Time Is Brain? — Surgical Revascularization of Acute Symptomatic Occlusion of the Internal Carotid Artery up to One Week

Weis-Müller, Barbara Theresia; Spivak-Dats, Asya; Turowski, Bernd; Siebler, Mario; Balzer, K.; Grabitz, K.; Godehardt, Erhard; Sandmann, W.

doi:10.1016/j.avsg.2012.05.023

Cited by 7 publications

(4 citation statements)

References 15 publications

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“…The North American Symptomatic Carotid Endarterectomy Trial (NACET) of the treatment of patients with carotid artery near-occlusion showed that these patients benefit from CEA without an increased risk of stroke [ 3 ]. Some studies indicated that the risk of postoperative cerebral hemorrhage was increased by the performance of CEA in these patients [ 4 , 5 ] due to the enhanced difficulty of the surgical technique, but other studies had different findings [ 6 ]. Using a simple method to assess the possibility and success rate of recanalization for the patients with carotid artery occlusion before CEA will be important for clinical decision making.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Endarterectomy Recanalization under Ultrasound Guidance in Symptomatic Patients with Carotid Artery Occlusion

Liu

et al. 2015

PLoS ONE

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Rigorous screening and good imaging would help perform surgery on carotid artery occlusion CAO safely and effectively. The purpose of this study was to retrospectively evaluate carotid endarterectomy (CEA) recanalization in patients with common carotid artery occlusion (CCAO) or internal carotid artery occlusion (ICAO) with color Doppler flow imaging (CDFI). A total of 59 patients undergoing CEA were enrolled. According to the results of CEA, the patients were divided into successful recanalization (group A) and unsuccessful recanalization (group B) groups. The original diameter, lesion length, proximal-to-distal diameter ratio and echo characteristics of the lesion within the lumen of the carotid artery were recorded before CEA and compared between the two groups. In regards to the achievement of repatency by CEA, the overall success rate was 74.6% (44/59), the success rate in CCAO patients was 75.9% (22/29) and the success rate in ICAO patients was 73.3% (22/30). There was no significant difference in the success rates between the CCAO and ICAO patients (χ2 = 0.050, P = 0.824). The overall rate of stroke and death within 30 postoperative days was 5.1% (3/59). For the CCAO patients, the lesion length in group A was shorter than that in group B (t = 3.221, P = 0.004). For the ICAO patients, the original diameter of the distal ICA was broader (t = 6.254, P = 0.000) and the proximal-to-distal ICA diameter ratio was smaller (t = 8.036, P = 0.000) in group A than in group B. The rate of recanalization for lumens with a homogeneous echo pattern (hypoecho or isoecho) was significantly higher than that for lumens with echo heterogeneity for both the CCAO and ICAO patients (χ2 = 14.477, P = 0.001; χ2 = 10.519, P = 0.003). However, for both the CCAO and ICAO patients, there was no difference in the rate of recanalization between patients with hypoecho and isoecho lesions (χ2 = 0.109, P = 0.742; χ2 = 0.836, P = 0.429). The original diameter, proximal-to-distal ICA diameter ratio, lesion length and echo characteristics may affect the success of CEA recanalization in patients with CCAO and ICAO. CDFI is helpful in screening patients with carotid artery occlusion and may improve the success rate of CEA.

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Section: Introductionmentioning

confidence: 99%

Evaluation of Endarterectomy Recanalization under Ultrasound Guidance in Symptomatic Patients with Carotid Artery Occlusion

Liu

et al. 2015

PLoS ONE

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“…Further restriction was done for the following reasons: the treated lesion was stenosis rather than occlusion (10 articles); no separate data were reported on patients with occlusion (3 articles); fewer than 5 patients included (3 articles); chronic occlusion was targeted (2 articles). Furthermore, two studies included the same patient cohort [25,26]; the one reporting results in the more urgent (72 hours v. 168 hours) setting was included [25]. After studying reference lists of the remaining articles, one additional study was found [27].…”

Section: Resultsmentioning

confidence: 99%

Surgery of acute occlusion of the extracranial internal carotid artery – a meta-analysis

Beneš

Bradáč

Horvath

et al. 2020

Vasa

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Summary. Acute occlusion of the extracranial internal carotid artery (eICA) is associated with poor prognosis. Surgical desobliteration has not received adequate attention in recent years. We therefore conducted a literature review and meta-analysis of surgical studies published after 2000 that treated eICA occlusion surgically in an emergency setting. The search identified 10 relevant articles that included a total of 175 patients. The outcomes analysed included rates of recanalization (93 %), early neurological improvement (66 %), modified Rankin Scale 0–2 (62 %), mortality (5 %), early reocclusion (4 %), in-hospital stroke (4 %) and symptomatic intracerebral haemorrhage (4 %). In conclusion, acute surgical desobliteration of eICA occlusion leads to high rates of recanalization and a majority of patients experience early neurological improvement and achieve favourable outcome. Rates of mortality, early reocclusion, in-hospital stroke and sICH are acceptable in the view of unfavourable natural history.

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“…In case of carotid artery damage during surgery, the surgical bypass will be performed immediately, either as a high-flow bypass with a saphenous graft [20] , [21] or in the form of STA-MCA bypass [16] , [22] . The sooner the reperfusion time is, the better the outcome is, although Weis-Muller has reported this time may be up to one week [23] . However, all cases in the Weis-Muller study were caused by intracranial atherosclerotic disease with an acute occlusion.…”

Section: Discussionmentioning

confidence: 99%

Emergency extra-intracranial bypass surgery in a patient with neurologic deficit after an accident in carotid occlusive test: A case report

Ngo

Trinh²,

Felbaum

et al. 2022

International Journal of Surgery Case Reports

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Time Is Brain? — Surgical Revascularization of Acute Symptomatic Occlusion of the Internal Carotid Artery up to One Week

Cited by 7 publications

References 15 publications

Evaluation of Endarterectomy Recanalization under Ultrasound Guidance in Symptomatic Patients with Carotid Artery Occlusion

Evaluation of Endarterectomy Recanalization under Ultrasound Guidance in Symptomatic Patients with Carotid Artery Occlusion

Surgery of acute occlusion of the extracranial internal carotid artery – a meta-analysis

Emergency extra-intracranial bypass surgery in a patient with neurologic deficit after an accident in carotid occlusive test: A case report

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