scholarly journals Prediction of Resthenosis After Carotid Endarterectomy by the Method of Computer Simulation

2021 ◽  
Vol 10 (2) ◽  
pp. 401-407
Author(s):  
A. N. Kazantsev ◽  
R. A. Vinogradov ◽  
Yu. N. Zakharov ◽  
V. G. Borisov ◽  
M. A. Chernyavsky ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Internal Carotid ◽  
Carotid Sinus ◽  
Geometric Model ◽  
Calculated Data ◽  
External Carotid ◽  
Model Data ◽  
Increased Risk

The article describes a computer modeling technique that allows predicting the development of restenosis of the internal carotid artery after carotid endarterectomy (CEE). A clinical case has been demonstrated that proves the effectiveness of the developed method. It is indicated that for the correct formation of the geometric model, data from multispiral computed tomography with angiography of the patient after CEE with a layer thickness of 0.6 mm and a current of 355 mA are required. To build a flow model, data of color duplex scanning in three sections are required: 1. In the proximal section of the common carotid artery (3 cm proximal to the bifurcation); 2. In the section of the external carotid artery, 2 cm distal to the carotid sinus; 3. In the section of the internal carotid artery, 2 cm distal to the carotid sinus. The result of computer calculations using specialized software (Sim Vascular, Python, Open Foam) is a mathematical model of blood flow in a vessel. It is an array of calculated data describing the speed and other characteristics of the flow at each point of the artery. Based on the analysis of RRT and TAWSS indicators, a computer model of bifurcation is formed, which makes it possible to predict areas of increased risk of restenosis development. Thus, the developed technique is able to identify a cohort of patients after CEE, subjected to a high probability of loss of the vessel lumen. Such an opportunity will provide a more precise supervision of these patients in the postoperative period with the aim of early diagnosis of restenosis and timely prevention of the development of adverse cardiovascular events. 

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.

scholarly journals Novel method for glomus-saving carotid endarterectomy sensu A. N. Kazantsev: cutting the internal carotid artery on the site from external and common carotid artery

2020 ◽  
Vol 25 (8) ◽  
pp. 3851
Author(s):  
A. N. Kazantsev ◽  
K. P. Chernykh ◽  
N. E. Zarkua ◽  
R. Yu. Lider ◽  
K. G. Kubachev ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Common Carotid Artery ◽  
Internal Carotid ◽  
Autologous Transplantation ◽  
External Carotid ◽  
Novel Method ◽  
Group 2 ◽  
Group 1

Aim. To analyze the results of using a novel method of glomus-saving carotid endarterectomy (CEE) sensu A. N. Kazantsev.Materials and methods. This cohort, comparative, prospective, open-label study from January 2018 to April 2020 included 475 patients who undergone one of the three glomus-saving types of CEE. Depending on the implemented revascularization strategy, all patients were divided into 3 groups: group 1 — 136 patients (28,631%) CEE sensu R. A. Vinogradov; group 2 — 125 patients (26,316%) — sensu K. A. Antsupov; group 3 — 214 patients (45,053%) — sensu A. N. Kazantsev. Glomus-saving CEE sensu A. N. Kazantsev was carried as follows. Arteriotomy was performed along the inner edge of the external carotid artery (ECA) adjacent to the carotid sinus, 2 to 3 cm above the mouth, depending on the atherosclerotic lesion, with a transition to the common carotid artery (CCA) (also 2 to 3 cm below the mouth of the ECA). The internal carotid artery (ICA) was cut off at the site formed by the wall of the ECA and CCA. Next, an endarterectomy from the ICA was performed using the eversion technique. The next step was an open endarterectomy from EСA and СCA. Next, the ICA at the saved site was implanted in the previous position.Results. No intergroup differences were observed during hospitalization. Due to intraoperative visualization of an extended lesion of the ICA, in some cases it became necessary to transform the operation: in group 1, 4,4% of cases required ICA prosthetics; in groups 2 and 3 — autologous ICA transplantation in 4,8% and 4,7% of cases, respectively. Also, 1 case of ischemic stroke was recorded in groups 1 and 2. The cause of the latter was ICA thrombosis due to intimal detachment distal to the removed plaque. All cases of ECA thrombosis in the hospital postoperative period were differentiated in group 2.In the long-term follow-up, the groups were also comparable in the complication rate. The cause of all ischemic strokes was the development of restenosis or thrombosis of the ICA/prosthesis. Among patients who underwent forced autologous transplantation of the ICA, restenosis was not recorded. It should also be noted that new ECA occlusions (n=12; 9,6%) were visualized 6 months after reconstruction only in group 2.Conclusion. CEE sensu A. N. Kazantsev is the simplest technique of glomus-saving reconstructions, which have demonstrated their safety and effectiveness.

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