scholarly journals Hybrid Surgical Repair for Recurrent Coarctation of the Transvers Arch: Case Report

2021 ◽  
Author(s):  
Kıvanc ATILGAN ◽  
Alper TOSYA ◽  
Fahri YEŞİL ◽  
Pinar Koksal Coskun ◽  
Burak ONUK ◽  
...  
Keyword(s):  
Stent Placement ◽  
Carotid Arteries ◽  
Surgical Repair ◽  
Median Sternotomy ◽  
Coarctation Of The Aorta ◽  
Complete Relief ◽  
Hybrid Technique ◽  
Transcatheter Intervention ◽  
Transverse Arch ◽  
Common Carotid Arteries

The incidence of postoperative recurrent coarctation of the aorta ranges from 5% to 50%, and largely depends on the age at initial repair. Due to the increased fibrosity and rigidity of the aorta in older age, stent placement is preferred instead of balloon angioplasty, resulting in an almost complete relief of the gradient in >95% of the patients. In patients with transverse arch hypoplasia, transcatheter intervention with further surgical intervention may be needed, and the use of stenting was shown to be effective in the treatment of patients with hypoplastic isthmus, arch or tubular coarctation. In this case of a late re-coarctation, we preferred to apply a hybrid technique for treatment. The first step of the treatment was debranching of the brachiocephalic and left common carotid arteries with upper mini median sternotomy. On the following day, the patient underwent a successful stent placement to the transvers arch.

Vein-Loaded Stent System to Occlude Wide-Necked Aneurysms

1998 ◽  
Vol 4 (1_suppl) ◽  
pp. 105-108
Author(s):  
T. Okamoto ◽  
T. Iwakoshi ◽  
M. Negoro ◽  
S. Miyachi ◽  
M. Bundou ◽  
...  
Keyword(s):  
Stent Placement ◽  
Carotid Arteries ◽  
Anticoagulation Therapy ◽  
The Other ◽  
Parent Artery ◽  
Clinical Use ◽  
Complete Occlusion ◽  
Stent System ◽  
Common Carotid Arteries

We devised a vein-loaded stent system to immediately close the aneurysmal orifice without interrupting the parent arterial flow. Ten experimental wide-necked aneurysms located on canine common carotid arteries were treated with the implantation of a newly modified vein-loaded stent system. After deploying the stent, half of them were managed under administration of 50 mg of ticlopidine hydrochloride per day and the other half followed up without any anticoagulation therapy. Immediately after the stent placement, all aneurysms were completely obliterated with patency of the parent artery in the successfully implanted vessels in both groups. Follow-up angiography one week later disclosed complete occlusion of the aneurysm with patency of the parent artery in 67% (2/3) of the group with ticlopidine, while none of the group without drugs showed patency of the parent artery. The rate of patency of the parent artery was found to be improved by administration of ticlopidine, but was still lower than that of a conventional stent. Further modifications will be needed before clinical use.

scholarly journals Morphometric analysis of intimal thickening secondary to stent placement in pig carotid arteries

2008 ◽  
Vol 23 (2) ◽  
pp. 165-172 ◽  
Author(s):  
Márcio Bastiani Pasa ◽  
Adamastor Humberto Pereira ◽  
Cyro Castro Júnior
Keyword(s):  
Delivery System ◽  
Morphometric Analysis ◽  
Stent Placement ◽  
Carotid Arteries ◽  
Distal Segment ◽  
Control Group ◽  
Intimal Thickening ◽  
Luminal Area ◽  
The Right ◽  
Common Carotid Arteries

OBJECTIVE: To evaluate intimal thickening secondary to stent placement or to insertion of the delivery system without stent placement in pig carotid arteries. METHODS: Stents were placed in the right common carotid arteries of 7 pigs, and 7 other control pigs underwent only insertion of the delivery system without stent placement. Uninjured contralateral common carotid arteries of the two groups were also used as controls. Samples of arterial tissue, obtained from the area adjacent to the distal segment of the stent four weeks after placement, underwent morphometric analysis. Morphometric data were compared with findings for arterial samples from injured arteries of the control group and uninjured contralateral arteries of the two groups. The unpaired Mann-Whitney U test and the Wilcoxon t test for nonparametric samples were used for statistical analysis. RESULTS: Greater intimal thickening was found in the group in which stents were placed (p=0.008). Changes in luminal area and media layer were not significantly different between the two groups. The comparison of contralateral carotid arteries of the two groups revealed significant changes in intimal and luminal areas. No statistically significant changes were found in medial layer area. CONCLUSIONS: All arteries that underwent stent placement showed intimal thickening without changes in the tunica media at four weeks. Dissection and insertion of the delivery system without stent placement was associated with a lesser degree of intimal thickening.

External Carotid Occlusion as a Cause of Recurrent Ischemia after Carotid Endarterectomy

Neurosurgery ◽  
1982 ◽  
Vol 11 (4) ◽  
pp. 518-521 ◽  
Author(s):  
Roger W. Countee ◽  
Thurairasah Vijayanathan ◽  
Shu Z. Wu
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Arteries ◽  
Internal Carotid ◽  
External Carotid Artery ◽  
External Carotid ◽  
Complete Relief ◽  
Avoidable Complication ◽  
Common Carotid Arteries

Abstract Our experiences with a patient who developed recurrent hemispheric transient ischemic attacks 3 1/2 years after ipsilateral carotid endarterectomy are described. Although repeat arteriography demonstrated smooth and unobstructed common and internal carotid arteries and a normal intracranial circulation, there was complete occlusion of the external carotid artery at its origin, which appeared as a stump or diverticulum at the origin of the internal carotid artery. This stump was filled with atherothrombotic debris and served as a source of emboli to the adjacent and patent internal carotid artery. Excision of the stump effected complete relief of the recurrent ischemic symptoms. The pernicious potential of an external carotid obstruction when adjacent to a patent internal carotid artery should be recognized. To prevent this avoidable complication of carotid endarterectomy, we recommend that the origin of the external carotid artery be treated with the same standards of technical perfection as those customarily applied to the internal and common carotid arteries during this procedure.

Effect of carvedilol on the redox-status of plasma low-molecular-weight aminothyols in rats with acute cerebral ischemia

2018 ◽  
pp. 12-18
Author(s):  
К.А. Никифорова ◽  
В.В. Александрин ◽  
П.О. Булгакова ◽  
А.В. Иванов ◽  
Э.Д. Вирюс ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Cerebral Ischemia ◽  
Carotid Arteries ◽  
Redox Status ◽  
Global Cerebral Ischemia ◽  
Low Molecular Weight ◽  
Adrenergic Antagonist ◽  
Acute Cerebral Ischemia ◽  
Common Carotid Arteries ◽  
Reduced Forms

Цель. Установить влияние неспецифического адреноблокатора карведилола на редокс-статус низкомолекулярных аминотиолов (цистеин, гомоцистеин, глутатион) в плазме крови при моделировании глобальной ишемии головного мозга у крыс. Методика. Нами была использована модель глобальной ишемии (пережатие общих сонных артерий с геморрагией длительностью 15 мин). Препарат вводили за 1 ч до операции. Уровни аминотиолов измеряли через 40 мин после начала реперфузии. Анализ уровня аминотиолов проводили методом жидкостной хроматографии. Результаты. Установлено, что у крыс, не подвергавшихся ишемии, карведилол в дозе 10 мг/кг вызывает рост редокс-статуса цистеина и глутатиона (в 3 и 3,5 раза соответственно по сравнению с контролем, p = 0,04 и p = 0,008) за счет увеличения их восстановленных форм. При ишемии данного эффекта не наблюдалось. Редокс-статус у крыс с ишемией на фоне карведилола (Цис = 0,85 ± 0,14%, Глн = 1,8 ± 0,7%, Гцис = 1,1 ± 0,8%) оставался таким же низким, как и у крыс с ишемией без введения карведилола (р > 0,8). Заключение. Полученный результат демонстрирует, что в условиях ишемии головного мозга карведилол не оказывает эффекта на гомеостаз аминотиолов плазмы крови, несмотря на выраженный антиоксидантный эффект в нормальных условиях. Aim. Effect of a nonspecific adrenergic antagonist carvedilol on the redox status of plasma low-molecular-weight aminothiols (cysteine, homocysteine, glutathione) was studied in rats with global cerebral ischemia (occlusion of common carotid arteries with hemorrhage). Methods. A model of global ischemia (occlusion of common carotid arteries with 15-min hemorrhage) was used. The drugs were administered one hour before the operation. Aminothiol levels were measured by HPLC with UV detection at 40 minutes after the onset of reperfusion. Results. Carvedilol 10 mg/kg increased the redox status of cysteine and glutathione in rats not exposed to ischemia (3 and 3.5 times, respectively, compared with the control, p = 0.04 and p = 0.008, respectively) but not of homocysteine, by increasing their reduced forms. However, this effect was not observed in ischemia. In rats with ischemia treated with carvedilol, the redox status (Cys = 0.85 ± 0.14%, GSH = 1.8 ± 0.7%, Hcys = 1.1 ± 0.8%) remained low similar to that in rats with ischemia not treated with carvedilol (p >0.8, 0.8, and 0.9, respectively). Conclusion. Carvedilol did not affect the homeostasis of blood plasma thiols in cerebral ischemia despite the pronounced antioxidant effect under the normal conditions.

Advantages of a mini right axillary thoracotomy for congenital heart defect repair in children

2021 ◽  
pp. 1-6
Author(s):  
Jannika Dodge-Khatami ◽  
Ali Dodge-Khatami
Keyword(s):  
Quality Of Life ◽  
Physical Activity ◽  
Global Health ◽  
Congenital Heart ◽  
Surgical Repair ◽  
Median Sternotomy ◽  
Axillary Approach ◽  
Post Operative Pain ◽  
The Right

Abstract Objectives: The mini right axillary thoracotomy is an alternative surgical approach to repair certain congenital heart defects. Quality-of-life metrics and clinical outcomes in children undergoing either the right axillary approach or median sternotomy were compared. Methods: Patients undergoing either approach for the same defects between 2018 and 2020 were included. Demographic details, operative data, and outcomes were compared between both groups. An abbreviated quality of life questionnaire based on the Infant/Toddler/Child Health Questionnaires focused on the patient’s global health, physical activity, and pain/discomfort was administered to all parents/guardians within two post-operative years. Results: Eighty-seven infants and children underwent surgical repair (right axillary thoracotomy, n = 54; sternotomy, n = 33) during the study period. There were no mortalities in either group. The right axillary thoracotomy group experienced significantly decreased red blood cell transfusion, intubation, intensive care, and hospital durations, and earlier chest tube removal. Up to 1 month, parents’ perception of their child’s degree and frequency of post-operative pain was significantly less after the right axillary thoracotomy approach. No difference was found in the patient’s global health or physical activity limitations beyond a month between the two groups. Conclusions: With the mini right axillary approach, surrogates of faster clinical recovery and hospital discharge were noted, with a significantly less perceived degree and frequency of post-operative pain initially, but without the quality of life differences at last follow-up. While providing obvious cosmetic advantages, the minimally invasive right axillary thoracotomy approach for the surgical repair of certain congenital heart lesions is a safe alternative to median sternotomy.

scholarly journals Synchronous Carotid Bifurcation Endarterectomy and Retrograde Kissing Stenting of the Innominate and Left Common Carotid Artery in a Patient with a Bovine Aortic Arch

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Alessandro Robaldo ◽  
Guido Carignano ◽  
Alberto Balderi ◽  
Claudio Novali
Keyword(s):  
Carotid Artery ◽  
Aortic Arch ◽  
Common Carotid Artery ◽  
Carotid Arteries ◽  
High Risk Patient ◽  
Carotid Bifurcation ◽  
Left Common Carotid Artery ◽  
The Right ◽  
Bovine Aortic Arch ◽  
Common Carotid Arteries

Management of the symptomatic multiple stenosis of supra-aortic vessels (MSSVs) in a “bovine” aortic arch (BAA) configuration is infrequently reported. The optimal treatment choice remains debatable. A successful hybrid treatment for a proximal critical stenosis of the innominate and left common carotid artery was performed in a high-risk patient with a tandem symptomatic lesion in the right carotid bifurcation and a concentric vulnerable plaque in the bovine trunk. This case supports the feasibility, safety, and efficacy of a combined carotid bifurcation endarterectomy and retrograde kissing stenting of common carotid arteries with cerebral protection after evaluation of radiological, anatomical, and clinical parameters.

scholarly journals Angioplasty and primary stenting of the subclavian, innominate, and common carotid arteries in 83 patients

1998 ◽  
Vol 28 (6) ◽  
pp. 1059-1065 ◽  
Author(s):  
Timothy M. Sullivan ◽  
Bruce H. Gray ◽  
J.Michael Bacharach ◽  
John Perl II ◽  
Mary Beth Childs ◽  
...  
Keyword(s):  
Carotid Arteries ◽  
Primary Stenting ◽  
Common Carotid Arteries
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