- Email: [email protected]
Cervical carotid to petrous carotid bypass for lesions of the upper cervical carotid artery
Session 12
Tuesday, September 12, 1995
1400-1700
Carotid 11 Room D 12.1 WITHDRAWN
12.2 Carotid Atherosclerotic Disease Following Irradiation of the Neck R.B. SMITH s III, K.A. CO YLE, A.B. LUMSDEN, A.A. SALAM, T.F. DODSON and E.L. CHAIKOF, Atlanta, Georgia, USA Individuals receiving external irradiation of the neck may develop radiation-induced carotid atherosclerotic disease with the attendant increased risk of stroke. Over a recent 10-year period, 21 carotid endarterectomies were performed in patients with a prior history of neck irradiation. Characteristics of these patients were compared with those of 1051 nonirradiated patients who underwent carotid endarterectomy during the same time period. The mean age of the irradiated group was 65.2 years, with 19 males and two females. Indications for surgery among the irradiated group included transient ischemic attacks in 11, amaurosis fugax in two, vascular tinnitus in one, and high-grade asymptomatic stenosis in seven. Six of the irradiated patients (28.6%) and 69 of the non irradiated group (6.4%) had undergone a previous endarterectomy of the operated side. The combined 30-day mortality and stroke morbidity among the irradiated patients was 0% compared with 4.3% among the 1051 nonirradiated patients. Neck irradiation may be associated with advanced atherosclerotic carotid disease. For this group, carotid endarterectomy represents a safe treatment for prevention of stroke. 12.3 Reconstructions of the C o m m o n Artery (CCA) G.Y. SEPA, C.S.DZSINICH, A. NEMES, K. H(]TTL, M. SZAZADOS and G. KERESZTUR Y, Budapest, Hungary Reconstructive procedures of the CCA are relatively rare. In a 10-year period we have observed 49 patients with CCA occlusion, while more than 2000 interventions were performed on the ICA. 43 of the 49 patients underwent surgical repair. In six patients there were no surgical interventions undertaken because of complementary ICA occlusions (3), or complete lack of symptoms (3). In the surgical group, the symptoms were TIA (6), stroke (5), amaurosis fugax (4), drop attack (1), dysarthria (4), dizziness (14). The CCA occlusion occurred bilaterally in 5 cases. The surgery was undertaken under general anesthesia. We performed retrograde TEA (9), carotid-subclavian transposition (2), subclavian carotid bypass (10), innominate-carotid bypass (3), aorta-carotid (distal) bypass (3), intercarotid bypass (2), subclavian-internal carotid crossover bypass (1), subclavian-external carotid bypass (1). In 10 patients a contralateral endarterectomy of the ICA had to be performed and
60
subsequently in one case an intercarotid graft was removed because of infection. No neurologic or surgical complications occurred in the early postoperative period. During the follow up study, one patient died with an MI, three reocclusions after prosthetic bypass procedures were observed, and two of them underwent successful reoperation. In summary: the reconstruction of the CCA is a safe procedure. Autolog reconstructions should be preferred. 12.4 Cervical Carotid to Petrous Carotid Bypass for Lesions of the U p p e r Cervical Carotid Artery S.C. NICHOLLS, D.W. NEWELL and M.S. GRADY, Seattle, Washington, USA Lesions of the upper cervical internal carotid artery cause problems in surgical management. Cervical carotid to petrous carotid bypass using reverse saphenous vein can be used to circumvent the problem of high cervical carotid lesions and is an alternative to direct exposure and manipulation of the ICA at this level. It offers advantage over standard extra cranial to intercranial bypass by providing high volume prograde flow directly to the carotid system and the extradural anastomosis does not involve direct dissecion of the brain. We describe the use of this procedure in three patients. Patient 1 presented with transient numbness and tingling in the right face and was managed with heparin and coumadin. The angiogram showed bilateral dissections. She returned one month later with recurrent symptoms. Following left cervical ICA to petrous ICA bypass she had symptom resolution. Patient 2 was status post gunshot wound to the right eye resulting in formation of an expanding pseudoaneurysm of the distal left ICA. Left cervical internal carotid artery to left petrous internal carotid artery bypass was performed. Postoperative course was uneventful. Patient 3 presented with carotid occlusion and ipsilateral hemispheric TIAs. These were hemodynamic in nature due to poor collateralization from the circle of Willis. Cervical to petrous carotid bypass was performed with resolution of symptoms. This technique can also be used in the subgroup of patients with carotid occlusion in whom continued ischemic symptoms may occur on a hemodynamic basis due to inadequate collateral channels. 12.5 The Asymptomatic Carotid Stenosis: Operative Results S. RICKE, K. KTENIDIS and S. HORSCH, Koln, Germany In 1988, around 250,000 patients suffered a stroke, and a further 85,000 died of cerebrovascular associated disease. The importance of operating on symptomless carotid artery stenosis is demonstrated by the fact that more than half of the patients who suffered a stroke never noticed any prodromal symptoms, i.e. the stroke occurred on the basis of a symptom-
CARDIOVASCULAR SURGERY SEPTEMBER 1995
Tuesday, September 12, 1995
1400-1700
Carotid 11 Room D 12.1 WITHDRAWN
12.2 Carotid Atherosclerotic Disease Following Irradiation of the Neck R.B. SMITH s III, K.A. CO YLE, A.B. LUMSDEN, A.A. SALAM, T.F. DODSON and E.L. CHAIKOF, Atlanta, Georgia, USA Individuals receiving external irradiation of the neck may develop radiation-induced carotid atherosclerotic disease with the attendant increased risk of stroke. Over a recent 10-year period, 21 carotid endarterectomies were performed in patients with a prior history of neck irradiation. Characteristics of these patients were compared with those of 1051 nonirradiated patients who underwent carotid endarterectomy during the same time period. The mean age of the irradiated group was 65.2 years, with 19 males and two females. Indications for surgery among the irradiated group included transient ischemic attacks in 11, amaurosis fugax in two, vascular tinnitus in one, and high-grade asymptomatic stenosis in seven. Six of the irradiated patients (28.6%) and 69 of the non irradiated group (6.4%) had undergone a previous endarterectomy of the operated side. The combined 30-day mortality and stroke morbidity among the irradiated patients was 0% compared with 4.3% among the 1051 nonirradiated patients. Neck irradiation may be associated with advanced atherosclerotic carotid disease. For this group, carotid endarterectomy represents a safe treatment for prevention of stroke. 12.3 Reconstructions of the C o m m o n Artery (CCA) G.Y. SEPA, C.S.DZSINICH, A. NEMES, K. H(]TTL, M. SZAZADOS and G. KERESZTUR Y, Budapest, Hungary Reconstructive procedures of the CCA are relatively rare. In a 10-year period we have observed 49 patients with CCA occlusion, while more than 2000 interventions were performed on the ICA. 43 of the 49 patients underwent surgical repair. In six patients there were no surgical interventions undertaken because of complementary ICA occlusions (3), or complete lack of symptoms (3). In the surgical group, the symptoms were TIA (6), stroke (5), amaurosis fugax (4), drop attack (1), dysarthria (4), dizziness (14). The CCA occlusion occurred bilaterally in 5 cases. The surgery was undertaken under general anesthesia. We performed retrograde TEA (9), carotid-subclavian transposition (2), subclavian carotid bypass (10), innominate-carotid bypass (3), aorta-carotid (distal) bypass (3), intercarotid bypass (2), subclavian-internal carotid crossover bypass (1), subclavian-external carotid bypass (1). In 10 patients a contralateral endarterectomy of the ICA had to be performed and
60
subsequently in one case an intercarotid graft was removed because of infection. No neurologic or surgical complications occurred in the early postoperative period. During the follow up study, one patient died with an MI, three reocclusions after prosthetic bypass procedures were observed, and two of them underwent successful reoperation. In summary: the reconstruction of the CCA is a safe procedure. Autolog reconstructions should be preferred. 12.4 Cervical Carotid to Petrous Carotid Bypass for Lesions of the U p p e r Cervical Carotid Artery S.C. NICHOLLS, D.W. NEWELL and M.S. GRADY, Seattle, Washington, USA Lesions of the upper cervical internal carotid artery cause problems in surgical management. Cervical carotid to petrous carotid bypass using reverse saphenous vein can be used to circumvent the problem of high cervical carotid lesions and is an alternative to direct exposure and manipulation of the ICA at this level. It offers advantage over standard extra cranial to intercranial bypass by providing high volume prograde flow directly to the carotid system and the extradural anastomosis does not involve direct dissecion of the brain. We describe the use of this procedure in three patients. Patient 1 presented with transient numbness and tingling in the right face and was managed with heparin and coumadin. The angiogram showed bilateral dissections. She returned one month later with recurrent symptoms. Following left cervical ICA to petrous ICA bypass she had symptom resolution. Patient 2 was status post gunshot wound to the right eye resulting in formation of an expanding pseudoaneurysm of the distal left ICA. Left cervical internal carotid artery to left petrous internal carotid artery bypass was performed. Postoperative course was uneventful. Patient 3 presented with carotid occlusion and ipsilateral hemispheric TIAs. These were hemodynamic in nature due to poor collateralization from the circle of Willis. Cervical to petrous carotid bypass was performed with resolution of symptoms. This technique can also be used in the subgroup of patients with carotid occlusion in whom continued ischemic symptoms may occur on a hemodynamic basis due to inadequate collateral channels. 12.5 The Asymptomatic Carotid Stenosis: Operative Results S. RICKE, K. KTENIDIS and S. HORSCH, Koln, Germany In 1988, around 250,000 patients suffered a stroke, and a further 85,000 died of cerebrovascular associated disease. The importance of operating on symptomless carotid artery stenosis is demonstrated by the fact that more than half of the patients who suffered a stroke never noticed any prodromal symptoms, i.e. the stroke occurred on the basis of a symptom-
CARDIOVASCULAR SURGERY SEPTEMBER 1995