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

Chen, Jie; Xu, Xin­guang; Sun, Ming-Sheng; Chen, Shu; Liu, Peng; Ye, Zhidong

doi:10.3389/fneur.2022.765795

Cited by 4 publications

(5 citation statements)

References 25 publications

(30 reference statements)

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“…Consistent with previous studies, a higher BP and carotid NO were found to be clinical risk factors for cerebral hyperperfusion after carotid revascularization 2,30 . An analysis of 51,001 CEA procedures used an overall model including preoperative, operative, and postoperative clinical variables to predict CHS and the AUC was 0.785, which was similar with the BP + NO model 2 .…”

Section: Discussionsupporting

confidence: 85%

Multidelay MR Arterial Spin Labeling Perfusion Map for the Prediction of Cerebral Hyperperfusion After Carotid Endarterectomy

Fan

Lai

Lin

et al. 2023

Magnetic Resonance Imaging

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BackgroundMultidelay arterial spin labeling (ASL) generates time‐resolved perfusion maps, which may provide sufficient and accurate hemodynamic information in carotid stenosis.PurposeTo use imaging markers derived from multidelay ASL magnetic resonance imaging (MRI) and to determine the optimal strategy for predicting cerebral hyperperfusion after carotid endarterectomy (CEA).Study TypeProspective observational cohort.SubjectsA total of 79 patients who underwent CEA for carotid stenosis.Field Strength/SequenceA 3.0 T/pseudo‐continuous ASL with three postlabeling delays of 1.0, 1.57, and 2.46 seconds using fast‐spin echo readout.AssessmentCerebral perfusion pressure, antegrade, and collateral flow were scored on a four‐grade ordinal scale based on preoperative multidelay ASL perfusion maps. Simultaneously, quantitative hemodynamic parameters including cerebral blood flow (CBF), arterial transit time (ATT), relative CBF (rCBF) and relative ATT (rATT; ipsilateral/contralateral values) were calculated. On the CBF ratio map obtained through dividing postoperative by preoperative CBF map, regions of interest were placed covering ipsilateral middle cerebral artery territory. Three neuroradiologists conducted this procedure. Cerebral hyperperfusion was defined as a CBF ratio >2.Statistical TestsWeighted κ values, independent sample t test, chi‐square test, Mann–Whitney U‐test, multivariable logistic regression analysis, receiver‐operating characteristic curve analysis, and Delong test. Significance level was P < 0.05.ResultsCerebral hyperperfusion was observed in 15 (19%) patients. Higher blood pressure (odd ratio [OR] = 1.08) and carotid near‐occlusion (NO; OR = 7.31) were clinical risk factors for postoperative hyperperfusion. Poor ASL perfusion score (OR = 37.33), decreased CBF (OR = 0.74), prolonged ATT (OR = 1.02), lower rCBF (OR = 0.91), and higher rATT (OR = 1.12) were independent imaging predictors of hyperperfusion. ASL perfusion score exhibited the highest specificity (95.3%), while CBF exhibited the highest sensitivity (93.3%) for the prediction of hyperperfusion. When combined with ASL perfusion score, CBF and ATT, the predictive ability was significantly higher than using blood pressure and NO alone (AUC: 0.98 vs. 0.78).Data ConclusionsMultidelay ASL can accurately predict cerebral hyperperfusion after CEA with high sensitivity and specificity.Evidence Level2Technical EfficacyStage 5

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Section: Discussionsupporting

confidence: 85%

Multidelay MR Arterial Spin Labeling Perfusion Map for the Prediction of Cerebral Hyperperfusion After Carotid Endarterectomy

Fan

Lai

Lin

et al. 2023

Magnetic Resonance Imaging

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“…The same study concluded that CEA outcomes for CNO patients with recurrent symptoms were not worse than those described in historical control groups. 15 In our study, postoperative TIA, ipsilateral ischemic stroke, and mortality rates, which were the study’s primary endpoints, were similar among our patient groups. We have no data on CNO patients, followed by BMT.…”

Section: Discussionsupporting

confidence: 60%

“… 13 In another recent study of 122 CNO patients, the success rate of the procedure was reported to be 100%, and the perioperative surgical risk in CNO patients was similar to that of non-CNO patients. 15 …”

Section: Discussionmentioning

confidence: 99%

“…Another meta-analysis involving CNO patients showed lower stroke rates after CEA and CAS than after medical treatment. 16 Zhang et al 15 evaluated CNO patients (n = 54, CNO with total collapse vs. n = 68, CNO without total collapse) in whom they performed CEA and reported restenosis at 8 months postoperatively in 1 patient in the entire non-collapsed group. The same study concluded that CEA outcomes for CNO patients with recurrent symptoms were not worse than those described in historical control groups.…”

Section: Discussionmentioning

confidence: 99%

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Cartoid Near Occlusion: Time to Re-think Endarectomy?

İner

2024

Anatol J Cardiol

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Objectives: Carotid near occlusion (CNO) treatment is still controversial. In the discussion of surgical revascularization of these patients, periprocedural complications and technical failure should be considered in addition to the long-term results. We examined the efficacy and safety of surgical treatment in CNO and non-CNO patients undergoing carotid endarterectomy (CEA). Methods: Data from 152 patients (118 male and 34 female) who underwent isolated CEA between January 2018 and June 2020 without critical contralateral lesions were retrospectively analyzed. Patients were divided into 2 groups: CNO (n = 52) and non-CNO (n = 100). The groups were compared regarding postoperative transient ischemic attack (TIA), ipsilateral ischemic stroke, and mortality. Results: The success rate of the procedure was 100% in the CNO group and 99% in the Non-CNO group. In the Non-CNO group, 1 patient had ipsilateral ischemic stroke on postoperative day 0, and this patient was treated with carotid artery stenting. While the number of patients who died in the non-CNO group was 3 (3%) overall, the exitus rate was 1 (1.9%) in the CNO group ( P > .05). In the CNO group, retinal TIA was observed in 1 patient (1.9%), ischemic stroke in 2 patients (3.8%), and TIA in 1 patient (1.9%). In the non-CNO group; Retinal TIA was observed in 1 patient (1.0%), ischemic stroke in 2 patients (2.0%), and TIA in 2 patients (2.0%). There was no statistically significant difference between the groups in terms of postoperative neurologic complications and primary endpoints at 12-month follow-up ( P > .05). Conclusions: Carotid endarterectomy is a safe, feasible, and advantageous procedure in selected CNO patients, as in non-CNO carotid artery patients. Therefore, we recommend a surgical approach to prevent neurological events in CNO patients.

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“…It has been reported that patients with distal ICA collapse associated with cervical ICA stenosis have difficulty in shunt insertion during CEA due to the narrow distal ICA. [ 14 ] In addition, it has been reported that CAS failed due to difficulty in system delivery, causing dissection and spasm. [ 1 , 10 , 12 ] Therefore, device induction into a collapsed ICA should be done with caution.…”

Section: Discussionmentioning

confidence: 99%

Dilation of proximal internal carotid artery collapse due to severe distal stenosis after angioplasty for distal stenosis: A case report

Kinosada¹,

Ikeda²,

Morita³

et al. 2023

Surgical Neurology International

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Background: We report a case of proximal internal carotid artery (ICA) collapse due to severe distal stenosis that dilated after angioplasty for distal stenosis. Case Description: A 69-year-old woman underwent thrombectomy for the left ICA occlusion due to stenosis of C3 portion and was discharged home with a modified Rankin Scale score of 0. One year later, she developed cerebral infarction due to progressive stenosis of the C3 portion of the left ICA with proximal ICA collapse and underwent emergency percutaneous transluminal angioplasty (PTA) for distal stenosis. Device guidance to the stenosis was difficult due to proximal ICA collapse. After PTA, blood flow in the left ICA increased, and proximal ICA collapse dilated over time. Due to severe residual stenosis, she underwent more aggressive PTA followed by Wingspan stenting. Device guidance to the residual stenosis was facilitated because proximal ICA collapse had already dilated. Six months later, proximal ICA collapse further dilated. Conclusion: PTA for severe distal stenosis with proximal ICA collapse may result in dilation of proximal ICA collapse over time.

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

Cited by 4 publications

References 25 publications

Multidelay MR Arterial Spin Labeling Perfusion Map for the Prediction of Cerebral Hyperperfusion After Carotid Endarterectomy

Multidelay MR Arterial Spin Labeling Perfusion Map for the Prediction of Cerebral Hyperperfusion After Carotid Endarterectomy

Cartoid Near Occlusion: Time to Re-think Endarectomy?

Dilation of proximal internal carotid artery collapse due to severe distal stenosis after angioplasty for distal stenosis: A case report

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