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.

Spontaneous Dissecting Pseudoaneurysm of the Extracranial Internal Carotid Artery: Endovascular Treatment with a Palmaz Stent

1998 ◽  
Vol 4 (1_suppl) ◽  
pp. 101-104 ◽  
Author(s):  
J. Deguchi ◽  
S. Nagasawa ◽  
H. Tanaka ◽  
S. Suzuki ◽  
Y. Hirota ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Conservative Therapy ◽  
Internal Carotid ◽  
Neurological Complications ◽  
Carotid Artery Dissection ◽  
Artery Dissection ◽  
Spontaneous Dissection ◽  
Cervical Internal Carotid Artery

This case illustrates the usefulness of an endovascular stent to treat a pseudoaneurysm of the cervical internal carotid artery. A 46-year-old male patient presented with a spontaneous dissection of the cervical internal carotid artery. After failing conservative therapy, he was treated by endovascular placement of a Palmaz stent at level of the pseudoaneurysm and dissection. Immediate obliteration of pseudoaneurysm was achieved, and patency of the internal carotid artery was maintained. The patient sustained no neurological complications and the stenosis of treated carotid artery did not occur during the 6-month follow-up period. For internal carotid artery dissection, stent placement seems to be a reasonable therapeutic alternative to direct surgery.

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.

Carotid Duplex Velocity Criteria Revisited for the Diagnosis of Carotid In-Stent Restenosis

Vascular ◽  
2007 ◽  
Vol 15 (3) ◽  
pp. 119-125 ◽  
Author(s):  
Ali F. AbuRahma ◽  
Damian Maxwell ◽  
Kris Eads ◽  
Sarah K. Flaherty ◽  
Tabitha Stutler
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Ct Angiography ◽  
Carotid Arteries ◽  
Internal Carotid ◽  
Carotid Angiography ◽  
Residual Stenosis ◽  
Stent Restenosis ◽  
The Mean ◽  
In Stent Restenosis

Carotid percutaneous transluminal angioplasty/stenting has become an accepted treatment modality for carotid artery stenosis in high-risk patients. There has been an ongoing debate regarding which duplex ultrasound (DUS) criteria to use to determine the rate of in-stent restenosis. This prospective study revisits DUS criteria for determining the rate of in-stent restenosis. In analyzing a subset of 12 patients (pilot study) who had both completion carotid angiography and DUS within 30 days, 10 patients with normal post-stenting carotid angiography (< 30% residual stenosis) had peak systolic velocities (PSVs) of the stented internal carotid artery (ICA) of ≤ 155 cm/s and two patients with ≥ 30% residual stenosis had internal carotid artery (ICA) PSVs of > 155 cm/s. Eighty-three patients who underwent carotid stenting as part of clinical trials were analyzed. All patients underwent post-stenting carotid DUS that was done at 1 month and every 6 months thereafter. PSVs and end-diastolic velocities of the ICA and common carotid artery were recorded. Patients with PSVs of the ICA of > 140 cm/s underwent carotid computed tomographic (CT) angiography. The perioperative stroke rate was 1.2%. When the old DUS velocity criteria for nonstented carotid arteries were applied, 54% of patients had ≥ 30% restenosis (PSV of > 120 cm/s), but when our new proposed DUS velocity criteria for stented arteries were applied (PSV of > 155 cm/s), 33% had ≥ 30% restenosis at a mean follow-up of 18 months ( p = .007). The mean PSVs for patients with normal stented carotid arteries based on CT angiography, were 122 cm/s versus 243 cm/s for ≥ 30% restenosis and 113 cm/s versus 230 cm/s for ≥ 30% restenosis based on our new criteria. The mean PSVs of in-stent restenosis of 30 to < 50%, 50 to < 70%, and 70 to 99%, based on CT angiography, were 205 cm/s, 264 cm/s, and 435 cm/s, respectively. Receiver operating curve analysis demonstrated that an ICA PSV of > 155 cm/s was optimal for detecting ≥ 30% in-stent restenosis, with a sensitivity of 100%, a specificity of 90%, a positive predictive value of 74%, and a negative predictive value of 100%. The currently used carotid DUS velocity criteria overestimated the incidence of in-stent restenosis. We propose new velocity criteria for the ICA PSV of > 155 cm/s to define ≥ 30% in-stent restenosis.

Role of magnetic resonance imaging in evaluating sphenoid sinus and internal carotid artery

2009 ◽  
Vol 123 (12) ◽  
pp. 1331-1337 ◽  
Author(s):  
H G Hatipoglu ◽  
M A Cetin ◽  
A Selvi ◽  
E Yuksel
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Sphenoid Sinus ◽  
Carotid Arteries ◽  
Internal Carotid ◽  
Minimal Distance ◽  
Resonance Imaging ◽  
Internal Carotid Arteries

AbstractObjective:This study aimed to determine whether magnetic resonance imaging has a role in the evaluation of the sphenoid sinus and internal carotid artery. In addition, we aimed to establish reference measurements for the minimal distance between the internal carotid arteries.Method:The sphenoid sinuses and neighbouring internal carotid arteries of 90 patients were evaluated using sagittal T1-weighted and axial and coronal T2-weighted magnetic resonance images.Results:Sphenoid sinus pneumatisation was categorised as occipitosphenoidal (0 per cent), conchal (3.3 per cent), presellar (14.4 per cent) or sellar (82.2 per cent). The internal carotid artery protruded into the sphenoid sinus in 32.8 per cent, with a septum in 9.4 per cent. The incidence of sellar-type sphenoid sinus pneumatisation was higher in patients with protrusion of the internal carotid artery into the sphenoid sinus (p < 0.001). The incidence of presellar pneumatisation was higher in patients without internal carotid artery protrusion (p < 0.001). The minimal distance between the internal carotid arteries varied between 9.04 and 24.26 mm (mean, 15.94 mm).Conclusion:Magnetic resonance imaging can provide useful information about the sphenoid sinus and internal carotid artery, prior to endoscopic sphenoidotomy and trans-sphenoidal hypophysectomy.

Reconstitution of “totally” occluded internal carotid arteries

1979 ◽  
Vol 50 (6) ◽  
pp. 747-757 ◽  
Author(s):  
Roger W. Countee ◽  
Thurairasah Vijayanathan
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Arteries ◽  
Internal Carotid ◽  
Injection Technique ◽  
Complete Relief ◽  
Content Type ◽  
Internal Carotid Arteries ◽  
Angiographic Technique ◽  
Fine Print

✓ The authors describe their experiences with five patients with delayed transient ischemic symptoms homolateral to internal carotid artery (ICA) occlusions. In each instance, initial arteriograms were interpreted as showing irreversible occlusions of these arteries in the neck and microvascular bypass procedures were contemplated. However, after repeat arteriographic evaluations with a modified injection technique, certain angiographic features were identified that suggested the mechanism of the symptoms in these patients and that their ICA's could be reconstituted in the neck. This was successfully accomplished in each patient with complete relief of ischemic symptoms. The angiographic technique employed and the arterial flow patterns identified in these patients are discussed. The details of the operative technique are described. It is concluded that routine arteriographic techniques may be inadequate to identify the reversible carotid occlusion. This may account for some of the confusion which surrounds the surgery of these vessels as well as the failure of extracranial-intracranial bypass to relieve recurrent ischemic symptoms in these individuals.

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 Carotid artery diameter assessment in men and women and the relation to age, sex and body mass index using ultrasonography

2021 ◽  
Vol 8 (9) ◽  
pp. 1274
Author(s):  
Magaji G. Ojaare ◽  
Terkimbi I. Annongu ◽  
Chia D. Msuega ◽  
Hameed O. Mohammad ◽  
Abubakar Farati ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Body Mass ◽  
Common Carotid Artery ◽  
Carotid Arteries ◽  
Internal Carotid ◽  
Left Internal Carotid Artery ◽  
Luminal Diameter ◽  
The Common

Background: Carotid artery dimensions are increasingly used for detecting early atherosclerosis and predicting clinical complications. Aim was to explore relationships between gender, age and body mass index (BMI) and the diameters of the common carotid artery (CCA) and internal carotid artery (ICA) using ultrasonography.Methods: This was a cross-sectional study carried out at the University of Maiduguri Teaching Hospital between February-October, 2011. The 400 adult males and females above 18 years underwent carotid artery ultrasonography for measurement of the IMT of the common and internal carotid arteries. The influence of age, sex, weight, height, and the basal metabolic index (BMI) was investigated.Results: There were 239 (59.80%) males and 161 (40.20%) females aged between 18 to 81 years (Mean±SD, 36.74±14.79 years). The mean±SD diameters for right common carotid artery (RCCA) and left common carotid artery (LCCA) were 6.39±0.71mm and 6.28±0.74mm respectively. The right internal carotid artery (RICA) and left internal carotid artery (LICA) had mean±SD diameters of 4.63±0.63 mm and 4.61±0.63 mm respectively. The luminal diameters of the carotid arteries increased significantly with age and increased BMI. The luminal diameters of the CCA and ICA were significantly smaller in women than in men.Conclusions: Common carotid and internal carotid artery luminal diameter tends to be larger in men than women among adults and increases with age and BMI. There is no difference in the luminal diameter between the left and right carotid artery. 

scholarly journals Ruptured dissecting aneurysm in communicating internal carotid artery segments treated using a stent-assisted endovascular technique

2018 ◽  
Vol 24 (2) ◽  
pp. 130-134 ◽  
Author(s):  
Chae Wook Huh ◽  
Sung-Chul Jin
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Glasgow Outcome Scale ◽  
Internal Carotid ◽  
Neurological Complications ◽  
Dissecting Aneurysm ◽  
Digital Subtraction ◽  
Endovascular Technique ◽  
Dissecting Aneurysms

Hemorrhagic intracranial dissecting aneurysms are known to have a poor natural history and an increased tendency to rebleed. The communicating segment of the internal carotid artery (ICA) is an infrequent site of dissection that is difficult to manage using deconstructive endovascular treatment because of the need to preserve important vascular branches. We report two cases of ruptured dissecting aneurysms that occurred in communicating segments of the ICA and treated using a reconstructive endovascular technique involving stent-assisted coiling. Case 1 was a 59-year-old woman who was diagnosed with subarachnoid hemorrhage (SAH). Digital subtraction angiography (DSA) indicated a ruptured dissecting aneurysm that arose from the left communicating segment of the ICA. Stent-assisted coiling was performed and followed by a second overlapping stent technique. No deterioration was observed on DSA after one week of follow-up or on magnetic resonance angiography (MRA) after four months of follow-up. The patient was discharged without neurological complications (Glasgow Outcome Scale 5). Case 2 was a 34-year-old man who was admitted with a diagnosis of SAH. DSA revealed a suspected lesion of a ruptured dissecting aneurysm of the left communicating segment of the ICA. Stent-assisted coiling was performed, and partial occlusion was achieved. No deterioration was observed on DSA after two weeks of follow-up or on MRA after six months of follow-up. The patient was discharged without neurological complications (Glasgow Outcome Scale 5). These cases suggest that using stent-assisted coiling could be a feasible modality for treating ruptured ICA dissecting aneurysms in the communicating segment.

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