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Demeuleneere A, Lambert J, Demeestere J, Lemmens R, Fourneau I, Houthoofd S, Schauwvlieghe PP, Jacob J, Cassiman C. A rare presentation of a common carotid artery occlusion. GMS OPHTHALMOLOGY CASES 2023; 13:Doc20. [PMID: 38111470 PMCID: PMC10726582 DOI: 10.3205/oc000228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
Background A common carotid artery occlusion (CCAO) is very rare and the clinical features of CCAO have rarely been described. Since the blood supply of the eye and orbit is derived from the internal carotid artery, a CCAO may present with various ophthalmological symptoms, ranging from incidental findings to complete visual loss but also other neuro-ophthalmological abnormalities. Case report A 61-year-old woman presented with acute monocular vision loss and an elevation deficit of the right eye. Fluorescein angiography showed delayed filling of both the retinal and choroidal vasculature, without occlusion/embolisms of the retinal arteries. Vascular imaging showed a right CCAO. Conclusion CCAO has a variable presentation. In patients with acute unilateral visual loss a CCAO should be considered, especially when ocular motility deficits are present. Fluorescein angiography examination can aid in the localization and diagnosis of the vascular insult. Urgent referral for a systemic work-up is essential.
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Affiliation(s)
| | - Julie Lambert
- Radiology Department, University Hospitals Leuven, Belgium
| | | | - Robin Lemmens
- Neurology Department, University Hospitals Leuven, Belgium
| | - Inge Fourneau
- Vascular Surgery Department, University Hospitals Leuven, Belgium
| | | | | | - Julie Jacob
- Ophthalmology Department, University Hospitals Leuven, Belgium
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2
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Wang J, Han Q, Zhou P, Hui P, Wang Z, Wang Z, Yu Z, Huang Y. Segmented carotid endarterectomy for treatment of Riles type 1A common carotid artery occlusion. Acta Neurochir (Wien) 2022; 164:3185-3196. [PMID: 35930077 DOI: 10.1007/s00701-022-05331-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 07/19/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Common carotid artery occlusion (CCAO) is a rare cause of cerebrovascular events. Symptomatic lesions are resistant to medical treatment and revascularization is often required, but there is no consensus on the treatment of CCAO at present. Riles type 1A CCAO is most likely to benefit from revascularization because it has patent outflow tract (internal carotid artery) which was supplied by patent external carotid artery (ECA) from collateral circulation. We described a novel surgical technique improved on the basis of the carotid endarterectomy (CEA) for treatment of Riles type 1A CCAO. METHODS We rigorously screened ten patients with symptomatic Riles type1A CCAO for surgery from January 2017 to May 2019 and performed a full preoperative assessment of the inadequate collateral circulation compensation. Moreover, we retrospectively reviewed our experience of the segmented CEA in the treatment of them in our single center. RESULTS Segmented CEA was performed on the left side in four cases and on the right side in six cases. The technical success rate of the procedure was 100%. Primary suture was used in nine cases. Only one patient (right CCAO) who had a history of neck radiotherapy was treated by the patch CEA. The mean temporary blocking time during surgery was 52.8 ± 9.15 min. The mean temporary blocking time for treating the upper segment of the common carotid artery (CCA) was 11.1 ± 2.64 min. In the postoperative period, cerebral perfusion on the ipsilateral site improved in all patients, myocardial infarction occurred in one patient, and recurrent laryngeal nerve damage occurred in another. No ischemic events or re-occlusion or restenosis (> 50%) of the treated CCA occurred during the mean follow-up of 32.6 ± 9.3 months. The preoperative mean modified Rankin Scale (mRS) score was 1.9 (range, 1-3; median, 2). At last follow-up for all patients, the mRS score was 1 (range, 0-3; median, 1). CONCLUSION Segmented CEA, which utilizes the compensatory effect of collateral circulation, is an effective and safe technique to treat patients suffering from Riles type 1A CCAO with hemodynamic cerebrovascular compromise.
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Affiliation(s)
- Jun Wang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, 215006, Jiangsu, People's Republic of China
| | - Qingdong Han
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, 215006, Jiangsu, People's Republic of China
| | - Peng Zhou
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, 215006, Jiangsu, People's Republic of China
| | - Pinjing Hui
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, 215006, Jiangsu, People's Republic of China
| | - Zhong Wang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, 215006, Jiangsu, People's Republic of China
| | - Zilan Wang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, 215006, Jiangsu, People's Republic of China
| | - Zhengquan Yu
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, 215006, Jiangsu, People's Republic of China.
| | - Yabo Huang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, 215006, Jiangsu, People's Republic of China.
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Deryabin SG, Dashyan VG, Gaibov SSK, Vorobyov DP. [Two-stage contralateral combined microvascular and wide-lumen anastomosis inTwo-stage contralateral combined microvascular and wide-lumen anastomosis in a patient with acute ischemic stroke patient with acute ischemic stroke]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2021; 85:68-74. [PMID: 33864670 DOI: 10.17116/neiro20218502168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Common carotid artery (CCA) thrombosis is a rare cause of ischemic stroke. In available literature, we found no studies devoted to cerebral revascularization for CCA occlusion in acute period of ischemic stroke. Successful treatment of concomitant occlusion of CCA, internal (ICA) and external carotid arteries (ECA) with microvascular anastomoses is very interesting for various specialists. To demonstrate the possibility of contralateral cerebral revascularization in a patient with CCA, ECA and ICA occlusion in acute period of ischemic stroke. Two-stage intervention was performed in a patient with ischemic stroke and carotid artery occlusion. At the first stage, EICMA was formed between the right superficial temporal artery and the M4 branch of the middle cerebral artery (MCA), at the second stage - anastomosis between the right and left ECAs using an autologous arterial graft from the radial artery. There is no generally accepted surgical strategy for CCA occlusion. Contralateral revascularization with blood flow redirecting from the right carotid artery to the left one makes it possible to avoid thrombectomy from the affected CCA and ECA. We have undertaken this method for the first time. We have not found such an approach in the available literature. This report demonstrates the possibility of successful cerebral revascularization in acute period of ischemic stroke in patients with combined occlusion of CCA, ICA and ECA.
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Affiliation(s)
- S G Deryabin
- Regional Clinical Hospital No. 2, Tyumen, Russia
| | - V G Dashyan
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - S S-Kh Gaibov
- Regional Clinical Hospital No. 2, Tyumen, Russia.,Tyumen State Medical University, Tyumen, Russia
| | - D P Vorobyov
- Regional Clinical Hospital No. 2, Tyumen, Russia.,Tyumen State Medical University, Tyumen, Russia
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Chen C, Ling C, Luo L, He H, Li M, Bhattarai R, Guo Y, Wang H, Guo Y. Comparison of the Effectiveness of Ring-Stripping Retrograde Endarterectomy and Carotid Artery Crossover Bypass in the Treatment of Patients with Symptomatic Riles Type 1A Common Carotid Artery Occlusion. J Stroke Cerebrovasc Dis 2020; 29:105143. [PMID: 32912498 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/22/2020] [Accepted: 07/08/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The surgical procedure most appropriate for treating symptomatic Riles type 1A common carotid artery occlusion (CCAO) is unclear. This study compares the effects of ring-stripping retrograde endarterectomy (RSRE) and carotid artery crossover bypass (CACB) on cerebral perfusion improvement in patients with symptomatic Riles type 1A CCAO. METHODS We conducted a retrospective analysis of symptomatic Riles type 1A CCAO patients treated at our centre. Postoperative improvements in the ipsilateral internal carotid artery (ICA) flow rate, ipsilateral cerebral blood perfusion (CBP) and the stroke recurrence rate were compared between patients who underwent RSRE and those who underwent CACB. RESULTS A total of 20 CCAO patients were surgically treated at our centre from 2011 to 2018. Nine of these patients underwent RSRE, and eleven underwent CACB. No significant differences were identified between the groups in the ipsilateral blood flow rate of the ICA immediately after surgery and the ipsilateral-to-contralateral mean transit time ratios 1 day after surgery. However, the flow rate in the ICA was significantly higher in the RSRE group than in the CACB group 1 year after surgery (135.44 ± 19.22 ml/min vs. 116.36 ± 17.70 ml/min, p = 0.033). For CBP, the ipsilateral-to-contralateral mean transit time ratios were significantly lower in RSRE patients than in CACB patients 1 year after surgery (1.005 ± 0.052 vs. 1.064 ± 0.066, p = 0.044). In addition, the postoperative modified Rankin scale (mRS) score at the latest follow-up point (p = 0.884) and the stroke recurrence rate during the follow-up (88.9% vs. 90.9%, p > 0.999) were not significantly different between the two groups. CONCLUSIONS Although the postoperative mRS score and the stroke recurrence rate were not significantly different between RSRE and CACB patients, compared to CACB, RSRE was better for improving the ipsilateral ICA flow rate and cerebral perfusion in symptomatic Riles type 1A CCAO patients.
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Affiliation(s)
- Chuan Chen
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, PR China.
| | - Cong Ling
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, PR China.
| | - Lun Luo
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, PR China.
| | - Haiyong He
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, PR China.
| | - Manting Li
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, PR China.
| | - Robin Bhattarai
- Department of Neurosurgery, Annapurna Neurological Institute & Allied Sciences, Maitighar, 24663, Kathmandu, Nepal
| | - Yuefei Guo
- Department of Radiology, Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, PR China.
| | - Hui Wang
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, PR China.
| | - Ying Guo
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, PR China.
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Li ZY, Chen C, Ling C, He HY, Luo L, Li H, Wang H. Surgical procedures including carotid-carotid crossover bypass and ring-stripping hybrid operation for Rile's type 1A common carotid artery occlusion: an experience of 6 cases. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:439. [PMID: 32395483 PMCID: PMC7210149 DOI: 10.21037/atm.2020.03.177] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Background At present, there is no consensus on the treatment of common carotid artery occlusion (CCAO). We explored the surgical indications and observed the therapeutic effects of carotid-carotid crossover bypass and ring-stripping hybrid operation for treatment of Rile’s type 1A CCAO. Methods The imaging data, clinical manifestations, surgical complications and postoperative ischemic events were retrospectively collected from the 6 cases with Rile’s type 1A CCAO that underwent surgery in our department from 2011 to 2018. Of the 6 cases, 4 received carotid-carotid crossover bypass and 2 ring-stripping hybrid operation. Results Of the 6 cases, 4 were male and 2 females, with a mean age of 62.7 years. All cases had the left CCAO combined with decreased computed tomography perfusion (CTP) in the left internal carotid artery blood supply area. In the 4 cases receiving carotid-carotid crossover bypass, the mean operation time was 186±13 min, the mean hospital stay was 17±1 d, postoperative CTP improved, one case had swallowing foreign body sensation, synthetic vascular grafts were patent and no ischemic events occurred during the mean follow-up of 62.3±26.3 months. In the 2 cases receiving ring-stripping hybrid operation, the mean operation time was 118±11 min, the mean hospital stay was 5.5±0.7 d, postoperative CTP improved, and the opened common carotid arteries (CCA) were patent and no ischemic events occurred during the mean follow-up of 17.5±3.5 months. Conclusions Rile’s type 1A CCAO with related symptoms and decreased CTP should be treated by revascularization. The carotid-carotid crossover bypass is a good choice in bypass schemes because of its easy operation and good long-term patency. The ring-stripping hybrid operation may be an ideal surgical scheme for Rile’s type 1A CCAO.
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Affiliation(s)
- Zhang-Yu Li
- Department of Neurosurgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Chuan Chen
- Department of Neurosurgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Cong Ling
- Department of Neurosurgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Hai-Yong He
- Department of Neurosurgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Lun Luo
- Department of Neurosurgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Hao Li
- Department of Neurosurgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Hui Wang
- Department of Neurosurgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
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Kotsis T, Christoforou P. Disobliteration of an Occluded Common Carotid Artery with Patent Bifurcation via Antegrade Ring Stripping. Vasc Specialist Int 2020; 36:38-44. [PMID: 32292767 PMCID: PMC7119154 DOI: 10.5758/vsi.2020.36.1.38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 02/19/2020] [Accepted: 02/25/2020] [Indexed: 11/20/2022] Open
Abstract
There is a lack of guidelines concerning common carotid artery (CCA) occlusive disease in the presence of a patent internal carotid artery (ICA). A novel surgical technique that disobliterates an occluded CCA was successfully performed in three cases. The detailed surgical steps are presented herein. After proximal division of the CCA behind the sternoclavicular junction, the occluded CCA was endarterectomized via antegrade ring stripping. After removal of the atheromatous core, the CCA was everted, and the wall remnants were cleaned under direct vision. Simultaneous eversion endarterectomy of the ICA was performed when necessary. After reversion of the CCA, it was transposed and anastomosed to the ipsilateral subclavian artery distal to the orifice of the vertebral artery. This novel technique can be used in selected cases by experienced surgeons.
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Affiliation(s)
- Thomas Kotsis
- Vascular Unit, 2nd Clinic of Surgery, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagitsa Christoforou
- Vascular Unit, 2nd Clinic of Surgery, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Hsu JC, Tsai HL. Endovascular recanalization of common carotid artery Total occlusion: two case reports and literature review. CVIR Endovasc 2020; 3:6. [PMID: 32027013 PMCID: PMC6966340 DOI: 10.1186/s42155-020-0097-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/08/2020] [Indexed: 11/23/2022] Open
Abstract
Background Common carotid artery total occlusion is rare but can be associated with a variety of neurological symptoms due to inadequate cerebral perfusion. The treatment includes bypass surgery, endarterectomy, and endovascular revascularization. Case presentation Herein, we report two cases of common carotid artery total occlusion treated by percutaneous transluminal angioplasty, and review the literature. Conclusion Both of our cases were successfully treated with endovascular revascularization for common carotid artery total stenosis. Endovascular therapy provided an alternative treatment. Further large clinical study for comparing the safety and efficiency in surgical and endovascular treatment may be required. Level of evidence Level 4, Case Series.
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Affiliation(s)
- Jung-Chi Hsu
- Department of Internal Medicine, Division of Cardiology, Saint Mary's Hospital Luodong, Yilan, 26546, Taiwan. .,Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, 7 Chung-Shan South Road, Taipei, 100, Taiwan.
| | - Han-Lin Tsai
- Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, 539 Jhongsiao Road, Chiayi, 600, Taiwan
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Matsuda Y, Koyama T. Evaluation of revascularization after total arch replacement in common carotid artery occlusion. World J Clin Cases 2018; 6:6-10. [PMID: 29376064 PMCID: PMC5767848 DOI: 10.12998/wjcc.v6.i1.6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 12/06/2017] [Accepted: 12/15/2017] [Indexed: 02/05/2023] Open
Abstract
Occlusion of the common carotid artery (CCA) is rare. CCA occlusion (CCAO) can present as drowsiness and right hemiplegia related to emboli after total arch replacement. Although we selected a follow-up at first because color duplex sonography showed retrograde flow from the left external carotid artery to the internal carotid artery, this patient had epilepsy and single-photon emission computed tomography (SPECT) acquired quantitative results of actual brain perfusion and showed insufficient collateral blood flow. To improve brain perfusion, we performed a bypass of the left subclavian artery to left CCA bypass. Postoperatively, the patient did not have epilepsy and drowsiness. Also, right hemiplegia improved enough for him to walk with support. SPECT showed increased left cerebral flow (the asymmetry ratio was 71% to 81%). Evaluation of the carotid artery with color duplex sonography alone was insufficient when CCAO showed retrograde or collateral flow. We should have performed quantitative evaluation with SPECT at the same time.
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Affiliation(s)
- Yasuhiro Matsuda
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, Hyogo 650-0047, Japan
| | - Tadaaki Koyama
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, Hyogo 650-0047, Japan
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Chen C, Ye Z, Luo L, Guo Y, Chang Y, Ning X, Wang H. Carotid-Carotid Artery Crossover Bypass with a Synthetic Vascular Graft for Symptomatic Type 1A Common Carotid Artery Occlusion. World Neurosurg 2017; 111:e286-e293. [PMID: 29269063 DOI: 10.1016/j.wneu.2017.12.060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 12/07/2017] [Accepted: 12/09/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the effect of carotid-carotid artery crossover bypass with a synthetic vascular graft for symptomatic type 1A common carotid artery occlusion (CCAO). METHODS A retrospective analysis was conducted of patients with symptomatic type 1A CCAO who underwent carotid-carotid artery crossover bypass surgery via a retropharyngeal route with a synthetic vascular graft in the Department of Neurosurgery at our hospital. Preoperative demographic data, surgical complications, incidence of stroke during follow-up, and other clinical data were summarized. RESULTS Between 2011 and 2016, carotid-carotid artery crossover bypass was performed with a synthetic vascular graft in 4 patients with type 1A CCAO. The mean patient age was 63.3 years (range, 49-69 years). Clinical symptoms included dizziness, amaurosis fugax, persistent limb numbness, and transient ischemic attack. In all 4 patients, postoperative computed tomography angiography showed internal carotid artery thickening due to successful bypass, whereas computed tomography perfusion showed improved postoperative cerebral perfusion on the side of the lesion. The sole perioperative complication was a complaint of foreign body sensation on swallowing in 1 patient. The mean duration of follow-up was 40.3 months (range, 14-77 months), during which no newly occurred cerebral ischemia or synthetic vascular graft occlusion was observed. CONCLUSIONS Carotid-carotid artery crossover bypass with a synthetic vascular graft is a safe and effective therapeutic approach for patients with symptomatic type 1A CCAO. However, studies with larger series are needed to enable more precise conclusions.
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Affiliation(s)
- Chuan Chen
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhuopeng Ye
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lun Luo
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yuefei Guo
- Department of Radiology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yanyu Chang
- Department of Neurology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xinjie Ning
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hui Wang
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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Modification to the Rice-Vannucci perinatal hypoxic-ischaemic encephalopathy model in the P7 rat improves the reliability of cerebral infarct development after 48hours. J Neurosci Methods 2017. [PMID: 28648719 DOI: 10.1016/j.jneumeth.2017.06.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The Rice-Vannucci model of hypoxic-ischaemic encephalopathy (HIE) has been associated with a high degree of variability with respect to the development of cerebral infarction and infarct lesion volume. For this reason, we examined the occurrence of communicational blood flow within the common carotid (CCA), internal (ICA), and external (ECA) carotid arteries following CCA occlusion as a source of variability in the model. NEW METHOD We propose a novel modification to the Rice-Vannucci model, whereby both the CCA and ECA are permanently ligated; mitigating communicational blood flow. RESULTS Using magnetic resonance angiography, phase-contrast velocity encoding, and pulsed arterial spin labelling, the modified Rice-Vannucci model (CCA/ECA occlusion) was demonstrated to mitigate communicational blood flow, whilst significantly reducing ipsilateral hemispherical cerebral blood flow (CBF). Comparatively, the original Rice-Vannucci model (CCA occlusion) demonstrated anterograde and retrograde blood flow within the ICA and CCA, respectively, with a non-significant reduction in ipsilateral CBF. Furthermore, CCA/ECA occlusion plus hypoxia (8% O2/92% N2; 2.5h) resulted in 100% of animals presenting with an infarct (vs 87%), significantly larger infarct volume at 48h (18.5% versus 10.0%; p<0.01), reduced standard deviation (±10% versus ±15%), and significantly worsened functional outcomes when compared to CCA occlusion plus hypoxia. COMPARISON WITH EXISTING METHOD We compared a modified Rice-Vannucci model (CCA/ECA occlusion±hypoxia) to the commonly used Rice-Vannucci model (CCA occlusion±hypoxia). CONCLUSION This study demonstrates that CCA/ECA occlusion in the Rice-Vannucci model of HIE reduces infarct volume variability by limiting communicational blood flow.
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Common carotid artery occlusion: a case series. ISRN NEUROLOGY 2013; 2013:198595. [PMID: 24167740 PMCID: PMC3791643 DOI: 10.1155/2013/198595] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 08/18/2013] [Indexed: 01/14/2023]
Abstract
Subjects and Methods. We analysed 5000 cerebrovascular ultrasound records. A total of 0.4% of the patients had common carotid artery occlusion (CCAO). Results. The mean age was 59.8 ± 14.2 years, and the male/female ratio was 2.33. The most frequent risk factors were hypertension, ischaemic heart disease, dyslipidemia, diabetes mellitus, and smoking. Right-sided and left-sided CCAO occurred in 65% and 30% of the cases, respectively, and bilateral occlusion was detected in one case (5%). Patent bifurcation was observed in 10 cases of CCAO in which the anterograde flow in the ICA was maintained from the external carotid artery with reversed flow. In two of the cases, the occluded CCA was hypoplastic. The aetiology of CCAO in the majority of cases was the atherosclerosis (15 cases). The male/female ratio was higher in the patients with occluded distal vessels, and the short-term outcome was poorer. Only two cases from this series underwent revascularisation surgery. Spontaneous recanalisation was observed in one case. Conclusions. The most frequent cause of CCAO was atherosclerosis. The outcome is improved in the cases with patent distal vessels, and spontaneous recanalisation is possible. Treatment methods have not been standardised. Surgical revascularisation is possible in cases of patent distal vessels, but the indications are debatable.
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Petzold A, Islam N, Hu HH, Plant GT. Embolic and Nonembolic Transient Monocular Visual Field Loss: A Clinicopathologic Review. Surv Ophthalmol 2013; 58:42-62. [DOI: 10.1016/j.survophthal.2012.02.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Revised: 02/01/2012] [Accepted: 02/07/2012] [Indexed: 12/01/2022]
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Nakamura A, Wakugawa Y, Yasaka M, Ogata T, Yasumori K, Kitazono T, Okada Y. Antegrade internal carotid artery collateral flow and cerebral blood flow in patients with common carotid artery occlusion. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:1561-1566. [PMID: 23011619 DOI: 10.7863/jum.2012.31.10.1561] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To determine the incidence of antegrade internal carotid artery collateral flow in patients with common carotid artery occlusion, which artery supplies blood to the internal carotid artery, and whether the flow affects regional cerebral blood flow in the middle cerebral artery territory. METHODS We determined the incidence of antegrade internal carotid artery collateral flow and identified its arterial origins using carotid sonography in 10 patients with common carotid artery occlusion and evaluated middle cerebral artery territory regional cerebral blood flow by single-photon emission computed tomography in these patients and 30 age- and sex-matched patients with internal carotid artery occlusion. RESULTS Six (60%) of the 10 patients with common carotid artery occlusion had antegrade internal carotid artery collateral flow, which was supplied through the carotid bifurcation from retrograde flow of the external carotid artery in 5 and by a small artery directly into the internal carotid artery in 1. The regional cerebral blood flow ipsilateral to the occlusion at rest was higher in patients with common carotid artery occlusion than those with internal carotid artery occlusion (mean ± SD, 40.4 ± 8.5 versus 34.3 ± 6.2 mL/100 g/min; P = .02). The regional cerebral blood flow was significantly higher in the 6 patients with antegrade internal carotid artery flow than those with internal carotid artery occlusion at rest (42.2 ± 7.2 versus 34.3 ± 6.2 mL/100 g/min; P = .02) but not in the other 4 patients without antegrade internal carotid artery flow. CONCLUSIONS Antegrade collateral internal carotid artery flow was found in 60% of patients with common carotid artery occlusion and was mainly supplied by retrograde external carotid artery flow. It contributes to maintenance of middle cerebral artery territory regional cerebral blood flow.
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Affiliation(s)
- Asako Nakamura
- Department of Cerebrovascular Diseases, Cerebrovascular Center and Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-8563, Japan.
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Lapchak PA. Effect of internal carotid artery reperfusion in combination with Tenecteplase on clinical scores and hemorrhage in a rabbit embolic stroke model. Brain Res 2009; 1294:211-7. [PMID: 19643097 DOI: 10.1016/j.brainres.2009.07.058] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Revised: 07/16/2009] [Accepted: 07/18/2009] [Indexed: 01/01/2023]
Abstract
In the present study, we used a modification of the rabbit small clot embolic stroke model (RSCEM), a multiple infarct ischemia model to achieve reperfusion (REP) through the internal carotid artery (ICA) following small clot embolization. We determined if increasing regional cortical blood flow (RCBF) following an embolic stroke is beneficial to neurological outcome. We compared this to cerebral reperfusion induced by the administration of the thrombolytic Tenecteplase (TNK, 1.5 mg/kg, IV bolus) in the presence or absence of REP. In this study, we also measured the incidence of ICH following REP and thrombolytic treatment. Following embolization, RCBF was reduced to 48-55% of baseline. When REP was induced by removal of a CCA ligature, RCBF initially increased to 185% of baseline. REP (P(50)=1.18+/-0.43 mg) had no effect on embolization-induced behavior measured 24 h following embolization compared to control (P(50)=1.01+/-0.48 mg). However, TNK treatment (2-hours post-embolization) in the absence or presence of REP (initiated 2 h following embolization) significantly (p<0.05) increased the group P(50) to 2.92+/-0.55 mg and 2.42+/-0.40 mg, respectively. In addition, ICH was increased in the REP (42%, p<0.05) and REP-TNK (35%, p>0.05) group compared to either the control group (5.5%) or TNK group (10%). This study show that reperfusion of ICA can increase RCBF following embolization, but this is not associated with improved neurological outcome measured using quantal analysis. However, TNK administration significantly increased behavioral outcome when given 2 h following embolization; an increase that is not affected by combining TNK with REP.
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Affiliation(s)
- Paul A Lapchak
- University of California San Diego, Department of Neuroscience, MTF 316, 9500 Gilman Drive, La Jolla, CA 92093-0624, USA.
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Ysa-Figueras A, Arruabarrena-Oyarbide A, Rodríguez-Bustabad M, López-Vidaur I, Gainza E. Revascularización cerebral inusual tras la corrección de un pseudoaneurisma carotídeo recurrente. ANGIOLOGIA 2009. [DOI: 10.1016/s0003-3170(09)11005-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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