Distal Cervical Carotid Artery Dissection after Carotid Endarterectomy: A Complication of Indwelling Shunt

Tamaki, Toru; Node, Yoji; Saito, Norihiro

doi:10.1155/2010/816937

Cited by 10 publications

(7 citation statements)

References 7 publications

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“…[ 1 ] However, only four cases of distal CAD due to an indwelling shunt have been reported. [ 9 , 10 , 16 ] In our case, CAD started at the tip of the elongated styloid process apart from the distal end of the endarterectomy, which coincided to the site where the balloon of the shunt was inflated. We estimated this pathophysiology to be caused by the mechanical conflict of the inflated balloon with the elongated styloid process, an etiology similar to that in the vascular Eagle syndrome.…”

Section: Discussionmentioning

confidence: 63%

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Elongated styloid process as a possible cause of distal carotid artery dissection after carotid endarterectomy using indwelling shunt: A case report

Suzuki

Kimura

Hasegawa

et al. 2022

Surgical Neurology International

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Background: A dissection beginning from a point distal to the endpoint of the carotid endarterectomy (CEA) is called distal carotid artery dissection (CAD), which is known as one of the significant surgical complications of CEA. Case Description: We present a case of distal CAD as a perioperative complication after CEA using indwelling shunt. We estimated this pathophysiology to be caused by the mechanical conflict of the inflated balloon with the elongated styloid process. Conclusion: Since a distal CAD can cause severe, irreversible neurological deficits, preoperative assessment of the styloid process should be routinely performed in CEA.

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Section: Discussionmentioning

confidence: 63%

“…[ 6 , 12 , 13 ] A dissection beginning from a point distal to the endpoint of the endarterectomy is called distal carotid artery dissection (CAD), which is known as one of the significant surgical complications of CEA. [ 9 , 10 , 16 ]…”

Section: Introductionmentioning

confidence: 99%

Elongated styloid process as a possible cause of distal carotid artery dissection after carotid endarterectomy using indwelling shunt: A case report

Suzuki

Kimura

Hasegawa

et al. 2022

Surgical Neurology International

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“…[ 18 ] Moreover, there are some reports on internal carotid artery dissection due to shunt insertion. [ 19 , 20 ] However, it is debatable whether routine shunting or elective shunting can prevent complications. A previous report revealed no significant difference in terms of mortality and morbidity.…”

Section: Discussionmentioning

confidence: 99%

Emergent carotid artery stenting for cervical internal carotid artery injury during carotid endarterectomy: A case report

Takahashi

Ikeda

Igarashi

et al. 2021

Surgical Neurology International

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Background: Carotid endarterectomy (CEA) has been the standard preventive procedure for cerebral infarction due to cervical internal carotid artery stenosis, and internal shunt insertion during CEA is widely accepted. However, troubleshooting knowledge is essential because potentially life-threatening complications can occur. Herein, we report a case of cervical internal carotid artery injury caused by the insertion of a shunt device during CEA. Case Description: A 78-year-old man with a history of hypertension, diabetes, and hyperuricemia developed temporary left hemiplegia. A former physician had diagnosed the patient with a transient cerebral ischemic attack. The patient’s medical history was significant for the right internal carotid artery stenosis, which was severe due to a vulnerable plaque. We performed CEA to remove the plaque; however, there was active bleeding in the distal carotid artery of the cervical region after we removed the shunt tube. Hemostasis was achieved through compression using a cotton piece. Intraoperative digital subtraction angiography (DSA) revealed severe stenosis at the internal carotid artery distal to the injury site due to hematoma compression. The patient underwent urgent carotid artery stenting and had two carotid artery stents superimposed on the injury site. On DSA, extravascular pooling of contrast media decreased on postoperative day (POD) 1 and then disappeared on POD 14. The patient was discharged home without sequela on POD 21. Conclusion: In the case of cervical internal carotid artery injury during CEA, hemostasis can be achieved by superimposing a carotid artery stent on the injury site, which is considered an acceptable troubleshooting technique.

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“…There are publications describing serious complications after shunt application [20,21]. A limitation of the above methods is their application after qualification and the beginning of the CEA, which limits the possibility of using endovascular treatment where the fact of CC intolerance is not so important.…”

Section: Discussionmentioning

confidence: 99%

The Anatomy of the Circle of Willis Is Not a Strong Enough Predictive Factor for the Prognosis of Cross-Clamping Intolerance during Carotid Endarterectomy

Myrcha

Lewczuk²,

Jakuciński³

et al. 2020

JCM

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Carotid endarterectomy (CEA) is safe and effective in reducing the risk of stroke in symptomatic severe carotid artery stenosis. Having information about cross-clamping (CC) intolerance before surgery may reduce the complication rate. The purpose of this study was to assess the usefulness of magnetic resonance angiography (MRA) and magnetic resonance angiography perfusion (P-MR) in determining the risk of CC intolerance during CEA. Material and methods: 40 patients after CEA with CC intolerance were included in Group I, and 15 with CC tolerance in Group II. All patients underwent MRA of the circle of Willis (CoW), P-MR with or without Acetazolamide; P(A)-MR in the postoperative period. Results: CoW was normal in the MRA in three cases (7.5%) in Group I, and in eight (53%) in Group II. We found P-MR abnormalities in all patients from Group I and in 40% from Group II. Using a calculated cut-off point of 0.322, the patients were classified as CC tolerant with 100% sensitivity or as CC intolerant with 95% specificity. After evaluating P-MR or MRA alone, the percentage of false negative results significantly increased. Conclusion: The highest value in predicting cross-clamping intolerance is achieved by using analysis of P(A)-MR and MRA of the CoW in combination.

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Distal Cervical Carotid Artery Dissection after Carotid Endarterectomy: A Complication of Indwelling Shunt

Cited by 10 publications

References 7 publications

Elongated styloid process as a possible cause of distal carotid artery dissection after carotid endarterectomy using indwelling shunt: A case report

Elongated styloid process as a possible cause of distal carotid artery dissection after carotid endarterectomy using indwelling shunt: A case report

Emergent carotid artery stenting for cervical internal carotid artery injury during carotid endarterectomy: A case report

The Anatomy of the Circle of Willis Is Not a Strong Enough Predictive Factor for the Prognosis of Cross-Clamping Intolerance during Carotid Endarterectomy

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