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Resolving siphon stenosis following endarterectomy
Insights
Tandem carotid lesions increase surgical risks. In select cases, endarterectomy may resolve intracranial stenosis, potentially avoiding bypass surgery.
Area of Science:
- Vascular Surgery
- Cerebrovascular Disease
- Interventional Neurology
Background:
- Tandem arteriosclerotic lesions in the carotid sinus and siphon pose surgical challenges.
- Severe carotid siphon stenosis often suggests microvascular bypass as a primary treatment.
- Carotid endarterectomy is a common procedure for carotid artery disease.
Observation:
- Two patients with tandem carotid sinus and severe siphon stenosis underwent carotid endarterectomy.
- Postoperative arteriography revealed resolution of the siphon stenosis in both cases.
- Embolism is a potential cause of intracranial obstruction in cases with extracranial lesions or distal siphon lesions.
Findings:
- Carotid endarterectomy successfully resolved severe siphon stenosis in patients with tandem lesions.
- A delayed arteriogram after endarterectomy may demonstrate resolution of intracranial stenosis.
- This approach can potentially prevent unnecessary microvascular bypass procedures.
Implications:
- Identifying extracranial lesions or distal siphon lesions should prompt consideration of embolic causes.
- Repeat arteriography after endarterectomy can reveal spontaneous resolution of intracranial lesions.
- This strategy may help avoid invasive bypass surgery in select patients with tandem carotid lesions.
Abstract:
Tandem arteriosclerotic lesions of the carotid sinus and siphon increase the risks of carotid endarterectomy; when the siphon is severely stenotic, a microvascular bypass may be the preferable procedure. Two patients, each with severe siphon stenosis and significant sinus lesions, however, were subjected to carotid endarterectomy as their initial surgical procedure. The postoperative arteriogram showed resolution of the siphon stenosis in both patients. The identification of an associated extracranial lesion, or the presence of a lesion located more distal in the siphon than atheroma usually occur, should alert the surgeon that the intracranial obstruction may be due to embolism. In patients with these tandem lesions, therefore, a repeat arteriogram, performed several weeks after endarterectomy of sufficient medial treatment interval, may show resolution of the intracranial lesion, and may avoid an unnecessary bypass procedure.