients, suffering hemodynamically significant stenosis of carotid arteries and/or presence of embologenic pluck, in whom from 2017 to 2019 yrs in V. T. Zaytsev Institute of General and Urgent Surgery NAMS of Ukraine, Kharkov intraoperative supportive conservative therapy, taking into account the risk for development of the cerebral ischemia and the reperfusion syndrome, was conducted. There were 52 (89.7%) men and 6 (10.3%) women. Middle age of the patients operated on have constituted (65 ± 15) yrs. Results. Basing on the literature data analyzed as well as on investigation of the thrombocytes aggregation in patients in perioperative period the algorithm of supportive conservative therapy was elaborated: injection of 5000 IU heparin 5 min before the internal carotid artery clamping under the ICT control; injection of Citicoline 1000 mg 5 min before the internal carotid artery clamping to the patients with neurological deficiency in accordance to the neurological test data and with application of a temporary by-pass. In all the patients in postoperative period the complications were absent. Control of the carotid arteries passability and the ischemia zone state on the 14th day was conducted, the carotid arteries stenosis was not revealed. Nonsignificant complications, such as the stressed hematoma, demanding postoperative wound revision and hemostasis performance, were observed in 4 patients. In 2 patients postoperative period was complicated by the hypoglossal nerve paresis because of its squeezing by hematoma. Conclusion. Citicoline injection before the carotid artery clamping in the carotid endarterectomy with a temporary by-pass permits to lower the risk for development of neurological complications, and while development of postoperative reperfusion syndrome –to reduce its signs.

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