A case of curative revascularization with carotid endarterectomy following thrombectomy for middle cerebral artery occlusion caused by a carotid web
Rintaro YokoyamaKoichi HaraguchiKazumi OganeYuki NakamuraSeiichiro ImatakaTakehiro SagaNoriaki HanyuNobuki MatsuuraKazuyoshi WatanabeTakeo Itô
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Endarterectomy
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Carotid endarterectomy (CEA) is a widespread and safe procedure associated with very little risk. Only at our hospital surgeons perform nearly 1000 of these surgeries annually, with serious complications occurring extremely rarely[1]. Cerebral ischemic events due to external carotid artery (ECA) thrombosis following a successful internal carotid artery (ICA) endarterectomy is one of such complications. We present a case of ECA thrombosis, following ICA endarterectomy that caused ischemic events.
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Carotid endarterectomy has been a widely used method of preventing primary or secondary cerebrovascular ischemic events since the 1950s. Over the past several years, the interest in this surgical procedure has increased due to the publication of several large randomized trials comparing best medical therapy (antithrombotic) with carotid endarterectomy. The North American Symptomatic Carotid Endarterectomy Trial (NASCET) has demonstrated a risk reduction of 65% in patients who underwent carotid endarterectomy for symptomatic carotid stenosis. The Asymptomatic Carotid Atherosclerosis Study (ACAS) also demonstrated a benefit of carotid endarterectomy, however, in a group of asymptomatic patients. There was an approximate reduction of 6% in stroke in patients undergoing carotid endarterectomy in this series. Carotid endarterectomy is the treatment of choice in patients with symptomatic extracranial carotid atherosclerosis. Data is now emerging that this is also an effective therapy in patients with asymptomatic carotid stenosis. The perioperative stroke risk by the surgeon performing the procedure and the patient's co‐morbid medical conditions are important factors to consider before proceeding with surgical treatment of this disorder.
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Octogenarians were not included in the major trials of carotid endarterectomy. Concern has been expressed about the role of carotid endarterectomy in this age group. This concern is based in part on uncertainty about the long-term survival of elderly patients after carotid endarterectomy. The aim of the present study was to assess relative survival in those patients >or=80 years of age undergoing carotid endarterectomy.A population-based record linkage study of all patients who underwent carotid endarterectomy from 1988 to 1998 in Western Australia was undertaken. Long-term relative survival after carotid endarterectomy was assessed against age- and sex-matched controls.During the period 1988 to 1998, 1796 (1306 male, 490 female) cases were identified. There were 151 patients >or=80 years of age. The cumulative survival at 5 years was 64.9% for those >or=80 years of age compared with 80.1% for those <80 years of age. Relative survival at 5 years was 118% (95% CI, 102 to 134) for those >or=80 years of age compared with 94.7% (95% CI, 92 to 97) for those <80 years of age.Long-term relative survival after carotid endarterectomy in patients >or=80 years of age was better than that of an age-matched population. The likelihood of living long enough to gain benefit from a carotid endarterectomy is not jeopardized by being too old.
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BACKGROUND AND PURPOSE: Current indications for carotid endarterectomy are determined by balancing the relative risks of surgery with the benefits of reduced risk of subsequent stroke. Our purpose was to use MR perfusion imaging to assess patients being considered for carotid endarterectomy and to monitor sequential changes in MR perfusion characteristics after surgery. In particular, we wished to determine whether this technique could be used to detect changes that might be related to post‐ carotid endarterectomy hyperemia. METHODS: We used a single-section gradient-recalled echo sequence to investigate 14 patients being examined before possible surgery for carotid artery disease. In the 12 patients in whom carotid endarterectomy was performed, sequential studies were performed 3 to 5 days after surgery and at 3 months. Analysis of bolus-arrival-time (BAT) images was performed. RESULTS: Significant delays in preoperative BAT images of 0.89 seconds (range, 0.05 to 3.22 seconds) were apparent between hemispheres. Excluding the two patients with contralateral internal carotid artery (ICA) occlusion, early arrival, possibly indicating postoperative hyperemia, was seen in five patients immediately after carotid endarterectomy but resolved within 3 to 5 months after surgery. CONCLUSION: MR perfusion imaging shows differences in BAT between hemispheres in patients with ICA stenosis. Changes in perfusion characteristics after carotid endarterectomy are complex, and early BAT on the operative side can occur soon after endarterectomy in over half those patients without an occluded contralateral vessel. The significance of these findings with regard to patient outcome and risk of postoperative hyperemia requires further investigation.
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ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Unlu A, Durukan A. Safe carotid endarterectomy: “one fits all strategy”. Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery. 2020;17(3):137-142. doi:10.5114/kitp.2020.99077. APA Unlu, A., & Durukan, A. (2020). Safe carotid endarterectomy: “one fits all strategy”. Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery, 17(3), 137-142. https://doi.org/10.5114/kitp.2020.99077 Chicago Unlu, Ahmet, and Ahmet Baris Durukan. 2020. "Safe carotid endarterectomy: “one fits all strategy”". Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery 17 (3): 137-142. doi:10.5114/kitp.2020.99077. Harvard Unlu, A., and Durukan, A. (2020). Safe carotid endarterectomy: “one fits all strategy”. Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery, 17(3), pp.137-142. https://doi.org/10.5114/kitp.2020.99077 MLA Unlu, Ahmet et al. "Safe carotid endarterectomy: “one fits all strategy”." Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery, vol. 17, no. 3, 2020, pp. 137-142. doi:10.5114/kitp.2020.99077. Vancouver Unlu A, Durukan A. Safe carotid endarterectomy: “one fits all strategy”. Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery. 2020;17(3):137-142. doi:10.5114/kitp.2020.99077.
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Aims: Selective endarterectomy is described as extraction of atheromatous plaque through an arteriotomy made starting from common carotid artery (CCA) and extending to external carotid artery (ECA). The aim of this study was to report the initial experience selective endarterectomy technique at our department.
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