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"Dual Internal Shunts Technique" for Carotid Endarterectomy with Carotid Vertebral Anastomosis: Technical Note
Hirokazu Nagasaki1, Michihisa Narikiyo1, So Ohashi1
1Department of Neurosurgery, Kawasaki Saiwai Hospital.
Insights
This study introduces a novel dual internal shunts technique for carotid endarterectomy, improving blood flow to both anterior and posterior circulation. The technique offers a safer and easier approach for managing complex carotid artery stenosis cases.
Area of Science:
- Vascular Surgery
- Neurology
- Cerebrovascular Disease
Background:
- Internal carotid artery stenosis poses a risk for both anterior and posterior circulation cerebral infarction.
- Revascularization procedures require careful management of blood flow, especially in cases involving vertebrobasilar anastomoses.
- Traditional dual shunt placement during carotid endarterectomy can be challenging due to unstable balloon positioning.
Observation:
- A 74-year-old male patient presented with 75% stenosis of the right internal carotid artery and acute cerebral infarction.
- The patient also had left subclavian artery occlusion, necessitating a right external carotid artery to vertebral artery anastomosis.
- Initial attempts at dual shunting for carotid endarterectomy proved difficult due to unstable shunt balloon placement.
Findings:
- A novel "dual internal shunts technique" was developed to address the challenges of dual shunt management.
- This technique involves tandem placement of shunt balloons in the common carotid artery, improving stability.
- The procedure demonstrated technical ease and safety, facilitating improved blood flow during carotid endarterectomy.
Implications:
- The dual internal shunts technique enhances safety and technical feasibility in carotid endarterectomy for complex stenosis.
- This method ensures adequate blood supply to both anterior and posterior cerebral circulations during surgery.
- The technique represents a significant advancement in managing patients with combined carotid stenosis and vertebrobasilar compromise.
Abstract:
In revascularization of internal carotid stenosis with carotid vertebrobasilar anastomoses, attention should be paid not only to the anterior circulation but also to the posterior circulation cerebral infarction. A 74-year-old man was referred for treatment of carotid artery stenosis; NASCET 75% stenosis in the right internal carotid artery and acute cerebral infarction were confirmed. Occlusion of the left subclavian artery and vascular anastomosis between the right external carotid artery and the vertebral artery were indicated, such that the right external carotid artery may maintain blood flow to the vertebrobasilar artery. Therefore, dual shunts were used for the common and internal carotid arteries and the common and external carotid arteries to maintain blood flow during carotid endarterectomy. Management of the dual shunts is difficult due to the instable parallel placement of the common carotid artery shunt balloons. To solve this problem, the "dual internal shunts technique" was performed. The first shunt was inserted into the external and common carotid arteries, and the second into the internal and common carotid arteries. The shunt balloon on the common carotid artery side was placed distal to the first shunt balloon so that the dual balloons were placed in a tandem position. The proximal balloon was subsequently deflated gradually to improve flow in both shunts. The procedure is technically easy and safe.
