Staged Cerebral Revascularization in a Patient With an Occluded Common Carotid Artery

Rabb, Craig H.; Moneta, Gregory L.

doi:10.1161/01.str.0000174191.19216.6b

Cited by 6 publications

(2 citation statements)

References 14 publications

(13 reference statements)

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“…Among the 21 published studies on CCAO treatment, 11 were case reports involving a total of 16 patients. [8][9][10][11][12][13][14][15][16][17] The other 10 studies 2,18-25 involved 6 to 24 patients, with a total of 130 patients.…”

Section: Discussionmentioning

confidence: 99%

Common Carotid Artery Occlusion: A Single-Center Experience in 40 Cases

et al. 2015

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artery occlusion (CCAO) has been little discussed in the literature compared with occlusion of the internal carotid artery (ICA). However, CCAO seems to be a different disease because of its presentation, treatment, and incidence.CCAO is diagnosed in approximately 3% of the symptomatic patients undergoing carotid angiography 1 and in only 1 to 5% of the patients with symptomatic cerebrovascular disease. 2,3 The development of exuberant collateral circulation and patency of the carotid bifurcation seems to protect against ischemic brain lesions. 3 However, several symptoms can occur, including hemispheric stroke, amaurosis fugax, and brain hypoperfusion. 2 To date, no consensus exists for treatment of asymptomatic patients, and decisions for treatment of symptomatic patients are controversial and made according to each case. 4The incidence of common carotid artery occlusion (CCAO) is approximately 3% in patients who undergo angiography for symptomatic cerebrovascular disease; however, few studies have reported on management of this condition. The objective of this article was to analyze risk factors, therapeutic options, and clinical benefits of surgical treatment at a hospital in the city of São Paulo, Brazil. Data were collected from medical records of 40 patients with CCAO who were treated from June 2002 to October 2013. Results were analyzed retrospectively. Most of the patients were men (63.0%), who were significantly younger than women. Most of the participants had hypertension (90.0%), and more than half had a history of smoking (52.5%). The mean number of coexisting comorbidities/risk factors was 2.9 AE 1.0. Half of our sample had ipsilateral patent internal and external carotid artery, and 32.5% presented with an occluded internal carotid artery and a patent external artery. Patients with both an internal and an external occluded carotid artery (12.5%) were significantly older. Contralateral arteriosclerosis was observed in 65% of the patients, mainly represented by 50 to 90% stenosis. Most patients were symptomatic (67.5%), and hemiparesis was the most common symptom (55.0%) found. Most (77.5%) of the patients underwent the medical treatment; one out of three endovascular approaches failed. During the mean follow-up of 55 AE 43 months (range, 2-136 months), 17.5% of the patients died within 4 days after surgical repair and after along 123 months of clinical follow-up. Coexisting comorbidities/risk factors were significantly associated with fatal outcomes, such as acute myocardial infarction. This study provides scientific evidences on treatment and outcomes of CCAO.

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Section: Discussionmentioning

confidence: 99%

Common Carotid Artery Occlusion: A Single-Center Experience in 40 Cases

et al. 2015

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“…10,18 Vein bypass from the left subclavian to the ECA, followed by STA-MCA bypass has been reported in a patient with left CCA and ICA occlusion. 19,20 ECA endarterectomy followed by STA-MCA bypass has been performed for symptomatic patients with ICA occlusion and severe ECA stenosis, though not with concomitant CCA occlusion. 12 Similarly, ECA stenting followed by STA-MCA bypass has been performed for symptomatic patients with ICA occlusion and severe ECA stenosis, though not with concomitant CCA occlusion as reported in the present study.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Staged Common and External Carotid Artery Stenting Followed by Superficial Temporal Artery to Middle Cerebral Artery Bypass

Mulcahy

Presti

Veken

et al. 2022

J Neurol Surg A Cent Eur Neurosurg

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Superficial temporal artery (STA) to middle cerebral artery (MCA) bypass surgery for internal carotid artery (ICA) occlusive disease necessarily requires sufficient external carotid artery (ECA) blood flow. Surgical bypass is therefore precluded if there is common carotid artery (CCA) occlusion. Here we present two such cases: one patient had a CCA occlusion, and the other had an ICA occlusion and ECA stenosis. Both had failed medical management, and were therefore treated with angioplasty and stenting of the ECA, followed by STA-MCA bypass. We describe the clinical and radiologic outcomes of these cases, and remark on the potential pitfalls associated with this novel approach.

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