Hybrid Surgery for Symptomatic Chronic Total Occlusion of Carotid Artery

Shih, Yu-Tung; Chen, Wen-Hsien; Lee, Wen-Lieng; Lee, Hsu‐Tung; Shen, Chiung‐Chyi; Tsuei, Yuang-Seng

doi:10.1227/neu.0b013e31827fca6c

Cited by 25 publications

(21 citation statements)

References 10 publications

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“…In certain cases of CTO of the ICA, effective compensatory collateral circulation provides sufficient arterial blood to meet the needs of the brain ( 39 ). These cases with a low degree of cerebral hemodynamic compromise, as well as some stage I cases with effective CVR function, may have a benign prognosis ( 40 ).…”

Section: Clinical Manifestationsmentioning

confidence: 99%

“…Hybrid surgery is considered to be a feasible and favorable alternative surgical procedure; a higher success rate may be achieved using the hybrid technique as it can provide improved control of endovascular manipulation ( 100 ). In 2013, Shih et al ( 39 ) successfully used this method to treat 3 cases with recurrent ischemic attacks due to CTO of the ICA.…”

Section: Treatmentsmentioning

confidence: 99%

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

Guo

et al. 2017

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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: Clinical Manifestationsmentioning

confidence: 99%

Section: Treatmentsmentioning

confidence: 99%

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

Guo

et al. 2017

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“…6 Over the years, we have gained experience and confidence in dealing with different kinds of vascular lesions via hybrid surgery in our neurosurgical hybrid operating suite. [12][13][14] Due to the aforementioned reasons, we considered a simple endoscope-assisted transsphenoidal puncture for CCF embolization as a suitable and feasible choice.…”

Section: Discussionmentioning

confidence: 99%

Endoscope-assisted transsphenoidal puncture of the cavernous sinus for embolization of carotid-cavernous fistula in a neurosurgical hybrid operating suite

Tang¹,

Liao²,

Chen

et al. 2017

Journal of Neurosurgery

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Endovascular embolization is the treatment of choice for carotid-cavernous fistulas (CCFs), but failure to catheterize the cavernous sinus may occur as a result of vessel tortuosity, hypoplasia, or stenosis. In addition to conventional transvenous or transarterial routes, alternative approaches should be considered. The authors present a case in which a straightforward route to the CCF was accessed via transsphenoidal puncture of the cavernous sinus in a neurosurgical hybrid operating suite. This 82-year-old man presented with severe chemosis and proptosis of the right eye. Digital subtraction angiography revealed a Type B CCF with a feeding artery arising from the meningohypophyseal trunk of the right cavernous segment of the internal carotid artery. The CCF drained through a thrombosed right superior ophthalmic vein that ended deep in the orbit; there were no patent sinuses or venous plexuses connecting to the CCF. An endoscope-assisted transsphenoidal puncture created direct access to the nidus for embolization. Embolic agents were deployed through the puncture needle to achieve complete obliteration. Endoscope-assisted transsphenoidal puncture of the cavernous sinus is a feasible alternative to treat difficult-to-access CCFs in a neurosurgical hybrid operating suite.

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“…As indicated in the Shih's report [43], hybrid surgery has a lot of advantages in comparison to the femoral endovascular approach. The hybrid technique allows insertion of the endovascular sheath into the true lumen with direct visualization, possibly saving operating time that would otherwise be spent on attempting blind recanalization in the occluded ICA segment.…”

Section: Application Of Hass For Carotid Artery Diseasesmentioning

confidence: 99%

The working road map in a neurosurgical Hybrid Angio-Surgical suite------ development and practice of a neurosurgical Hybrid Angio-Surgical suite

Ren

Wang

et al. 2018

Chin Neurosurg Jl

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Background: The concept of a Hybrid Angio-Surgical Suite (HASS) has emerged as a solution to the complexity of cerebrovascular surgery and the need for immediate intraoperative feedback. When to use it, what cases are suitable for its use, who can use it and how to use it remain debatable. Objective: Provide the information regarding the application of the HASS for hospital, neurosurgeon and interventionalist. Methods: We review the literatures of case reports and studies on the use of the hybrid angio-sugical suite along with application of HASS in our own practice. Results: Indications for using HASS on different types of cerebral vascular disease, including cerebral aneurysm, AVM, DAVF, carotid and vertebral stenosis/occlusion, are addressed. The application of HASS for other non-cerebral vascular diseases, such as trauma, spine and skullbase cases, is reviewed and discussed. Conclusion: HASS has made many surgical procedures safer and many difficult or previously untreatable conditions much more tractable and cost-effective. Other than used in cerebral vascular disease, HASS has much more applications, such as trauma, spine and other neurosurgical diseases.

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Hybrid Surgery for Symptomatic Chronic Total Occlusion of Carotid Artery

Abstract: We consider this hybrid surgery to be a feasible and good alternative surgical procedure for the treatment of CTO of the internal carotid artery.

Cited by 25 publications

References 10 publications

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

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

Endoscope-assisted transsphenoidal puncture of the cavernous sinus for embolization of carotid-cavernous fistula in a neurosurgical hybrid operating suite

The working road map in a neurosurgical Hybrid Angio-Surgical suite------ development and practice of a neurosurgical Hybrid Angio-Surgical suite

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