Sonographic Evaluation of Complications of Extracranial Carotid Artery Interventions

Millet, John D.; Cavallo, Joseph J.; Scoutt, Leslie M.; Gunabushanam, Gowthaman

doi:10.1002/jum.14376

Cited by 5 publications

(5 citation statements)

References 72 publications

(149 reference statements)

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“…CAS is an effective treatment for carotid artery stenosis[ 6 - 9 ]. However, embolism is one of the most common and serious complications during the perioperative period[ 10 ]. A clinical study, which retrospectively analyzed 19826 consecutive patients who underwent DSA, showed that embolic complications occurred in 0.05% of all patients[ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…The CREST (Carotid Revascularization Endarterectomy vs Stenting Trial) and other studies showed that CAS had the same effect as CEA in treating symptomatic and asymptomatic carotid stenosis, and there was no significant difference in the incidence of overall postoperative complications even though CAS was less invasive than CEA[ 6 - 9 ]. Embolism is a common complication after CAS, which is usually reported as nervous system embolism[ 10 ]. However, no cases of ileal hemorrhagic infarction caused by mesenteric artery embolism after CAS have been reported.…”

Section: Introductionmentioning

confidence: 99%

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Ileal hemorrhagic infarction after carotid artery stenting: A case report and review of the literature

Shen

et al. 2021

WJCC

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BACKGROUND Ileal hemorrhagic infarction after carotid artery stenting (CAS) is a fatal complication. The prognosis of ileal hemorrhagic infarction after CAS is very poor if not treated in a timely manner. We describe a rare case of ileal hemorrhagic infarction due to acute embolism of the mesenteric artery after CAS. CASE SUMMARY A 67-year-old man with acute ischemic stroke underwent CAS via the right femoral artery approach 21 d after intensive medical treatment. On the first day after surgery, the patient had abdominal distension and abdominal pain. Abdominal enhanced computed tomography revealed intestinal obstruction, severe stenosis of the superior mesenteric artery, and poor distal angiography. An exploratory laparotomy was performed, and pathological examination showed hemorrhagic ileal infarction. It was subsequently found that the patient had intestinal flatulence. With the guidance of an ultrasound scan, the patient underwent abdominal puncture, drainage, and catheterization. After 58 d of treatment, the patient was discharged from hospital with a National Institutes of Health Stroke Scale score of 2 points, and a Modified Rankin Scale score of 1 point. At the 6-mo follow-up, the patient had an excellent functional outcome without stroke or mesenteric ischemia. Furthermore, computed tomography angiography showed that the carotid stent was patent. CONCLUSION Ileal hemorrhagic infarction is a fatal complication after CAS, usually caused by mesenteric artery embolism. Thus, more attention should be paid to the complications of embolism in the vascular system as well as the nervous system after CAS, and the complications should be identified and treated as early as possible.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Ileal hemorrhagic infarction after carotid artery stenting: A case report and review of the literature

Shen

et al. 2021

WJCC

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“…Carotid endarterectomy in neurosurgery can effectively prevent plaque-sheddinginduced stroke and ischemic cerebrovascular diseases. However, intimal denudation results in intimal injury and thinning of the blood vessel wall, which can cause arterial dissection [27,28]. It is crucial to closely monitor such patients and prevent excessive intimal damage.…”

Section: Novel Animal Model In Carotid Artery Dissectionmentioning

confidence: 99%

Intimal Injury Potentially Plays a Key Role in the Formation of Carotid Artery Dissection: A Novel Animal Model Establishing

Peng¹,

Pang²,

Li³

et al. 2023

Cerebrovasc Dis

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Research on the pathophysiological mechanism of carotid artery dissection and its clinical translation is limited due to the lack of effective animal models to simulate the occurrence of this condition. Assuming that intimal injury is an important factor in the formation of carotid dissection, we established a novel method for inducing carotid dissection models by scraping the carotid intima using a fine needle. Scraping the carotid intima with fine needles can induce the rapid formation of carotid dissection. Magnetic resonance imaging and hematoxylin-eosin staining suggest the presence of false lumens and mural hematomas in the vessels. Our model-induction technique, inspired by iatrogenic catheter-induced artery dissections (carotid, coronary, aortic), significantly mimics the pathological process of clinical carotid dissection. The results suggest that mechanical injury may be a significant cause of carotid dissection and that intimal injury is a major factor in the formation of arterial dissections. This approach will provide assistance in the understanding of medically induced arterial dissection.

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“…CDU and TCCS are recommended following carotid revascularization procedures for the immediate and long‐term follow‐up. Soon after recanalization, carotid duplex examination is performed for the screening of possible complications such as dissections, fluid collections, pseudoaneurysm formation, thrombosis at the site of the treated stenosis, restenosis, and stent thrombosis …”

Section: Neurosonology Applications In Postoperative Monitoringmentioning

confidence: 99%

“…On the other hand, wound abscesses deriving from superinfections of hematomas are rare . Hematomas are recognized on gray‐scale carotid ultrasounds as soft tissue masses with heterogeneous echogenicity, with no flow within on color duplex . The formation of pseudoaneurysms is also a rare complication of CEA, occurring in less than .4% of cases, and results from rupture of the entire vessel wall and the subsequent tamponade of the hematoma from adjacent tissues .…”

Section: Neurosonology Applications In Postoperative Monitoringmentioning

confidence: 99%

The Role of Neurosonology in the Diagnosis and Management of Patients with Carotid Artery Disease: A Review

Kargiotis

Safouris

Magoufis

et al. 2018

Journal of Neuroimaging

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Carotid artery disease (CAD) is a common cause of ischemic stroke with high rates of recurrence. Carotid endarterectomy (CEA) or carotid artery stenting (CAS) are highly recommended for the secondary prevention of symptomatic CAD during the first 14 days following the index event of transient ischemic attack or minor stroke. CEA or CAS may also be offered in selected cases with severe asymptomatic stenosis. Herein, we review the utility of neurosonology in the diagnosis and pre-/peri-interventional assessment of CAD patients who undergo carotid revascularization procedures. Carotid ultrasound may provide invaluable information on plaque echogenicity, ulceration, risk of thrombosis, and rupture. Transcranial Doppler or transcranial color-coded sonography may further assist by mapping collateral circulation, evaluating the impairment of vasomotor reactivity, detecting microembolization, or reperfusion hemorrhage in real time. Neurosonology examinations are indispensable bedside tools assisting in the diagnosis, risk stratification, peri-interventional monitoring, and follow-up of patients with CAD.

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Sonographic Evaluation of Complications of Extracranial Carotid Artery Interventions

Cited by 5 publications

References 72 publications

Ileal hemorrhagic infarction after carotid artery stenting: A case report and review of the literature

Ileal hemorrhagic infarction after carotid artery stenting: A case report and review of the literature

Intimal Injury Potentially Plays a Key Role in the Formation of Carotid Artery Dissection: A Novel Animal Model Establishing

The Role of Neurosonology in the Diagnosis and Management of Patients with Carotid Artery Disease: A Review

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