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Revascularization of the internal carotid artery for isolated, stenotic, and symptomatic kinking
Giulio Illuminati1, Francesco G Calió, Vassilios Papaspyropoulos
1Francesco Durante, Department of Surgical Sciences and Applied Technology, University of Rome La Sapienza, Via Vincenzo Bellini 14, 00198 Roma, Italy. giulio.illuminati@uniroma1.it
Insights
Surgical revascularization for internal carotid artery kinking is safe and effective. This procedure prevents stroke and relieves symptoms of cerebral ischemia, offering significant long-term benefits.
Area of Science:
- Vascular Surgery
- Cerebrovascular Disease
- Neurosurgery
Background:
- Internal carotid artery kinking can cause symptomatic cerebral ischemia.
- Surgical intervention aims to restore blood flow and prevent stroke.
Purpose of the Study:
- To evaluate the safety and effectiveness of internal carotid artery revascularization for isolated, stenotic, and symptomatic kinking.
- To assess the procedure's impact on stroke prevention and symptom relief.
Main Methods:
- A consecutive sample clinical study involving 54 patients (mean age 67 years) with 55 revascularizations.
- Procedures included shortening/reimplantation, bypass grafting, and transposition.
- Follow-up averaged 44 months, analyzed using life-table methods.
Main Results:
- No postoperative deaths occurred; the stroke rate was 1.8%.
- Five-year cumulative rates: survival 70%, primary patency 89%, overall stroke-free 92%, and neurologic symptom-free 90%.
- High rates of ipsilateral stroke-free (96%) and symptom-free (93%) outcomes were observed.
Conclusions:
- Revascularization for internal carotid artery kinking is a safe and effective treatment.
- The procedure successfully prevents stroke and alleviates symptoms of cerebrovascular insufficiency.
- Long-term data supports the efficacy of surgical intervention for this condition.
Hypothesis:
The operation for isolated, stenotic, and symptomatic kinking of the internal carotid artery is safe and effective in preventing stroke and relieving the symptoms of cerebral ischemia.
Design:
A consecutive sample clinical study with a mean follow-up of 44 months.
Setting:
The surgical department of an academic tertiary care center and an affiliated secondary care center.
Patients:
Fifty-four patients with a mean age of 67 years underwent 55 revascularizations of the internal carotid artery. The surgical procedures consisted of the following: shortening and reimplantation in the common carotid artery in 36 cases, bypass grafting in 15 cases, and transposition into the external carotid artery in 4 cases.
Main Outcome Measures:
Cumulative survival, primary patency, and stroke-free and neurologic symptom-free rates expressed by standard life-table analysis.
Results:
No patients died in the postoperative period. The postoperative stroke rate was 1.8%. The cumulative rates (SEs) at 5 years were as follows: survival, 70% (10.2%); primary patency, 89% (7.8%); overall stroke free, 92% (6.8%); ipsilateral stroke free, 96% (5.3%); neurologic symptom free, 90% (7.5%); and ipsilateral symptom free, 93% (6.5%).
Conclusion:
Revascularization of the internal carotid artery for the treatment of isolated, stenotic, and symptomatic kinking is safe and effective in preventing stroke and relieving symptoms of cerebrovascular insufficiency.