Revisiting carotid endarterectomy: Neobulb technique using external carotid artery as a patch

Objectives This study describes an alternative carotid bifurcation endarterectomy technique in which the external carotid artery is used as a suture patch. Methods Charts of ten patients with atherosclerotic carotid stenosis that were treated using the neobulb technique between 2002 and 2019 were reviewed. Results No major surgical adverse event was observed in the postoperative assessments. No postoperative common or internal carotid stenosis was observed in the mid- or long-term follow-up. Conclusions The neobulb technique allows carotid endarterectomy closure without a synthetic or venous patch, using the external carotid artery as an autologous patch, while preserving distal flow into the external carotid artery branches.

Topographic and anatomical features of muscular and vascular structures in lateral cervical region during prenatal period of human ontogenesis

Background. One of topical areas of morphological research is features of topographic a relationships of the vascular, nervous, muscular, fascial and cartilaginous structures of the neck in prenatal period of human ontogenesis, as data on their formation at different stages of development will improve diagnostic methods of visualization and surgical correction of congenital and acquired pathologies of head and neck. Objective. To find out the peculiarities of synthopia of vascular and muscular structures of the lateral cervical region in human prefetuses. Methods. 9 human prenatal specimens aged 9-12 weeks of prenatal development have been studied by using a set of morphological methods, according to existing bioethical norms. Results. During 9th week of development, bony and musclar boundaries of the lateral triangle of the neck, the carotid vagina, and the components of the vascular-nervous bundle of the neck have been determined. Within the carotid triangle, the external carotid artery is located superficially; it is crossed frontally by the cervical branch of facial nerve and the sublingual nerve. The superior thyroid artery departs from the external carotid artery at the level of the cartilaginous model of the large horns of hyoid bone and passes to the rudiment of thyroid gland. Retropharyngeal space is found at 9th week of development, moderately filled with adipose tissue. The anterior vertebral plate of the cervical fascia forms the bottom for posterior triangle of neck. Conclusion. The lateral cervical region in human prefetuses is represented by a multilayered topographic zone with formed boundaries and contents. Cervical fascia forms carotid vagina within the carotid triangle, and pharyngeal space. The course of blood vessels and nerves within the lateral cervical region is variable. Three-dimensional reconstructions of prefetuses serve as evidence of the early formation of definitive topographic connections within early bony and cartilaginous models in relation to the muscles of the anterior and lateral cervical regions.

Dural arteriovenous fistula presenting as reversible dementia

DAVF is an abnormal connection between arteries and veins, where supply is mainly through branches arising from the external carotid artery. A 30 years old male had multiple episodes of seizures and progressive behavioral and cognitive decline, inattention and disorientation to time, place and person, along with ptosis and ophthalmoplegia in the right eye. DSA provided a definitive diagnosis of hypervascular Dural AV fistula at the right transverse sigmoid junction with significant cortical venous hypertension. Through femoral access, both underwent transarterial embolization through the Middle Meningeal branch of the right external carotid artery using onyx, resulting in complete occlusion of fistula and resolution of venous hypertension. Post embolisation, cognitive function assessment revealed increased attention span and improved orientation with time, place and person. Thus, DAVF can be one of the rare but reversible causes of dementia. Early diagnosis and treatment may help to dramatically improve patients’ clinical condition and minimize long-term disability.

A cadaveric study of relationship of external carotid artery with reference to adjacent anatomical landmarks

Evaluation of carotid bifurcation level and relationship of External Carotid Artery (ECA) with reference to adjacent anatomical landmarks is important in planning various surgical and radiological procedures related to the carotid arteries. The aim was to study the relationship of External Carotid Artery with reference to Adjacent Anatomical landmarks in cadavers. 60 cadavers - 52 male and 8 female embalmed with 10% formalin were dissected over the period of two years for this study. The distance between the origin and the termination of ECA was found to be in the range of 25–70 mm on the right side and in the range of 25–68 mm on the left side. The distance between the origin of ECA and the carotid tubercle was found to be in the range of 23–50 mm on the right side and in the range of 22–48 mm on the left side. The distance between the origin of ECA and the angle of the mandible was found to be in the range of 18–30 mm on the right side and in the range of 20–32 mm on the left side. The anatomical knowledge of relationship of External Carotid Artery with reference to adjacent anatomical landmarks is helpful for vascular surgeons to plan surgeries and prevent complications during various diagnostic and therapeutic procedures.

Case Report and Literature Review: Catastrophic Embolism Following Cosmetic Injection of Autologous Fat in the Face

Injection of autologous fat on the face is a commonly performed procedure in plastic surgery. However, it can lead to rare but devastating complications due to fat embolism. In this study, we presented two cases of cerebral infarction and/or sudden vision loss after cosmetic injections of autologous fat on the face. Two women underwent injections into the temporal and frontal areas, respectively. In case 1, the patient underwent decompressive craniectomy as her condition deteriorated continuously and died. In case 2, the patient's vision had not improved at the 3-month follow-up visit. Imaging examinations showed occlusion of the right external carotid artery in case 1, and multiple retinal arterioles were segmentally occluded in case 2. We also screened relevant studies via a systematic search of PubMed (last updated on May 9, 2020) and performed a narrative review due to the significant heterogeneity between the studies. To prevent this catastrophic event, the autologous fat injection should be performed carefully. If embolization does occur, early diagnosis and timely treatment may help improve functional outcomes.

Hemodynamic Impact of Stenting on Carotid Bifurcation: A Potential Role of the Stented Segment and External Carotid Artery

Carotid stenting near the bifurcation carina is associated with adverse events, especially in-stent restenosis, thrombosis, and side branch occlusion in clinical data. This study is aimed at determining the potential biomechanical mechanisms for these adverse events after carotid stenting. The patient-specific carotid models were constructed with different stenting scenarios to study the flow distribution and hemodynamic parameters, such as wall shear stress (WSS), flow velocity, relative residence time (RRT), and oscillating shear index (OSI) in the carotid bifurcation. The results suggested that the existing stents surely reduced blood flow to the external carotid artery (ECA) but enhanced local flow disturbance both in ECA and stented internal carotid artery (ICA), and the inner posterior wall of the stented ICA and the outer posterior wall of ECA might endure a relatively low level of WSS and remarkably elevated OSI and RRT. In addition, the implanted stent leads to more ECA adverse flow than ICA after stenting. While disturbed flow near the strut increased as stent length increased, blood flow and areas of local flow disturbance in ECA slightly decreased as stent length increased. In conclusion, the results revealed that ECA might be in relatively high levels of abnormal local hemodynamics after stenting, followed by stented ICA, leading to potential adverse events after intervention.

Bilateral typeIIpersistent proatlantal intersegmental artery: a rare variant of persistent carotid-vertebrobasilar anastomoses

The persistent proatlantal intersegmental artery is a rare variant of persistent carotid-vertebrobasilar anastomoses, especially their bilateral presence is rarer. We report a case of bilateral typeII persistent proatlantal intersegmental artery. The absence of bilateral vertebral arteries was incidentally noted on neck ultrasound examination. Subsequent time-of-flight MR angiography confirmed this. The bilateral typeIIpersistent proatlantal intersegmental artery arose from the cervical external carotid artery, penetrated the C1 transverse foramen, entered the skull via the foramen magnum, and joined the lower portion of the basilar artery.