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 Hybrid intervention in a patient with tandem proximal-distal lesion of the internal carotid artery in acute ischemic stroke

2021 ◽  
Vol 179 (6) ◽  
pp. 61-65
Author(s):  
I P. Dudanov ◽  
V. V. Zelenin ◽  
O. I. Kudryavtsev ◽  
B. S. Abuazab ◽  
F. A. Vryganov ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Functional Results ◽  
Artery Occlusion ◽  
Left Internal Carotid Artery ◽  
Stroke Severity ◽  
Acute Period ◽  
Tandem Occlusion

RELEVANCE. Pathological tortuosity of the carotid artery and thrombotic occlusion of the intracranial segment of the carotid artery, critical subostial stenosis are the main causes of tandem lesions in patients with intracranial cerebral artery occlusion. Proximal occlusion may prevent intracranial endovascular access to distal tandem occlusion and increase the risk of endovascular complications.The OBJECTIVE was to evaluate technical and functional results of the hybrid technologies used in treatment of a patient with tandem damage of proximal and distal segments of the carotid basin in the acute period of ischemic stroke.CLINICAL OBSERVATION. The result of the intervention was a change in stroke severity by comparing scores on the national Institutes of Health Stroke Scale (nIHSS) after a hybrid intervention – primary reconstruction of the left internal carotid artery with pronounced pathological tortuosity in the extracranial segment and thrombectomy from the tandem M1 occlusion of the left medial artery segment in a patient with ischemic stroke in the left carotid pool in the acute period. A rare clinical observation is presented.

Clinical features of ocular ischemic syndrome in atherosclerotic lesions of the internal carotid artery

2018 ◽  
Vol 16 (5) ◽  
pp. 173-178
Author(s):  
V. V. Tuzlaev ◽  
◽  
V. V. Egorov ◽  
I. Z. Kravchenko ◽  
G. P. Smoliakova ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Clinical Features ◽  
Internal Carotid ◽  
Ocular Ischemic Syndrome ◽  
Atherosclerotic Lesions ◽  
Ischemic Syndrome

Retromandibular Fossa Approach to the High Cervical Internal Carotid Artery: An Anatomic Study

2008 ◽  
Vol 62 (suppl_5) ◽  
pp. ONS363-ONS370 ◽  
Author(s):  
Yusuf Izci ◽  
Roham Moftakhar ◽  
Mark Pyle ◽  
Mustafa K. Basşkaya
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Average Length ◽  
Cranial Nerves ◽  
External Carotid Artery ◽  
External Carotid ◽  
Digastric Muscle ◽  
High Cervical ◽  
Cervical Internal Carotid Artery

Abstract Objective: Access to the high cervical internal carotid artery (ICA) is technically challenging for the treatment of lesions in and around this region. The aims of this study were to analyze the efficacy of approaching the high cervical ICA through the retromandibular fossa and to compare preauricular and postauricular incisions. In addition, the relevant neural and vascular structures of this region are demonstrated in cadaveric dissections. Methods: The retromandibular fossa approach was performed in four arterial and venous latex-injected cadaveric heads and necks (eight sides) via preauricular and postauricular incisions. This approach included three steps: 1) sternocleidomastoid muscle dissection; 2) transparotid dissection; and 3) removal of the styloid apparatus and opening of the retromandibular fossa to expose the cervical ICA with the internal jugular vein along with Cranial Nerves X, XI, and XII. Results: The posterior belly of the digastric muscle and the styloid muscles were the main obstacles to reaching the high cervical ICA. The high cervical ICA was successfully exposed through the retromandibular fossa in all specimens. In all specimens, the cervical ICA exhibited an S-shaped curve in the retromandibular fossa. The external carotid artery was located more superficially than the ICA in all specimens. The average length of the ICA in the retromandibular fossa was 6.8 cm. Conclusion: The entire cervical ICA can be exposed via the retromandibular fossa approach without neural and vascular injury by use of meticulous dissection and good anatomic knowledge. Mandibulotomy is not necessary for adequate visualization of the high cervical ICA.

scholarly journals Recanalization of Extracranial Internal Carotid Artery Occlusion after i.v. Thrombolysis for Acute Ischemic Stroke

PLoS ONE ◽  
2013 ◽  
Vol 8 (1) ◽  
pp. e55318 ◽  
Author(s):  
Raimund Pechlaner ◽  
Michael Knoflach ◽  
Benjamin Matosevic ◽  
Michael Ruecker ◽  
Christoph Schmidauer ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Acute Ischemic Stroke ◽  
Internal Carotid ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Internal Carotid Artery Occlusion ◽  
Extracranial Internal Carotid Artery

Dynamic Computed Tomography Angiography in Suspected Brain Death: A Noninvasive Biomarker

2014 ◽  
Vol 65 (4) ◽  
pp. 352-359 ◽  
Author(s):  
Santanu Chakraborty ◽  
Reem A. Adas
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Brain Death ◽  
Internal Carotid ◽  
External Carotid Artery ◽  
External Carotid ◽  
Ancillary Test ◽  
Organ Harvesting

Purpose Neurologic determination of death or brain death is primarily a clinical diagnosis. This must respect all guarantees required by law and should be determined early to avoid unnecessary treatment and allow organ harvesting for transplantation. Ancillary testing is used in situations in which clinical assessment is impossible or confounded by other factors. Our purpose is to determine the utility of dynamic computed tomographic angiography (dCTA) as an ancillary test for diagnosis of brain death. Materials and Methods We retrospectively reviewed 13 consecutive patients with suspected brain death in the intensive care unit who had dCTA. Contrast appearance timings recorded from the dCTA data were compared to findings from 15 controls selected from patients who presented with symptoms of acute stroke but showed no stroke in follow-up imaging. Results The dCTA allows us to reliably assess cerebral blood flow and to record time of individual cerebral vessels opacification. It also helps us to assess the intracranial flow qualitatively against the flow in extracranial vessels as a reference. We compared the time difference between enhancement of the external and internal carotid arteries and branches. In all patients who were brain dead, internal carotid artery enhancement was delayed, which occurred after external carotid artery branches were opacified. Conclusion In patients with suspected brain death, dCTA reliably demonstrated the lack of cerebral blood flow, with extracranial circulation as an internal reference. Our initial results suggest that inversion of time of contrast appearance between internal carotid artery and external carotid artery branches at the skull base could predict a lack of distal intracranial flow.

Sign in / Sign up

Export Citation Format

Share Document