Carotid Endarterectomy for Pseudo-occlusion of the Cervical Internal Carotid Artery

Hirata, Yoko; Sakata, Noriyuki; Tsuchimochi, Hirohito; Tsugu, Hitoshi; Onishi, Hirokazu; Inoue, Tatsuo

doi:10.1007/978-3-319-02411-0_16

Cited by 6 publications

(6 citation statements)

References 15 publications

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“…Patients with CNO were then excluded from most subsequent randomized controlled trials. So only data from cohort studies evaluating CEA, CAS, or best medical treatment (BMT) were reported ( 9 , 16 – 18 ) and the reported results were highly heterogenous. Since the periprocedural risk for CEA decreased significantly in the past years ( 19 ), more and more investigators tried to carry out CEA for patients with CNO and achieved good results.…”

Section: Discussionmentioning

confidence: 99%

Carotid Endarterectomy for the Treatment of Carotid Near-Occlusion With Recurrent Symptoms

Chen

Sun

et al. 2022

Front. Neurol.

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ObjectiveReport our preliminary experience of carotid endarterectomy (CEA) for the treatment of carotid near-occlusion (CNO) with recurrent symptoms.Materials and MethodsRetrospectively analyze the demographics, treatment detail, and outcomes data of 122 patients with CNO from 2014 to 2020. According to whether distal full collapse exists, patients were classified into the full collapse group and the non-full collapse group. The incidence of death, myocardial infarction, stroke, and other variables were compared between the two groups.ResultsA total of 122 patients with CNO and recurrent symptoms were enrolled. The demographics were comparable between the two groups. Thirty-day incidence of primary endpoints was 1.85% in the full collapse group and 4.41% in the non-full collapse group. Twelve-month incidence of primary endpoints was 7.41% in the full collapse group and 4.41% in the non-full collapse group. One re-stenosis occurred in the non-full collapse group 8 months after CEA.ConclusionFor patients with CNO with recurrent symptoms, CEA is not worse than the results described in historical control groups, despite whether distal full collapse exists. The shunt is important to avoid intraoperative hypoperfusion and postoperative hyperperfusion. The long-term results should be further evaluated.

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Section: Discussionmentioning

confidence: 99%

Carotid Endarterectomy for the Treatment of Carotid Near-Occlusion With Recurrent Symptoms

Chen

Sun

et al. 2022

Front. Neurol.

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“…Reported outcomes were highly heterogeneous and ranged from a 30-day stroke/death risk of 0–11.1% for CEA [11–13, 20] to 0–9.2% for CAS [5–7, 16–18] and 0–43% for best medical treatment (BMT) [8, 12, 19]. Furthermore, analyses of published studies are hampered by both a variety in inclusion criteria and the reporting of different clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…A limited number of cohort studies have published the results of their centers’ preferred treatment approach, which varied from CEA [ 11 – 13 ] to carotid artery stenting (CAS) [ 4 – 7 , 14 – 18 ] or BMT [ 8 , 12 , 19 ]. Reported outcomes were highly heterogeneous and ranged from a 30-day stroke/death risk of 0–11.1% for CEA [ 11 – 13 , 20 ] to 0–9.2% for CAS [ 5 – 7 , 16 – 18 ] and 0–43% for best medical treatment (BMT) [ 8 , 12 , 19 ]. Furthermore, analyses of published studies are hampered by both a variety in inclusion criteria and the reporting of different clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…From this time onwards, OMT was recommended in patients with symptomatic ICA NO and these patients were excluded from randomized controlled trials. Since then, a wide variety in cohort studies was published on treatment approaches and results [4–8, 11–20]. More recently, a meta-analysis (mainly based on small cohort studies) could not provide a new, definitive recommendation for clinical practice because of the limited number of included studies and patients, the use of a variety in diagnostic criteria, and the lack of a distinction between ICA NO with or without a post-stenotic full collapse [21].…”

Section: Introductionmentioning

confidence: 99%

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Carotid endarterectomy in patients with recurrent symptoms associated with an ipsilateral carotid artery near occlusion with full collapse

et al. 2018

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ObjectiveNear occlusion (NO) of the internal carotid artery (ICA) with full collapse (NOFC) is a rare condition, with a prevalence of around 1%. Guidelines on carotid stenosis recommend a conservative treatment in patients with a single-event ipsilateral to a NOFC, but the optimal treatment for patients with recurrent symptoms associated with NOFC remains uncertain. We describe a consecutive series of patients with recurrent symptoms associated with NOFC (RSNOFC) who underwent carotid endarterectomy (CEA).MethodsFrom 2008 to 2017, 17 consecutive patients with RSNOFC were treated according to our standardized multidisciplinary work-up and protocol and included for this single-center cohort study. NO was defined according to the angiographic North American Symptomatic Carotid Endarterectomy Trial criteria. Only patients with NOFC were included in this study.ResultsStandard longitudinal CEA was performed in 15 patients, whereas in 2 patients the ICA was ligated with concomitant endarterectomy of the ECA. Within 30 postoperative days, one patient died from a hemorrhagic infarction. During follow-up (median 23 months) one patient died of unknown cause 90 days after CEA. No TIA, stroke, myocardial infarction or re-stenosis occurred in the remaining patients.ConclusionIn patients with RSNOFC, CEA may be considered a potential treatment option. Although procedural risks in this small subgroup may be higher as compared to patients with low-to-moderate risk anatomy, this risk may outbalance the natural course.

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“…After applying exclusion criteria, 92 studies were excluded and finally 33 articles participated in the meta-analysis. More specifically, the literature review revealed 13 articles on CEA (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24), 12 articles on CAS (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36), 5 studies on BMT and CEA (37)(38)(39)(40)(41), 2 studies on CEA and CAS (42,43) and 1 study on BMT (44) (Figure 1: flow chart). The demographic characteristics of the 33 eligible studies included in our study are presented in Tables 1,2.…”

Section: Resultsmentioning

confidence: 99%

Management of internal carotid artery near-occlusion: the need for updated evidence

et al. 2020

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Near occlusion of internal carotid artery (ICA) is a rare and easily misdiagnosed condition and the decision for revascularisation still remains controversial. We conducted an updated meta-analysis in order to investigate outcomes after carotid endarterectomy (CEA), carotid artery stenting (CAS) or best medical treatment (BMT) in patients with near-occlusion of the ICA. We also aimed to investigate the role of time as a potential moderator of the near-ICA occlusion-stroke rate association. A multiple electronic health database search on articles published up to November 2019 was performed. The pooled stroke rate after CEA, CAS and BMT were calculated. We also investigated transient ischemic attack (TIA), strokerelated death, myocardial infarction (MI), any cause of death and ICA restenosis crude rates (%). A total of 33 articles were finally deemed eligible. The pooled stroke rate was 1.52% [95% confidence interval (CI): 0.09-4.02%] after CEA, 1.80% (95% CI: 0.61-3.40%) after CAS and 8.39% (95% CI: 3.39-14.80%) after BMT. Out of 896 CEA patients, we recorded 22 TIAs (2.5%), 33 all-cause deaths (3.7%), 5 stroke-related deaths (0.6%) and 6 MIs (0.7%). Concerning outcomes after 603 CAS patients, we recorded 7 TIAs (1.2%), 56 all-cause deaths (9.3%), 4 stroke-related deaths (0.7%) and 22 MIs (3.6%). Among 263 patients who were treated with BMT, we found 16 TIAs (6.1%), 10 all-cause deaths (3.8%), no stroke-related death, and no MI. Crude restenosis rate during follow-up was 9.0% (54/601) for CEA and 4.1% (24/592) for CAS patients. No significant effect of publication year upon stroke rate after CEA was recorded. However, there was a significant reversed association between pooled stroke rate after CAS and publication year (P=0.05). A statistically significant reversed association between pooled stroke rate after BMT and publication year was also recorded (P<0.01). The results of this updated meta-analysis revealed high stroke rate for patients with near-occlusion of ICA who treated only with BMT, while intervention seemed to be safe and effective. A downward trend in the stroke rates over time after CAS and BMT was also discovered. These highlight that patients with near-occlusion of ICA should be included and investigated in future studies.

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Carotid Endarterectomy for Pseudo-occlusion of the Cervical Internal Carotid Artery

Abstract: Patients with PO had more fibrous plaques and two different histological features, including total occlusion with recanalization or severe stenosis. The plaque histology may be related to the pathogenesis and the surgical outcome.

Cited by 6 publications

References 15 publications

Carotid Endarterectomy for the Treatment of Carotid Near-Occlusion With Recurrent Symptoms

Carotid Endarterectomy for the Treatment of Carotid Near-Occlusion With Recurrent Symptoms

Carotid endarterectomy in patients with recurrent symptoms associated with an ipsilateral carotid artery near occlusion with full collapse

Management of internal carotid artery near-occlusion: the need for updated evidence

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