Cerebrovascular CO2 reactivity after carotid artery occlusion

1988 ◽  
Vol 69 (1) ◽  
pp. 24-28 ◽  
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.

Anterior communicating artery collateral flow protection against ischemic change during carotid endarterectomy

1993 ◽  
Vol 79 (3) ◽  
pp. 379-382 ◽  
Author(s):  
Maria V. Lopez-Bresnahan ◽  
Lee A. Kearse ◽  
Paulino Yanez ◽  
Tina I. Young
Keyword(s):  
Cerebral Ischemia ◽  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Cerebral Arteries ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Anterior Communicating Artery ◽  
Collateral Flow ◽  
Content Type ◽  
Carotid Circulation

✓ The purpose of this study was to determine whether preoperative angiographic patterns of collateral cerebral blood flow correlate with protection against intraoperative electroencephalographic (EEG) evidence of cerebral ischemia caused by carotid artery cross-clamping during carotid endarterectomy. Previous studies have shown that contralateral carotid artery occlusion and intracranial stenoses are associated with cerebral ischemia during carotid endarterectomy; however, the angiographic collateral flow patterns associated with cerebral ischemia have not been identified. This paper reports a retrospective study of 67 patients who underwent two- to four-vessel cerebral angiography followed by carotid endarterectomy with 16-channel EEG monitoring. The angiograms were reviewed for extracranial occlusive disease and collateral flow patterns, and the EEG recordings were analyzed for ischemic changes during carotid artery cross-clamping. Statistical analysis was by Fisher's exact test. Cross-filling of the anterior and middle cerebral arteries from the contralateral carotid artery through the anterior communicating artery correlated with a decreased incidence of EEG ischemic changes. Only 21% of patients with this collateral flow pattern showed ischemic changes compared to 50% of patients without this pattern (p < 0.03). Three angiographic findings occurring in combination on the side contralateral to surgery correlated with EEG ischemia: 1) occlusion of the contralateral internal carotid artery (five of seven or 71%, p < 0.03); 2) collateral flow from the external carotid circulation to the internal carotid circulation via the ophthalmic artery; and 3) collateral flow from the posterior circulation to the contralateral anterior circulation via the posterior communicating artery. The data presented here corroborate the correlation between contralateral carotid artery occlusion and cerebral ischemia during carotid endarterectomy. They also demonstrate that cross-filling of the anterior and middle cerebral arteries by the contralateral carotid artery protects against such ischemia. This collateral flow may serve as an indicator of tolerance to carotid artery cross-clamping.

Emergency embolectomy for acute occlusion of the middle cerebral artery

1985 ◽  
Vol 62 (5) ◽  
pp. 639-647 ◽  
Author(s):  
Fredric B. Meyer ◽  
David G. Piepgras ◽  
Thoralf M. Sundt ◽  
Takehiko Yanagihara
Keyword(s):  
Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Excellent Result ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Left Middle Cerebral Artery ◽  
Collateral Flow ◽  
Content Type ◽  
Acute Occlusion

✓ Twenty cases treated with emergency embolectomy for acute occlusion of the middle cerebral artery were reviewed. There were 10 males and 10 females, with an average age of 55 years. The left middle cerebral artery was involved in 17 patients and the right in three. Flow was restored in 16 patients (75%). The embolus originated in the heart in seven, the carotid artery in seven, the aorta in three, an aneurysm in one, and an indeterminate source in two. It was technically most difficult to achieve patency with atheromatous emboli from the aorta. Two patients (10%) had an excellent result with no neurological deficit, five (25%) were left with a minimal deficit but were employable, seven (35%) had a fair result but were still independent and employable, four (20%) did poorly, and two (10%) died. Patients with an associated ipsilateral carotid artery occlusion did poorly. Collateral flow, as judged from preoperative angiograms, was the best predictor of outcome.

Abstract WP150: BeamSAT MRI Help to Identify Patients at Risk for Intolerance to Temporary Internal Carotid Artery Occlusion During CEA and CAS

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Jun Tanaka ◽  
Kohkichi Hosoda ◽  
Yusuke Yamamoto ◽  
Taichiro Imahori ◽  
Atsushi Fujita ◽  
...  
Keyword(s):  
At Risk ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Preoperative Assessment ◽  
Contralateral Side ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Collateral Flow ◽  
Patients At Risk

Introduction: Pencil Beam type presaturation (BeamSAT) pulse on a major cervical vessel enables selective suppression of blood flow signal of the applied vessel in MR angiography (MRA). By subtracting the BeamSAT pulse-added MRA of an internal carotid artery (ICA) from conventional MRA, only the contralateral ICA image (SubBeamSAT image) can be obtained (Figure A, B). In this way, an ICA-selective MRA with more physiologial flow pattern can be obtained, because it requires no powerful injection of contrast medium. Purpose: The aim of this study was to investigate whether preoperative assessment of the flow of Acom/A1 by SubBeamSAT image and posterior communicating artery (Pcom) by conventional MRA could identify patients at risk for intolerance to intraoperative temporary ICA occlusion. Method: 29 patients who underwent carotid endarterectomy (CEA) (n = 17) or carotid artery stenting (CAS) (n = 12) were enrolled in the current study. All patients underwent the SubBeamSAT images and conventional MRA pre- and post-operatively. Response to ICA temporally occlusion was recorded during the revascularization procedure. Results: Among twenty-nine patients, 4 patients who demonstrate neither the Acom/A1 flow on SubBeamSAT image (Figure. B) nor Pcom flow on MRA showed intolerance. In contrast, the remaining 25 patients who demonstrated Acom/A1 (Figure. A) and/or Pcom flow showed tolerance. Intolerance to ICA occlusion was excellently predicted by visualization of collateral flow via Acom and Pcom (specificity: 100%, sensitivity: 100%, p=0.00004). Conclusions: SubBeamSAT image is useful for evaluating the flow of Acom from A1 portion of the healthy side to A2 portion of the contralateral side, which is often difficult to evaluate with conventional MRA. With the SubBeamSAT image, it is feasible to evaluate the Acom/A1 flow accurately. In conclusion, SubBeamSAT image enables excellent prediction for the intolerance to temporary ICA occlusion.

scholarly journals Bypass Surgery for Symptomatic Common Carotid Artery Occlusion with Arterial Grafts: A Report of Five Cases

2017 ◽  
Vol 45 (2) ◽  
pp. 135-139
Author(s):  
Yasuhiro SANADA ◽  
Hisashi KUBOTA ◽  
Nobuhiro NAKAGAWA ◽  
Norihito FUKAWA ◽  
Kiyoshi TSUJI ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Common Carotid Artery ◽  
Bypass Surgery ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Arterial Grafts ◽  
Common Carotid Artery Occlusion

Neurosurgical applications of ocular pneumoplethysmography

1981 ◽  
Vol 54 (5) ◽  
pp. 588-595 ◽  
Author(s):  
William F. Bingham
Keyword(s):  
Standard Deviation ◽  
Carotid Artery ◽  
Intracranial Aneurysm ◽  
Carotid Endarterectomy ◽  
Contralateral Side ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Content Type ◽  
Final Adjustment ◽  
Fine Print

✓ Ocular pneumoplethysmography (OPG), a semiautomated form of suction ophthalmodynamometry, was used to evaluate and follow 15 patients who underwent carotid endarterectomy and two patients in whom gradual carotid artery occlusion was performed for inoperable intracranial aneurysm. Postoperative corrected ophthalmic arterial pressures (COAP's) on the operated side in the carotid endarterectomy patients averaged 12.5 mm Hg higher than before surgery, the standard deviation being 4.9 mm Hg for clinically stable patients. There was no significant change in COAP on the contralateral side. Several problems were encountered in closing down carotid clamps, the most potentially serious being a precipitous fall in COAP with the final adjustment. The current uses of OPG and similar techniques are reviewed, and potential neurosurgical applications are discussed.

Axilloaxillary Bypass for the Treatment of Subclavian Artery Stenosis Complicated by Bilateral Common Carotid Artery Occlusion: Technical Case Report

Neurosurgery ◽  
2003 ◽  
Vol 53 (2) ◽  
pp. 444-447 ◽  
Author(s):  
Masahiro Ogino ◽  
Masashi Nagumo ◽  
Toru Nakagawa ◽  
Masashi Nakatsukasa ◽  
Ikuro Murase
Keyword(s):  
Blood Flow ◽  
Carotid Artery ◽  
Vertebral Artery ◽  
Subclavian Artery ◽  
Bypass Surgery ◽  
Left Subclavian Artery ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Bilateral Common Carotid Artery ◽  
Common Carotid Artery Occlusion

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.

Collateral flow and ischemic brain lesions in patients with unilateral carotid artery occlusion

Neurology ◽  
2003 ◽  
Vol 60 (9) ◽  
pp. 1435-1441 ◽  
Author(s):  
R. H.C. Bisschops ◽  
C. J.M. Klijn ◽  
L. J. Kappelle ◽  
A. C. van Huffelen ◽  
J. van der Grond
Keyword(s):  
Carotid Artery ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Brain Lesions ◽  
Collateral Flow ◽  
Ischemic Brain

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

Neurosurgery ◽  
2011 ◽  
Vol 68 (6) ◽  
pp. 1687-1694 ◽  
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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