scholarly journals Combined therapeutic approach of intra-arterial thrombolysis and carotid endarterectomy in selected patients with acute thrombotic carotid occlusion

2001 ◽  
Vol 34 (3) ◽  
pp. 532-540 ◽  
Author(s):  
Masaaki Uno ◽  
Fusamitsu Hamazaki ◽  
Takeshi Kohno ◽  
Akira Sebe ◽  
Hidehisa Horiguchi ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Therapeutic Approach ◽  
Carotid Occlusion ◽  
Arterial Thrombolysis

Prospective study of carotid endarterectomy and contralateral carotid occlusion

1996 ◽  
Vol 83 (10) ◽  
pp. 1370-1372 ◽  
Author(s):  
A. F. Da Silva ◽  
P. McCollum ◽  
T. Szymanska ◽  
L. De Cossart
Keyword(s):  
Prospective Study ◽  
Carotid Endarterectomy ◽  
Carotid Occlusion

Correlation of Regional Cerebral Blood Flow with Ischemic Electroencephalographic Changes during Sevoflurane-Nitrous Oxide Anesthesia for Carotid Endarterectomy 

1998 ◽  
Vol 88 (4) ◽  
pp. 892-897 ◽  
Author(s):  
Robert E. Grady ◽  
Margaret R. Weglinski ◽  
Frank W. Sharbrough ◽  
William J. Perkins
Keyword(s):  
Blood Flow ◽  
Nitrous Oxide ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Cerebral Blood Flow ◽  
Carotid Endarterectomy ◽  
Regional Cerebral Blood Flow ◽  
Carotid Occlusion ◽  
Regional Cerebral Blood ◽  
Eeg Changes

Background Carotid endarterectomy necessitates temporary unilateral carotid artery occlusion. Critical regional cerebral blood flow (rCBF) has been defined as the rCBF below which electroencephalographic (EEG) changes of ischemia occur. This study determined the rCBF50, the rCBF value at which 50% of patients will not demonstrate EEG evidence of cerebral ischemia with carotid cross-clamping. Methods Fifty-two patients undergoing elective carotid endarterectomy were administered 0.6-1.2% (0.3-0.6 minimum alveolar concentration) sevoflurane in 50% nitrous oxide (N2O). A 16-channel EEG was used for monitoring. The washout curves from intracarotid 133Xenon injections were used to calculate rCBF before and at the time of carotid occlusion by the half-time (t(1/2)) technique. The quality of the EEG with respect to ischemia detection was assessed by an experienced electroencephalographer. Results Ischemic EEG changes developed in 5 of 52 patients within 3 min of carotid occlusion at rCBFs of 7, 8, 11, 11, and 13 ml x 100 g(-1) x min(-1). Logistic regression analysis was used to calculate an rCBF50 of 11.5 +/- 1.4 ml x 100 g(-1) x min(-1) for sevoflurane. The EEG signal demonstrated the necessary amplitude, frequency, and stability for the accurate detection of cerebral ischemia in all patients within the range of 0.6-1.2% sevoflurane in 50% N2O. Conclusions The rCBF50 of 0.6-1.2% sevoflurane in 50% N2O, as determined using logistic regression analysis, is 11.5 +/- 1.4 ml 100 g(-1) x min(-1). Further, in patients anesthetized in this manner, ischemic EEG changes due to carotid occlusion were accurately and rapidly detected.

Comparison of postoperative results between carotid endarterectomy and carotid artery stenting for patients with contralateral carotid artery occlusion: A meta-analysis

Vascular ◽  
2019 ◽  
Vol 27 (6) ◽  
pp. 595-603 ◽  
Author(s):  
Wen-Qiang Xin ◽  
Yan Zhao ◽  
Tie-Zhu Ma ◽  
Yi-Kuan Gao ◽  
Wei-Han Wang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Artery Stenting ◽  
Meta Analysis ◽  
Carotid Occlusion ◽  
Cochrane Library ◽  
Post Procedure ◽  
Pubmed Database ◽  
Significant Difference

Objectives The purpose of this study was to conduct a meta-analysis to systematically compare the safety and efficacy of carotid endarterectomy and carotid artery stenting in contralateral carotid occlusion patients who needed reperfusion. Methods This study retrieved potential academic articles comparing results between carotid endarterectomy and carotid artery stenting for patients with contralateral carotid occlusion from the MEDLINE database, the PubMed database the EMBASE database, and the Cochrane Library from January 1990 to May 2018. The reference articles for the identified studies were carefully reviewed to ensure that all available documents were represented in the study. Results Four retrospective cohort study involving 6252 patients with contralateral carotid occlusion were included in our meta-analysis. During 30-day follow-up, there is significant difference in post-procedure mortality (odds ratio (OR) = 0.476, 95% confidence interval (CI) (0.306–0.740), P = 0.001); no significant differences are not found in post-procedure stroke (risk difference (RD) = 0.002, 95%CI (–0.007 to 0.011); P = 0.631), myocardial infarction (RD = 0.003, 95%CI (–0.002 to 0.008); P = 0.301), and transient cerebral ischemia (RD = 1.059, 95%CI (–0.188 to 5.964); P = 0.948). Conclusions Carotid endarterectomy was associated with a lower incidence of mortality compared to carotid artery stenting for patients with contralateral carotid occlusion. Regarding stroke, myocardial infarction, and transient ischemic attack, there was no significant difference between the two groups. More randomized controlled trials and prospective cohorts are necessary to help further clarify the ideal approach for these patients.

scholarly journals Carotid Endarterectomy with Routine Shunt for Patients with Contralateral Carotid Occlusion

2017 ◽  
Vol 23 (5) ◽  
pp. 227-232 ◽  
Author(s):  
Jie Kong ◽  
Jinyong Li ◽  
Zhidong Ye ◽  
Xueqiang Fan ◽  
Jianyan Wen ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Carotid Occlusion

scholarly journals Contributions of Anesthesiology to the Surgical Treatment of Cerebrovascular Disease

2008 ◽  
Vol 108 (4) ◽  
pp. 756-758 ◽  
Author(s):  
Charles D. Collard ◽  
James M. Anton ◽  
John R. Cooper ◽  
N Martin Giesecke ◽  
David S. Warner
Keyword(s):  
Cerebral Ischemia ◽  
General Anesthesia ◽  
Carotid Endarterectomy ◽  
Local Anesthesia ◽  
Collateral Circulation ◽  
Carotid Arteries ◽  
Arterial Oxygen Tension ◽  
Carotid Occlusion ◽  
Arterial Oxygen ◽  
Cerebral Metabolic Rate

Increased tolerance to cerebral ischemia produced by general anesthesia during temporary carotid occlusion. By B. A. Wells, A. S. Keats, and D. A. Cooley. Surgery 1963; 54:216-23. Local anesthesia with little or no preoperative sedation is currently recommended as the anesthetic of choice for temporary carotid occlusion during carotid endarterectomy. Purported advantages include minimal circulatory and respiratory changes from the local anesthetic, and constant verbal contact can be maintained with the patient so that neurologic changes are promptly recognized. However, local anesthesia may not be satisfactory in uncooperative or semiconscious patients. We therefore undertook a trial of general anesthesia in 56 consecutive patients undergoing carotid endarterectomy. Patients were induced in standardized fashion using intravenous thiopental (100-400 mg), atropine (0.2 mg), and succinylcholine (40-80 mg). Cyclopropane, along with deliberate hypercapnia and hypertension, was used for anesthesia maintenance. All patients tolerated carotid occlusion for periods of up to 30 min during general anesthesia without shunt, bypass, or hypothermia. Except for one patient, electroencephalogram evidence of cerebral ischemia was not apparent during occlusion, and no patient suffered postoperative neurologic sequela. Twenty percent of patients who had their carotid arteries occluded preoperatively for 30-60 s without general anesthesia suffered convulsions. These data suggest that general anesthesia increased the tolerance to cerebral ischemia. Potential mechanisms involved might include: 1) decreased cerebral metabolic rate for oxygen; 2) increased cerebral blood flow from hypercapnia; 3) increased arterial oxygen tension; and 4) recruitment of new routes of collateral circulation.

scholarly journals Improvement in Cerebral and Ocular Hemodynamics Early after Carotid Endarterectomy in Patients of Severe Carotid Artery Stenosis with or without Contralateral Carotid Occlusion

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Jian Wang ◽  
Weici Wang ◽  
Bi Jin ◽  
Yanrong Zhang ◽  
Ping Xu ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Cerebral Artery ◽  
Reverse Flow ◽  
Color Doppler ◽  
Blood Perfusion ◽  
Color Doppler Imaging ◽  
Carotid Occlusion ◽  
Doppler Imaging ◽  
Ipsilateral Side ◽  
Anterior Circulation

Purpose. To investigate the alternation in cerebral and ocular blood flow velocity (BFV) in patients of carotid stenosis (CS) with or without contralateral carotid occlusion (CO) early after carotid endarterectomy (CEA).Patients and Methods. Nineteen patients underwent CEA for ≥50% CS. Fourteen patients had the unilateral CS, and five patients had the ipsilateral CS and the contralateral CO. Transcranial Doppler (TCD) and Color Doppler Imaging (CDI) were performed before and early after CEA.Results. In patients with unilateral CS, significant improvements in BFV were observed in anterior cerebral artery (ACA) and middle cerebral artery (MCA) on the ipsilateral side after CEA. In patients of ipsilateral CS and contralateral CO, significant improvements in BFV were observed in the ACA and MCA not only on the ipsilateral side but also on the contralateral side postoperatively. The ipsilateral ophthalmic artery (OA) retrograde flows in two patients were recovered to anterograde direction following CEA. The BFV in short posterior ciliary artery (SPCA) of the ipsilateral side significantly increased postoperatively irrespective of the presence of contralateral CO.Conclusions. CEA improved cerebral anterior circulation hemodynamics especially in patients of unilateral CS and contralateral CO, normalized the OA reverse flow, and increased the blood perfusion of SPCA.

scholarly journals Cerebral Neuromonitoring During Carotid Endarterectomy and Impact of Contralateral Internal Carotid Occlusion

2018 ◽  
Vol 68 (2) ◽  
pp. 652-653
Author(s):  
D. Sef ◽  
A. Skopljanac-Macina ◽  
M. Milosevic ◽  
A. Skrtic ◽  
V. Vidjak
Keyword(s):  
Carotid Endarterectomy ◽  
Internal Carotid ◽  
Carotid Occlusion ◽  
Internal Carotid Occlusion

Current Status of Carotid Endarterectomy for Atheromatous Disease

Neurosurgery ◽  
1983 ◽  
Vol 13 (6) ◽  
pp. 718-723 ◽  
Author(s):  
Christopher M. Loftus ◽  
Donald O. Quest
Keyword(s):  
Surgical Treatment ◽  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Neurological Deficit ◽  
Carotid Occlusion ◽  
Current Status ◽  
Carotid Surgery ◽  
Transient Ischemic Attacks ◽  
Carotid Disease ◽  
Symptomatic Carotid

Abstract The authors discuss the indications for both elective and emergency carotid endarterectomy. Reports on the surgical treatment of asymptomatic bruit and contralateral carotid stenosis are reviewed. The results of endarterectomy for symptomatic carotid disease, including transient ischemic attacks, acute neurological deficit, and complete carotid occlusion, are discussed. The complications and risks of carotid surgery are also presented.

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