Carotid thromboendarterectomy for recent total occlusion of the internal carotid artery

Kasper, Gregory; Wladis, Alan R.; Lohr, Joann M.; Roedersheimer, L. Richard; Reed, Robert; Miller, Timothy J.; Welling, Richard E.

doi:10.1067/mva.2001.112213

Cited by 51 publications

(39 citation statements)

References 26 publications

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“…However, some surgeons report encouraging results from emergency operations for patients with severe stenosis or occlusion of the internal carotid artery existing for Յ24 hours. 324,386,[451][452][453][454][455][456][457][458][459][460] In general, improvement after surgery was found among patients with mild to moderate neurological impairments. Still, the data are limited, and the usefulness of urgent surgery among patients with severe neurological deficits is even less clear.…”

Section: A Carotid Endarterectomymentioning

confidence: 99%

Guidelines for the Early Management of Adults With Ischemic Stroke

Adams

Zoppo²,

Alberts

et al. 2007

Stroke

2,114

483

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Purpose-Our goal is to provide an overview of the current evidence about components of the evaluation and treatment of adults with acute ischemic stroke. The intended audience is physicians and other emergency healthcare providers who treat patients within the first 48 hours after stroke. In addition, information for healthcare policy makers is included. Methods-Members of the panel were appointed

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Section: A Carotid Endarterectomymentioning

confidence: 99%

Guidelines for the Early Management of Adults With Ischemic Stroke

Adams

Zoppo²,

Alberts

et al. 2007

Stroke

2,114

483

View full text Add to dashboard Cite

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“…Acute atherothrombotic cervical ICA occlusion with hemodynamic impairment portends a particularly worse prognosis being associated with early clinical deterioration and late stroke recurrence risk [3]. Several authors have reported successful emergency recanalization for atherothrombotic cervical ICA occlusion [7,8,12,13,16,18]. However, such treatments remain controversial.…”

Section: Discussionmentioning

confidence: 99%

“…After embolus was directly removed via arteriotomy, if no backflow was observed, remaining embolus in the distal ICA was pulled using a FURUI's Double-Balloon Internal Shunt device, and vigorous backflow was achieved. A balloon embolectomy catheter such as Fogarty catheter for extraction of clots in the distal ICA was used in the previous reports describing emergency CEA or CTEA for atherothrombotic occlusion [8,12,13,18]. The maneuver of retrieving embolus in the distal ICA probably avoids risks of injury of intima and distal embolism more with using shunt device rather than using Fogarty catheter because the catheter has to pass through the embolus and has to extract the embolus after inflation of the balloon.…”

Section: Discussionmentioning

confidence: 99%

“…These treatments may be effective in selected patients [7,8,12,13,16,18]. There are, however, no reports regarding open embolectomy for cardioembolic occlusion.…”

Section: Introductionmentioning

confidence: 99%

“…Because of the poor prognosis, various procedural approaches to acute recanalization for atherothrombotic occlusion have been reported including emergency carotid endarterectomy (CEA) or carotid thromboendarterectomy (CTEA) [8,12,13,18], and emergent endovascular interventions [7,16]. These treatments may be effective in selected patients [7,8,12,13,16,18].…”

Section: Introductionmentioning

confidence: 99%

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Urgent open embolectomy for cardioembolic cervical internal carotid artery occlusion

et al. 2010

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Acute ischemic stroke attributable to cervical internal carotid artery (ICA) occlusion is frequently associated with severe disability or death, and is usually caused by atherosclerosis. By contrast, the cardioembolic cervical ICA occlusion is rare, and feasibility of urgent recanalization remains unclear. We present the first study in the literature that focuses on urgent open embolectomy for treatment of cardioembolic cervical ICA occlusion. A retrospective review of the charts for patients undergoing open embolectomy was performed. Between April 2006 and September 2007, 640 consecutive patients with acute ischemic stroke were treated. Of them, 3 patients (0.47%) with the acute complete cardioembolic cervical ICA occlusion underwent urgent open embolectomy. All patients presented with profound neurological deficits and atrial fibrillation. The urgent open embolectomy achieved complete recanalization in all patients without any complications. All emboli in 3 patients were very large and fibrinous in histological findings. Two of 3 patients showed rapid improvement in neurological functions after surgical treatments. The cardioembolic occlusion of the cervical ICA is rare, but its possibility should be considered in patients with the acute ischemic stroke suffering profound neurological deficits and atrial fibrillation. Urgent open embolectomy may be a treatment option to obtain successful recanalization for cardioembolic cervical ICA occlusion and is recommended because it is technically easier and similar to the carotid endarterectomy.

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Carotid Endarterectomy and Carotid Artery Stenting for Patients With Crescendo Transient Ischemic Attacks

Fereydooni

Gorecka

et al. 2019

JAMA Surg

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IMPORTANCEThromboembolic stroke attributable to an ipsilateral carotid artery plaque is a leading cause of disability in the United States and a major source of morbidity. Randomized clinical trials have demonstrated the efficacy of carotid endarterectomy and carotid stenting at minimizing stroke risk in patients with minor stroke and transient ischemic attack. However, there is no consensus on guidelines for medical management and the timing of revascularization in patients with multiple recurrent episodes of transient ischemic attack over hours or days, an acute neurological event known as crescendo transient ischemic attack.OBJECTIVE To review the management of and timing of intervention in patients presenting with crescendo transient ischemic attack.EVIDENCE REVIEW This systematic review included all English-language articles published from January 1, 1985, to January 1, 2019, available from PubMed (MEDLINE) and Google Scholar. Articles were excluded if they did not include analysis of patients with symptoms, did not report the timing of intervention after crescendo transient ischemic attack, or mixed analysis of patients with stroke in evolution with patients with crescendo transient ischemic attack. The quality of the evidence was assessed with the modified rating from the Oxford Centre for Evidence-based Medicine.OBSERVATIONS Patients with crescendo transient ischemic attack were found to have a higher risk of stroke or death after carotid endarterectomy compared with patients with a single transient ischemic attack or stable stroke. With medical therapy alone, a considerable number of patients with crescendo transient ischemic attack experience a completed stroke within several months and have a poor prognosis without intervention. Urgent carotid endarterectomy, typically performed within 48 hours of initial presentation, is beneficial in carefully selected patients. There have been several reports of operative treatment within the first 24 hours of presentation; however, review of these reports does not show any additional benefit from emergency treatment. Carotid artery stenting is reserved only for selected patients with prohibitive surgical risk for endarterectomy. The literature does not clearly support any additional benefit of intravenous heparin therapy over mono or dual antiplatelet therapy prior to carotid endarterectomy. CONCLUSIONS AND RELEVANCECrescendo transient ischemic attack is best managed with optimal medical management as well as urgent carotid endarterectomy within 2 days of presentation. Surgical endarterectomy appears to be preferred because of the increased embolic potential of bifurcation plaque, whereas stenting is an option for patients with contraindications for surgery. With ongoing advances in cerebrovascular imaging and medical treatment of stroke, there is a need for better evidence to determine the optimal timing and preoperative medical management of patients with crescendo transient ischemic attack.

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Carotid thromboendarterectomy for recent total occlusion of the internal carotid artery

Cited by 51 publications

References 26 publications

Guidelines for the Early Management of Adults With Ischemic Stroke

Guidelines for the Early Management of Adults With Ischemic Stroke

Urgent open embolectomy for cardioembolic cervical internal carotid artery occlusion

Carotid Endarterectomy and Carotid Artery Stenting for Patients With Crescendo Transient Ischemic Attacks

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