Indwelling double-balloon shunt for carotid endarterectomy

Furui, Tomoo; Hasuo, M

doi:10.3171/jns.1984.60.4.0861

Cited by 26 publications

(9 citation statements)

References 4 publications

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“…8) The proximal tube was clamped, then the distal shunt tube was inserted carefully into the ICA, taking care not to push in debris, then the balloon of the distal tube was inflated with 0.2-0.3 ml of saline with great care taken not to damage the intima of the ICA by overinflation. The balloon was held in place from the outside of the ICA with a small encircling clip, far enough distal to the upper extent of arteriotomy to not hinder the manipulation of the distal plaque end (Fig.…”

Section: Cea Proceduresmentioning

confidence: 99%

Incidence of Ischemic Lesions by Diffusion-Weighted Imaging After Carotid Endarterectomy With Routine Shunt Usage

Inoue

Tsutsumi

Maeda³

et al. 2006

Neurol. Med. Chir.(Tokyo)

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Temporary intraluminal shunt was used during 72 consecutive carotid endarterectomies (CEAs) in 61 patients (bilateral CEA in 11 patients) during October 2001 and September 2005. The medical records of these patients were retrospectively reviewed. All procedures were performed with routine shunt insertion without monitoring such as electroencephalography. Pre-and postoperative diffusion-weighted magnetic resonance (MR) imaging was used to detect ischemic complications. Postoperative angiography was performed in 70 cases to detect abnormalities such as major stenosis or dissection of the distal end. Symptomatic ischemic complication occurred in one patient at 1 month. Postoperative diffusion-weighted MR imaging detected new hyperintense lesions in three patients including the symptomatic patient. Postoperative angiography confirmed that the distal end was satisfactory in all cases. The incidence of ischemic lesions of embolic origin after CEA with routine shunt usage is acceptably low if the procedure of shunt device insertion and removal is meticulously conducted.

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Section: Cea Proceduresmentioning

confidence: 99%

Incidence of Ischemic Lesions by Diffusion-Weighted Imaging After Carotid Endarterectomy With Routine Shunt Usage

Inoue

Tsutsumi

Maeda³

et al. 2006

Neurol. Med. Chir.(Tokyo)

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“…Third, we regarded Sundt and P-I shunts as representative two-way and three-way shunts, respectively. There are, however, many other modified types of internal shunts of various diameters, lengths, materials, and structures, 7 , 20 , 21) which may improve the drawbacks pointed out in the present study.…”

Section: Discussionmentioning

confidence: 72%

“…Shunt tubes are generally divided into two categories: two-way and three-way types. The former includes Sundt, 2) Javid, 3) and Argyle 4) shunts, and the latter Pruitt-Inahara, 5) Brener, 6) and Furui 7) shunts. Most surgeons tend to have a favorite shunt and prefer not to use a different type, especially with selective shunting protocol providing fewer opportunities of handling shunts than routine shunting.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Internal Shunts during Carotid Endarterectomy under Routine Shunting Policy

Katano

Yamada

2014

Neurol. Med. Chir.(Tokyo)

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We compared patients who underwent carotid endarterectomy (CEA) using two-way and three-way internal shunts and discussed which shunt was more appropriate and effective for surgeons. Eighty-two patients (mean 69.5 ± 6.1 years old, mean degrees of stenosis 79.6 ± 10.4%) who had undergone CEA by our routine shunting policy were examined concerning the difference of Sundt and Pruitt-Inahara (P-I) shunts in clinical use. Carotid clamping time for the P-I shunt was over 2 minutes longer than that by Sundt in either split or conventional continuous arteriotomy (p < 0.001). The proportions of cases with multiple trials of either arteriotomy or insertion of a shunt tube, cases detected more than one high-intensity spot on diffusion-weighted images of magnetic resonance imaging after CEA, and cases detected postoperative intimal flaps detected by multi-detector CT angiography showed no significant differences between the two shunt groups. The two-way Sundt shunt was quicker than the three-way P-I shunt in placement with no remarkable problems. Split arteriotomy was not useful in shortening the placement time for either Sundt or P-I shunt tubes, compared with continuous arteriotomy. A simple two-way shunt with easy handling like the Sundt shunt would be also appropriate to choose in selective shunting under the unfamiliarity of treating shunts.

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“…2E) and/or an aspiration maneuver utilizing a shunt tube. A commercially available trilumen Furui shunt device (Inter Medical Co., Ltd.) 5 was inserted into the distal ICA, and the distal embolus was aspirated using a 10-ml syringe after inflation of the balloon and temporary clamping of the other side of the shunt tube. The embolus was extracted with the inserted shunt tube after deflation of the balloon (Figs.…”

Section: Surgical Embolectomy In Conjunction With Ceamentioning

confidence: 99%

Emergent intracranial surgical embolectomy in conjunction with carotid endarterectomy for acute internal carotid artery terminus embolic occlusion and tandem occlusion of the cervical carotid artery due to plaque rupture

Hasegawa¹,

Inoue²,

Tamura³

et al. 2015

JNS

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A brupt intracranial large-vessel occlusion is associated with poor functional outcomes and a high mortality rate. The only possible solution is restoration of flow as soon as possible within a limited therapeutic time window. 1,13,18 Among these large vessel occlusions, the internal carotid artery (ICA) terminus occlusion is extremely difficult to manage.Acute ICA terminus occlusion responds poorly to intravenous administration of tissue plasminogen activator (tPA) due to its high clot burden; the recanalization rate is 4.4% in response to intravenous tPA alone and is 43.5% in response to intravenous tPA followed by additional endovascular treatment.1 Although new endovascular devices have accomplished better outcomes, the recanalization aBBReViatioNS ACoA = anterior communicating artery; CEA = carotid endarterectomy; DWI = diffusion-weighted imaging; ICA = internal carotid artery; MCA = middle cerebral artery; MRA = magnetic resonance angiography; mRS = modified Rankin Scale; NIHSS = National Institutes of Health Stroke Scale; PCoA = posterior communicating artery; TIMI = Thrombolysis In Myocardial Infarction; tPA = tissue plasminogen activator. SuBmitted December 25, 2013. accepted November 13, 2014. iNclude wheN citiNg Published online January 9, 2015; DOI: 10.3171/2014.11.JNS132855. diScloSuRe The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.Emergent intracranial surgical embolectomy in conjunction with carotid endarterectomy for acute internal carotid artery terminus embolic occlusion and tandem occlusion of the cervical carotid artery due to plaque rupture hirotaka hasegawa, md, tomohiro inoue, md, akira tamura, md, phd, and isamu Saito, md, phd Department of Neurosurgery, Fuji Brain Institute and Hospital, Shizuoka, Japan Acute internal carotid artery (ICA) terminus occlusion is associated with extremely poor functional outcomes or mortality, especially when it is caused by plaque rupture of the cervical ICA with engrafted thrombus that elongates and extends into the ICA terminus. The goal of this study was to evaluate the efficacy and safety of surgical embolectomy in conjunction with carotid endarterectomy (CEA) for acute ICA terminus occlusion associated with cervical plaque rupture resulting in tandem occlusion. A retrospective review of medical records was performed. Clinical and radiographic characteristics were evaluated, including details of surgical technique, recanalization grade, recanalization time, complications, modified Rankin Scale (mRS) score at 3 months, and National Institutes of Health Stroke Scale (NIHSS) score improvement at 1 month. Three patients (mean age 77.3 years; median presenting NIHSS Score 22, range 19-26) presented with abrupt tandem occlusion of the cervical ICA and ICA terminus and were selected for surgery after confirmation of embolic high-density signal at the ICA terminus on CT and diffusion-weighted imaging (DWI)/magnetic resonance angiography (MRA) mismatch. All patients under...

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Indwelling double-balloon shunt for carotid endarterectomy

Cited by 26 publications

References 4 publications

Incidence of Ischemic Lesions by Diffusion-Weighted Imaging After Carotid Endarterectomy With Routine Shunt Usage

Incidence of Ischemic Lesions by Diffusion-Weighted Imaging After Carotid Endarterectomy With Routine Shunt Usage

Comparison of Internal Shunts during Carotid Endarterectomy under Routine Shunting Policy

Emergent intracranial surgical embolectomy in conjunction with carotid endarterectomy for acute internal carotid artery terminus embolic occlusion and tandem occlusion of the cervical carotid artery due to plaque rupture

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