Increased Risk of Cerebral Thrombo-embolic Complication during Gradual Carotid Artery Occlusion Combined with Extra- and Intracranial Bypass Surgery in the Treatment of an Inaccessible Carotid Aneurysm

Abstract OBJECTIVE AND IMPORTANCE We successfully treated a patient with stenosis of the left subclavian artery, complicated by bilateral common carotid artery occlusion, via axilloaxillary bypass surgery. CLINICAL PRESENTATION A 67-year-old patient with a history of hypertension and cerebral infarction underwent neck irradiation for treatment of a vocal cord tumor. Three months later, he began to experience transient tetraparesis several times per day. The blood pressure measurements for his right and left arms were different. Supratentorial blood flow was markedly low. The common carotid arteries were bilaterally occluded, and the right vertebral artery was hypoplastic. Therefore, only the left vertebral artery contributed to the patient's cerebral circulation; his left subclavian artery was severely stenotic. INTERVENTION The patient underwent axilloaxillary bypass surgery because the procedure avoids thoracotomy or sternotomy, manipulation of the carotid artery, and interruption of the vertebral artery blood flow. The patient has been free of symptoms for more than 5 years. CONCLUSION Neurosurgeons should be aware that extra-anatomic bypass surgery is an effective treatment option for selected patients with cerebral ischemia.

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High-Flow Extracranial-to-Intracranial Excimer Laser–Assisted Nonocclusive Anastomosis Bypass for Symptomatic Carotid Artery Occlusion

Neurosurgery ◽

10.1227/neu.0b013e318214e2e7 ◽

2011 ◽

Vol 68 (6) ◽

pp. 1687-1694 ◽

Cited By ~ 11

Author(s):

Tristan P.C. van Doormaal ◽

Catharina J.M. Klijn ◽

Perry T.C. van Doormaal ◽

L. Jaap Kappelle ◽

Luca Regli ◽

...

Keyword(s):

Ischemic Stroke ◽

Carotid Artery ◽

Bypass Surgery ◽

Artery Occlusion ◽

Carotid Artery Occlusion ◽

High Flow ◽

Transient Ischemic Attacks ◽

Mean Flow ◽

Symptomatic Carotid

Abstract BACKGROUND: A high-flow bypass is theoretically more effective than a conventional low-flow bypass in preventing strokes in patients with symptomatic carotid artery occlusion and a compromised hemodynamic state of the brain. OBJECTIVE: To study the results of excimer laser-assisted nonocclusive anastomosis (ELANA) high-flow extracranial-to-intracranial (EC-IC) bypass surgery in these patients. METHODS: Between August 1998 and May 2008, 24 patients underwent ELANA EC-IC bypass surgery because of transient ischemic attacks or minor ischemic stroke associated with carotid artery occlusion. We retrospectively collected information. Follow-up data were updated by structured telephone interviews between May and September 2008. RESULTS: In all patients, the ELANA EC-IC bypass was patent at the end of surgery with a mean flow of 106 ± 41 mL/min. Within 30 days after the operation, 22 patients (92%) had no major complication, whereas 2 patients (8%) had a fatal intracerebral hemorrhage. During follow-up of a mean 4.4 ± 2.4 years, the bypass remained patent in 18 of the 22 surviving patients (82%) with a mean flow of 141 ± 59 mL/min. All patients with a patent bypass remained free of transient ischemic attacks and ischemic stroke. In 4 patients, the bypass occluded, accompanied by ipsilateral transient ischemic attacks in 2 patients, ipsilateral ischemic stroke in 1 patient, and contralateral ischemic stroke in another patient. CONCLUSION: ELANA EC-IC bypass surgery in patients with carotid artery occlusion is technically feasible and results in cessation of ongoing transient ischemic attacks and minor ischemic strokes, but carries a risk of postoperative hemorrhage.

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Postoperative Resolution of 123I-Iomazenil Uptake and Metabolic Rate of Oxygen in the Cerebral Cortex Accompanied by Postoperative Improvement of Cognition in a Patient Undergoing Extracranial-Intracranial Arterial Bypass Surgery for Internal Carotid Artery Occlusion

Clinical Nuclear Medicine ◽

10.1097/rlu.0b013e31820aa17b ◽

2011 ◽

Vol 36 (5) ◽

pp. 361-362 ◽

Cited By ~ 1

Author(s):

Kohei Chida ◽

Kuniaki Ogasawara ◽

Kenta Aso ◽

Hiroki Kuroda ◽

Hideo Saito ◽

...

Keyword(s):

Cerebral Cortex ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Metabolic Rate ◽

Bypass Surgery ◽

Internal Carotid ◽

Artery Occlusion ◽

Carotid Artery Occlusion ◽

Arterial Bypass ◽

Postoperative Improvement

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Cerebrovascular CO2 reactivity after carotid artery occlusion

Journal of Neurosurgery ◽

10.3171/jns.1988.69.1.0024 ◽

1988 ◽

Vol 69 (1) ◽

pp. 24-28 ◽

Cited By ~ 21

Author(s):

Guy L. Clifton ◽

Halcott T. Haden ◽

John R. Taylor ◽

Michael Sobel

Keyword(s):

Carotid Artery ◽

Bypass Surgery ◽

Artery Occlusion ◽

Carotid Artery Occlusion ◽

Collateral Flow ◽

Physiological Basis ◽

Content Type ◽

Normal Individuals ◽

Cerebrovascular Co2 Reactivity ◽

Normal Men

✓ Cerebral blood flow (CBF) was measured in 39 men at normocapnia and after 5% CO2 inhalation using the xenon-133 technique. Twenty-three patients had unilateral carotid artery occlusion with no angiographic evidence of contralateral carotid artery stenosis or ophthalmic collateral flow. Eleven of these patients had undergone extracranial-intracranial (EC-IC) bypass surgery. Sixteen age-matched normal men underwent CBF measurements at normocapnia and hypercapnia to provide control data. Mean hemispheric CBF was not different between hemispheres ipsilateral and contralateral to the carotid artery occlusion either in the patients who had undergone bypass surgery or in those with carotid artery occlusion alone. Considering all patients with carotid artery occlusion, mean CO2 reactivity was decreased in the hemisphere ipsilateral to the occlusion as compared to the contralateral hemisphere in both groups. Based on data from normal individuals, a hemispheric difference in CO2 reactivity of more than 0.94%/mm Hg PaCO2 or a global CO2 reactivity of less than 0.66%/mm Hg PaCO2 was considered abnormal for an individual patient. Six of 23 patients with carotid artery occlusion (three with an EC-IC bypass) had global or hemispheric abnormalities in CO2 reactivity. Patients with impaired CO2 reactivity were not distinguishable from other patients by neurological examination, presence of transient ischemic attacks, or evidence of infarction on computerized tomography scanning. This test was safe and simple to perform and may be a useful means of detecting impaired cerebrovascular collateral reserve capacity. If impaired CO2 reactivity after carotid artery occlusion proves to be associated with a high risk of subsequent stroke, the test would provide a physiological basis for selecting a subgroup of patients who could be helped by cerebral revascularization.

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Arterial Bypass Surgery Using a Spontaneously Formed “Bonnet” Superficial Temporal Artery in a Patient With Symptomatic Common Carotid Artery Occlusion

Operative Neurosurgery ◽

10.1227/01.neu.0000383877.00075.b4 ◽

2010 ◽

Vol 67 (3) ◽

pp. onsE316-onsE317 ◽

Cited By ~ 6

Author(s):

Kenta Aso ◽

Kuniaki Ogasawara ◽

Masakazu Kobayashi ◽

Kenji Yoshida

Keyword(s):

Blood Flow ◽

Carotid Artery ◽

Common Carotid Artery ◽

Bypass Surgery ◽

Superficial Temporal Artery ◽

Temporal Artery ◽

Artery Occlusion ◽

Carotid Artery Occlusion ◽

Arterial Bypass ◽

Arterial Bypass Surgery

Abstract BACKGROUND: Common carotid artery (CCA) occlusive disease may cause hemodynamic cerebral ischemia resulting in the development of ischemic symptoms. The blood flow in the superficial temporal artery (STA) ipsilateral to the occluded CCA is usually poor, which limits its use as a donor artery for extracranial-intracranial arterial bypass surgery. CLINICAL PRESENTATION: Despite antiplatelet therapy, recurrent transient ischemic attacks manifesting as motor aphasia developed in a 72-year-old man. Neuroradiological imaging revealed misery perfusion in the bilateral cerebral hemispheres caused by left CCA occlusion and right internal carotid artery occlusion. Blood flow from the STA contralateral to the occluded CCA perfused the ipsilateral STA over the midline in a retrograde fashion. INTERVENTION: After confirming the direction and the pressure of the blood flow in the spontaneously formed “bonnet” STA, the STA was anastomosed to a cortical artery in the symptomatic frontal lobe so that blood flow in the ipsilateral STA was supplied from the contralateral STA. The procedure was accomplished without difficulty, and no further ischemic symptoms developed after surgery. Postoperative cerebral angiography demonstrated an increase in collateral flow to the anastomosed bonnet STA and perfusion to an entire territory of the upper trunk of the symptomatic middle cerebral artery via the anastomosis. CONCLUSION: This case suggests that arterial bypass surgery can be performed using a spontaneously formed bonnet STA as a donor in a patient with symptomatic CCA occlusion.

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