Surgical Advances for Extracranial Carotid Stenosis

Neurosurgery ◽  
2014 ◽  
Vol 74 (suppl_1) ◽  
pp. S83-S91 ◽  
Author(s):  
Robert E. Harbaugh ◽  
Akshal Patel
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Internal Carotid ◽  
Carotid Artery Disease ◽  
Carotid Angioplasty ◽  
Artery Disease ◽  
Angioplasty And Stenting ◽  
Carotid Angioplasty And Stenting

Abstract Carotid endarterectomy is a commonly performed operation to prevent stroke in patients who have asymptomatic or symptomatic internal carotid artery atherosclerotic stenosis. Carotid angioplasty and stenting has also been advocated for treatment of these patients. In this article, we address a number of questions for which a review of available data will advance our understanding of the role of carotid endarterectomy in stroke prevention. These include the following: Are carotid endarterectomy and carotid angioplasty and stenting equivalent procedures for the treatment of carotid artery disease? Which patients should be deemed at high risk for carotid endarterectomy? Should carotid endarterectomy be an urgent procedure in symptomatic patients with severe internal carotid artery stenosis? Finally, what is the role of carotid endarterectomy in asymptomatic patients? We also review the senior author's personal experience with >2000 consecutive carotid endarterectomies, with special attention to his present approach to this operation. We believe that carotid endarterectomy, in experienced hands, is a minimally invasive operation that remains the procedure of choice for most patients with carotid artery disease who will benefit from invasive treatment.

Hemodynamic Compromise During Carotid Angioplasty and Stenting

2011 ◽  
Author(s):  
A. G. Lynch ◽  
M. T. Walsh
Keyword(s):  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Artery Disease ◽  
Arterial Disease ◽  
Neurological Deficits ◽  
Carotid Angioplasty ◽  
Hemodynamic Compromise ◽  
Artery Disease ◽  
Angioplasty And Stenting ◽  
Carotid Angioplasty And Stenting

Modern surgical treatment of arterial disease is moving towards minimally invasive procedures, as the benefits are numerous. However, one area that is resisting this trend is the treatment of carotid artery disease. For the past number of decades carotid endarterectomy surgery has been referred to as the “gold standard” in the treatment of carotid artery disease. However, in recent year’s carotid angioplasty and stenting (CAS) has emerged to challenge carotid endarterectomy surgery (CES) as a viable alternative for the prevention of strokes. However uptake of this procedure has been hindered due to the peri-operative complications associated with the treatment. During this procedure blood flow in one of the internal carotid arteries supplying blood to the brain is interrupted for a period of time. However, it has been shown that not all patients can accommodate this interruption. Qureshi et al. suggests that ischemic neurological deficits occur in 3 to 13% of patients as a result of hemodynamic compromise.

Surgical Treatment of Carotid Artery Disease

2020 ◽  
Author(s):  
Wesley S. Moore
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Internal Carotid ◽  
Carotid Artery Disease ◽  
Carotid Bifurcation ◽  
Eversion Endarterectomy ◽  
Artery Disease ◽  
Carotid Arterial

The rationale for operating on patients with carotid artery disease is to prevent stroke. It has been estimated that in 50 to 80% of patients who experience an ischemic stroke, the underlying cause is a lesion in the distribution of the carotid artery, usually in the vicinity of the carotid bifurcation. Appropriate identification and intervention could significantly reduce the incidence of ischemic stroke. Carotid endarterectomy for both symptomatic and asymptomatic carotid artery stenosis has been extensively evaluated in prospective, randomized trials. Surgical reconstruction of the carotid artery yields the greatest benefits when done by surgeons who can keep complication rates to an absolute minimum. The majority of complications associated with carotid arterial procedures are either technical or judgmental; accordingly, this review emphasizes the procedural aspects of planning and operation considered to be particularly important for deriving the best short- and long-term results from surgical intervention. Specifically, this review covers preoperative evaluation, operative planning, operative technique, postoperative care, follow-up, and alternatives to direct carotid reconstruction. Figures show carotid arterial procedures including recommended patient positioning, the commonly used vertical incision, the alternative transverse incision, mobilization of the sternocleidomastoid muscle to identify the jugular vein, palpation of the internal carotid artery, division of the structures between the internal and external carotid arteries to allow the carotid bifurcation to drop down, division of the posterior belly of the digastric muscle to yield additional exposure of the internal carotid artery, a graphic representation of the measurement of internal carotid artery back-pressure, a central infarct zone surrounded by an ischemic zone, shunt placement, open endarterectomy, eversion endarterectomy, repair of fibromuscular dysplasia, and repair of coiling or kinking of the internal carotid artery. This review contains 17 figures, and 25 references Key words: Carotid artery disease; Carotid endarterectomy; Carotid angioplasty with stenting; Eversion endarterectomy; Open endarterectomy; Carotid plaque; TCAR  

scholarly journals Impact of head movements on morphology and flow in the internal carotid artery after carotid angioplasty and stenting versus endarterectomy

2005 ◽  
Vol 41 (3) ◽  
pp. 469-475 ◽  
Author(s):  
Jan Albert Vos ◽  
A.W. Floris Vos ◽  
Matteus A.M. Linsen ◽  
J. Tim Marcus ◽  
Timotheus Th.C. Overtoom ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Head Movements ◽  
Carotid Angioplasty ◽  
Angioplasty And Stenting ◽  
Carotid Angioplasty And Stenting

Surgical Treatment of Carotid Artery Disease

2020 ◽  
Author(s):  
Wesley S. Moore
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Internal Carotid ◽  
Carotid Artery Disease ◽  
Carotid Bifurcation ◽  
Eversion Endarterectomy ◽  
Artery Disease ◽  
Carotid Arterial

The rationale for operating on patients with carotid artery disease is to prevent stroke. It has been estimated that in 50 to 80% of patients who experience an ischemic stroke, the underlying cause is a lesion in the distribution of the carotid artery, usually in the vicinity of the carotid bifurcation. Appropriate identification and intervention could significantly reduce the incidence of ischemic stroke. Carotid endarterectomy for both symptomatic and asymptomatic carotid artery stenosis has been extensively evaluated in prospective, randomized trials. Surgical reconstruction of the carotid artery yields the greatest benefits when done by surgeons who can keep complication rates to an absolute minimum. The majority of complications associated with carotid arterial procedures are either technical or judgmental; accordingly, this review emphasizes the procedural aspects of planning and operation considered to be particularly important for deriving the best short- and long-term results from surgical intervention. Specifically, this review covers preoperative evaluation, operative planning, operative technique, postoperative care, follow-up, and alternatives to direct carotid reconstruction. Figures show carotid arterial procedures including recommended patient positioning, the commonly used vertical incision, the alternative transverse incision, mobilization of the sternocleidomastoid muscle to identify the jugular vein, palpation of the internal carotid artery, division of the structures between the internal and external carotid arteries to allow the carotid bifurcation to drop down, division of the posterior belly of the digastric muscle to yield additional exposure of the internal carotid artery, a graphic representation of the measurement of internal carotid artery back-pressure, a central infarct zone surrounded by an ischemic zone, shunt placement, open endarterectomy, eversion endarterectomy, repair of fibromuscular dysplasia, and repair of coiling or kinking of the internal carotid artery. This review contains 17 figures, and 25 references Key words: Carotid artery disease; Carotid endarterectomy; Carotid angioplasty with stenting; Eversion endarterectomy; Open endarterectomy; Carotid plaque; TCAR  

Results of carotid stenting for asymptomatic carotid artery stenosis

2021 ◽  
Vol 22 (1) ◽  
pp. 71-77
Author(s):  
S. A. Bagin ◽  
◽  
Z. Kh. Shugushev ◽  
D. A. Maksimkin ◽  
P. E. Krainyukov ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Internal Carotid ◽  
Internal Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
Carotid Angioplasty ◽  
Cerebral Circulation Disorders ◽  
Angioplasty And Stenting ◽  
Carotid Angioplasty And Stenting

Objective: prospective analysis of 30-day outcomes from stenting procedure in patients with asymptomatic internal carotid artery stenosis depending on the type of implanted stent. Material and Methods: the study included 108 patients who underwent endovascular surgical treatment for asymptomatic internal carotid artery stenosis from 2012 to 2017. Depending on the type of implanted stent the patients were divided into 4 groups (the first (n = 37) – steel, the second (n = 32) -nitilon, the third (n = 20) – doublelayered stents, the fourth (n = 19) – double-layer stents with an inner layer of polyethylene terephthalate. Results: there was no mortality in the studied groups for 30 days after surgery. The cumulative incidence of cerebral circulation disorders within 30 days of carotid angioplasty and stenting was 9.7% (n = 10), with ischemic stroke occurring in 1.85% (n = 2) cases. Conclusion: carotid angioplasty and stenting is a safe and effective method of secondary prevention of cerebral circulation disorders with the level of perioperative complications not exceeding other preventive procedures.

scholarly journals Insight into the Periprocedural Embolic Events of Internal Carotid Artery Angioplasty

2011 ◽  
Vol 17 (4) ◽  
pp. 452-458 ◽  
Author(s):  
L. Jiang ◽  
F. Ling ◽  
B. Wang ◽  
Z. Miao
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Clinical Outcomes ◽  
Internal Carotid ◽  
Carotid Angioplasty ◽  
Underlying Mechanisms ◽  
Angioplasty And Stenting ◽  
Carotid Angioplasty And Stenting ◽  
Insight Into

Thromboembolism is a major risk of carotid angioplasty and stenting (CAS). Although the incidence of distal embolism has been documented by MRI and TCD studies, the mechanisms and management of this complication are rarely reported. Here we describe four patients with periprocedural embolic events to demonstrate the mechanisms of thromboembolism in CAS. Different remedies were applied to these patients according to the underlying mechanisms of thromboembolism and good clinical outcomes were achieved.

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