Internal Carotid Artery Occlusion Research Articles

Flow-augmentation STA-MCA bypass for acute and subacute ischemic stroke due to internal carotid artery occlusion and the role of advanced neuroimaging with hemodynamic and flow-measurement in the decision-making: preliminary data.

A major clinical challenge is the adequate identification of patients with acute (<1 week) and subacute (1-6 weeks) ischemic stroke due to internal carotid artery (ICA) occlusion who could benefit from a surgical revascularization after a failure of endovascular and/or medical treatment. Recently, two novel quantitative imaging modalities have been introduced: (I) quantitative magnetic resonance angiography (qMRA) with non-invasive optimal vessel analysis (NOVA) for quantification of blood flow in major cerebral arteries (in mL/min), and (II) blood oxygenation level-dependent (BOLD) functional magnetic resonance imaging to assess cerebrovascular reactivity (CVR). The aim of this study is to present our cohort of patients who underwent surgical revascularization in the acute and subacute phase of ischemic stroke as well as to demonstrate the importance of hemodynamic and flow assessment for the decision-making regarding surgical revascularization in patients with acute and subacute stroke and ICA-occlusion. Symptomatic patients with acute and subacute ischemic stroke because of persistent ICA-occlusion despite optimal medical/endovascular recanalization therapy who were treated at the Neuroscience Clinical Center of the University Hospital Zurich underwent both BOLD-CVR and qMRA-NOVA to study the hemodynamic and collateral vessel status. Patients selected for surgical revascularization according to our previously published flowchart were included in this prospective cohort study. Repeated NOVA and BOLD-CVR investigations were done after bypass surgery as follow up as well as clinical follow up. Continuous BOLD-CVR and qMRA-NOVA variables were compared using paired Student t-test. Between May 2019 and September 2022, superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery was performed in 12 patients with acute and subacute stroke because of ICA-occlusion despite of optimal endovascular and/or medical treatment prior to the surgery. Impaired BOLD-CVR in the occluded vascular territory [MCA territory: ipsilateral vs. contralateral: -0.03±0.07 vs. 0.11±0.07 %BOLD/mmHgCO2, P<0.001] as well as reduced hemispheric flow with qMRA-NOVA (ipsilateral vs. contralateral: 228.00±54.62 vs. 384.50±70.99 mL/min, P=0.01) were measured indicating insufficient collateralization. Post-operative qMRA-NOVA showed improved hemispheric flow (via bypass) (pre-bypass vs. post-bypass: 236.60±76.45 vs. 334.20±131.33 mL/min, P=0.02) and the 3-month-follow-up with BOLD-CVR showed improved cerebral hemodynamics (MCA territory: pre-bypass vs. post-bypass: -0.01±0.05 vs. 0.06±0.03 %BOLD/mmHgCO2, P=0.02) in all patients studied. Quantitative assessment with BOLD-CVR and qMRA-NOVA allows us to evaluate the pre- and post-operative cerebral hemodynamics and collateral vessel status in patients with acute/subacute stroke due to ICA occlusion who may benefit from surgical revascularization after failure of endovascular/medical treatment.

Acute internal carotid artery occlusion following administration of Andexanet alfa for the reversal of direct factor Xa inhibitors in patients with cerebral hemorrhage

An 87-year-old woman receiving aspirin and apixaban with a history of large artery atherosclerotic stroke, and pulmonary embolism presented to the hospital for aphasia and right hemiplegia. A head CT scan showed 18-ml hematoma in the left thalamus. Low-dose Andexanet alfa was administered 84 minutes after the onset of stroke, and 10 hours and 24 minutes after the last dose of apixaban. Three hours later after admission, she had flaccid hemiplegia and became comatose. CT and CT angiography revealed occlusion of left internal carotid artery (ICA) and no evidence of hematoma expansion. Although repetitive mechanical thrombectomy resulted in recanalization (modified TICI 2b), carotid ultrasound revealed the occlusion of left ICA on next day. On day 7, she died of brain herniation following extensive cerebral infarction. It has been reported that some patients did experience thrombotic events after administration of Andexanet alfa. Our case illustrates that even large vessel occlusion might occur after intravenous injection of Andexanet alfa. Thus, careful follow-up, including cerebrovascular imaging, is required immediately after administration of Andexanet alfa.

Less invasive bonnet bypass with subcutaneous tunneling method for common carotid artery occlusion - A technical note.

Common carotid artery occlusion (CCAO) sometimes requires vascular reconstruction. Ipsilateral superficial temporal artery (STA)-middle cerebral artery (MCA) bypass is unsuitable due to insufficient blood flow to the external carotid artery. The bonnet bypass, one treatment option for CCAO, requires a long coronal incision and bone groove to prevent malposition and collapse of an interposition graft. However, this long incision might lead to skin complications and reduced collateral blood flow. A 60-year-old man who experienced recurrent ischemic stroke presented with the right internal carotid artery occlusion and left CCAO. The left STA was unavailable; however, both branches of his right STA were well-developed. Minimizing skin invasion was a priority because the patient had diabetes mellitus. We performed a right STA parietal branch - right MCA anastomosis, followed by a right STA frontal branch - left radial artery graft (RAG) - left MCA bonnet bypass using small intermittent skin incisions. We drilled a bone groove extending across the entire length of the interposition graft through the small intermittent skin incisions. Furthermore, we applied a right STA-RAG end-to-side anastomosis instead of an endto-end anastomosis to preserve collateral skin anastomosis. Postoperatively, the bypass remained patent, and the patient was discharged without complications. The bonnet bypass is a potential treatment for CCAO, but the procedure is invasive. Our modified bonnet bypass method enables less invasive management, preventing collapse and malposition of the interposition graft and minimizing skin complications.

Endovascular Management of Post-Irradiated Carotid Blowout Syndrome in Patients with Lower Neck Cancers

Lower neck cancers (LNCs) include specific tumour types and have some different vascular supply or collaterals from other head and neck cancers. This prospective study evaluated the outcome of endovascular management of post-irradiated carotid blowout syndrome (PCBS) in patients with LNC by comparing reconstructive management (RE) and deconstructive management (DE). This was a single institute, prospective cohort study. Patients with LNC complicated by PCBS between 2015 and 2021 were enrolled for RE or DE. RE was performed by stent graft placement covering the pathological lesion and preventive external carotid artery (ECA) embolisation without balloon test occlusion (BTO). DE was performed after successful BTO by permanent coil/adhesive agent embolisation of the internal carotid artery (ICA) and ECA to common carotid artery, or ICA occlusion alone if the pathological lesion was ICA only. Cross occlusion included proximal and distal ends of the pathological lesion in all patients. Rebleeding events, haemostatic period, and neurological complications were evaluated. A total of 59 patients (mean age 58.5 years; 56 male) were enrolled, including 28 patients undergoing RE and 31 patients undergoing DE. Three patients originally grouped to DE were transferred to RE owing to failed BTO. The results of RE vs. DE were as follows: rebleeding events, 13/28 (46%) vs. 10/31 (32%) (p = .27); haemostatic period, 9.4 ± 14.0 months vs. 14.2 ± 27.8 months (p = .59); neurological complication, 4/28 (14%) vs. 5/31 (16%) (p = .84); and survival time, 11.8 ± 14.6 months vs. 15.1 ± 27.5 months (p = .61). No difference in rebleeding risk and neurological complications was observed between DE and RE groups. RE could be used as a potential routine treatment for PCBS in patients with LNC.

Repeated ischemic strokes due to infectious arteritis of both internal carotid and basilar arteries as a complication of sphenoiditis and otitis

The article presents a case of a 54-year-old female patient who, over the course of 2 years, suffered 5 cerebrovascular accidents (CVA) due to infectious arteritis of both internal carotid arteries (ICA) and basilar artery as a complication of sphenoiditis and otitis. According to neuroimaging data, the steno-occlusive process in the ICA developed gradually, starting with the intracranial ICA narrowing with the contrast enhancement by vessel wall, the development of its occlusion six months later, and the detection of the extracranial ICA occlusion with the formation of «flame sign» at its mouth a year later. Repeated examination of the cerebrospinal liquid at an early stage of the disease revealed cytosis up to 367/3 and protein 0.66 g/l. The correct diagnosis was established only after 3 years with a retrospective analysis of clinical, neuroimaging, and laboratory data. Therefore, targeted antibiotic therapy was not carried out, which led to the progression of ICA occlusion and repeated strokes. Infectious arteritis should be taken into account in the differential diagnosis of the causes of the ICA occlusive process.

CT angiographic patterns predict carotid pseudo-occlusion in acute ischemic stroke.

Identifying carotid pseudo-occlusion (PO) from true occlusion (TO) has implications in determining the candidacy and feasibility of successful endovascular thrombectomy (EVT) in acute ischemic stroke (AIS). We reviewed the computed tomography angiographic (CTA) patterns differentiating a PO from a TO and analyzed the rate of successful recanalization after EVT. Patients with AIS and proximal internal carotid artery (ICA) occlusion who underwent EVT from 2014 to 2021 were identified. The patterns of carotid occlusion in CTA were classified into beak, dome, and flat patterns and correlated with microcatheter digital subtraction angiography (DSA) as PO and TO. The rates of successful recanalization in PO and TO were analyzed. Of the 24 patients, 16 (66%) had ICA PO and eight (33%) had TO in DSA. A beak pattern of the proximal ICA on CTA was significantly higher among the PO group patients (87.5% vs. 25%, P = 0.005), and a flat pattern was significantly higher among the TO group patients (50% vs. 12%, P = 0.005). A gradual contrast decline of the proximal ICA on CTA images was seen only in PO group patients (85.7% vs. 0%, P = 0.05). There was no significant difference in the rate of successful recanalization between PO and TO group patients (81.25% vs. 62.5%, P = 0.362). Beak pattern and gradual contrast decline at the proximal ICA occlusion site in CTA are suggestive of carotid PO. Identification of PO in CTA can help in planning intervention strategies and prognostication.

Ultrasound Diagnosed Fetal Hydranencephaly in the Prenatal Period

Abstract Hydranencephaly is a rare congenital encephalopathy characterized by a near complete absence of the cerebral cortical mantle and basal ganglia, with consequent replacement by cerebrospinal fluid (CSF). Although hydranencephaly is an extremely rare congenital entity with an incidence &lt;1/10,000 live births, there are no known gender or racial predilections. However, polyhydramnios is a recognized association. Brain infarction from bilateral internal carotid artery occlusion, fetal hypoxia, leukomalacia, and congenital infections have all been implicated as possible etiologies for this rare entity. Ultrasonography can be used for prenatal diagnosis of fetal hydranencephaly, assessment for possible associations, and to exclude the common differential diagnoses. The objective of this report is to present an extremely rare congenital encephalopathy diagnosed in utero in a pregnant patient at the third trimester using ultrasonography, to review pertinent literature about this condition, and to highlight the role of ultrasonography in making a diagnosis of hydranencephaly while excluding common differential diagnoses. This was a case of hydranencephaly diagnosed at the third trimester of gestation, precisely at 36 weeks (with a discrepancy in the sonographically estimated average fetal gestational age which was about 33 weeks) at the time of diagnosis in a Nigerian tertiary health facility. Sonography revealed a disproportionately large fetal cranium relative to other fetal parts, the absence of a large proportion of the cerebral cortical mantle, and its replacement with anechoic CSF. The falx cerebri was preserved. Hydranencephaly is a rare congenital entity. Its diagnosis can be unraveled in the prenatal period with the use of ultrasonography particularly in resource-poor centers in sub-Saharan Africa where advanced imaging modalities such as magnetic resonance imaging are not readily available.

Technique for Recanalization of Sheath Introducer Occlusion due to Captured Thrombus during Mechanical Thrombectomy for Acute Ischemic Stroke: A Technical Note.

Mechanical thrombectomy (MT) is the gold standard treatment for acute ischemic stroke. During these interventions, a thrombus frequently obstructs a guiding catheter. The obstructed guiding catheter should be withdrawn before distal embolism occurs; however, albeit infrequently, the thrombus occludes even a sheath introducer (SI). While conventionally new SI placement is required for continuation of treatment, we propose a viable alternative for recanalization of the occluded SI, termed vacuum-assisted delivery of thrombus (VADT), with a clinical report of our cases. The usefulness of this technique was also evaluated in simulation experiments. The VADT procedure is as follows: 1) insert a peel-away sheath, originally attached to a balloon-guiding catheter (BGC), into the SI to continuously open the hemostatic valve; 2) advance the BGC into the peel-away sheath while applying mechanical aspiration; and 3) remove the peel-away sheath/BGC assembly slowly. In a simulation environment using an artificial thrombus, we repeated the VADT procedure five times and reproducibly achieved SI reopening within only 10-20 seconds. From March 2013 to September 2022, 204 patients were treated with MT at our stroke center and SI occlusion occurred in three patients (1.5%). These events occurred exclusively in patients with extracranial internal carotid artery occlusion. All three patients with SI occlusion underwent successfully thrombus extraction in the SI using the VADT on the first try. The results of clinical experience and simulation experiments strongly support VADT as a reliable option for recanalization of an occluded SI.

Acute bilateral middle cerebral artery occlusion treated with thrombectomy via the anterior communicating artery in a patient with chronic left cervical internal carotid artery occlusion: a case report

Acute bilateral middle cerebral artery occlusion treated with thrombectomy via the anterior communicating artery in a patient with chronic left cervical internal carotid artery occlusion: a case report

A Case of Ruptured Middle Portion Posterior Communicating Artery Aneurysm with Ipsilateral Internal Carotid Artery Occlusion Treated by Superficial Temporal Artery-Middle Cerebral Artery Anastomosis and Endovascular Treatment

A Case of Ruptured Middle Portion Posterior Communicating Artery Aneurysm with Ipsilateral Internal Carotid Artery Occlusion Treated by Superficial Temporal Artery-Middle Cerebral Artery Anastomosis and Endovascular Treatment

Mechanical Thrombectomy for Acute Cardiogenic Internal Carotid Artery Occlusion with Cross-Flow through the Communicating Artery.

To report mechanical thrombectomy (MT) for internal carotid artery (ICA) occlusion with cross-flow through the communicating artery ("with" group), and to compare it with ICA or middle cerebral artery occlusion without cross-flow ("without" group). This study included 10 and 57 cases of the "with" and "without" groups, respectively. Cases analyzed by rapid processing of perfusion and diffusion (RAPID) since October 2020 were included. Puncture-to-reperfusion time was 78.5 and 39 min (p=0.0155), the National Institutes of Health Stroke Scale score at discharge was 10.5 and 4 (p=0.0166), decline from pre to post Diffusion-Weighted Image-Alberta Stroke Program Early computed tomography (CT) Score was 0.5 and 0 (p=0.0495), and the modified Rankin Scale score at 90 days was 4 and 2 (p=0.0195) in the "with" and "without" groups, respectively. Furthermore, Tmax values of > 6 s (50 cc vs. 164 cc; p=0.0277) and Tmax > 4 s/Tmax > 6 s ratio (3.23 vs. 1.55) (p=0.0074) were significantly different between the "with" and "without" groups. The "with" group may have been affected by the longer treatment time and being at high risk of distal migration of thrombus due to poor prognosis. Although the region with a Tmax of > 6 s tends to be small in patients of the "with" group, it indicates a low-perfusion state that can lead to cerebral infarction, and MT should be performed.

Treatment Outcome of Flow Diverter Device for Medium-Sized Cerebral Aneurysms: A Single-Center Report.

Flow diverters (FDs), first introduced in Japan in 2015, were initially limited to wide-necked large cerebral aneurysms, which pose a high treatment risk. However, based on the results of the PREMIER study, the indications have expanded since 2020, and the number of treatment cases is increasing in Japan. At our hospital, FD placement with adjunctive coil embolization has been actively performed for medium-sized cerebral aneurysms, as indicated in the PREMIER study; herein, we report the outcomes of this treatment. Of the 25 patients with 28 aneurysms who underwent FD placement at our institution between April 2022 and June 2023, 15 with 17 wide-necked unruptured cerebral aneurysms with a maximum diameter of <12 mm in the internal carotid artery (ICA) or vertebral artery (VA) were included. Postoperative complications were investigated in each case, and the aneurysm occlusion status was assessed using ultrashort echo time (UTE)-MRA at 3 months postoperatively and angiography at 6 months postoperatively. Fifteen patients who underwent coiling or stent-assisted coiling (SAC) for the same criteria during the same period were compared. Baseline characteristics and treatment results were compared between FD and coiling/SAC cases. Four males and 11 females with a mean age of 61.7 ± 12.8 years were included, and the median follow-up period was 9 months (6-18 months). There were 14 aneurysms of the ICA and 3 of the VA, and the mean maximum aneurysm diameter was 7.9 ± 1.7 mm. All patients were treated using the Pipeline Flex with Shield Technology (Medtronic, Minneapolis, MN, USA), and 14 aneurysms (82.4%) were treated with adjunctive coil embolization. There were no symptomatic strokes in the perioperative period; only one patient receiving corticosteroid therapy for thyroid eye disease had asymptomatic ICA occlusion at 3 months. Fifteen aneurysms (88.2%) were not visible on UTE-MRA at 3 months postoperatively, and angiography at 6 months showed complete occlusion in 16 (94.1%) aneurysms. The coiling/SAC group had a smaller neck size and higher volume embolization ratio than the FD group; however, complete occlusion was higher in the FD group. FD placement with adjunctive coil embolization for medium-sized cerebral aneurysms is expected to result in good occlusion rates in the early postoperative period.

A case of subsequent no-reflow phenomenon following mechanical thrombectomy under flow reversal system for isolated ICA occlusion

A case of subsequent no-reflow phenomenon following mechanical thrombectomy under flow reversal system for isolated ICA occlusion

Carotid artery stenting for ICA occlusion complicating acute type A aortic dissection

Carotid artery stenting for ICA occlusion complicating acute type A aortic dissection

Health Check-up Support for the Beneficiaries of Basic Livelihood Act: Two Years of the Coalition Experience and Outcomes.

Objective: Self-sufficiency Center is a organization which provide support for individual skill acquisition and work opportunities to beneficiaries of basic livelihood act. The goal of this study is to provide health care, customized counseling, and treatment at the community level to improve their health status.Methods: The subjects of this study were participants in three district self-sufficiency center of Seoul that received welfare funds in 2015 and 2016. All examinations included self-written surveys, body measurement, blood and urine tests, abdominal ultrasound and gastroscopy. Optional biopsy, colonocopy, lung CT and thyroid ultrasound were charged extra.Result: Through this examination, one case of colon cancer, two cases of cervical cancer, two cases of thyroid cancer and one case of lung cancer were found for malignant tumors. One case of internal carotid artery occlusion, one case of ascending aortic dilatation, three cases of hepatitis B antigen carrier and chronic liver disease, and diseases such as high blood pressure and dyslipidemia were newly diagnosed or found to be poorly controlled. Patients with all abnormal results were requested medical treatment with a specialist, and at least one year after the examination, approximately 45% of them found follow-up lost. In a retrospective telephone survey with 62 participants, they responded that they were not receiving medical treatment or health examinations because lack of time or cost. They responded that they will participate private health examinations again if economic support is provided.Conclusion: Through this private health examination whith people of low economic levels, it was confirmed that they were not in good health, but they have desire to do health examination and will voluntarily participate health examination if they have low economic burden. One clue to health inequality could be that people with low economic status are more likely to develop diseases due to cost burdens and neglect of health care.

Clinical Characteristics of Immediate Contralateral Ischemia Subsequent to Revascularization for Moyamoya Disease

Moyamoya disease is a bilateral steno-occlusive disease involving the cerebral vasculature. While some patients are affected by procedure-related ipsilateral ischemia, ischemic complications contralateral to the revascularization are rarely observed. We retrospectively investigated 135 hemispheres (103 patients) that underwent revascularization in our institution between April 2006 and September 2022. Revascularization surgery comprised single superficial temporal artery-middle cerebral artery anastomosis and encephalo-myo-synangiosis. Certain patients aged under 10years underwent indirect revascularization. Bilateral revascularization was performed with an interval of >3months. Medical records and neuroimages were reviewed, and patients with contralateral ischemic complications were identified. Some cases underwent genetic analysis. The mean age was 34.5 (range: 5-71) years, and 95 cases (70.4%) were in women. Of the 102 cases examined for the RNF213 c.14429G > A (p.Arg4810Lys) variant, 33 (32.4%) and 69 (67.6%) showed the GG and GA genotype, respectively. Three cases (2.2%, all female, age range 44-71years) were complicated with contralateral infarction. The infarcted area distributions of the 2 cases with RNF213 c.14429G > A variant were patchy and peripheral. Theother case showed on magnetic resonance imaging (MRI) angiography total occlusion of the internal carotidartery where patency had been confirmed preoperatively. Contralateral ischemia after revascularization occurred in 2.2% of cases. We classified them into peripheral and central types: peripheral type, an infarction owing to hemodynamic insufficiency or intracranial blood flow redistribution; central type, total occlusion of the contralateral internal carotid artery. Intensive preoperative management can minimize the risk of peripheral types, and neurosurgeons should beware of severe central types.

Unilateral Agenesis of the Internal Carotid Artery: A Report of Two Rare Cases

Background: Internal carotid artery (ICA) agenesis occurs when one or both of the blood vessels that supply blood to the brain do not develop. Congenital agenesis of the ICA rarely occurs. It is usually asymptomatic but may sometimes associate with neurological symptoms such as migraine and pulsatile tinnitus. Moreover, differentiating it from occlusion of ICA is important in patients with stroke. Case Report: We report two cases (63-years-old man and 69-year-old woman) of asymptomatic unilateral ICA agenesis who were referred to our cardiovascular hospital for coronary artery bypass graft. Due to a suspicious history of transient ischemic attack, the patients underwent carotid ultrasonography. With findings suggestive of unilateral ICA agenesis at color Doppler, patients underwent computed tomography angiography that confirmed the diagnosis. Conclusion: Suspecting ICA agenesis at color Doppler imaging of the neck and differentiating it from occluded ICA at CT angiography is important for correct diagnosis and management of the patients.

Association Between Hypoperfusion Intensity Ratio and Postthrombectomy Malignant Brain Edema for Acute Ischemic Stroke.

Malignant brain edema (MBE) is a life-threatening complication that can occur after mechanical thrombectomy (MT) for acute ischemic stroke. The hypoperfusion intensity ratio (HIR) reflects the tissue-level perfusion status within the ischemic territory. This study investigated the association between HIR and MBE occurrence after MT in patients with anterior circulation large artery occlusion. We conducted a retrospective cohort study of patients who received MT at a comprehensive stroke center from February 2020 to June 2022. Using computed tomography perfusion, the HIR was derived from the ratio of tissue volume with a time to maximum (Tmax) > 10s to that with a Tmax > 6s. We dichotomized patients based on the occurrence of MBE following MT. The primary outcome, assessed using a multivariable logistic regression model, was the MBE occurrence post MT. The secondary outcome focused on favorable outcomes, defined as achieving a modified Rankin Scale score of 0-2 at 90days. Of the 603 included patients, 90 (14.9%) developed MBE after MT. The median HIR exhibited a significantly higher value in the MBE group compared with the non-MBE group (0.5 vs. 0.3; P < 0.001). Multivariable logistic regression analysis indicated that a higher HIR (adjusted odds ratio [aOR] 8.98; 95% confidence interval [CI] 2.85-28.25; P < 0.001), baseline large infarction (Alberta Stroke Program Early Computed Tomography Score < 6; aOR 1.77; 95% CI 1.04-3.01; P = 0.035), internal carotid artery occlusion (aOR 1.80; 95% CI 1.07-3.01; P = 0.028), and unsuccessful recanalization (aOR 8.45; 95% CI 4.75-15.03; P < 0.001) were independently associated with MBE post MT. Among those with successful recanalization, a higher HIR (P = 0.017) and baseline large infarction (P = 0.032) remained as predictors of MBE occurrence. Furthermore, a higher HIR (P = 0.001) and the occurrence of MBE (P < 0.001) both correlated with reduced odds of achieving favorable outcomes. The presence of a higher HIR on pretreatment perfusion imaging serves as a robust predictor for MBE occurrence after MT, irrespective of successful recanalization.

HEMODYNAMIC PARAMETERS OF EXTRACRANIAL CEREBRAL ARTERIES AND HEART IN PATIENTS WITH OCCLUSION OF THE INTERNAL CAROTID ARTERY DURING VASCULAR SURGERY

HighlightsWe have analyzed the parameters of cerebral hemodynamics and left ventricular functional capacity in patients with occlusion and stenosis of the contralateral internal carotid artery during vascular surgery. Considering the importance of the left ventricular functional capacity and treatment options to ensure the stability of cerebral circulation in patients with occlusion and hemodynamically significant stenosis of the contralateral carotid artery, its detailed study at all stages of vascular surgery remains necessary. AbstractAim. To study cerebral hemodynamics and left ventricular functional capacity in patients with occlusion and stenosis of the contralateral internal carotid artery (ICA) to optimize treatment at the preoperative phase.Methods. The study compared the hemodynamic parameters of the blood flow of the ICA, vertebral arteries and left ventricular functional capacity in patients with ICA occlusion and contralateral ICA stenosis, which formed the 1 group (12 patients), and patients with unilateral hemodynamically significant stenosis, which formed the 2 group (52 patients). The blood flow in the extracranial portions of the major arteries of the head and heart was assessed using ultrasound, and the arterial vascular system and brain structure was assessed using MRI and MRA.Results. Before surgery, statistically significant differences in velocity parameters in the vertebral arteries on the occlusion side were found; on the contralateral occlusion side, velocity parameters in ICA were significantly different from the corresponding indicators in the group with unilateral stenosis; after surgery, statistically significant differences were found in the common carotid and vertebral arteries on the occlusion side; on the contralateral occlusion side, differences in velocity parameters in the common carotid, internal, and vertebral arteries were revealed in comparison with the group with unilateral stenosis. Of the indicators of the left ventricular functional capacity, only left ventricular ejection fraction differed significantly when comparing the group of patients with occlusion and stenosis of ICA and the group of patients with unilateral stenosis. Moreover, when evaluating pre- and postoperative outcomes in the group of patients with occlusion, significant differences were obtained only regarding the vertebral artery on the side of occlusion – the peak systolic blood flow velocity and the volumetric blood flow velocity significantly decreased. There were no significant differences between the common carotid, internal carotid arteries on the contralateral occlusion side, and middle cerebral arteries.Conclusion. Carrying out a comprehensive ultrasound examination of the main arteries of the head in combination with magnetic resonance imaging of the brain is a reliable and adequate way to assess cerebral hemodynamics, changes in the vascular bed and structure of the brain. Given the extreme importance of the left ventricular functional capacity to ensure the stability of cerebral circulation in patients with occlusion of the internal carotid artery and contralateral hemodynamically significant stenosis, its detailed study before carotid endarterectomy is necessary to adjust therapeutic measures.

Hybrid surgery can improve neurocognitive function in patients with internal carotid artery occlusion

Internal carotid artery occlusion (ICAO) is a relatively uncommon but important cause of transient ischaemic attack and cerebral infarction. Hybrid surgery (HS) improves cerebral perfusion, but its impact on neurocognitive function has been controversial. Patients with symptomatic chronic ICAO treated by hybrid surgery or medical treatment from 2016 to 2019 were included. We recorded and analysed the clinical characteristics, angiographic data, outcomes and cognitive status. Functional assessments, including the National Institutes of Health Stroke Scale (NIHSS), the Barthel Index, and a battery of neuropsychological tests, including the Mini-Mental State Examination (MMSE), Alzheimer Disease Assessment Scale–Cognitive Subtest (ADAS-cog), verbal fluency, and Colour Trail test Parts 1 and 2, were administered. Significant improvements in the ADAS (before, 7.5 ± 6.2 versus after, 5.2 ± 5.7; P = 0.022), MMSE (before, 25.5 ± 2.8 versus after, 28.1 ± 2.3; P = 0.013), and Colour Trail test Part 1 (before, 118.3 ± 26.5 versus after, 96.2 ± 23.1; P = 0.016) were observed six months after HS. Moreover, the abovementioned postprocedure scales were ameliorated in the HS group. This study found that in patients with multiple symptomatic ICAO and objective ipsilateral ischaemia, successful HS leads to improvement in the scores of three cognitive tests.