Surgical treatment for bilateral carotid arterial stenosis

Tsukahara, Tetsuya; Ogino, Eiji; Aoyama, Takako; Nakakuki, Takuya; Murakami, Mamoru

doi:10.1007/3-211-27911-3_21

Cited by 4 publications

(10 citation statements)

References 6 publications

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“…Therefore, the number of cases in which bilateral CEA has been performed has been decreasing since the introduction of CAS 5,8 .…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, combined therapy using CAS and CEA could be beneficial for a relatively large group of patients with bilateral carotid stenosis 5,8 .…”

Section: Discussionmentioning

confidence: 99%

“…Recently, the combined therapy of CAS followed by CEA has been recommended by several authors [5][6][7][8] , who suggest that this strategy is a safe and feasible option for patients with bilateral carotid stenosis and coronary artery disease, because CAS can be usually performed under local anesthesia 6,7 . Most of the symptomatic patients without coronary artery disease in their article also underwent CAS for the asymptomatic side and then CEA for the symptomatic side, because symptomatic plaques are often vulnerable and sometimes unsafe for CAS 5,8 .…”

Section: Discussionmentioning

confidence: 99%

“…Most of the symptomatic patients without coronary artery disease in their article also underwent CAS for the asymptomatic side and then CEA for the symptomatic side, because symptomatic plaques are often vulnerable and sometimes unsafe for CAS 5,8 . It was thought that CAS would be better for the first revascularization procedure than CEA, because contralateral stenosis would adversely affect CEA.…”

Section: Discussionmentioning

confidence: 99%

“…However, it is sometimes difficult to manage patients with bilateral severe carotid stenosis. Since the introduction of CAS, a combined treatment for bilateral lesions using CEA and CAS has been developed [5][6][7][8] . Its treatment strategy is complex, and there are several possible approaches that have yet to be decided which side to treat first, which procedure to perform, etc.-but will be determined by general condition, symptoms, plaque characteristics, anatomical situation, hemodynamic state, and other factors.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Treatment Strategy for Bilateral Carotid Stenosis: 2 Cases of Carotid Endarterectomy for the Symptomatic Side Followed by Carotid Stenting

Hokari¹,

Isobe²,

Asano

et al. 2014

Journal of Stroke and Cerebrovascular Diseases

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Since the introduction of carotid stenting (CAS), a combined treatment for bilateral lesions using carotid endarterectomy (CEA) and CAS has been developed. However, there has been only one report about CEA then CAS. Herein we describe two patients with bilateral severe carotid stenosis who were treated by CEA for the symptomatic side and by CAS for the contra-lateral asymptomatic side.A 71-year-old man underwent CEA for the symptomatic side. Although the patient suffered hyperperfusion syndrome after CEA, he recovered fully after 3 weeks of rehabilitation. Two months later, CAS was performed for the asymptomatic side and he was discharged with no deficit.A 67-year-old man underwent CEA for the symptomatic side. The patient developed no post-operative neurological deficits except for hoarseness. Four weeks later, CAS was performed for the contralateral asymptomatic side. After the procedure, however, severe hypotension occurred, and treatment by continuous injection of catecholamine was necessary to maintain systematic blood pressure. The patient was ultimately discharged with no deficit.The combined therapy of CAS for the asymptomatic side and then CEA for the symptomatic side has been recommended by several authors. However, one of the problems of this strategy is the higher incidence of post procedural hemodynamic complications, and hypotension after CAS may be dangerous for the symptomatic hemisphere. We suggest a combined therapy using CEA for the symptomatic side and then CAS for the asymptomatic side can be one beneficial treatment option for patients with bilateral carotid stenosis without coronary artery disease.

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“…Therefore, the number of cases in which bilateral CEA has been performed has been decreasing since the introduction of CAS 5,8 .…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, combined therapy using CAS and CEA could be beneficial for a relatively large group of patients with bilateral carotid stenosis 5,8 .…”

Section: Discussionmentioning

confidence: 99%