Modified Eversion Carotid Endarterectomy (mECEA): Analysis of Clinical and Financial Outcomes

Musicant, Scott E.; Guzzetta, Vincent J.; Terramani, Thomas T.; Greenwood, Kristina L.; Chiodo, Wendy C.; Heaney, Karen M.; Berthiaume, Shelley J.

doi:10.1016/j.avsg.2016.10.046

Cited by 13 publications

(1 citation statement)

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“…Resection of atherosclerotic plaques in the intima can reduce the incidence of cerebral infarction at low cost and with a high success rate. This is therefore one of the methods used to prevent and treat moderate and severe cerebrovascular stenosis[12]. However, this operation is more traumatic and has higher requirements regarding the patient’s physical condition; it is therefore not suitable for patients with stenotic vessels that are too long or difficult to expose.…”

Section: Discussionmentioning

confidence: 99%

Brachiocephalic artery stenting through the carotid artery: A case report and review of the literature

Wang

Liu

2019

WJCC

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BACKGROUNDAs the population ages and people’s living standards gradually improve, the incidence of cerebrovascular disease in China is increasing annually, posing a serious threat to people’s health. The incidence of brachiocephalic artery stenosis in ischemic cerebrovascular disease is relatively low, accounting for 0.5% to 2% of patients, but its consequences are very serious. Herein, we report a case of brachiocephalic artery stenting through the carotid artery.CASE SUMMARYThe patient was a 66-year-old man. He came to our hospital because of repeated dizziness and was diagnosed with ischemic cerebrovascular disease (stenosis at the beginning of the brachiocephalic artery). Cerebral angiography suggested that the stenosis of the brachiocephalic artery had almost occluded it. Contrast agent threaded a line through the stenosis, and there was reversed blood flow through the right vertebral artery to compensate for the subclavian steal syndrome in the right subclavian artery. To improve the symptoms, we placed an Express LD (8 mm × 37 mm) balloon expanding stent in the stenosis section. After the operation, the patient’s dizziness significantly improved. However, after 6 mo, the patient was re-admitted to the hospital due to dizziness. A computed tomography scan of the head revealed multiple cerebral infarctions in bilateral basal ganglia and the right lateral ventricle. An auxiliary examination including computerized tomography angiography of the vessels of the head and cerebral angiography both showed severe stenosis in the brachiocephalic artery stent. During the operation, the guidewire and catheter were matched to reach the opening of the brachiocephalic artery. Therefore, we decided to use a right carotid artery approach to complete the operation. We sutured the neck puncture point with a vascular stapler and then ended the operation. After the operation, the patient recovered well, his symptoms related to dizziness disappeared, and his right radial artery pulsation could be detected.CONCLUSIONIn patients with brachial artery stenosis, when the femoral artery approach is difficult, the carotid artery is an unconventional but safe and effective approach. At the same time, the use of vascular suturing devices to suture a carotid puncture point is also commendable. Although it is beyond the published scope of the application, when used cautiously, it can effectively avoid cerebral ischemia caused by prolonged artificial compression, and improper suturing can lead to stenosis of the puncture site and improper blood pressure, resulting in the formation of a hematoma. Finally, satisfactory hemostasis can be achieved.

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Section: Discussionmentioning

confidence: 99%