Joint Study of Extracranial Arterial Occlusion

Gomensoro, J. B.

doi:10.1001/jama.1973.03220210013003

Cited by 41 publications

(2 citation statements)

References 13 publications

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“…Best medical treatment is indicated for CTO of the ICA with stable hemodynamics and full compensation ( 46 , 85 ). In addition, conservative treatments are adopted for patients who decline surgical retreatment.…”

Section: Treatmentsmentioning

confidence: 99%

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: Treatmentsmentioning

confidence: 99%

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

Guo

et al. 2017

biom rep

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“…[4] These conclusions were inconsistent with the study by Gomensoro et al, which states that the disease is stable and no embolism would be observed after the ICA occlusion. [15] The mechanisms underlying a carotid artery occlusion-induced stroke may be as follows: first, hypodynamic cerebral infarction is caused by insufficient blood perfusion at the distal end of the occluded carotid artery. Second, cerebral infarction is caused by an embolus in the occluded aortic arch, common carotid artery, and ICA entering into the brain through the external carotid artery, Willis, and other bypass vessels.…”

Section: Discussionmentioning

confidence: 99%

Interventional recanalization as a treatment of carotid stump syndrome caused by right internal carotid artery occlusion

Xu¹,

Wang

Luo³

2019

Medicine

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Rationale:Carotid stump syndrome is a cerebral infarction caused by an embolus formed subsequent to the vortex of blood flow from the occluded stump, which then moves through the collateral vessels into the brain. The covered stent and stent-assisted coil embolization stump are the effective interventions for the carotid artery stump.Patient concerns:A 71-year-old man twice experienced left limb weakness; diffusion weighted imaging confirmed the diagnosis of cerebral infarction. Cervical computed tomography angiography, intracranial magnetic resonance angiography, and digital subtraction angiography were conducted to evaluate collateral circulation, intraluminal composition, and shape of the carotid stump.Diagnoses:The patient was diagnosed with cerebral infarction and right carotid stump syndrome.Intervention:The patient underwent interventional recanalization of the occluded internal carotid artery, which relieved his symptoms and led to satisfactory therapeutic outcomes during the clinical follow-up.Outcomes:A 9-month clinical follow-up revealed no stroke recurrence.Lessons:Interventional recanalization for the carotid artery stump syndrome is feasible. Accurate preoperative evaluation including collateral circulation, intraluminal composition, and shape of the carotid stump can assure a successful vascularization and guided management.

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Detection of carotid bifurcation disease: Comparison of ultrasound tests with angiography

Padayachee

Lewis

Gosling

1982

Journal of British Surgery

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Doppler-shift ultrasound with spectral analysis permits the measurement of the relative heights of systolic peaks (the A/B ratio) in blood velocity sonograms from supra-orbital and common carotid arteries, the temporal artery occlusion test, the common carotid resistance index and transit times of flow-velocity waves in the internal carotid pathway. The results are compared with 201 carotid angiograms and expressed in terms of sensitivity (true positive) and specificity (true negative). Supra-orbital and common carotid A/B ratios, in combination with the temporal artery occlusion test, detected all grades of carotid artery disease with a sensitivity of 72 per cent and a specificity of 93 per cent. The corrected transit time gave a sensitivity of 57 per cent and a specificity of 89 per cent, whilst the Resistance Index gave a sensitivity of 60 per cent and a specificity of 80 per cent. The values of ultrasound parameters associated with severe disease, defined as reductions in lumen diameter of 75 per cent or more, of the internal carotid artery are examined. The temporal artery occlusion test gave a sensitivity of 91 per cent and a specificity of 94 per cent. These results were more accurate than those obtained for the corrected transit time (sensitivity 83 per cent, specificity 92 per cent) and for the Resistance Index (sensitivity 75 per cent and specificity 92 per cent). The results show that of the tests described the supra-orbital and common carotid artery A/B ratios, together with the temporal artery occlusion test, gave the best sensitivity and specificity for detection of both severe and minor carotid bifurcation disease.

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Joint Study of Extracranial Arterial Occlusion

Cited by 41 publications

References 13 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)

Interventional recanalization as a treatment of carotid stump syndrome caused by right internal carotid artery occlusion

Detection of carotid bifurcation disease: Comparison of ultrasound tests with angiography

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