Selection of the approach to the distal internal carotid artery from the second cervical vertebra to the base of the skull

Mock, Charles; Lilly, Michael; McRae, Robert G.; Carney, Wilfred I.

doi:10.1016/0741-5214(91)90050-5

Cited by 53 publications

(49 citation statements)

References 15 publications

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“…Anterior mandibular subluxation and nasal intubation during general anesthesia can be helpful if the need for high dissection is predicted by preoperative studies. Complete hypoglossal nerve dissection and mobilization, division of the posterior belly of the digastric muscle, division of the stylohyoid muscle, vertical mandibular ramus osteotomy, and styloidectomy [6][7][8] are other maneuvers that can be used. Even with these adjuncts, achieving a satisfactory end point and closure in this setting can be difficult.…”

Section: Discussionmentioning

confidence: 99%

Carotid endarterectomy with adjunctive cephalad carotid stenting: Complementary, not competitive, techniques

Tameo

Dougherty

Calligaro

2008

Journal of Vascular Surgery

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Objective: Stenosis of the cephalad internal carotid artery (ICA) can present a challenge, making it difficult to obtain a technically satisfying distal end point during endarterectomy. Surgical revision of distal defects can be difficult and yield unsatisfactory results. The purpose of this review is to evaluate the efficacy of intraoperative carotid stenting as an adjunct to endarterectomy to salvage technical defects identified at the cephalad ICA endarterectomy site. Methods: Between January 2001 and February 2008, 14 patients were found to have technical defects located at the cephalad ICA endarterectomy site on intraoperative completion arteriogram. All defects were treated with adjunctive carotid stenting. Patient age ranged from 53 to 84 years (mean, 69 years). Indications for surgery were asymptomatic stenosis (nine), amaurosis fugax (two), and cerebrovascular accident (three). Operative time ranged from 2 to 5 hours (mean, 2.5 hours). Cervical block was used in all but two patients who received general anesthesia. Results: Technically satisfying results with stenting were achieved in all 14 patients. One patient suffered a perioperative transient ischemic attack; however, neurologic symptoms were noted before placement of the stent in this patient. There were no stent-related complications. All stents remained patent on duplex follow-up averaging 18 months. Conclusion: Intraoperative salvage carotid stenting is an effective and safe adjunct to endarterectomy when unsatisfactory technical defects are identified at the cephalad ICA endarterectomy site. ( J Vasc Surg 2008;48:351-4.)

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Section: Discussionmentioning

confidence: 99%

Carotid endarterectomy with adjunctive cephalad carotid stenting: Complementary, not competitive, techniques

Tameo

Dougherty

Calligaro

2008

Journal of Vascular Surgery

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“…The present study objectively demonstrated the efficacy of MS, which was previously only subjectively reported to increase ICA exposure by 5.5-20 mm to the cranial side [3][4][5][7][8][9][10][11]. We found that MS increased mastoid-mandible distance by 5.7 ± 3.1 mm and MIM angle by 13.3 ± 7.9º, and that wire fixation with interdental insertion of Coltoflax ® putty was the most effective technique.…”

Section: Quantitative Findings and Rationale For Msmentioning

confidence: 54%

“…Moreover, use of an intraluminal shunt requires more distal exposure of the ICA. Various techniques used for CEA in cases of cephalic location of the lesions have been reported, including the retrojugular approach [13], dissection and ligation of the adjacent structures (sternocleidomastoid artery, occipital artery and vein [14,15], ansa cervicalis [14], and posterior belly of the digastric muscle [14,16]), nasotracheal intubation [17], mandibular osteotomy [18,19], elevation of the hypoglossal nerve [1,15,16], and MS [3][4][5][6][7][8][9][10][11]20].…”

Section: Cephalic Location Of Cea and Reported Modificationsmentioning

confidence: 99%

“…In Japanese patients, the position of the carotid artery bifurcation is approximately one vertebral body higher than in patients in Western countries [2], so that adequate exposure of the ICA is more difficult to achieve. If a higher approach is taken (above the mastoid-mandibular line, which extends from the tip of the mastoid process to the angle of the mandible), an operative space cephalic to the mastoid-mandibular line is required [3]. Mandibular subluxation (MS) for CEA has been proposed to access such a cephalic location of the bifurcation [3][4][5][6][7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of Mandibular Subluxation for Carotid Endarterectomy with Combined Fixation Using Interdental Wire and Putty

Sato¹,

Yamazaki²,

Shimizu³

et al. 2016

Angiol

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Bifurcation of the carotid artery at a cephalic location greatly increases the risk associated with carotid endarterectomy (CEA). Mandibular subluxation (MS) can improve access to the cephalic location; however, the benefits of MS remain unclear. The present study objectively assessed the efficacy of MS. MS was performed with only wire fixation of healthy teeth in four patients (Group A), with wire fixation reinforced by inserting Coltoflax ® putty between healthy teeth in 17 patients (Group B), and with wiring between maxillary and mandibular screws reinforced by inserting Coltoflax ® putty between the wires in five edentulous patients (Group C). Pre-and postoperative axial computed tomography angiography images at the level of the tip of the mastoid process were used to compare the following measurements: mastoid-mandible distance between the anterior margin of the mastoid process and posterior margin of the mandible; and mastoid-internal carotid artery-mandible (MIM) angle between the line connecting the anterior margin of the mastoid process and the center of the internal carotid artery, and the line connecting the posterior margin of the mandible and the center of the internal carotid artery. MS increased the overall mastoid-mandible distance by 5.7 ± 3.1 mm. The increase was significantly greater in Group B (6.7 ± 2.0 mm) than in Group A or C (4.0 ± 4.1 mm) (P=0.032). MS increased the overall MIM angle by 13.3 ± 7.9º. MS with the combination of wire with Coltoflax ® putty offered the widest surgical corridor for CEA.

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“…So beschreiben Frim et al in einer Serie von 115 Patienten eine Mandibulasubluxation als komplikationsarme Möglichkeit, um die Exposition der ACI um 1-2 cm zu erweitern [8]. Die Ergebnisse wurden später in einer kleineren Serie mit allerdings nur 10 Patienten bestätigt, insbesondere wurden keine Hirnnervenverletzungen beschrieben [9,10]. Der Nachteil der mandibulären Subluxation besteht darin, dass die Notwendigkeit zur hohen Präpara-tion schon präoperativ erkannt werden muss.…”

Section: Diskussionunclassified

Der hohe Zugang zur Arteria carotis interna

Attigah

Hyhlik‐Dürr

Hakimi

et al. 2009

Chirurg

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High exposure of the internal carotid artery is a challenging procedure even for experienced surgeons. Access to the distal internal carotid artery is impeded by progressive encroachment of the mastoid process and the angle of the mandible and furthermore at this level the artery is intimately associated with the hypoglossal and glossopharyngeal nerves. If high exposure is needed we prefer preparation of the distal internal carotid artery by dissection of the venter posterior of the digastric muscle and the styloid process including the stylohyoid and stylopharyngeus muscles. This procedure can be advantageously carried out without additional preoperative requirements. The need for high access to the internal carotid artery depends strongly on the underlying pathology: in atherosclerotic disease the rate of high access in our patients is approximately 4.4%, whereas in carotid aneurysms the rate is considerably higher and averages about 15%.

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Selection of the approach to the distal internal carotid artery from the second cervical vertebra to the base of the skull

Cited by 53 publications

References 15 publications

Carotid endarterectomy with adjunctive cephalad carotid stenting: Complementary, not competitive, techniques

Carotid endarterectomy with adjunctive cephalad carotid stenting: Complementary, not competitive, techniques

Efficacy of Mandibular Subluxation for Carotid Endarterectomy with Combined Fixation Using Interdental Wire and Putty

Der hohe Zugang zur Arteria carotis interna

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