Carotid artery stenting for patients with occipital–vertebral anastomosis

Kajikawa, Ryuichiro; Fujinaka, Toshiyuki; Nakamura, Hajime; Kinoshita, Manabu; Nishida, Tomomi; Kishima, Haruhiko

doi:10.1177/1591019918802924

Cited by 5 publications

(5 citation statements)

References 19 publications

(28 reference statements)

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“…The frequency of observing this anastomosis on cerebral angiography is 8/1000 cases and is more often recognized in patients with vascular occlusive disease. 9 ) Severe stenosis of the ECA may generate a pressure gradient from the VA toward the ECA via the OA. To date, 11 cases of patients with PHA arising from the ECA have been reported, 2 , 3 , 10 - 16 ) and two of them underwent CEA ( Table 1 ).…”

Section: Discussionmentioning

confidence: 99%

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Carotid Endarterectomy for Vertebrobasilar Insufficiency Caused by Severe Stenosis of Primitive Hypoglossal Artery: A Technical Case Report and Literature Review

Segawa

Inoue

Noda

et al. 2022

Neurol. Med. Chir.(Tokyo)

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Persistent primitive hypoglossal artery (PHA) originating from the external carotid artery (ECA) is a rare anomaly. Reports of carotid endarterectomy (CEA) for ECA stenosis associated with this anomaly are even rarer. A 76-year-old woman presented to a medical clinic with a major complaint of refractory dizziness. Carotid ultrasound study suggested severe stenosis of the left cervical carotid bifurcation; therefore, she was referred to our department for a possible CEA. The imaging results indicated severe stenosis of the left carotid bifurcation and that the ECA was a PHA and the origin of the dominant vertebrobasilar artery (VBA). CEA was performed with the special caution of providing VBA collateral flow during clamping and preventing microembolisms during declamping of the ECA. Postoperative head magnetic resonance imaging revealed no new findings of cerebral infarction, and her dizziness disappeared. CEA associated with stenosis of the PHA as the origin of a dominant VBA was safely performed with an appropriate understanding of possible collateral pathways during cross-clamping.

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Section: Discussionmentioning

confidence: 99%

“… 18 ) When securing the cervical blood vessel, the collateral circulation was preserved by clamping the site just proximal to the OA. In almost all autopsy cases, OA-VA anastomosis is observed, 9 ) and blood flow to the posterior circulation may be expected by performing CEA without clamping the OA in PHA type 2.…”

Section: Discussionmentioning

confidence: 99%

Carotid Endarterectomy for Vertebrobasilar Insufficiency Caused by Severe Stenosis of Primitive Hypoglossal Artery: A Technical Case Report and Literature Review

Segawa

Inoue

Noda

et al. 2022

Neurol. Med. Chir.(Tokyo)

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“…It is seen in almost all cases at autopsy, but its prevalence in cerebral angiography varies from 0.8% to 4%. However, in a study of patients who underwent carotid artery stenting due to carotid artery stenosis, the frequency of OA-VA anastomosis was higher at 14.9% (7 out of 47) ( 8 ). Among a total of 23 cases of OA-VA anastomosis found in extracranial main arterial trunks occlusive disease, seven cases were ICA stenosis/occlusion and two cases were CCAO, according to a previous literature review conducted by Miyachi et al ( 9 ).…”

Section: Discussionmentioning

confidence: 97%

Asymptomatic Common Carotid Artery Occlusion and Occipital-Vertebral Artery Anastomosis: A Case Report and Literature Review

Choi

Byun

Choi

et al. 2023

J Korean Soc Radiol

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Common carotid artery occlusion (CCAO) is a very rare disorder that has rarely been studied. CCAO causes several neurological symptoms but can sometimes be asymptomatic due to the development of various anastomoses. Herein, we report the case of a 70-year-old male patient diagnosed with asymptomatic CCAO due to anastomotic flow. The patient underwent transfemoral cerebral angiography (TFCA) and was found to have CCAO with two collateral pathways, including an occipital artery-vertebral artery anastomosis. We emphasize the importance of TFCA when CCAO is suspected and review the types and anastomotic pathways of CCAO.

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“… 3 ) Vascular anastomosis includes remnant cases of persistent primitive arteries 2 ) and cases involving the branch vessels of the ECA. 1 ) Reports suggest that the anastomosis of a branch of the ECA and VA occurs as a complement to decreased blood flow due to stenosis or occlusion of the VA. 4 ) While treating ICA stenosis with anastomotic vessels, attention should be paid not only to the anterior circulation but also to the posterior circulation embolism and hemodynamic cerebral ischemia via anastomosis. Therefore, preservation of blood flow in the ECA was necessary during CEA.…”

Section: Discussionmentioning

confidence: 99%

"Dual Internal Shunts Technique" for Carotid Endarterectomy with Carotid Vertebral Anastomosis: Technical Note

NAGASAKI,

NARIKIYO,

OHASHI

et al. 2023

Neurol. Med. Chir.(Tokyo)

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In revascularization of internal carotid stenosis with carotid vertebrobasilar anastomoses, attention should be paid not only to the anterior circulation but also to the posterior circulation cerebral infarction. A 74-year-old man was referred for treatment of carotid artery stenosis; NASCET 75% stenosis in the right internal carotid artery and acute cerebral infarction were confirmed. Occlusion of the left subclavian artery and vascular anastomosis between the right external carotid artery and the vertebral artery were indicated, such that the right external carotid artery may maintain blood flow to the vertebrobasilar artery. Therefore, dual shunts were used for the common and internal carotid arteries and the common and external carotid arteries to maintain blood flow during carotid endarterectomy. Management of the dual shunts is difficult due to the instable parallel placement of the common carotid artery shunt balloons. To solve this problem, the “dual internal shunts technique” was performed. The first shunt was inserted into the external and common carotid arteries, and the second into the internal and common carotid arteries. The shunt balloon on the common carotid artery side was placed distal to the first shunt balloon so that the dual balloons were placed in a tandem position. The proximal balloon was subsequently deflated gradually to improve flow in both shunts. The procedure is technically easy and safe.

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Carotid artery stenting for patients with occipital–vertebral anastomosis

Cited by 5 publications

References 19 publications

Carotid Endarterectomy for Vertebrobasilar Insufficiency Caused by Severe Stenosis of Primitive Hypoglossal Artery: A Technical Case Report and Literature Review

Carotid Endarterectomy for Vertebrobasilar Insufficiency Caused by Severe Stenosis of Primitive Hypoglossal Artery: A Technical Case Report and Literature Review

Asymptomatic Common Carotid Artery Occlusion and Occipital-Vertebral Artery Anastomosis: A Case Report and Literature Review

"Dual Internal Shunts Technique" for Carotid Endarterectomy with Carotid Vertebral Anastomosis: Technical Note

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