Endovascular Treatment for Pseudo-occlusion of the Internal Carotid Artery

Neurosurgery ◽  
2006 ◽  
Vol 59 (2) ◽  
pp. 301-309 ◽  
Author(s):  
Tomoaki Terada ◽  
Mitsuharu Tsuura ◽  
Hiroyuki Matsumoto ◽  
Osamu Masuo ◽  
Tomoyuki Tsumoto ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Internal Carotid ◽  
Perioperative Complications ◽  
Carotid Stenting ◽  
Clinical Results ◽  
Transluminal Angioplasty ◽  
Embolic Protection

Abstract OBJECTIVE: The surgical benefit to pseudo-occlusion of the internal carotid artery (ICA) is controversial. Because the benefit of carotid endarterectomy for pseudo-occlusion of the ICA remains uncertain, we examined the use of carotid stenting as a possible alternative treatment for this condition. METHODS: Twenty cases of carotid pseudo-occlusion (17 symptomatic, three asymptomatic) were treated with carotid artery stenting. Nineteen patients were treated with various embolic protection techniques. Our clinical results, including angiographic follow-up data, perioperative complications, and data on the effectiveness of the embolic protection methods were studied for ICA pseudo-occlusion. RESULTS: All pseudo-occlusions were successfully dilated, and the stenotic ratio was reduced from 95 to 6.7% on average. No neurological deterioration was encountered in any of the cases, although one patient died of cardiac event 1 day after treatment. None of the patients experienced stroke during the mean 24.8 month follow-up period, although one patient died from myocardial infarction. Among the 17 cases in which follow-up angiography was performed at 6 months after stenting, only one patient demonstrated restenosis. This patient was successfully treated with repeated percutaneous transluminal angioplasty. The rate of restenosis in our series was 5.9%, and the morbidity/mortality rate within 30 days was 5%. CONCLUSION: The clinical results of carotid stenting for ICA pseudo-occlusion under embolic protection were fairly good from the viewpoints of periprocedural neurological morbidity, angiographic follow-up results, and stroke prevention. Carotid stenting can be considered an alternative to carotid endarterectomy in patients with ICA pseudo-occlusion.

Management of postoperative internal carotid artery intimal flap after carotid endarterectomy: a cohort study and systematic review

2021 ◽  
pp. 1-8
Author(s):  
Jonathan Rychen ◽  
Adrian Madarasz ◽  
Michael Murek ◽  
Philippe Schucht ◽  
Mirjam R. Heldner ◽  
...  
Keyword(s):  
Systematic Review ◽  
Carotid Artery ◽  
Literature Review ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Systematic Literature Review ◽  
Internal Carotid ◽  
Management Strategies ◽  
Intimal Flap

OBJECTIVE Postoperative internal carotid artery (ICA) intimal flap (IF) is a potential complication after carotid endarterectomy (CEA) for carotid artery stenosis. There are no clear recommendations in the current literature on the management of this condition due to sparse evidence. Some authors advocate carotid stent placement or reoperation, while others suggest watchful waiting. The aim of this study was to analyze incidence and management strategies of postoperative ICA-IF, and moreover, to put these findings into context with a systematic literature review. METHODS The authors retrospectively reviewed all consecutive CEA cases performed at the University Hospital of Bern over a decade (January 2008 to December 2018). The incidence of postoperative ICA-IF, risk factors, management strategies, and outcomes were analyzed. These results were put into context with a systematic review following the PRISMA guidelines. RESULTS A total of 725 CEAs were performed between January 2008 and December 2018. Postoperative ICA-IF was detected by routine duplex neurovascular ultrasound (NVUS) in 13 patients, corresponding to an incidence rate of 1.8% (95% CI 1.0%–3.1%). There were no associated intraluminal thrombi on the detected IF. Intraoperative shunt placement was used in 5.6% and one or more intima tack sutures were performed in 42.5% of the 725 cases. There was no significant association between intraoperative shunt placement and the occurrence of an IF (p > 0.99). Two patients (15.4%) with IF experienced a transient postoperative neurological deficit (transient ischemic attack). In these cases, the symptoms resolved spontaneously without any interventions or change in the antiplatelet regimen. All other cases (84.6%) with IF were asymptomatic. In 1 patient (7.7%) with IF, the antiplatelet treatment was switched from a mono- to a dual-antiaggregating regimen because the IF led to a stenosis > 70%; this patient remained asymptomatic. All cases of IFs were managed conservatively with close radiological follow-up evaluations, without reoperation or stenting of the ICA. All 13 IFs vanished spontaneously after a mean duration of 6.9 months (median 1.5 months, range 0.5–48 months). A systematic literature review revealed a postoperative ICA-IF incidence of 3.0% (95% CI 2.1%–4.1%) with relatively heterogenous management strategies. CONCLUSIONS Postoperative ICA-IF is a rare finding after CEA. Conservative therapy with close NVUS follow-up evaluations appears to be an acceptable and safe management strategy for asymptomatic IFs without associated intraluminal thrombi.

scholarly journals Surgical Treatment of Proximal Segmental Occlusion of the Internal Carotid Artery

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Srdjan Babić ◽  
Slobodan Tanasković ◽  
Mihailo Nešković ◽  
Predrag Gajin ◽  
Dragoslav Nenezić ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Intracerebral Hemorrhage ◽  
Carotid Endarterectomy ◽  
Internal Carotid ◽  
Long Term Results ◽  
Common Symptom ◽  
Coronary Syndrome

Purpose. To present the feasibility, safety, and efficacy of carotid endarterectomy in patients with type II internal carotid artery occlusions, including the long-term outcomes. Methods. From March 2008 to August 2015, 74 consecutive patients (48 men with a mean age of 65.1 ± 8.06 years) underwent carotid endarterectomy because of internal carotid artery (ICA) segmental occlusions. These were verified with preoperative carotid duplex scans (CDS) and CT angiography (CTA). Also, brain CT scanning was performed in all these patients. The indication for treatment was made jointly by a vascular surgeon, neurologist, and an interventional radiologist in a multidisciplinary team (MDT) context. After successful treatment, all the patients were followed-up at 1, 3, 6, and 12 months, then every 6 months thereafter. Results. The most common symptom at presentation was transient ischaemic attack (TIA) in 49 patients (66.2%), followed by stroke in the past six months in the 17 remaining patients (23%). Revascularisation of the ICA with endarterectomy techniques was performed successfully in all the patients with an average clamp time of 11.9 min. All the procedures were performed under general anaesthesia in combination with a superficial cervical block. The early complication rate was 8.1% and included two cardiac events (2.7%) (one rhythm disorder and one acute coronary syndrome), three TIAs (4.1%), and one intracerebral hemorrhage (1.3%). Only one patient with the intracerebral hemorrhage died 5 days after surgery giving a postoperative mortality of 1.3% for this series. During the follow-up period (mean 50.4 ± 31.3 months), the primary patency rates at 1, 3, 5, and 7 years were 98.4%, 94.9%, 92.9%, and 82.9%, respectively. Likewise, the survival rates were 98.7%, 96.8%, 89%, and 77.6%, respectively. Ultrasound Doppler controls during follow-up detected 8 ICA restenoses; however, only 3 of these patients required further endovascular treatment. Conclusions. Carotid endarterectomy of internal carotid artery (ICA) segmental occlusion is a safe and effective procedure associated with acceptable risk and good long-term results. Therefore, the current guidelines which do not recommend carotid endarterectomy in this patient group should be reassessed, with the requirement for ongoing large-scale randomized controlled trials to compare CEA with best medical therapy in this patient cohort.

scholarly journals Staged Carotid Stenting and Carotid Endarterectomy for Bilateral Internal Carotid Artery Stenosis

2003 ◽  
Vol 9 (1_suppl) ◽  
pp. 143-148 ◽  
Author(s):  
H. Fukuda ◽  
K. Iihara ◽  
N. Sakai ◽  
K. Murao ◽  
H. Sakai ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Complication Rate ◽  
Carotid Artery Stenosis ◽  
Internal Carotid ◽  
Carotid Stenting ◽  
Internal Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
Minor Stroke

The purpose of this study was to evaluate the efficacy and safety of staged carotid stenting (CS) and carotid endarterectomy (CEA) for bilateral internal carotid artery stenosis. With this strategy, initial carotid stenting was performed for the high grade carotid stenosis to reduce the risk of subsequent CEA. Eight patients were treated with staged CS and CEA; CS for asymptomatic side followed by CEA for symptomatic side. Sufficient revascularization was obtained in all procedures but one CS procedure. Two minor stroke caused by distal embolism occurred during the perioperative period of CS. Postprocedural persistent hypotension was observed in one CS procedure. The mean interval between CS and CEA was 19.8 days. In conclusion, although our strategy has some advantages such as avoidance of bilateral cranial nerve palsy and shorter admission period over staged CEA, relatively high complication rate was noted at the first CS without any stroke morbidity post CEA. Our preliminary result showed that further reduction of periprocedural complication rate at the initial stenting is mandatory for this approach justified.

Intracranial dissection during carotid endarterectomy treated by carotid stenting

VASA ◽  
2009 ◽  
Vol 38 (1) ◽  
pp. 81-84 ◽  
Author(s):  
Attigah ◽  
Ganten ◽  
Hyhlik-Dürr ◽  
Kotelis ◽  
Geisbüsch ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Cerebral Perfusion ◽  
Internal Carotid ◽  
Fatal Outcome ◽  
Carotid Stenting ◽  
Thrombotic Occlusion ◽  
Completion Angiography ◽  
Intracranial Dissection

Intracranial dissection of the internal carotid artery after carotid endarterectomy (CEA) is a serious complication with a potentially fatal outcome. We report on a 67 male with a symptomatic high grad stenosis of the internal carotid artery. Intraoperative completion angiography showed a thrombotic occlusion and the internal carotid artery (ICA) was resected with interposition of a Dacron graft. Completion angiography then revealed a dissection of the petreous ICA, which was corrected by insertion of a coronary artery stent.Stenting of the ICA is a useful tool to restore cerebral perfusion without time delay and completion imaging is extremely helpful for early detection of dissection during CEA.

“Internal cross-clamping” for symptomatic internal carotid artery thrombus

2007 ◽  
Vol 107 (6) ◽  
pp. 1223-1227 ◽  
Author(s):  
Robert D. Ecker ◽  
Ramachandra P. Tummala ◽  
Elad I. Levy ◽  
L. Nelson Hopkins
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Stent Placement ◽  
Internal Carotid ◽  
Intraluminal Thrombus ◽  
Symptomatic Carotid ◽  
Embolic Protection ◽  
Symptomatic Carotid Stenosis ◽  
The Right

✓Both carotid endarterectomy and carotid artery stent placement with filter embolic protection present a higher risk for patients with internal carotid artery (ICA) lesions containing intraluminal thrombus. Despite the risk associated with intervention, patients with symptomatic intraluminal thrombus who were enrolled in the North American Symptomatic Endarterectomy Trial did better with surgical than medical treatment. We describe the novel use of an endovascular “internal cross-clamping” technique in two patients with symptomatic intraluminal thrombus in the ICA. A 57-year-old woman presented with a history of multiple episodes of left upper-extremity numbness, mild dysarthria, and agraphia occurring over the previous 24 hours. Cranial magnetic resonance imaging revealed a scattered watershed infarction of the right hemisphere and a critical stenosis of the right ICA. An 81-year-old man awoke with hemiplegia and inability to follow commands after undergoing a complicated carotid endarterectomy. Computed tomographic perfusion imaging demonstrated an increased time to peak in the left middle cerebral territory, and emergent angiography demonstrated both intimal flaps and thrombus in the endarterectomy bed. The lesions in both patients were treated with endovascular stent placement using both proximal and distal flow occlusion—a functional “internal cross-clamping”—for embolic protection. To our knowledge, this is the first report of internal trapping and stent placement for symptomatic carotid stenosis containing intraluminal thrombus. This treatment strategy should be added to the armamentarium of endovascular surgeons in selected patients with symptomatic carotid intraluminal thrombus.

Failure of Transluminal Angioplasty in the Treatment of Myointimal Hyperplasia of the Internal Carotid Artery: Case Report

Neurosurgery ◽  
1991 ◽  
Vol 28 (1) ◽  
pp. 148-151 ◽  
Author(s):  
Frank Culicchia ◽  
Robert F. Spetzler ◽  
Richard A. Flom
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Percutaneous Transluminal Angioplasty ◽  
Carotid Arteries ◽  
Internal Carotid ◽  
Transluminal Angioplasty ◽  
Angiographic Study ◽  
Vessel Lumen ◽  
Percutaneous Transluminal

Abstract Recurrent stenosis of the carotid arteries after a carotid endarterectomy for atherosclerosis can occur as a result of myointimal hyperplasia. This condition was treated by percutaneous transluminal angioplasty. Excellent dilatation of the vessel lumen was documented after balloon dilatation. A 6-month follow-up angiographic study, however, demonstrated recurrent high-grade stenosis at the same level in both carotid arteries. Presumably, the failure of percutaneous transluminal angioplasty and the treatment of myointimal hyperplasia of the internal carotid artery results in the same condition after the original endarterectomy, that is, additional myointimal hyperplasia.

2D-TOF MRA Follow-up Study of Percutaneous Transluminal Angioplasty for Severely Stenotic Cervical Internal Carotid Artery

1997 ◽  
Vol 3 (2_suppl) ◽  
pp. 187-189
Author(s):  
T. Ueda ◽  
S. Yoshimura ◽  
Y. Kaku ◽  
S. Shirakami ◽  
T. Andoh ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Percutaneous Transluminal Angioplasty ◽  
Internal Carotid ◽  
Transluminal Angioplasty ◽  
Intimal Flap ◽  
Follow Up Study ◽  
Percutaneous Transluminal ◽  
Cervical Internal Carotid Artery

Percutaneous transluminal angioplasty (PTA) for severe arteriosclerotic stenosis in the cervical internal carotid artery (ICA) was successfully carried out in 23 cases between December 1994 and August 1996. In order to analyze the condition of the cervical ICA in the early stage after PTA, 12 stenotic lesions of 11 cases were exposed to follow-up study of stenotic cervical ICA after PTA with magnetic resonance angiography (MRA) 1 to 150 days postoperatively. In six lesions, the diameter of the cervical ICA was dilated sequentially. In another four lesions, the diameter of the cervical ICA was decreased in the first three weeks and dilated over the next three weeks. Angiographically, these lesions had a small intimal flap at the balloon dilated portion, which was speculated to cause the turbulent flow in the first stage. In the remaining 2 lesions, restenotic changes in cervical ICAs were observed within three weeks after PTA. Follow-up angiography was performed over three months after PTA in five cases of this series and compared with MRA. Consequently, the diameters of the cervical ICA between angiography and MRA were closely correlated. The evaluation of the lesion after PTA of the cervical ICA demonstrated that MRA is beneficial, but within three weeks after PTA, caution should be paid for underestimation of the small intimal flap on MRA.

Influence of surgical reconstruction of the internal carotid artery on the hemodynamics of the eye in patients with chronic ischemic neuropathy

2021 ◽  
pp. 121-125
Author(s):  
V.V. Tuzlaev ◽  
◽  
O.V. Kolenko ◽  
V.V. Egorov ◽  
I.Z. Kravchenko ◽  
...  
Keyword(s):  
Blood Flow ◽  
Optic Nerve ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Internal Carotid ◽  
Surgical Reconstruction ◽  
Atherosclerotic Stenosis ◽  
Ica Stenosis

Purpose. To assess the effect of carotid endarterectomy (CE) on the hemodynamics of the eye, the neuroreceptor apparatus in patients with chronic ischemic neuroopticopathy (CIN) associated with hemodynamically significant atherosclerotic stenosis of the internal carotid artery (ICA). Material and methods. The study included 20 patients (20 eyes) with unilateral CIN. In all cases, Doppler ultrasound was used to assess the parameters of the linear blood flow velocity in patients after CE. Results. Surgical reconstruction of the ICA in all patients led to an improvement in blood flow in the vessels of the eye, in ⅔ of cases it stopped the process of neurodegeneration in the optic nerve (optic nerve) and contributed to an increase in the maximum corrected visual acuity at a follow-up of 1 year. Conclusion. Our studies indicate the advisability of performing ICA CE in patients with CIN associated with hemodynamically significant atherosclerotic ICA stenosis. The question of the use of pharmacological neuroprotection of the optic nerve in the postoperative period of CE remains relevant. Key words: chronic ischemic neuroopticopathy, ocular ischemic syndrome, internal carotid artery, carotid endarterectomy.

Common Carotid Artery Imbrication as an Adjunct to Carotid Endarterectomy to Prevent Postoperative Carotid Kinking

2007 ◽  
Vol 73 (3) ◽  
pp. 276-278
Author(s):  
Juergen Falkensammer ◽  
Albert G. Hakaim ◽  
W. Andrew Oldenburg ◽  
Todd B. Berland
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Common Carotid Artery ◽  
Internal Carotid ◽  
Duplex Ultrasound ◽  
Retrospective Chart Review ◽  
Patch Angioplasty ◽  
The Common

Mobilization of a tortuous carotid artery during endarterectomy may produce redundancy of the carotid artery, and kinking. We reviewed our experience with common carotid artery (CCA) imbrication as a technique to shorten the common and internal carotid artery postendarterectomy and to avoid carotid kinking. A retrospective chart review of 163 patients who underwent carotid endarterectomy by the same surgeon between August 1998 and February 2006 was performed. All patients underwent conventional endarterectomy via a longitudinal arteriotomy with an indwelling shunt and patch angioplasty. Patients undergoing concomitant carotid artery imbrication were identified. Twelve patients who underwent carotid imbrication were identified. The mean age was 74.9 ± 8.8 years. Nine patients underwent imbrication of the CCA, and in three cases, the internal carotid artery was plicated. Follow-up duplex ultrasound examinations were available for 10 individuals and mean follow-up time was 10.7 months (range, 1–58 months). There were no cases of peri- or postoperative cerebral accidents and there was no case of restenosis. CCA imbrication as an adjunct to carotid endarterectomy is a feasible technique in preventing postoperative carotid kinking.

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