Bilateral Carotid Endarterectomy Research Articles

Influence of vein-patch angioplasty on carotid endarterectomy healing.

We studied the influence of venous patching on the patency, endothelial regeneration, and wall healing of endarterectomized carotid arteries in a canine model. Thirteen dogs underwent bilateral common carotid endarterectomies (intimectomy and partial media excision). In each dog, one artery was closed by continuous suture and the contralateral artery was closed by external jugular vein-patch angioplasty; arteries were excised at two postoperative intervals (two to three and four to five weeks) for light, scanning, and transmission electron microscopy. The patency of arteries closed primarily (9/13 [69%]) was not significantly different compared with arteries closed with venous patches (12/13 [92%]). By scanning electron microscopy, regeneration of the endothelial monolayer occurred by migration from the endarterectomy end points and suture lines. Despite survival of the vein-patch endothelium, the rate and pattern of reendothelialization was not altered by venous patching. In both patched and unpatched vessels, endothelial regeneration was incomplete at two to three weeks and completed by four to five weeks. The histologic characteristics of the endarterectomized arterial wall after operation were also not influenced by the closure technique. In contrast with the healing artery wall, vein-patch walls did not develop a thickened intima. Although venous patching does not influence early patency, endothelial regeneration, or wall healing after endarterectomy, vein-patch angioplasty does increase vessel diameter and prevents the development of circumferential intimal thickening, attributes that are beneficial in minimizing restenosis.

Staged bilateral carotid endarterectomy

In a series of 56 staged bilateral carotid endarterectomies, new neurologic symptoms developed in 5% and 20% following the first and second procedure, respectively. All complications were transient or minor. The incidence of postendarterectomy hypertension was significantly higher following the second procedure, when operations were staged less than 3 weeks apart. A correlation between these hypertensive episodes and the occurrence of new neurologic symptoms could not be shown. However, as this correlation has been proved in several other reports, bilateral carotid endarterectomy is advised to be staged at least 3 weeks apart. In addition, a conservative attitude towards contralateral asymptomatic lesions is proposed.

Posterior communicating artery visualization in predicting results of carotid endarterectomy for vertebrobasilar insufficiency

Retrospectively, 51 patients who related two or more signs or symptoms of vertebrobasilar insufficiency and possessed concomitant carotid arterial disease were identified. The patient population was separated into two groups based on the presence or absence of an angiographically visualized posterior communicating artery during selective carotid artery injection. All patients had undergone unilateral or staged bilateral carotid endarterectomy. Comparison of postoperative clinical outcome with intracerebral angiographic findings exhibited statistically significant improvement in favor of those patients with at least one visualized posterior communicating artery. There was a greater likelihood of severe vertebral artery stenosis in those patients whose symptoms were not relieved by carotid endarterectomy.

Morphine-Induced Respiratory Depression following Bilateral Carotid Endarterectomy

Morphine-Induced Respiratory Depression following Bilateral Carotid Endarterectomy

Surgical experience with simultaneous bilateral carotid endarterectomies.

Eighty patients who had undergone bilateral carotid endarterectomy at the same operation were reviewed. All operative procedures were performed under general anaesthesia and during systemic heparinization and in all but six cases by using internal shunt. There were three deaths related to the operation representing 3.8% hospital mortality. Transient neurological deficits were noted in four patients (5% incidence) and permanent neurological deficits in four patients (also 5% incidence). A 100% late follow-up after an average period of 48 months revealed that 85.7% of the long-term survivors were functionally normal or improved. There were ten late deaths with heart disease accounting for 50% and stroke 30%.

Simultaneous Bilateral Carotid Endarterectomies

Twelve patients with bilateral symptomatic lesions of internal carotid arteries have had bilateral carotid endarterectomy at single operations without complications. These were patients up to age 80 who had prior mycardial infarction, stroke with recovery, and hemispheric and nonhemispheric episodes. Neurologist's clearance and three- or four-vessel intracranial-extracranial angiography preceded all operations, which were performed with the patient under general anesthesia. Stump pressure measurements were the principal guideline of adequacy of collateral flow and predictor of safe outcome. The safety of this concept of bilateral operations during one anesthesia can eliminate uncertainties of sequence and timing, obviate delay and indecision, and avoid the hazards of a second anesthetic-operative experience.

Electrocardiographic changes after surgical manipulation of the carotid arteries (author's transl)

Seven patients showed deep symmetrical T wave inversions in their electrocardiograms after bilateral carotid endarterectomy. There was no evidence for myocardial ischaemia. These changes reversed completely within three months. Similar disturbances of repolarisation were seen in rats after bilateral denervation of the carotid sinus. These changes are probably of neurogenic origin, like those seen with central nervous system disorders. Their origin seems to be correlated to the acute imbalance of the autonomic innervation of the heart after surgical disturbance of baro- and chemoreceptors.

Electrocardiographic changes after bilateral carotid endarterectomy.

WE have observed striking electrocardiographic changes that simulated subendocardial infarction in patients without clinical evidence of infarction who had undergone bilateral carotid endarterectomy.Patients, Methods and ResultsFive consecutive patients (Table 1) with transient ischemic attacks were examined with standard 12-lead electrocardiograms (Marquette electrocardiograph) before and after staged (five to 25 days apart), bilateral, standard-bifurcation carotid endarterectomies without use of an internal shunt. No patient experienced hypotension during or after the operation or was on a drug known to influence the electrocardiogram. Serial measurements of glutamic oxalacetic tramsaminase and isoenzymes of lactic dehydrogenase were within normal limits before and after . . .

EFFECT OF CAROTID ENDARTERECTOMY ON CAROTID CHEMORECEPTOR AND BARORECEPTOR FUNCTION IN MAN

Abstract The ventilatory response to inhaled carbon dioxide was measured during hyperoxia (Pao2 over 200 torr) and hypoxia (Pao2 of 40 torr) in 14 patients before and one to nine weeks after carotid endarterectomy for transient attacks of cerebral ischemia. Ventilatory response was unchanged in the seven patients undergoing unilateral carotid endarterectomy. All seven patients undergoing staged bilateral procedures lost their ventilatory response to hypoxia and showed a 5.8-torr increase in mean resting Paco2. In four patients studied, hypoxia at constant Paco2 increased systolic blood pressure before and clearly decreased it after bilateral surgery. Bilateral carotid endarterectomy results in a loss of carotid-body function, with loss of the usual compensatory respiratory or circulatory responses to hypoxia. Baroreceptor activity, as measured by the standard Valsalva maneuver, was minimal before and showed no consistent change as a result of surgery.

Bilateral carotid endarterectomy with attempted preservation of carotid body function.

Hickey, Robert F. M.D.; Ehrenfeld, William K. M.D., F.F.C.S.; Hamilton, F. Norman M.D.; Labson, C. Philip Jr M.D.† Author Information

Effect of carotid endarterectomy on carotid chemoreceptor and baroreceptor function in man.

Abstract The ventilatory response to inhaled carbon dioxide was measured during hyperoxia (Pao2 over 200 torr) and hypoxia (Pao2 of 40 torr) in 14 patients before and one to nine weeks after carotid endarterectomy for transient attacks of cerebral ischemia. Ventilatory response was unchanged in the seven patients undergoing unilateral carotid endarterectomy. All seven patients undergoing staged bilateral procedures lost their ventilatory response to hypoxia and showed a 5.8-torr increase in mean resting Paco2. In four patients studied, hypoxia at constant Paco2 increased systolic blood pressure before and clearly decreased it after bilateral surgery. Bilateral carotid endarterectomy results in a loss of carotid-body function, with loss of the usual compensatory respiratory or circulatory responses to hypoxia. Baroreceptor activity, as measured by the standard Valsalva maneuver, was minimal before and showed no consistent change as a result of surgery.

Combined Carotid Endarterectomy and Coronary Bypass Grafting: Risk versus Benefit - A Review

Carotid Endarterectomy (CEA) performed in combination with coronary artery bypass grafting (CABG) have also increased steadily since Bernhard and colleague’s initial report in 1972. Coexistence of symptomatic coronary artery disease and significant carotid artery stenosis ranges from 3.4% to 22%. The incidence of postoperative stroke after CABG ranges from 0.7% to 5%. Coronary revascularization in a patient with internal carotid artery stenosis more than 50% is associated with a postoperative stroke rate of 6%, which increases significantly to more than 16% when stenosis is more than 90%. To reduce the potential risk for postoperative stroke after CABG in patients with significant or symptomatic carotid artery stenosis, many surgeons have advocated combined CABG with unilateral carotid endarterectomy. However, clinical experience with the concomitant approach is conflicting. On the basis of the long-term results, it is estimated that simultaneous carotid endarterectomy and myocardial revascularization in conjunction with cardiopulmonary bypass is a method safe enough to prefer its routine use with acceptable low operative risk and satisfactory long-term morbidity. The overall 30-day mortality of combined CABG with bilateral carotid endarterectomy was 6.1% and that was unrelated to primary cardiac or cerebrovascular events. Favorable outcome also supports the justification for performing concomitant coronary artery bypass grafting with bilateral carotid endarterectomies in selected patients. Key words: Carotid endarterectomy; Coronary Bypass Grafting. DOI: 10.3329/uhj.v6i1.7194University Heart Journal Vol.6(1) 2010 pp.41-44