Chronic Common Carotid Artery Occlusion Research Articles

A Case of Symptomatic Internal Carotid Artery Stenosis and Concomitant Ipsilateral Chronic Common Carotid Artery Occlusion Treated with Carotid Endarterectomy

A Case of Symptomatic Internal Carotid Artery Stenosis and Concomitant Ipsilateral Chronic Common Carotid Artery Occlusion Treated with Carotid Endarterectomy

Long-term outcomes of axillary to carotid bypass for symptomatic patients with chronic common carotid artery occlusion

ObjectiveRelatively little is known about the natural history of atherosclerotic common carotid artery occlusion and optimal treatment of these patients is still unclear. The aim of this retrospective study was to evaluate the immediate- and long-term outcomes of axillary to carotid bypass with polytetrafluoroethylene graft for symptomatic patients with chronic common carotid artery occlusion. MethodsFrom March 2001 to December 2017, 58 symptomatic patients (41 men; mean age 64.7 years) with chronic common carotid artery occlusion underwent axillary to carotid bypass at one academic hospital. The clinical data of this patient cohort were retrospectively analyzed. The cumulative graft patency, overall survival, freedom from symptoms, and freedom from ipsilateral stroke were calculated with Kaplan-Meier method. ResultsThirty-three patients presented with transient ischemic attack and 25 patients presented with minor stroke. At 30 days after bypass, the overall perioperative complication rate was 3.4% (2/58). Mild injuries of brachial plexus occurred in one (1.7%) patient and myocardial infarction occurred in one (1.7%) patient. No perioperative stroke or death occurred. The median follow-up was 51 months (range, 12-203) for this series. The cumulative graft patency rates at 1, 3, 5, and 10 years were 100%, 100%, 94%, and 83%, respectively. The cumulative freedom from symptoms rates at 1, 3, 5, and 10 years were 100%, 100%, 94%, and 75%, respectively. The cumulative freedom from ipsilateral stroke rates at 1, 3, 5, and 10 years were 100%, 100%, 94%, and 82%, respectively. The overall survival rates at 1, 3, 5, and 10 years were 98%, 89%, 81%, and 67%, respectively. ConclusionsAxillary to carotid bypass with polytetrafluoroethylene graft is safe and durable for symptomatic patients with chronic common carotid artery occlusion. The results of this study should be confirmed with a larger, randomized controlled trial in future.

Ring-Stripping Retrograde Endarterectomy for Treatment of Common Carotid Artery Occlusion: A Minimally Invasive, Effective Procedure

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). 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±6.3years; P<0.001). Risk factors, clinical characteristics, and CCAO classification of patients and effectiveness and safety of IS-RRCEA were analyzed. 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±13.3months 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. 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.

Thyrocervical trunk—external carotid artery bypass for positional cerebral ischemia due to common carotid artery occlusion

Medically refractory positional cerebral ischemia (PCI) and concomitant orthostatic hypotension associated with chronic common carotid artery (CCA) occlusion are rare. In this technical report, the authors describe an extracranial bypass in which the thyrocervical trunk was used as a donor vessel to treat three cases of CCA occlusion with PCI. Postoperatively, although orthostatic hypotension remained, ischemia-related symptoms resolved in all three patients and long-term graft patency was demonstrated. It is possible to treat cerebral ischemia due to CCA occlusion with extracranial bypass surgery. In these patients, the thyrocervical trunk proved to be a suitable donor vessel for the reconstitution of blood flow within the external carotid artery.

Thyrocervical trunk–external carotid artery bypass for positional cerebral ischemia due to common carotid artery occlusion

Medically refractory positional cerebral ischemia and concomitant orthostatic hypotension associated with chronic common carotid artery (CCA) occlusion are rare. The authors detail their experience with three cases treated exclusively by an extracranial bypass in which the thyrocervical trunk was used as the donor vessel. Postoperatively grafts were patent and symptoms resolved in all three patients, although orthostatic hypotension remained. Postural cerebral ischemia due to CCA occlusion can be treated by extracranial bypass surgery. The thyrocervical trunk is a suitable donor for reconstruction of the external carotid artery in these cases.