Ipsilateral External Carotid Research Articles

Electrothrombosis of Spontaneous Carotid-Cavernous Fistula by Copper Needle Insertion

Abstract Electrothrombosis by copper needle insertion was used to treat three cases of spontaneous carotid-cavernous fistula. These patients had been treated conservatively for 6 months or more, but their symptoms had not improved. Angiography showed that the feeding arteries were branches of both the ipsilateral internal and the ipsilateral external carotid artery. Frontotemporal craniotomy was performed, and copper needles were inserted transdurally into the cavernous sinus. Closure of the fistula was verified by intraoperative angiography in all cases, and the symptoms improved after the operation. However, one patient had postoperative transient 3rd nerve palsy. Another had Gerstmann's syndrome due to narrowing of the internal carotid artery by a needle and worsening of the preoperative 6th nerve palsy. In one case, the operation was uneventful. Based on our experience, we discuss several problems with this technique.

Noninvasive diagnosis of internal carotid artery occlusion

In summary, internal carotid artery occlusion can be reliably diagnosed by noninvasive techniques, particularly when complementary studies such as B-mode imaging, oculopneumoplethysmography and Doppler frequency spectral analysis are used in combination. Our data suggest that it may also be possible to distinguish acute thrombosis from chronic occlusion by real-time ultrasonography, although further evaluation is necessary. Additional clinically important information about the ipsilateral external carotid artery and the contralateral internal carotid artery is also obtained with this combination of noninvasive studies. Finally, although internal carotid artery occlusion remains a therapeutic challenge to the clinician, its noninvasive diagnosis may be of great help in planning early therapy and in determining arteriographic needs.

The treatment of cerebral ischemia by external carotid artery revascularization.

Thirteen patients with internal carotid artery occlusion and symptomatic external carotid artery stenosis underwent external carotid artery revascularization by means of endarterectomy (n = 10) or subclavian artery--external carotid artery bypass (n = 3). All patients but one were followed up, for five to 46 months (mean, 20 months). There were no operative deaths or complications and no late strokes. One patient (7.7%) required early extracranial-intracranial (EC-IC) bypass for failure of the external carotid artery endarterectomy to relieve the initial symptoms. All remaining patients were completely (n = 9) or partially (n = 2) relieved of symptoms, and EC-IC bypass was not required. There were no criteria identified by either oculopneumoplethysmography or angiography that could reliably predict the need for subsequent EC-IC bypass. Ninety-two percent of the patients were adequately treated with external carotid artery revascularization alone, suggesting that subsequent EC-IC bypass is seldom required in patients with ipsilateral internal carotid artery occlusion and external carotid artery stenosis.

Carotid angioplasty in the management of external carotid artery stenosis associated with an occluded internal carotid artery.

The author describes the surgical treatment of 14 patients in whom angiography demonstrated total occlusion of the internal carotid artery (ICA) associated with stenosis at the origin of the ipsilateral external carotid artery (ECA). Each patient underwent ECA endarterectomy followed by an angioplasty to enlarge the ECA outflow tract by incorporating the ICA stump into the proximal ECA. Nine patients subsequently underwent superficial temporal-middle cerebral artery anastomosis. There was no mortality or permanent neurological morbidity. This method of treating ECA stenosis is recommended because it is simple and effective and because it simultaneously eliminates the ICA stump as a potential source of cerebral emboli.

The External Carotid Artery in Revascularization of the Upper Extremity

The ipsilateral external carotid artery can be used for revascularization of the axillary and brachial arteries when the contralateral axillary artery is not available. A successful case is presented and the technique described.

External carotid artery in internal carotid artery occlusion. Angiographic, therapeutic, and prognostic considerations.

Twenty-three instances of internal carotid artery occlusion occurring with minimal neurological deficit in 22 patients are described. Although each of these patients was referred to the neurosurgical service for evaluation for an extracranial-intracranial microvascular bypass procedure, complete arteriographic evaluations of their cerebrovasculature suggested that alternative methods should be the treatment of choice. For each patient reported the ipsilateral external carotid artery was demonstrated by angiography to be an important source of collateral blood supply to the cerebral hemispheres or retinae distal to the occluded internal carotid arteries. Ten patients with no significant atherosclerotic narrowing or ulceration of the external carotid artery have remained free of symptoms of cerebral ischemia for 6 to 40 months. In twelve patients who developed delayed recurrent cerebral or retinal ischemia ipsilateral to their internal carotid artery occlusion, there were found obstructive and/or ulcerative plaques involving the common and/or external carotid arteries. Thromboendarterectomy in 11 of these patients gave complete relief of ischemic symptoms during the 4 to 36 months of postoperative follow up. One of these 12 patients refused operation and went on to develop a major cerebral infarction. Angiographic identification of a functionally important external carotid artery ipsilateral to an internal carotid artery occlusion carries considerable prognostic and therapeutic significance.

ARTERIAL LIGATION IN EPISTAXIS

Unremitting severe nose bleeds may require arterial ligation. One or more of the four vascular systems supplying the nose may need such surgical interference. Dye injection of 14 cadavers was performed to demonstrate the vascular supply of the nose and the effects of various arterial ligations. Depending upon the site of haemorrhage within the nose, up to three vascular systems may need occlusion. These are the ipsilateral and contralateral external carotid arterial systems and the ipsilateral ethmoidal arteries.

Right-sided cervical aortic arch

Cervical aortic arch is a rare congenital anomaly that should be suspected in a patient with a large pulsatile supraclavicular mass. Pulse and blood pressure abnormalities are frequently present, as are symptoms suggestive of an intrathoracic vascular ring. Diminution of femoral pulses by compression of the supraclavicular mass against cervical vertebrae is a valuable clinical maneuver for diagnosis of this condition, which can be confirmed on aortography. A 30-year-old woman with a right-sided aortic arch is the twelfth reported case of this anomaly. This is the first case where the ipsilateral external carotid vessel arises separately from the intrathoracic portion of the aorta instead of from the apex of the cervical arch. The actual redundant nature of the cervical arch plus the separate origins of the right internal and external carotid support, but do not prove, the thesis that the cervical arch represents a persistence of the embryonic third arch.

Mandibular collateral circulation

An attempt has been made to examine, in a quantitative manner, the respective roles of the contralateral external carotid artery and the ipsilateral internal carotid artery in providing collateral flow to the mandible. Occlusion of the ipsilateral external carotid artery resulted in a 29 per cent decrease in mental arterial pressure, and an additional decrease of approximately 25 per cent resulted when the contralateral external carotid artery was occluded. Clamping of the ipsilateral internal carotid produced a negligible change. It was possible to relate collateral blood flow in the mandible to observed changes in mental arterial pressure.