Surgical treatment of recurrent carotid artery stenosis

1994 ◽  
Vol 80 (5) ◽  
pp. 781-787 ◽  
Author(s):  
Fredric B. Meyer ◽  
David G. Piepgras ◽  
Nicolee C. Fode
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Neurological Complications ◽  
Artery Stenosis ◽  
Intraluminal Thrombus ◽  
Content Type ◽  
Interposition Graft ◽  
Patch Graft ◽  
Organized Thrombus ◽  
Fine Print

✓ Ninety-two surgical procedures were performed in 82 patients for recurrent carotid artery stenosis. The etiology was recurrent atherosclerosis in 45 cases, myointimal hyperplasia in 20, organized thrombus without a significant underlying plaque in 20, and scarring along the proximal arteriotomy site in seven. The operations included a repeat endarterectomy in 66 cases and reconstruction with an interposition graft in 22. All five major neurological complications occurred in symptomatic patients, and included three instances of intraoperative embolization during exposure of the carotid artery. The majority of neurological complications occurred in symptomatic patients who had intraluminal thrombus confirmed at surgery. There were four perioperative deaths, due to cerebral hemorrhage in two patients and myocardial infarction in two. In the patients whose original surgery was performed at the Mayo Clinic, the risk of recurrent carotid artery stenosis was 3.1% with a primary closure compared to 1.6% when a patch graft was used. These results indicate that surgery for recurrent carotid artery stenosis is technically more difficult and carries a significantly higher risk than surgery for primary disease. The difficulty is due to the friable recurrent plaque associated with intraluminal thrombus, which increases the risk of embolization during carotid artery exposure. In the majority of patients with recurrent atherosclerosis, a repeat endarterectomy can be achieved. However, in some patients, there is scarring without a definite plane of cleavage between the recurrent disease and the underlying media, making an endarterectomy difficult. In these cases, excision of the diseased segment and reconstruction with an interposition graft is the best treatment. The findings presented here also suggest that closure of the original arteriotomy with a patch graft decreases the risk of recurrent carotid artery stenosis.

Percutaneous transluminal angioplasty and stent placement for recurrent carotid artery stenosis

1999 ◽  
Vol 90 (4) ◽  
pp. 688-694 ◽  
Author(s):  
Giuseppe Lanzino ◽  
Robert A. Mericle ◽  
Demetrius K. Lopes ◽  
Ajay K. Wakhloo ◽  
Lee R. Guterman ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Stent Placement ◽  
Carotid Artery Stenosis ◽  
Percutaneous Transluminal Angioplasty ◽  
Transluminal Angioplasty ◽  
Artery Stenosis ◽  
Content Type ◽  
Percutaneous Transluminal ◽  
Fine Print

Object. Treatment consisting of percutaneous transluminal angioplasty (PTA) and stent placement has recently been proposed as an alternative to surgical reexploration in patients with recurrent carotid artery stenosis following endarterectomy. The authors retrospectively reviewed their experience after performing 25 procedures in 21 patients to assess the safety and efficacy of PTA with or without stent placement for carotid artery restenosis.Methods. The mean interval between endarterectomy and the endovascular procedures was 57 months (range 8–220 months). Seven arteries in five patients were treated by PTA alone (including bilateral procedures in one patient and repeated angioplasty in the same vessel in another). Early suboptimum results and recurrent stenosis in some of these initial cases prompted the authors to combine PTA with stent placement in the treatment of 18 arteries over the past 3 years. No major periprocedural deficits (neurological or cardiac complications) or death occurred. There was one periprocedural transient neurological event, and in one patient a pseudoaneurysm of the femoral artery (at the access site) required surgical repair. In the 16 patients who each underwent at least 6 months of follow-up review, no neurological events ipsilateral to the treated artery had occurred after a mean follow-up period of 27 months (range 6–57 months). Three of five patients who underwent PTA alone developed significant (> 50%) asymptomatic restenoses that required repeated angioplasty in one and PTA with stent placement in two patients. Significant restenosis (55%) was observed in only one of the vessels treated by combined angioplasty and stent placement.Conclusions. Endovascular PTA and stenting of recurrent carotid artery stenosis is both technically feasible and safe and has a satisfactory midterm patency. This procedure can be considered a viable alternative to surgical reexploration in patients with recurrent carotid artery stenosis.

Carotid artery stenosis with intraluminal thrombus discovered during carotid artery stenting

2009 ◽  
Vol 27 (9) ◽  
pp. 367-370 ◽  
Author(s):  
Katsutoshi Takayama ◽  
Toshiaki Taoka ◽  
Hiroyuki Nakagawa ◽  
Toshiteru Miyasaka ◽  
Kaoru Myouchin ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Carotid Artery Stenting ◽  
Artery Stenosis ◽  
Intraluminal Thrombus

scholarly journals Comparison of Mid-, and Late- Term Morbidity and Mortality Results of Surgical Endarterectomy Versus Endovascular Stent Implantation in Carotid Artery Stenosis

2021 ◽  
Author(s):  
İsmail Selçuk ◽  
Nehir Selçuk ◽  
Murat Fatih Can ◽  
Ahmet Turan Yılmaz
Keyword(s):  
Carotid Artery ◽  
Stent Implantation ◽  
Carotid Artery Stenosis ◽  
Laboratory Data ◽  
Neurological Complications ◽  
Artery Stenosis ◽  
Morbidity And Mortality ◽  
Endovascular Stent ◽  
Group A ◽  
Group B

Objective: Carotid artery stenosis is an important etiological cause of cerebrovascular events and stent implantation is widely used as an alternative treatment to endarterectomy. In this study, we compared the mid and late-term results of carotid artery stenosis patients who underwent endarterectomy and stent implantation. Methods: Patients who underwent endarterectomy (Group A, n: 27) and endovascular stent implantation (Group B, n: 22) due to carotid artery stenosis between 2008 and 2014 were included in the study. All examination, laboratory data and radiological images were collected from the hospital database. Morbidity and mortality developed in the mid (1-12 months) and late term (>12 months) periods were evaluated retrospectively. Results: While there were no neurological complications and restenosis in the midterm in Group A, 2 patients (9.09%) had stroke and 2 patients (9.09%) had restenosis in Group B. In the late-term, while there were no neurological complications in Group A, stroke in 3 patients (13.63%) (p=0.048) in Group B, restenosis was observed in 1 patient in Group A and 5 patients in Group B (3.7% vs 22.72%, p=0.043). Conclusion: We recommend endarterectomy as the primary approach for carotid artery revascularization and percutaneous approach especially in high-risk patients with recurrent ICA stenosis and distal carotid artery lesions.

Rerupture of coil-embolized aneurysm during long-term observation

1998 ◽  
Vol 88 (6) ◽  
pp. 1096-1098 ◽  
Author(s):  
Hiroshi Manabe ◽  
Seiichiro Fujita ◽  
Toru Hatayama ◽  
Shigeharu Suzuki ◽  
Soroku Yagihashi
Keyword(s):  
Endothelial Cells ◽  
Carotid Artery ◽  
Internal Carotid ◽  
Content Type ◽  
Long Period ◽  
Detachable Coils ◽  
Long Term Observation ◽  
Organized Thrombus ◽  
Fine Print

✓ The authors describe the histopathological findings in a case involving rerupture of a recanalized aneurysm of the internal carotid artery 8 months after partial (95%) embolization with interlocking detachable coils. The aneurysm was filled with poorly organized thrombus, and its orifice was devoid of endothelial cells. It appears likely that a long period of observation may be required to confirm the complete thrombotic organization of coil-embolized aneurysms. This indicates that caution is needed because rupture may follow recanalization of the aneurysm.

Surgical reconstruction of the proximal vertebral artery

1984 ◽  
Vol 61 (5) ◽  
pp. 874-881 ◽  
Author(s):  
Fernando G. Diaz ◽  
James I. Ausman ◽  
Raul A. de los Reyes ◽  
Jeffrey Pearce ◽  
Carl Shrontz ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Vertebral Artery ◽  
Subclavian Artery ◽  
Antiplatelet Agents ◽  
Artery Stenosis ◽  
Surgical Reconstruction ◽  
Vertebrobasilar Insufficiency ◽  
Artery Ligation ◽  
Content Type ◽  
Fine Print

✓ The authors have reviewed their experience in the management of 55 patients admitted to Henry Ford Hospital with symptoms of vertebrobasilar insufficiency and associated proximal vertebral artery stenosis or occlusion. In 48 patients, the symptoms occurred as multiple repeated events, five of which resulted in permanent deficits. The remaining seven patients had single events, four of which caused permanent deficit. These patients had been treated unsuccessfully with antiplatelet agents (37 cases) and with anticoagulant drugs (15 cases) before surgery. Most patients had multiple angiographic abnormalities, including bilateral vertebral stenosis in 19 cases, unilateral vertebral stenosis and contralateral occlusion in 18, unilateral vertebral hypoplasia and contralateral stenosis in 10, subclavian artery stenosis with steal in seven, and bilateral vertebral artery occlusion in one case. Posterior communicating arteries could not be demonstrated angiographically in 18 patients. Thirty-four patients had associated stenotic or occlusive lesions of the internal carotid artery. Forty-eight underwent a vertebral-to-carotid artery transposition. Of these, 18 had an associated carotid endarterectomy and seven had a vertebral artery endarterectomy immediately before the transposition. Two patients had saphenous vein grafts, one from the subclavian and one from the common carotid artery to the vertebral artery. Other surgical procedures included vertebral artery ligation in one case, transposition of the vertebral artery to the thyrocervical trunk in two cases and to the subclavian artery in one case, and endarterectomy of the origin of the vertebral artery in one case. All but two patients had complete resolution of their symptoms: one had persistent dizziness and the other had syncopal episodes. Complications included transient Horner's syndrome (30 cases) which became permanent in four cases, vocal cord paralysis (three cases), elevated hemidiaphragm without respiratory difficulty (two cases), and superficial wound infection (one case). There were no deaths. Although the presentation of patients with vertebrobasilar insufficiency is generally characteristic, we believe that a specific diagnosis can be established only by angiographic means. Anticoagulants have been used to alleviate symptoms in some cases but are ineffective in solving the primary hemodynamic problem. Surgical reconstruction of the affected area deserves further evaluation in the management of these patients.

Angioplasty of symptomatic high-grade internal carotid artery stenosis with intraluminal thrombus: therapeutic approach

2004 ◽  
Vol 46 (4) ◽  
pp. 313-317 ◽  
Author(s):  
F. Boza ◽  
J. Ruano ◽  
A. Gonz�lez ◽  
J. R. Gonz�lez-Marcos ◽  
A. Gil-Peralta ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Therapeutic Approach ◽  
Internal Carotid ◽  
Internal Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
High Grade ◽  
Intraluminal Thrombus

The hemodynamic effects of internal carotid artery stenosis and occlusion

1987 ◽  
Vol 66 (5) ◽  
pp. 755-763 ◽  
Author(s):  
A. David Mendelow ◽  
David I. Graham ◽  
Ursula I. Tuor ◽  
William Fitch
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Cerebral Arteries ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Internal Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
Content Type ◽  
Anterior Section ◽  
Arterial Blood

✓ The purpose of this study was to determine in subhuman primates whether hemodynamic mechanisms (as compared with embolic mechanisms) contribute to cerebral ischemia following carotid artery occlusion or stenosis. Following carotid artery occlusion there was loss of cerebral autoregulation: cerebral blood flow (CBF) measured with the xenon-133 technique became passively dependent upon the mean arterial blood pressure (MABP) over an MABP range of 30 to 110 mm Hg. By contrast, autoregulation was preserved in normal animals and in animals with a 90% carotid artery stenosis. Regional CBF was measured with carbon-14-labeled iodoantipyrine autoradiography in normotensive baboons, in hypotensive animals, and in hypotensive animals with carotid artery occlusion or stenosis. With carotid artery occlusion and hypotension, reduced levels of local CBF were seen ipsilaterally in the boundary zones between the anterior and middle cerebral arteries with 35% of the area of an anterior section through the hemisphere displaying a CBF value of less than 20 ml/100 gm/min. Comparable values with hypotension were 21% with carotid artery stenosis, 20% with no proximal vascular lesion, and 1% in normotensive animals. These areas of reduced CBF corresponded with areas of boundary-zone ischemia seen with light microscopy. The study suggests that while hemodynamic ischemia develops with carotid artery occlusion, it does not occur with even a 90% carotid artery stenosis or in normal animals.

Role of EEG monitoring and cross-clamping duration in carotid endarterectomy

1986 ◽  
Vol 65 (6) ◽  
pp. 815-819 ◽  
Author(s):  
Massimo Collice ◽  
Orazio Arena ◽  
Romero A. Fontana ◽  
Manuela Mola ◽  
Nora Galbiati
Keyword(s):  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Clinical Importance ◽  
Neurological Complications ◽  
Artery Occlusion ◽  
Consecutive Series ◽  
Eeg Monitoring ◽  
Content Type ◽  
Eeg Changes ◽  
Fine Print

✓ The usefulness of electroencephalographic (EEG) monitoring as well as the significance of the period of cross clamping in carotid endarterectomy have not been completely defined. In particular, the clinical importance of major EEG changes has not been fully investigated and some recent studies seem to indicate that the method has little value. As to the duration of cross clamping, there is strong evidence that occlusion times of about 15 minutes are tolerated under general anesthesia, but no information is available regarding longer periods of occlusion. The authors describe a consecutive series of 141 carotid endarterectomies in which the patients with EEG changes were shunted only when occlusion was anticipated to last longer than 30 minutes. Early major EEG changes (during the first 4 minutes) occurred in 14% of the cases. In the absence of EEG changes, long occlusion periods of 40 to 50 minutes were well tolerated. In contrast, the 20 patients with major persistent EEG changes did not tolerate protracted occlusion and three of them had immediate postoperative neurological complications. It seems that, in these circumstances, the incidence of neurological deficit is a function of the duration of cross clamping: these three patients had undergone occlusion for 15 to 30 minutes. Their deficits partially resolved. On the basis of these results it is concluded that: 1) EEG recording is a reliable monitoring system in carotid artery cross clamping. No major strokes due to temporary carotid artery occlusion occurred in the series. 2) The clinical significance of major persistent EEG changes is not negligible. Cross clamping for longer than 15 minutes in the presence of significant EEG alterations is potentially dangerous.

scholarly journals Methods of Surgical Treatment of Combined Stenosis of the Carotid and Coronary Arteries. Systematic Review

2021 ◽  
Vol 10 (3) ◽  
pp. 521-529
Author(s):  
A. A. Abdurakhmanov ◽  
N. M.-U. Sultanbayeva ◽  
L. F. Samarkhodzhayeva ◽  
Sh. Z. Umarova ◽  
S. Ch. Dzhalalov ◽  
...  
Keyword(s):  
Systematic Review ◽  
Surgical Treatment ◽  
Carotid Artery ◽  
Coronary Arteries ◽  
Carotid Artery Stenosis ◽  
Neurological Complications ◽  
Artery Stenosis ◽  
Cardiac Complications ◽  
Staged Operations ◽  
Complications And Mortality

Aim of study. To determine the optimal tactics of surgical treatment of patients with combined stenosis of the carotid and coronary arteries by comparing the results of the simultaneous and staged approach according to the literature.Material and methods. A systematic literature search was performed in the PubMed and MEDLINE databases to compare the results of simultaneous and staged interventions for combined stenosis of the carotid and coronary arteries. The following keywords were used as a search query: (“combined coronary and carotid artery stenosis and simultaneous”), (“combined coronary and carotid artery stenosis and staged”), (“combined coronary and carotid artery stenosis and cost”). We compared the results of simultaneous (interventions on the vessels of both systems are performed simultaneously) and staged operations (interventions are performed alternately, with a time interval from 2 to 160 days). References from included studies were also manually reviewed. The search was conducted by two independent experts (S.L., S.N.), and any disagreement was resolved by the clinical expert (A.A.).Results. A literature search identified 198 potentially relevant studies. A total of 13 studies met the inclusion criteria, of which 5 included two interventions. This systematic analysis includes the results of treatment of 43,758 patients with combined stenosis of the carotid and coronary arteries, who underwent staged or simultaneous revascularization of the vessels of the carotid and coronary flow. Perioperative neurological complications in the group of staged operations were observed somewhat more often than in the group of simultaneous interventions (3.2% versus 4.22%; p=0.8), myocardial infarction was observed with a frequency of 1.5% in the group of simultaneous interventions, and 2.5% (p=0.5) in the group of staged interventions. The mortality rate after simultaneous and staged interventions was 3.9% and 3.6%, respectively, with a fairly high spread in the study groups (p=0.5). Data analysis showed that simultaneous interventions did not affect the incidence of neurological, cardiac complications, and deaths (OR (odds ratio) 1.02; 95% CI (confidence interval) — 0.98–1.14, p = 0, 69; OR — 1.26; 95% CI — 0.66-2.41; p=0.48; and OR — 0.97; 95% CI — 0.67-1.38; p=0.85 — respectively).Conclusion. 1. The cumulative incidence of neurological and cardiac complications and mortality in staged tactics, according to observational studies included in this systematic review, is 4.2%; 2.6% and 3.6%, respectively (p>0.05). 2. The cumulative incidence of neurological and cardiac complications and mortality with simultaneous tactics according to observational studies included in this systematic review is 3.3%; 1.5% and 3.9%, respectively (p>0.05). 3. Given the relatively low risk of developing myocardial infarction (OR — 1.26; 95% CI — 0.66–2.41; I2 — 94%), the low risk of developing neurological complications (OR 1.02; 95% CI — 0,98–1.14; I2=75%), and deaths (OR — 0.97; 95% CI — 0.67–1.38; I2 — 76%) — (p>0.05), with simultaneous interventions, it can be concluded that simultaneous interventions may be the method of choice for surgical treatment for combined stenosis of the carotid and coronary arteries.

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