Ring-stripping retrograde common carotid endarterectomy
case report
Keywords:
Carotid artery, Arteries, Endarterectomy, Atherosclerosis, Cerebrovascular diseaseAbstract
CONTEXT: Total occlusion of the common carotid is rare and the indications and techniques for surgical treatment are still a matter of controversy. OBJECTIVE: To demonstrate the feasibility of retrograde common carotid endarterectomy. DESIGN: Retrospective case report study. SETTING: Tertiary care private hospital. PARTICIPANTS: Three patients underwent ring-stripping retrograde common carotid endarterectomy. Their ages were 81, 68 and 65 years. All were hypertensive with generalized atherosclerosis, two had diabetes mellitus, and one had undergone coronary artery bypass some years earlier and had non-dialytic chronic renal insufficiency. Symptoms of brain ischemia were present in two patients. All patients had total occlusion of the common carotid, extending from the origin to the bifurcation and localized in the right common carotid in two cases. In two cases the internal carotid artery was also occluded. MAIN MEASUREMENTS: Postoperative early mortality and stroke rate, and the medium and long-term endarterectomy patency. RESULTS: There were no deaths. One patient had a transient ischemic attack. All endarterectomies were patent after eight months, four years and seven years of follow-up. CONCLUSION: There is low mortality, and the procedure can be done through only one cervical incision. Tandem lesions of the carotid arteries can be treated together. It is suitable for long total occlusions of the common carotid, and long-term patency.
Downloads
References
Moore WS, Blaisdell W, Hall AD. Retrograde thrombectomy for chronic occlusion of the common carotid artery. Arch Surg 1967;95:664-73.
Aguiar ET, Lederman A, Higutchi C, Schreen G. Early and late results of carotid endarterectomy: retrospective study of 70 op- erations. São Paulo Med J Med 2001;119:206-11.
Berger R, Morasch MD, Kline RA Transthoracic repair of in- nominate and common carotid artery disease: immediate and long-term outcome for 100 consecutive surgical reconstructions. J Vasc Surg 1998;27:34-42.
Owens LV, Tinsley Jr. EA, Criado E, Burnham SJ, Keagy BA. Extra-thoracic reconstruction of arterial occlusive disease in- volving the supra-aortic trunks. J Vasc Surg 1995;22:217-22.
Pernes JM, Marjelle J, Auguste M, et al. Techniques endoluminales de traitement des lésions de troncs supra- aortiques (a l’exception de la carotide interne). In: Techniques chirurgicales - chirurgie vasculaire. Encycl Méd Chir. Paris: Elsevier 1999;43-128:14p.
Hass WK, Fields WS, North RR, Kricheff II, Chase NE, Bauer RB. Joint study of extracranial carotid occlusion. II: Arteriography techniques, sites and complications. JAMA 1968;201:961-8.
Belkin M, Mackey WC, Pessin MS, Caplan LR, O’Donnel TF. Common carotid artery occlusion with patent internal and external carotid arteries: Diagnosis and surgical management. J Vasc Surg 1993;17:1019-28.
Vogt DP, Hertzer NR, O’Hara PJ, Beven EG. Brachiocephalic arterial reconstruction. Ann Surg 1982;196:541-52.
Queral LA, Criado FJ. The treatment of focal aortic and branch lesions with Palmaz stents. J Vasc Surg 1996;23:368-75.
Riles TS, Imparato AM, Posner MP, Eikelboom BC. Common carotid occlusion. Assessment of distal vessels. Ann Surg 1983;199:363-6.
Kiefer E. Chirurgie des troncs supra-aortiques. In: Techniques chirurgicales - chirurgie vasculaire. Encycl Méd Chir. Paris: Elsevier 1987;43-120:16p.
Moore WS, Malone JM, Goldstone J. Extra-thoracic repair of branch occlusions of the aortic arch. Am J Surg 1976;132:249-57.
Longo PH, Zaclis J. Anastomose entre artéria carótida externa e artéria vertebral em dois casos de trombose de artéria carótida interna. Arq Neuropsiq 1958;16:353-60.
Almeida GM, Longo PH. Anastomose carotidobasilar: persistência da artéria trigeminal primitiva (6 casos) e da primeira artéria segmentar cervical (1 caso). Rev Paul Med 1965;67:195-202.
Zaclis J, Longo PH, Matosinho-França LC. Distribuição do contraste em angiografias cerebrais: I - Angiografias carotídeas com enchimento do tronco basilar. Arq Neuropsiq 1957;15:97-124.
AbuRhama AF, Copeland SE. Bilateral internal carotid artery occlusion: natural history and surgical alternatives. Cardiovasc Surg 1998,6:579-83.
Lamberth WC. External carotid endarterectomy: indications, operative technique and results. Surgery 1983;93:57-63.
Crawford ES, DeBackey ME, Morris Jr. GC, Howell JF. Surgi- cal treatment of occlusion of innominate, common carotid and subclavian arteries: a 10-year experience. Surgery 1969;65:17.
Aguiar ET, Mariño JCS. Surgery of the brachiocephalic arter- ies. In: Anais IMAGO 94 - Third International Congress of Angioradiology and Vascular Intervention, Miami, USA, Sep- tember 11-15, 1994.
Fry WR, Martin JD, Clagett GP, Fry WJ. Extra-thoracic ca- rotid reconstruction: the subclavian-carotid artery bypass. J Vasc Surg 1992;15:83-9.
Sidhu PS, Morgan MBF, Walters HL, Baskerville PA, Fraser SCA. Combined carotid bifurcation endarterectomy and intra- operative transluminal angioplasty of proximal common carotid artery stenosis: an alternative to extra-thoracic bypass. Clin Radiol 1998;53:444-7.
Aguiar ET. Trombendarterectomia aortilíaco-femoral com anéis. Professorial thesis. Faculdade de Medicina da Universidade de São Paulo. 1999. 93p.
