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Operative strategies in patients with symptomatic internal carotid artery occlusion
A V Sterpetti1, R J Feldhaus, R D Schultz
1Department of Surgery, Creighton University School of Medicine, Omaha, Neb 68131.
Insights
Surgical repair of symptomatic internal carotid artery occlusion had high risks. Alternative carotid endarterectomy or external carotid artery reconstruction offered better outcomes depending on symptom presentation and anatomy.
Area of Science:
- Vascular Surgery
- Neurology
- Cerebrovascular Disease
Background:
- Symptomatic internal carotid artery occlusion presents a significant risk of stroke.
- Traditional thromboendarterectomy for occluded internal carotid arteries has shown high complication rates and poor long-term patency.
- Alternative surgical strategies are needed to manage this condition effectively.
Purpose of the Study:
- To review a 15-year surgical experience with 98 patients undergoing extracranial artery reconstruction for symptomatic internal carotid artery occlusion.
- To evaluate the efficacy and outcomes of different surgical approaches, including carotid endarterectomy and external carotid artery reconstruction.
- To determine the optimal surgical strategy based on patient symptoms and anatomical patterns.
Main Methods:
- Retrospective review of 98 patients with symptomatic internal carotid artery occlusion treated surgically over 15 years.
- Analysis of surgical outcomes, including mortality, morbidity, and long-term patency rates.
- Stratification of results based on surgical procedure (thromboendarterectomy, contralateral carotid endarterectomy, ipsilateral external carotid artery reconstruction) and symptom presentation.
Main Results:
- Thromboendarterectomy of the occluded internal carotid artery was associated with high mortality and morbidity, with rare long-term patency.
- Contralateral carotid endarterectomy successfully relieved nonlateralizing cerebral ischemic symptoms.
- External carotid artery reconstruction on the side of occlusion effectively relieved focal symptoms, though results were less encouraging for ipsilateral focal symptoms.
Conclusions:
- Surgical management of symptomatic internal carotid artery occlusion requires individualized planning based on specific symptoms and anatomical considerations.
- Contralateral carotid endarterectomy and ipsilateral external carotid artery reconstruction represent viable alternatives to direct thromboendarterectomy with potentially better outcomes.
- Tailoring surgical interventions to the patient's clinical and anatomical profile is crucial for optimizing results in internal carotid artery occlusion.
Abstract:
A 15-year experience with 98 patients who underwent extracranial artery reconstruction for symptomatic internal carotid artery occlusion is reviewed. Thromboendarterectomy of the occluded carotid artery resulted in unacceptably high mortality and morbidity rates, and long-term patency of the internal carotid artery was rarely achieved. Carotid endarterectomy on the side opposite the occlusion proved to be successful in relieving nonlateralizing symptoms of cerebral ischemia, whereas results were less encouraging in patients with focal symptoms in the hemisphere ipsilateral to the occlusion. External carotid artery reconstruction on the side of the occlusion was successful in relieving focal symptoms. Surgical treatment in patients with symptomatic internal carotid artery occlusion should be planned in each patient on the basis of symptoms and anatomic pattern.