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At least 19 recordsLinked to original sources
PubMed2004

Intima-media thickness of common carotid artery, carotid atherosclerosis and subtypes of ischemic cerebral disease.

It has been shown that common carotid intima-media thickness (CCA-IMT) is a useful outcome measure in clinical studies and intervention trials reflecting early stage of atherosclerosis and cardiovascular risk. The present study examined the association between CCA-IMT and incident ischemic stroke and its subtypes in 75 cases and 21 controls. Cases with ischemic brain infarctions (IBI) were consecutively recruited and classified into subtypes by CT and Bamford's classification (the size and site of infarct) like total anterior circulation infarcts (TACIs), partial anterior circulation infarcts (PACIs), posterior circulation infarcts (POCIs) or lacunar infarcts (LACIs). Controls were recruited among individuals hospitalized at the same institutions and matched for age and sex. Patients and control subjects underwent B-mode ultrasonographic measurements of IMT of the distal wall of both common carotid arteries. Of 75 patients with an acute ischemic stroke, 10 (14%) were classified as TACIs, 34 (45%) with PACIs, 12 (16%) with POCIs and 19 (25%) with LACIs. Mean CCA-IMT was higher in cases (1.03+/-0.18 mm) than in controls (0.85+/-0.18 mm; p<0.0001). The difference in CCA-IMT between cases and controls was significant and the relation between CCA-IMT and IBI remained after adjustment for main cardiovascular risk factors. Regarding the subtypes of IBI, IMT values were significantly higher in patients with TACIs and PACIs versus those with LACIs and POCIs. An increased CCA-IMT was associated with the all subtypes IBI and was significantly higher in those with anterior circulation infarcts versus posterior circulation and lacunar infarcts.

Analysis of Variance↗
PubMed1992

[Sympathetic postganglionic innervation of external carotid artery, internal carotid artery, common carotid artery and aorta in the dog--experimental study using HRP and WGA-HRP].

The sympathetic postganglionic innervation of the external carotid artery, internal carotid artery, common carotid artery (CCA) and aorta was studied by using retrograde axonal transport of the horseradish peroxidase (HRP) and wheat germ agglutinin-HRP conjugates (WGA-HRP). When the powder of HRP was applied to the sheaths of internal and external carotid arteries, labeled cells were found only in the ipsilateral superior cervical ganglion (SCG). After injection of WGA-HRP into the walls of the (1) distal, (2) middle, and (3) proximal parts of the CCA, labeled cells were observed in the following ganglia, respectively; (1) the SCG and middle cervical ganglion (MCG), (2) the SCG, MCG and stellate ganglion (SG), and (3) the MCG and SG. These labeled cells were seen in these ganglia of both sides, but they were more marked ipsilaterally. Following injections of WGA-HRP into the walls of ascending and descending aortae, labeled cells were found in the bilateral MCG and SG. These results suggest that the vasodilation of the head and neck after stellate ganglion block using local anesthetic agents is caused by neuronal block of preganglionic sympathetic fibers passing through the stellate ganglion and terminating in the superior cervical ganglion.

Animals↗
PubMed1986

[Agenesis of the left internal carotid artery, common carotid artery and main trunk of the external carotid artery associated with multiple cerebral aneurysms: case report].

A case of agenesis of the left internal carotid artery, common carotid artery and main trunk of external carotid artery with multiple cerebral aneurysms is presented. No similar case has been reported before. A 70-year-old man who had severe headache was admitted to the neurological department of Matsuyama Shimin Hospital. On admission he demonstrated nuchal rigidity and motor aphasia. CT scan revealed subarachnoid hemorrhage with intracerebral hematoma in the left temporal area. Right common carotid angiography, bilateral retrograde brachial angiography and aortography demonstrated an agenesis of the left internal carotid artery, common carotid artery and main trunk of external carotid artery with aneurysms of the anterior communicating artery, left middle cerebral artery and basilar tip. And these revealed that the left middle cerebral artery was fed from the basilar artery via the dilated left posterior communicating artery, and the left ophthalmic artery was originated from the left middle cerebral artery. CT of the base of the skull revealed no carotid canal on the left side. We confirmed these findings by operation. The importance of altered hemodynamic forces on the circle of Willis produced by the agenesis of the internal carotid artery and the embryological considerations are discussed.

Aged↗
PubMed1987

Agenesis of the left internal carotid artery, common carotid artery, and main trunk of the external carotid artery associated with multiple cerebral aneurysms.

A case of agenesis of the left internal carotid artery, common carotid artery, and the main trunk of the external carotid artery with multiple cerebral aneurysms is presented. This case was diagnosed by angiography and computed tomography scanning and confirmed by operation. Correlation between the anomaly of the circle of Willis based on the absence of the internal carotid artery and the development of cerebral aneurysm is discussed on the basis of the reported cases.

Aged↗
PubMed1977

[Pre- and postoperative Doppler-ultrasound measurements in carotid artery surgery (carotid artery Doppler) (author's transl)].

The evaluation of carotid artery perfusion with Doppler-ultrasound is based on semiquantitative measurements of blood flow in the terminal branches of the ophthalmic arteries (supratrochlear and supraorbital artery) and the common carotid arteries. Diagnosis is performed with a set of 8 parameters and informs about obstructions in the carotid artery as well as the collateral circulation. The method was applied on 1500 patients of whom 340 underwent angiography and has proved to be about 90% reliable. Its value in carotid artery surgery was evaluated with 62 extracranial reconstructive operations on 55 patients and 35 iatrogene anastomoses between the temporal superficial and a branch of the middle cerebral artery on 35 patients.

Arterial Occlusive Diseases↗
PubMed2000

Aneurysms at nonbranching sites in the surpaclinoid portion of the internal carotid artery: internal carotid artery trunk aneurysms.

OBJECTIVE: Aneurysms at nonbranching sites in the supraclinoid internal carotid artery (ICA), known as blood blister-like aneurysms or ICA anterior or dorsal wall aneurysms, are not well understood. To clarify this clinical entity, 7408 patients with subarachnoid hemorrhage who were treated during a 5-year period were analyzed. METHODS: Forty-eight patients had aneurysms that were intraoperatively confirmed to be located at a nonbranching site in the supraclinoid portion of the ICA. Neuroradiological and clinicopathological features and outcomes were studied. RESULTS: The aneurysms were divided into the "blister type," with a blood blister-like configuration and fragile walls, and the "saccular type," with a saccular configuration and a relatively firm neck, like ordinary berry aneurysms. The most frequent origin was the anteromedial wall for both types. ICA dissection was associated only with the blister type, and hypertension was more frequent with the blister type (P = 0.0978). The preoperative conditions of the patients were the same, but the outcomes for patients with blister-type aneurysms were worse, because of frequent intra- and postoperative aneurysmal bleeding. Saccular-type aneurysms were safely clipped. Treatment of blister-type aneurysms by clipping on wrapping material achieved good results, but ICA trapping (P = 0.0952), clipping (P = 0.0146), and wrapping (P = 0.0110) were associated with much worse results. CONCLUSION: Blister-type and saccular-type aneurysms have different shapes and wall characteristics. The saccular type can be treated by clipping, whereas the blister type requires clipping on wrapping material. ICA trunk aneurysms may be a better designation to express the diversity of these aneurysms, rather than ICA blood blister-like or anterior or dorsal wall aneurysms.

Adult↗
PubMed2005

Aneurysms of the carotid artery.

Carotid artery aneurysms are an uncommon but important problem. The available data suggests that, untreated, these aneurysms lead to neurologic symptoms from embolization. Pseudoaneurysms of the carotid artery result from injury or may be the long-term sequelae of a spontaneous carotid dissection. While open surgery has been the primary mode of treatment, these aneurysms are being treated more commonly with endovascular approaches. This trend is partly the result of the increasing experience with the endovascular treatment of carotid artery stenosis. The endovascular approach offers advantages in other situations where open access to the distal extent of the aneurysm is difficult or neck radiation leads to concerns about wound healing. This article outlines the etiology, new diagnostic modalities, and treatment of aneurysms of the carotid artery.

Aneurysm↗
PubMed1995

Blunt trauma to the carotid arteries.

Carotid artery dissection is a rare occurrence in the trauma patient. Two cases of blunt trauma resulting in carotid artery dissection are reported. Initial recognition by clinicians is often difficult because of the diverse clinical manifestations, the delay in presentation, and the associated multi-organ system injuries that accompany carotid artery dissection. Because the diagnosis of carotid injury is rarely suspected in patients with neurological deficits, the first diagnostic test performed is usually computed tomography (CT) of the head. Angiography should be strongly considered when the following occur: (a) Neurologic deficits are incompatible with CT findings; (b) there is monoparesis or hemiparesis with a normal mental status examination; (c) there is severe cervical trauma with an abnormal neurological exam; or (d) a basilar skull fracture is present in a patient with an abnormal mental status exam. Once diagnosed, the management of carotid artery dissection is complex and no generalized guidelines have been established.

Adult↗
PubMed1988

The importance of arteriographic interpretation in occlusion or pseudo-occlusion of the carotid artery.

Carotid arteriography can be misleading in that roentgenographic occlusion of the internal carotid artery (ICA) may be suggested when the artery is actually anatomically patent. The distinction of occlusion versus pseudo-occlusion is crucial in recommending proper treatment. Aroused by the misinterpretation of two arteriograms by our radiology departments, a review of 780 arteriograms done on 780 patients during a three year period was begun. Of these, eight (1.0 per cent) symptomatic patients had conflicting arteriographic reports, with the radiologists reporting complete occlusion and the authors describing pseudo-occlusion. Established arteriographic criteria for pseudo-occlusion of the ICA are emphasized. These eight patients underwent carotid arterial exploration and all were found to have patent ICA. After successful carotid endarterectomy, seven of the eight patients have remained asymptomatic and have had no hemodynamically significant stenosis on noninvasive testing in the follow-up period, ranging from two to 38 months. Therefore, in evaluating patients with carotid territory symptoms, knowledge of the established arteriographic criteria for ICA pseudo-occlusion should alert the physician to the possibility of ICA patency. If this is suspected, the patient should undergo exploration of the carotid artery with subsequent endarterectomy if patency is demonstrated.

Aged↗
PubMed1995

Analysis of aprotinin on the mean arterial pressure, carotid artery blood flow, and hindlimb vascular resistance in the live rat, and pulmonary vascular resistance in the isolated perfused rat lung.

The effects of aprotinin on mean arterial pressure, carotid artery blood flow, pulmonary vascular resistance, and systemic vascular resistance have not been well documented. Therefore, the responses of aprotinin on the mean arterial pressure, carotid artery blood flow and the changes in pulmonary and hindlimb vascular resistances were investigated in the rat using ultrasonic flow probe analysis, and in two isolated vascular bed preparations. In studies on cardiac output using ultrasonic flow analysis, injections of aprotinin, in doses of 70-7000 KIU intravenously (iv), resulted in no changes in carotid artery ultrasonic flow, suggesting no changes in cardiac output. In isolated blood-perfused lung studies under conditions of controlled pulmonary blood flow, aprotinin, in doses of 7-7000 KIU intra-arterially (ia), caused no significant changes in pulmonary arterial perfusion pressure. Aprotinin, in doses of 7-240 KIU, was injected iv into the hindquarters perfusion circuit, and hindquarters arterial perfusion pressure did not change. Additionally, in the hindquarters perfusion preparation, aprotinin, in doses of 70-7000 KIU, ia resulted in no changes in mean arterial pressure. The present data demonstrate aprotinin has no significant response in MAP, carotid artery blood flow, pulmonary vascular resistance, or hindlimb vascular resistance in the rat.

Animals↗
PubMed1976

Surgical treatment of kinked internal carotid arteries.

Carotid artery insufficiency is caused by an abnormal kinked or coiled internal carotid artery in 15-20 per cent of symptomatic patients. Surgical correction should be considered if other causes for the neurological signs are excluded, a pronounced kinked or coiled area is demonstrated and if there is not a severe neurological deficit. As well as eliminating the elongation, surgical correction should include intraluminal inspection of the artery as, in 38-5 per cent of cases, a concomitant arteriosclerotic stenosis requires simultaneous correction.

Adult↗
PubMed1987

[Subclavian artery to external carotid artery bypass with saphenous vein graft in the treatment of common carotid artery stenosis].

A case of TIAs due to proximal common carotid artery stenosis which was successfully treated with autogenous saphenous vein graft between the subclavian artery and the external carotid artery is presented. A 57-year-old, right handed female was admitted to our hospital for the treatment of left common carotid artery stenosis which was pointed out at a local hospital. She had a 7-years' history of repeated transient right hemiparesis and/or left amaurosis fugax. No neurological deficit was revealed on admission. Angiography showed an 80% irregular stenosis of the left common carotid artery at its origin, hypoplastic A1-portion of the left anterior cerebral artery and hypoplasia of the left posterior communicating artery. No other stenotic lesions were disclosed in a four-vessel study. Several kinds of surgical procedures have been reported for the treatment of common carotid stenotic lesion, in accordance with the site and extension of the lesion and hemodynamic factors. To maintain a sufficient blood flow of the left internal carotid artery, we considered four different operative methods such as (1) endarterectomy of the common carotid artery, (2) subclavian to common carotid artery bypass, (3) subclavian to external carotid artery bypass and (4) subclavian to middle cerebral artery bypass. The first two operative procedures force to clamp the common carotid artery which was the only one feeding artery of the left middle cerebral artery because of poor cross flow in this case. These procedures were thought highly possibly to give rise to cerebral infarction on the left side. The fourth method needs a long graft which has higher risk of bypass occlusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Anastomosis, Surgical↗
PubMedDate not supplied

Long-term histopathologic and IVUS evaluations of a novel coiled sheet stent in porcine carotid arteries.

Carotid angioplasty with stent placement has been proposed as an alternative method for revascularization of carotid artery stenosis. A novel stent with a laser-cut, rolled sheet of Nitinol (EndoTex Interventional Systems, Inc., Cupertino, CA) has been developed to customize treatment of stenotic lesions in carotid arteries utilizing a single stent, designed to adapt to multiple diameters and to tapered or nontapered configurations. The purpose of this study is to evaluate the conformability and vascular response to a novel stent in a chronic porcine carotid model using serial three-dimensional intravascular ultrasound (IVUS) analysis as well as histological examination. Ten Yucatan pigs underwent stent implantation in both normal carotid arteries with adjunctive balloon angioplasty. Three-dimensional IVUS analysis was performed before stent implantation, after adjunctive balloon angioplasty, and at follow-up [1 month (n = 6), 3 months (n = 6), or 6 months (n = 8)]. Histological examination (injury score, percent plaque obstruction, and qualitative analysis) was also performed. All stents were successfully deployed and well apposed in different sized vessels (lumen area range: 19-30 mm(2)). Volumetric IVUS analysis showed no significant difference between the lumen areas before stent implantation and after adjunctive balloon angioplasty and no stent area change at each follow-up point compared to immediately postprocedure. Histological examination revealed minimal injury and neointimal hyperplasia at each follow-up point. In the chronic porcine carotid model, the novel stent system demonstrated good conformability, resulting in minimal vessel injury and neointimal formation.

Alloys↗
PubMed1975

Operative assessment of carotid endarterectomy: Internal carotid arterial back pressure, carotid arterial blood flow, and carotid arteriography.

Determination of ICA back pressure, electromagnetic measurement of internal carotid arterial blood flow, and performance of operative carotid arteriography have been assessed in a series of elective carotid endarterectomies. If ICA back pressure is used to determine the need for an internal shunt, our data suggest that a minimal pressure of 60-70 mmHg is required to insure adequacy of collateral cerebral blood flow in all patients. Internal carotid arterial blood flow was not significantly increased after endarterectomy. Although flow measurements are of some interest, their routine measurement does not appear to have significant clinical usefulness. Operative carotid arteriography is a valuable technique in identifying unsuspected technical errors at the site of endarterectomy and should be used routinely.

Aged↗
PubMed2000

Routine or selective carotid artery shunting for carotid endarterectomy (and different methods of monitoring in selective shunting).

BACKGROUND: Temporary interruption of blood flow during carotid endarterectomy can be avoided by using a shunt across the clamped section of the carotid artery. This may improve outcome. OBJECTIVES: The objective of this review was to assess the effect of routine versus selective shunting during carotid endarterectomy, and to assess the best method for selecting patients for shunting. SEARCH STRATEGY: We searched the Cochrane Stroke Group trials register, Medline (1966 to 1994), Embase (1980 to 1995) and Index to Scientific and Technical Proceedings (1980 to 1994). We handsearched Annals of Surgery (1981 to 1995), British Journal of Surgery (1985 to 1995), European Journal of Vascular Surgery (1988 to 1995) and World Journal of Surgery (1978 to 1995). SELECTION CRITERIA: Randomised and quasi-randomised trials of routine shunting compared with no shunting, and trials that compared different shunting policies in patients undergoing carotid endarterectomy. DATA COLLECTION AND ANALYSIS: Two reviewers independently applied the inclusion criteria. The data were extracted by one reviewer and double-checked. Trial quality was assessed. MAIN RESULTS: Three trials were included. Two trials involving 590 patients compared routine shunting with no shunting. The other trial involving 131 patients compared shunting with a combination of electroencephalographic and carotid pressure measurement, with shunting by carotid pressure measurement alone. Allocation was adequately concealed in one trial, and one trial was quasi-randomised. Analysis was by intention-to-treat where possible. For routine versus no shunting, there was no significant difference in the rate of all stroke, ipsilateral stroke or death up to 30 days after surgery, although data were limited. There was no significant difference between the risk of ipsilateral stroke in patients selected for shunting with the combination of electroencephalographic and carotid pressure assessment compared to pressure assessment alone, although again the data were limited. REVIEWER'S CONCLUSIONS: The data presently available are too limited to either support or refute the use of routine or selective shunting in carotid endarterectomy. Large scale randomized trials using no shunting as the control group are required. No one method of monitoring in selective shunting has been shown to produce better outcomes.

Arteriovenous Shunt, Surgical↗
PubMed2005

Surgical anatomy of the cervical carotid artery for carotid endarterectomy.

Carotid endarterectomy (CEA) is the main treatment for atherosclerotic plaque of the cervical internal carotid artery. The surgical anatomy of the carotid arteries was studied in the carotid triangle of 49 cadavers. The carotid bifurcation was located at the level of the lower third of C-3. The superior thyroid artery arose from the anterior wall of the external carotid artery in 70% of specimens and from the distal portion of the common carotid artery in 30%. The lingual artery arose as a separate trunk between the origins of the superior thyroid and facial arteries in 81% of specimens, with the facial artery from a common trunk in 18%, and with the superior thyroid artery in 1%. The occipital artery arose from the posterior aspect of the external carotid artery above the level of origin of the facial artery in 57% of specimens, between the origins of the facial and lingual arteries in 32%, and below the origin of the lingual artery in 11%. The origin of the occipital artery was positioned low and the distal portion of the occipital artery was crossed by the hypoglossal nerve in 20%. The ascending pharyngeal artery arose from the posterior wall of the external carotid artery above the level of origin of the lingual artery in 66% of specimens, below the origin of the lingual artery in 9%, from the proximal portion of the occipital artery in 19%, from the carotid bifurcation in 2%, and from the internal carotid artery in 2%. The branches of the external carotid artery are the key landmarks for adequate exposure and appropriate placement of cross-clamps on the carotid arteries. It is necessary to understand the surgical anatomy of the carotid arteries to carry out successful removal of plaque and minimize postoperative complications in a bloodless surgical field.

Aged↗