scholarly journals Superficial Temporal Artery-Middle Cerebral Artery Anastomosis for Internal Carotid Artery Occlusion by Subacute In-Stent Thrombosis after Carotid Artery Stenting

2012 ◽  
Vol 52 (6) ◽  
pp. 551 ◽  
Author(s):  
Hoi Jung Choi ◽  
Sung Tae Kim ◽  
Yeong Gyun Jeong ◽  
Hae Woong Jeong
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Stent Thrombosis ◽  
Carotid Artery Stenting ◽  
Internal Carotid ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion

External Carotid Endarterectomy Followed by Superficial Temporal Artery to Middle Cerebral Artery Anastomosis for Internal Carotid Artery Occlusion with Advanced Ipsilateral External Carotid Stenosis

2008 ◽  
Vol 62 (suppl_5) ◽  
pp. ONS395-ONS399 ◽  
Author(s):  
Takakazu Kawamata ◽  
Yoshikazu Okada ◽  
Akitsugu Kawashima ◽  
Kohji Yamaguchi ◽  
Tomokatsu Hori
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Internal Carotid Artery Occlusion ◽  
External Carotid ◽  
Cerebrovascular Complications

Abstract Objective: For patients with internal carotid artery occlusion with advanced narrowing of the ipsilateral external carotid artery (ECA), we performed preventive carotid endarterectomy (CEA) for the ECA stenosis before superficial temporal artery (STA) to middle cerebral artery (MCA) anastomosis for internal carotid artery occlusion. Methods: Between August 2002 and July 2005, we treated seven patients with such lesions, six men and one woman, ranging in age from 52 to 66 years (median, 60 yr). Before STA-MCA anastomosis, we performed preventive CEA for advanced ECA stenosis (>70%) to ensure sufficient blood flow to the STA. STA-MCA double anastomoses were performed more than 1 month after the CEA. Postoperative cerebrovascular complications and carotid restenosis were investigated. Results: All patients in the present series had an excellent postoperative course without cerebrovascular complications during either the CEA or STA-MCA anastomosis phase. Furthermore, no postoperative carotid restenosis occurred, and all STA-MCA anastomoses were patent during a mean follow-up period of 35.6 months. Conclusion: The present study suggests that surgical management by external CEA followed by STA-MCA anastomosis is safe and effective for patients with internal carotid artery occlusion and advanced stenosis of the ipsilateral ECA.

scholarly journals Ekstrakranijinės-intrakranijinės jungties operacijos galimybės ir dažnis ištikus išeminiam insultui miego arterijos baseine

2003 ◽  
Vol 1 (2) ◽  
pp. 0-0
Author(s):  
Kęstutis Laurikėnas
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Stroke Patients ◽  
Hemispheric Stroke ◽  
Preoperative Selection

Kęstutis LaurikėnasVilniaus universiteto Neuroangiochirurgijos centras,Vilniaus greitosios pagalbos universitetinės ligoninėsKraujagyslių chirurgijos skyrius,Šiltnamių g. 29, LT-2043 VilniusEl paštas: [email protected] Įvadas / tikslas Šiuo metu pasaulinėje medicinos literatūroje raginama atlikti naujus ekstrakranijinės-intrakranijinės jungties operacijų veiksmingumo tyrimus, siekiant nurodyti aiškesnes šių operacijų indikacijas. Darbo tikslas buvo išsiaiškinti, kokiai daliai ligonių, sergančių išeminiais galvos smegenų sutrikimais, instrumentinių tyrimų būdu randama užakusi vidinė miego arterija arba susiaurėjusi a. cerebri media, ir kokiam šių ligonių skaičiui įmanoma atlikti ekstrakranijinės-intrakranijinės jungties operaciją. Ligoniai ir metodai 2000 metais VGPUL gydyta 418 ligonių, kuriems buvo išeminis kraujotakos sutrikimas miego arterijos baseine. Po detalaus klinikinio ir instrumentinio ištyrimo operuoti 95 ligoniai (23 % visų neembolinio tipo išeminių kraujotakos sutrikimų miego arterijos baseine). Rezultatai Hipoperfuzinio tipo išeminis insultas miego arterijos baseine ištiko 25 % ligonių iš visų 1677 smegenų kraujotakos nepakankamumu sergančių ligonių, gydytų stacionare. Iš 418 ligonių 385 (92 %) diagnozuotas išeminis insultas ir tik 33 ligoniams (8 %) – praeinantys kraujotakos sutrikimai miego arterijos baseine. Iš 418 ligonių chirurginis gydymas taikytas 95 (23 %) ligoniams. Tačiau patomorfologiniai miego arterijos ir jos šakų pokyčiai rasti net 183 (44 %) ligoniams iš 418, sergančių kraujotakos sutrikimais miego arterijos baseine. Ekstrakranijinės-intrakranijinės jungties operacija atlikta 12 ligonių (12,6 % visų miego arterijos rekonstrukcinių operacijų), iš jų 7 ligoniams miego arterija buvo užakusi kakle, 5 ligoniams diagnozuotas a. cerebri media užakimas arba kritinė stenozė, be to, 9 ligoniai sirgo išeminiu insultu ir 3 ligoniams buvo praeinantys kraujotakos sutrikimai (TIA). Išvados Dauguma ligonių, kuriems yra praeinantys išeminiai kraujotakos sutrikimai miego arterijos baseine, yra gydomi ambulatoriškai, reikiamai neištiriami arba iš viso liga nediagnozuojama. Todėl galima teigti, jog Lietuvoje miego arterijos patologija yra užleista. Prasminiai žodžiai: ekstrakranijinė-intrakranijinė jungtis, išeminis insultas, miego arterijos užakimas, chirurginis gydymas. Extracranial-intracranial bypass operations in cases of ishemic events of the brain Kęstutis Laurikėnas Background Surgical correction of insuffitient collateral circulation in cases of internal carotid artery occlusion first was postulated in 1951 by C. M. Fisher. The operative technique of M. G. Yasargil, using the superficial temporal artery as a bypass, is now the most successful surgical operation for cerebral revascularisation. The establishment of extra-intracranial arterial bypass surgery is based on the fact that nature itself in cases of stenosis or occlusion of internal carotid artery creates such a bypass, usually using the ophthalmic artery. But sometimes the patients could benefit from extra-intracranial bypass operation. Our retrospective study discovered a good number of neurologically successful extra-intracranial operations which have been performed in a large number of stroke patients. Results In the Vilnius Emergency Hospital we treated 418 patients with hemispheric stroke (with carotid or middle cerebral artery stenosis or occlusions). Neurologically deteriorated patients with large ischemic changes on CT were treated conservatively. After CT, TCD, Duplex and angiographic investigations we performed 83 carotid endarterectomies (20% of all patients) and only 12 extracranial-intracranial bypasses (3% of all patients) with good postoperative outcomes. Conclusions Good postoperative results were obtained only after a meticulous clinical preoperative selection of stroke patients. Extra-intracranial bypass was suitable in only about 3 per cent of nonembolic hemispheric stroke patients. Keywords: extracranial-intracranial bypass, carotid artery occlusion, stroke, surgical treatment

scholarly journals Trapping, dome puncture, and direct suction decompression in conjunction with assistant superficial temporal artery- middle cerebral artery bypass to clip giant internal carotid artery bifurcation aneurysm

2019 ◽  
Vol 10 ◽  
pp. 205
Author(s):  
Seiei Torazawa ◽  
Hideaki Ono ◽  
Tomohiro Inoue ◽  
Takeo Tanishima ◽  
Akira Tamura ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Optimal Treatment ◽  
Aneurysm Neck ◽  
Bifurcation Aneurysm

Background: Very large and giant aneurysms (≥20 mm) of the internal carotid artery (ICA) bifurcation (ICAbif) are definitely rare, and optimal treatment is not established. Endovascular treatments are reported as suboptimal due to difficulties of complete occlusion and tendencies to recanalization. Therefore, direct surgery remains an effective strategy if the clipping can be performed safely and reliably, although very difficult. Case Description: Two cases of ICAbif aneurysms (>20 mm) were treated. Prior assistant superficial temporal artery (STA)-middle cerebral artery (MCA) bypass was performed to avoid ischemic complications during prolonged temporary occlusion of the arteries in both cases. In Case 1 (22-mm aneurysm), the dome was inadvertently torn in applying the clip because trapping had resulted in insufficient decompression. Therefore, in Case 2 (28-mm aneurysm), almost complete trapping of the aneurysm and subsequent dome puncture was performed, and the aneurysm was totally deflated by suction from the incision. This complete aneurysm decompression allowed safe dissection and successful clipping. Conclusion: Trapping, deliberate aneurysm dome puncture, and suction decompression from the incision in conjunction with assistant STA-MCA bypass can achieve complete aneurysm deflation, and these techniques enable safe dissection of the aneurysm and direct clipping of the aneurysm neck. Direct clipping with this technique for very large and giant ICAbif aneurysms may be the optimal treatment choice with the acceptable outcome if endovascular treatment remains suboptimal.

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