Carotid Bypass for Carotid Occlusion

Hage, Ziad A.; Behbahani, Mandana; Amin‐Hanjani, Sepideh; Charbel, Fady T.

doi:10.1007/s11883-015-0517-6

Cited by 11 publications

(10 citation statements)

References 39 publications

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“…In the past 20 years, there has been considerable progress in imaging techniques, which has enabled physicians to identify conditions including hemodynamic ischemia and poor collateral circulation as well as patients at high risk of recurrent stroke ( 52 ).…”

Section: Imagingmentioning

confidence: 99%

Current understanding of chronic total occlusion of the internal carotid artery (Review)

Guo

et al. 2017

biom rep

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At present, there is limited understanding of chronic total occlusion (CTO) of the internal carotid artery (ICA). Therefore, the present report collected related cases from PubMed and reviewed the literature. Cerebral vessels may form collateral circulation immediately or gradually following CTO of the ICA. The natural history of CTO of the ICA includes a variety of outcomes, all of which are biased toward a non-benign progressive process and are characterized by insufficient cerebral perfusion, embolus detachment and cognitive dysfunction. The majority of cases of CTO of the ICA require treatment. In early studies, the results of external-ICA bypass were unsatisfactory, while recanalization is now considered the only viable option. The current treatment indications mainly depend on the degree of injury to the cerebrovascular reserve and the extent to which the oxygen extraction fraction is increased. The length, height and duration of ICA occlusion are also relevant, though more frequently, the condition depends on multiple factors. Endovascular interventional recanalization, carotid endarterectomy (CEA) and hybrid surgery may be conducted in a select group of patients. As novel materials are developed, the success rate of simple recanalization may gradually increase; however, hybrid surgery may be more representative of the current trend, as advanced CEA can remove carotid atherosclerosis plaques, thus reducing the technological demands of the subsequent interventional recanalization. There are many complications that may result from recanalization following CTO of the ICA, including hyperperfusion and technical errors; therefore, the operation must be conducted carefully. If the recanalization is successful, it typically results in a stable improvement of patient condition in the long term. However, despite these conclusions, more studies are required in the future to further improve current understanding of CTO of the ICA.

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Section: Imagingmentioning

confidence: 99%

Current understanding of chronic total occlusion of the internal carotid artery (Review)

Guo

et al. 2017

biom rep

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“…After this, investigators tried to find the subgroup of patients who might benefit from bypass surgery by determining hemodynamic consequences of ICA stenosis especially in elderly patients with atherosclerotic ICA stenosis. Recently, another trial about the effect of atherosclerotic carotid artery stenosis surgery (COSS) for stroke prevention again concluded that EC-IC bypass surgery did not reduce stroke compared with medical therapy [2][3][4][5]. Intracranial atherosclerosis was separately examined with similar results [6,7].…”

Section: Introductionmentioning

confidence: 99%

“…In extracranial [1][2][3][4][5] or intracranial [6,7,33] atherosclerotic ICA stenosis and in child and adult MMD [16][17][18][19][20][21][22][23][24][25][26]34], respectively with different reasons, basal/acetazolamide SPECT was proposed to evaluate the hemodynamic significance of already-characterized steno-occlusive lesions in ICA or cerebral arteries [6,7,21,22]. For elderly atherosclerotic patients, once functional impairment due to stenosis on the ipsilateral hemisphere is suspected, basal/acetazolamide SPECT was supposed to disclose the cases that need EC-IC bypass surgery [1,4,35], endarterectomy [36], stenting [37], or medical treatments. There is obviously a gray area of finding the indicated patients with failure of medical treatment, which depends on patients' suffering of a certain period taking the risk of strokes.…”

Section: Introductionmentioning

confidence: 99%

“…In the literature, at first, investigators proposed that randomized clinical trials were warranted and then several trials revealed that EC-IC bypass for extracranial ICA stenosis [1] and EC-IC bypass surgery for extracranial or intracranial ICA stenosis [3] and direct or indirect bypass surgery for intracranial ICA stenosis [6] did not prove their superiority in efficacy in short-term or long-term prevention of stroke or its related death compared with best medical treatment. In addition, carotid artery endarterectomy was not found to improve the prevention of stroke [9][10][11][12], that is to say, the annual risk of stroke of 5 to 8% with medical therapy was not reduced with endarterectomy [4]. Mostly, these surgical procedures were adopted as a remedy of hemodynamic failure, insufficiency, or impairment and for reduction of the next incidents of stroke for symptomatic patients.…”

Section: Introductionmentioning

confidence: 99%

“…Mostly, these surgical procedures were adopted as a remedy of hemodynamic failure, insufficiency, or impairment and for reduction of the next incidents of stroke for symptomatic patients. Positron emission tomography (PET) to measure oxygen consumption and blood flow so as to define the misery perfusion or basal/acetazolamide SPECT to disclose the impaired vascular reserve were used as inclusion criteria in these randomized clinical trials [4]. Acute or emergency cases are sometimes said to be an appropriate indication despite the non-superior preventive effect of these surgical procedures.…”

Section: Introductionmentioning

confidence: 99%

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Basal and Acetazolamide Brain Perfusion SPECT in Internal Carotid Artery Stenosis

Wong

Shagera

Ryoo

et al. 2020

Nucl Med Mol Imaging

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Internal carotid artery (ICA) stenosis including Moyamoya disease needs revascularization when hemodynamic insufficiency is validated. Vascular reserve impairment was the key to find the indication for endarterectomy/bypass surgery in the atherosclerotic ICA stenosis and to determine the indication, treatment effect, and prognosis in Moyamoya diseases. Vascular reserve was quantitatively assessed by 1-day split-dose I-123 IMP basal/acetazolamide SPECT in Japan or by Tc-99m HMPAO SPECT in other countries using qualitative or semi-quantitative method. We summarized the development of 1-day basal/ acetazolamide brain perfusion SPECT for ICA stenosis, both quantitative and qualitative methods, and their methodological issues regarding (1) acquisition protocol; (2) qualitative assessment, either visual or deep learning-based; (3) clinical use for atherosclerotic ICA steno-occlusive diseases and mostly Moyamoya diseases; and (4) their impact on the choice of treatment options. Trials to use CT perfusion or perfusion MRI using contrast materials or arterial spin labeling were briefly discussed in their endeavor to use basal studies alone to replace acetazolamide-challenge SPECT. Theoretical and practical issues imply that basal perfusion evaluation, no matter how much sophisticated, will not disclose vascular reserve. Acetazolamide rarely causes serious adverse reactions but included fatality, and now, we need to monitor patients closely in acetazolamide-challenge studies.

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