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Murray-Ramcharan M, Coetzee SI, Patalano P. Symptomatic Common Carotid Artery Stenosis Managed With Carotid Endarterectomy. Cureus 2023; 15:e49062. [PMID: 38125247 PMCID: PMC10730333 DOI: 10.7759/cureus.49062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2023] [Indexed: 12/23/2023] Open
Abstract
Extracranial carotid artery disease is typical at the carotid bifurcation and internal carotid artery (ICA) and is rarely symptomatic from isolated common carotid artery (CCA) stenosis. We present the case of a 60-year-old female patient who presented with a transient ischemic attack (TIA) with significant stenosis of the ipsilateral CCA only, without any involvement of the ICA or bifurcation. This was treated with carotid endarterectomy (CEA) with desirable postoperative outcomes; at up to six months postoperative follow-up, this patient had no recurrence of symptoms. We draw attention to the current gap in the literature with regard to a lack of specific guidelines for optimal evidence-based surgical treatment for this specific condition, with recent advances within certain vascular societies.
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Affiliation(s)
| | - Son-Isha Coetzee
- Surgery, St. George's University School of Medicine, New York, USA
| | - Peter Patalano
- Vascular Surgery, Woodhull Medical Center, Brooklyn, USA
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2
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Choi Y, Byun JS, Choi HS, Choi JK, Kim S. Asymptomatic Common Carotid Artery Occlusion and Occipital-Vertebral Artery Anastomosis: A Case Report and Literature Review. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:1152-1157. [PMID: 37869126 PMCID: PMC10585084 DOI: 10.3348/jksr.2022.0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/24/2022] [Accepted: 01/20/2023] [Indexed: 10/24/2023]
Abstract
Common carotid artery occlusion (CCAO) is a very rare disorder that has rarely been studied. CCAO causes several neurological symptoms but can sometimes be asymptomatic due to the development of various anastomoses. Herein, we report the case of a 70-year-old male patient diagnosed with asymptomatic CCAO due to anastomotic flow. The patient underwent transfemoral cerebral angiography (TFCA) and was found to have CCAO with two collateral pathways, including an occipital artery-vertebral artery anastomosis. We emphasize the importance of TFCA when CCAO is suspected and review the types and anastomotic pathways of CCAO.
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3
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Short jump vein graft for the treatment of symptomatic Riles type 1A occlusion of common carotid artery: case report and review of literature. Acta Neurochir (Wien) 2023; 165:637-642. [PMID: 36396842 DOI: 10.1007/s00701-022-05419-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 11/03/2022] [Indexed: 11/18/2022]
Abstract
A 62-year-old man was presented with transient ischemic attack 1 day after percutaneous coronary intervention. Magnetic resonance imaging demonstrated fresh cerebral infarction in the left hemisphere. Digital subtraction angiography showed left Riles type 1A common carotid artery occlusion (CCAO). Blood flow in the internal carotid artery (ICA) was derived from the external carotid artery, which came through the anastomosis between the left occipital artery and a muscular branch of left vertebral artery. We performed short jump graft from CCA to ICA using saphenous vein, followed by ligation of CCA. The graft remained patent at the 1-year follow-up.
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Yamaguchi K, Funatsu T, Moteki Y, Nonaka T, Niwa A, Imanaka K, Kim K, Ishikawa T, Mochizuki T, Okada Y, Kawamata T. Subclavian Artery-Carotid Artery Bypass for Subclavian Artery or Common Carotid Artery Severe Stenosis or Occlusion. Neurol Med Chir (Tokyo) 2023. [PMID: 37005246 DOI: 10.2176/jns-nmc.2022-0307] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Various surgical treatments are available for occlusive subclavian and common carotid artery diseases. Nevertheless, to date, when cerebral endovascular treatment is utilized, revascularization via direct surgery may be required. This study reported five symptomatic cases of revascularization for CCA and SCA occlusive and stenotic lesions that were expected to be challenging to treat with endovascular treatment. We performed subclavian artery-common carotid artery or internal carotid artery bypass using artificial blood vessels or saphenous vein grafts in five patients with subclavian steal syndrome, symptomatic common carotid artery occlusion, and severe proximal common carotid artery stenosis. In this study, good bypass patency was achieved in all five cases. Although there were no intraoperative complications, one patient had a postoperative lymphatic leak. Moreover, there was no recurrence of stroke during postoperative follow-up for an average of 2 years. Conclusively, subclavian artery-common carotid artery bypass can be an effective surgical treatment for common carotid artery occlusion, proximal common carotid artery stenosis, and subclavian artery occlusion.
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Affiliation(s)
- Koji Yamaguchi
- Department of Neurosurgery, Tokyo Women's Medical University
| | | | - Yosuke Moteki
- Department of Neurosurgery, Tokyo Women's Medical University
| | - Taku Nonaka
- Department of Neurosurgery, Tokyo Women's Medical University
| | - Akihiro Niwa
- Department of Neurosurgery, Tokyo Women's Medical University
| | - Kosuke Imanaka
- Department of Neurosurgery, Tokyo Women's Medical University
| | - Kilsoo Kim
- Department of Neurosurgery, Tokyo Women's Medical University
| | | | | | - Yoshikazu Okada
- Department of Neurosurgery, St. Luke's International Hospital
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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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Miceli G, Tuttolomondo A, Velardo M, Bencivinni F, Poma S, Pinto A. "The importance of being external": review of the literature of the rare phenomenon of common carotid occlusion with bulb reverse-crossed stenosis and external collaterals activation. Is still correct speaking about carotid steal? J Ultrasound 2022; 25:435-442. [PMID: 35032023 PMCID: PMC9402855 DOI: 10.1007/s40477-021-00644-1] [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: 07/13/2021] [Accepted: 11/27/2021] [Indexed: 11/25/2022] Open
Abstract
Common carotid artery occlusion (CCAO) is a rare phenomenon associated with the development of neurological symptoms. In CCAO, diversion of blood flow from the external carotid artery (ECA) to the internal carotid artery (ICA) via the carotid bulb (CB) may occur. This pathway activation has been called "carotid steal". Starting from a particular case we describe the ECD finding of a complete occlusion of CCA with patency of ICA and ECA. In case of occlusion of CCA, inversion of the ECA flow may occur, towards the ICA, and it can be damped by a significant stenosis crossed in retrograde direction that may concur to maintain the pressure balance between the two circulations. Usually, this particular compensation can guarantee normal flow velocities in middle cerebral arteries without signs of activation of anterior collateral pathways. In this review we underline the protective role of ECA and we propose a new definition for this phenomenon. The ECA may provide blood to the cerebral circulation through several anastomotic secondary channels. Finally, only with an extensive knowledge of hemodynamic information of all intracranial and extracranial arteries, including ECA, we can estimate cerebral ischemic risk of the patient and choose the correct management of this occlusion.
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Affiliation(s)
- Giuseppe Miceli
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), Università degli Studi di Palermo, piazza delle Cliniche 2, 90127, Palermo, Italy.
| | - Antonino Tuttolomondo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), Università degli Studi di Palermo, piazza delle Cliniche 2, 90127, Palermo, Italy
| | - Mariachiara Velardo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), Università degli Studi di Palermo, piazza delle Cliniche 2, 90127, Palermo, Italy
| | | | - Sonia Poma
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), Università degli Studi di Palermo, piazza delle Cliniche 2, 90127, Palermo, Italy
| | - Antonio Pinto
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), Università degli Studi di Palermo, piazza delle Cliniche 2, 90127, Palermo, Italy
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7
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Gaisenok OV, Rezvaya AA. [A comparative analysis of the clinical and anamnestic status of patients with chronic occlusion of the carotid arteries based on the data of observational registries]. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:33-41. [PMID: 36582159 DOI: 10.17116/jnevro202212212233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To study the clinical and anamnestic status of patients with chronic carotid artery occlusion (CCAO) based on the analysis of risk factors, demographic and clinical and anatomical characteristics, the dynamics of the disease; to evaluate ongoing drug therapy, the incidence of strokes (MI) and deaths (according to the local registry compared with the results of other observational studies). MATERIAL AND METHODS PubMed and eLibrary searches for a systematic review were performed from October 24 to December 10, 2021 independently by two investigators. Out of 870 articles, based on inclusion/exclusion criteria, 8 studies were selected and included in the systematic review. RESULTS A comparative analysis of the clinical and anamnestic status of patients with CCAO according to the present review showed the following data on the prevalence of the main risk factors/diseases: hypertension - 79.1%; male gender - 83.7%; smoking - 46%; diabetes mellitus - 30.5%. Of the entire of own Duplex registry group (n=2548), 7 patients were identified with CCAO (0.27%). All patients were male (mean age 71.3±9.4 years). Endpoints were recorded in 5 of 7 participants during the follow-up period (8.9 years): 5 deaths, 2 fatal MI, 1 non-fatal MI, 1 myocardial infarction. A significant impact of the fact of MI on the survival of patients was confirmed using the standard log-rank test (p=0.02 and the Cox-Mendel test (p=0.04). The incidence of MI during the prospective follow-up according to the analyzed studies ranged from 4.3% (within a month of follow-up) to 42.8% (with a follow-up of 8.9 years), and averaged 12%. CONCLUSIONS A comparative analysis of the clinical and anamnestic status of patients with CCAO based on data from observational registers showed that the probability of detecting this pathology is associated with age and male gender. Data obtained from prospective observation of patients with CCAO in our own study show that the development of MI is one of the main factors affecting the survival of this category of patients.
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Affiliation(s)
- O V Gaisenok
- United Hospital with Outpatient Department of the Administrative Department of the President of the Russian Federation, Moscow, Russia
| | - A A Rezvaya
- Central State Medical Academy of the Administrative Department of the President of the Russian Federation, Moscow, Russia
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8
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Gunawardena T, Godakandage M, Abeywickrama S, Saseekaran B, Cassim R, Wijeyaratne M. A Case of Common Carotid Artery Occlusion: A Unique Pattern of Occlusion and Lessons Learned. Ann Vasc Dis 2022; 15:49-52. [PMID: 35432656 PMCID: PMC8958408 DOI: 10.3400/avd.cr.21-00080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/16/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | | | - Rezni Cassim
- University Vascular Surgical Unit, National Hospital of Colombo
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Wan Y, Chen HC, Lee CY, Lin HY, Nien CW. Acute visual loss as the first ocular symptom in a Sjögren's syndrome patient with bilateral common carotid artery occlusion: a case report. BMC Ophthalmol 2021; 21:409. [PMID: 34837998 PMCID: PMC8626982 DOI: 10.1186/s12886-021-02177-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/16/2021] [Indexed: 11/15/2022] Open
Abstract
Background Sjögren’s syndrome may be a risk factor for carotid artery stenosis. Bilateral common carotid artery occlusion (BCCAO) in a patient with Sjögren’s syndrome was not reported before. In this report, we describe a female with Sjögren’s syndrome who had acute visual loss due to ocular ischemic syndrome (OIS) with BCCAO. Case presentation A 50-year-old female with Sjögren’s syndrome visited our clinic with acute visual loss in the left eye. The best corrected visual acuity (BCVA) was 2/100 in the left eye, and the intraocular pressure (IOP) was normal in both eyes. Ocular ischemic change was observed during the ophthalmic examination. Aortography and computed tomography angiography (CTA) showed nearly total occlusion of the bilateral CCA. Thus, OIS with BCCAO was diagnosed. The vision in the left eye improved to 30/100 after carotid artery stenting for the left common carotid artery. Conclusions BCCAO may be present in patients with Sjögren’s syndrome. Large vessel abnormalities should be considered when acute visual loss is found in a patient with Sjögren’s syndrome.
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Affiliation(s)
- Yi Wan
- Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Hung-Chi Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan.,Department of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan.,Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chia-Yi Lee
- Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Hung-Yu Lin
- Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua, Taiwan.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Exercise and Health Promotion, Chung Chou University of Science and Technology, Changhua, Taiwan.,Department of Optometry, Chung Shan Medical University, Taichung, Taiwan
| | - Chan-Wei Nien
- Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua, Taiwan. .,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan. .,Department of Optometry, Central Taiwan University of Science and Technology, Taichung, Taiwan.
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10
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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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11
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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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12
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Ogawa S, Ohgaki F, Mizuta R, Furuta Y, Fujitani S, Fujimoto S, Ota T. Two cases of symptomatic common carotid artery occlusion treated by carotid endarterectomy with L-shaped ministernotomy. Surg Neurol Int 2020; 11:1. [PMID: 31966920 PMCID: PMC6969376 DOI: 10.25259/sni_463_2019] [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: 12/03/2019] [Accepted: 12/12/2019] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Common carotid artery occlusion (CCAO) is rare. Symptomatic lesions are resistant to medical treatment and revascularization are often required, but there is no consensus on the treatment of CCAO. In this paper, two cases of symptomatic CCAO treated by carotid endarterectomy (CEA) with L-shaped ministernotomy, in which the lesions extended to the beginning part of the CCA, are reported. CASE DESCRIPTION Case 1 involved a 74-year-old man who presented with transient left limb numbness and an abnormal right visual field. Cerebrovascular angiography showed that the right CCA was occluded immediately after its origin and blood was supplied from the posterior circulation. CEA was performed with an L-shaped ministernotomy that allowed exposure of the CCA origin with minimal invasion. There were no complications associated with the sternal incision and he was discharged with a modified Rankin Scale (mRS) score of 0. Case 2 involved a 70-year-old man who presented with left half-blindness. Magnetic resonance imaging showed infarction in the right posterior cerebral artery region and neck echo showed CCA pseudo occlusion just before the carotid bulb. A new infarction in the right middle cerebral artery region developed during hospitalization. CEA with partial sternotomy was performed. The patient was rehabilitated with no deterioration of neurological findings and transferred with an mRS score of 3. CONCLUSION There were no complications resulting from partial sternotomy in the two cases presented. CEA with partial sternotomy could be an effective treatment option for CCAO in which the internal carotid artery is patent and thrombus extends to the proximal CCA.
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Affiliation(s)
- Shotaro Ogawa
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
| | - Fukutaro Ohgaki
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
| | - Ryosuke Mizuta
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
| | - Yasuyuki Furuta
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
| | - Shigeta Fujitani
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
| | - So Fujimoto
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
| | - Takahiro Ota
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
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13
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Rattan A, Kataria R, Kumar A, Azam Q. Blunt carotid injury with thrombotic occlusion: Is an intervention always required for best outcome? Trauma Case Rep 2019; 24:100263. [PMID: 31872027 PMCID: PMC6911937 DOI: 10.1016/j.tcr.2019.100263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2019] [Indexed: 01/26/2023] Open
Abstract
Blunt cerebrovascular injuries are rare, comprises of 0.08 to 0.33% of all traumatic blunt injuries. Depending on the grade of severity, they may heal with minimal consequences or may lead to debilitating and devastating stroke. Surgically accessible lesions are infrequent and hence endovascular management is preferred modality for high-grade lesions. We hereby present a case of complete thrombosis of the common carotid artery, which couldn't receive either surgical or endovascular treatment due to low resource settings. The patient developed a stroke after 18 h of trauma, which, however, recovered completely and dramatically within 96 h. To the best of our knowledge, such rapid and complete recovery from stroke secondary to blunt carotid injury managed non-operatively hasn't been reported in literature so far. Our report adds to the scarce but growing body of evidence recommending conservative management in BCVI in absence of enlarging pseudoaneurysm and dissection with near-complete stenosis.
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Affiliation(s)
- Amulya Rattan
- Department of Trauma Surgery & Critical Care, Trauma Center, AIIMS Rishikesh, India
| | - Ruby Kataria
- Department of Trauma Surgery & Critical Care, Trauma Center, AIIMS Rishikesh, India
| | - Ajay Kumar
- Department of Trauma Surgery & Critical Care, Trauma Center, AIIMS Rishikesh, India
| | - Quamar Azam
- Department of Trauma Surgery & Critical Care, Trauma Center, AIIMS Rishikesh, India
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14
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Wang J, Zheng C, Hou B, Huang A, Zhang X, Du B. Four collateral circulation pathways were observed after common carotid artery occlusion. BMC Neurol 2019; 19:201. [PMID: 31429719 PMCID: PMC6701128 DOI: 10.1186/s12883-019-1425-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 08/07/2019] [Indexed: 11/29/2022] Open
Abstract
Background Common carotid artery (CCA) occlusion (CCAO) is a rare condition. Owing to collateral circulation, ipsilateral internal carotid artery (ICA) and external carotid artery (ECA) are often patent. Methods This study included 16 patients with unilateral CCAO and patent ipsilateral ICA and ECA. The pathways which supplied ICA were investigated by digital subtraction angiography (DSA), transcranial Doppler (TCD), magnetic resonance angiography (MRA) and computed tomography angiography (CTA). Results In all 16 patients, TCD found antegrade blood flow in ipsilateral ICA, which was supplied by retrograde blood flow in ipsilateral ECA through carotid bifurcation. We call this phenomenon “ICA steal”. DSA and CTA discovered four pathways of ICA steal, including 1) ipsilateral vertebral artery – occipital artery – ECA – ICA, 2) ipsilateral thyrocervical trunk or costocervical trunk – ascending cervical artery or deep cervical artery – occipital artery – ECA – ICA, 3) contralateral ECA – contralateral superior thyroid artery – ipsilateral superior thyroid artery – ipsilateral ECA – ICA, and 4) ipsilateral thyrocervical trunk – inferior thyroid artery – superior thyroid artery – ECA – ICA. Conclusions ICA is possible to be patent and supplied by several collateral circulation pathways after CCAO.
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Affiliation(s)
- Jianan Wang
- Department of Postgraduate, Third Military Medical University, Chongqing, China.,Department of Neurology, General Hospital of the PLA Rocket Force, No.16 Xinjiekouwai Street, Xicheng District, Beijing, 100088, China
| | - Chengrong Zheng
- Department of Cardiovascular Medicine, General Hospital of the PLA Rocket Force, No.16 Xinjiekouwai Street, Xicheng District, Beijing, 100088, China
| | - Bei Hou
- Department of Critical Care Medicine, General Hospital of the PLA Rocket Force, No.16 Xinjiekouwai Street, Xicheng District, Beijing, 100088, China
| | - Aihua Huang
- Department of Neurology, General Hospital of the PLA Rocket Force, No.16 Xinjiekouwai Street, Xicheng District, Beijing, 100088, China
| | - Xiongwei Zhang
- Department of Neurology, General Hospital of the PLA Rocket Force, No.16 Xinjiekouwai Street, Xicheng District, Beijing, 100088, China.
| | - Bin Du
- Department of Neurointervention, General Hospital of the PLA Rocket Force, No.16 Xinjiekouwai Street, Xicheng District, Beijing, 100088, China.
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15
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Maltezos C, Anastasiadou C, Papapetrou A, Galyfos G, Sachmpazidis I, Papacharalampous G. Symptomatic Bilateral Carotid Artery Occlusion: An Uncommon Pattern of Carotid Pathology. Vasc Specialist Int 2018; 34:31-34. [PMID: 29984215 PMCID: PMC6027800 DOI: 10.5758/vsi.2018.34.2.31] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 03/03/2018] [Accepted: 03/16/2018] [Indexed: 11/30/2022] Open
Abstract
We report an unusual case of an 83-year-old man who was admitted with dizziness and repeated drop attacks. He was diagnosed with bilateral carotid artery occlusion and he underwent a left subclavian to left carotid bypass with ringed polytetrafluoroethylene graft. The patient’s postoperative course was uneventful and no symptoms presented during a 6-month follow-up. Finally, we discuss on proper management of such patients.
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Affiliation(s)
| | | | | | - George Galyfos
- Department of Vascular Surgery, KAT General Hospital, Athens, Greece
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16
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Wang X, Liu Y, Bai J, Zhi K, Qu L. Ring-Stripping Retrograde Endarterectomy for Treatment of Common Carotid Artery Occlusion: A Minimally Invasive, Effective Procedure. Ann Vasc Surg 2018; 53:36-43. [PMID: 29885429 DOI: 10.1016/j.avsg.2018.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 03/26/2018] [Accepted: 04/02/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND To evaluate the efficacy and safety of in situ ring-stripping retrograde carotid endarterectomy (IS-RRCEA) in long-segment, symptomatic, chronic common carotid artery occlusion (CCAO). METHODS Thirty-nine patients (24 men; 15 women) with symptomatic chronic CCAO who underwent IS-RRCEA in our center were included retrospectively. The mean age of the men was significantly less than that of the women (59.6 ± 5.8 vs. 67.8 ± 6.3 years; P < 0.001). Risk factors, clinical characteristics, and CCAO classification of patients and effectiveness and safety of IS-RRCEA were analyzed. RESULTS Patients presented with the following symptoms: dizziness (6; 15.4%), transient ischemic attack (TIA; 33; 84.6%), and decreased vision (15; 38.5%). IS-RRCEA was performed on the left side in 25 (64.1%) cases and on the right side in 14 (35.9%) cases. The technical success rate of the procedure was 100%. Cerebral perfusion on the ipsilateral site improved in all patients. In the postoperative period, stroke and myocardial infarction occurred in one patient, and recurrent laryngeal nerve damage occurred in another; these patients' symptoms mostly resolved except for residual paresis in the stroke patient. Thirty-eight patients (97.4%) were followed for a mean of 29 ± 13.3 months after the IS-RRCEA; in 1-year follow-up, 31 patients (31/33; 93.9%) with preoperative TIA have had no TIAs; 2 patients (2/33; 6.1%) have fewer TIAs. Two patients (2/6; 33.3%) with preoperative dizziness have had no dizziness, and 4 (4/6; 66.7%) have had fewer episode of dizziness, no recurrent stenosis (>50%), or recognized occlusion. CONCLUSIONS Our single-center experience indicates that IS-RRCEA is an effective treatment for selected types of CCAO. Studies of the operation in larger populations with longer term follow-up should be conducted.
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Affiliation(s)
- Xiaomin Wang
- Department of Vascular and Endovascular Surgery, Changzheng Hospital Affiliated to the Second Military Medical University, Shanghai, China
| | - Yandong Liu
- Department of Vascular and Endovascular Surgery, Changzheng Hospital Affiliated to the Second Military Medical University, Shanghai, China
| | - Jun Bai
- Department of Vascular and Endovascular Surgery, Changzheng Hospital Affiliated to the Second Military Medical University, Shanghai, China
| | - Kangkang Zhi
- Department of Vascular and Endovascular Surgery, Changzheng Hospital Affiliated to the Second Military Medical University, Shanghai, China
| | - Lefeng Qu
- Department of Vascular and Endovascular Surgery, Changzheng Hospital Affiliated to the Second Military Medical University, Shanghai, China.
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