Home > Riviste > The Journal of Cardiovascular Surgery > Fascicoli precedenti > The Journal of Cardiovascular Surgery 2001 Giugno;42(3) > The Journal of Cardiovascular Surgery 2001 Giugno;42(3):365-8

ULTIMO FASCICOLO
 

ARTICLE TOOLS

Estratti

THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632


eTOC

 

ORIGINAL ARTICLES  VASCULAR SECTION


The Journal of Cardiovascular Surgery 2001 Giugno;42(3):365-8

lingua: Inglese

Management of carotid coils during routine carotid endarterectomy

Hines G. L., Bilaniuk J., Cruz V.

From ­the Department of Thoracic and Cardiovascular Surgery Winthrop-University Hospital, Mineola, New York, ­USA


PDF  


Background. A ­coil in ­the inter­nal carot­id ­artery (ICA), ­defined as a cir­cu­lar con­fig­u­ra­tion or exag­ger­at­ed “S” ­shape of ­the ­ICA, is occa­sion­al­ly encoun­tered dur­ing endar­te­rec­to­my ­for carot­id bifur­ca­tion ­lesions. The sig­nif­i­cance of ­coils as an eti­ol­o­gy ­for symp­toms is dif­fi­cult to deter­mine. It is ­thought, how­ev­er, ­that ­the fail­ure to cor­rect ­coils ­and ­kinks dur­ing rou­tine carot­id endar­te­rec­to­my (CE) ­may ­lead to tur­bu­lence ­and fail­ure of ­the CE. Various tech­niques ­have ­been dis­cussed to ­repair ­coils.
Methods. Our tech­nique con­sist­ed of com­plete dis­sec­tion of ­the ­coil, rou­tine ­use of a Javid ­shunt, stan­dard endar­te­rec­to­my, resec­tion of ­the redun­dant ­ICA, re-ap­prox­i­ma­tion of ­the pos­te­ri­or ­wall of ­the ­ICA ­and ­patch angio­plas­ty of ­the ante­ri­or ­wall. Three hun­dred ­and fif­teen ­patients under­went CE ­between August, 1998 ­and February, 2000. Fifteen ­patients (4.7%) ­had a carot­id ­coil ­that ­was ­repaired. There ­were ­ten ­men ­and ­five wom­en. Mean ­age ­was 72.6±6.1 ­years. Ten ­patients ­had an asymp­to­mat­ic sten­o­sis. Four ­patients ­had lat­er­al­iz­ing symp­toms ­and ­one ­patient ­had diz­zi­ness. Fifteen ­patients under­went pre­op­er­a­tive ­duplex scan­ning ­and 14 of ­these ­patients ­had ­MRA ­scans per­formed. All ­patients ­had a pre­op­er­a­tive sten­o­sis of 80-99% by ­duplex on ­the oper­at­ed ­side. The ­right carot­id ­artery ­was ­repaired in 12 ­patients. The ­left in ­three ­patients. The ­length of resect­ed ­artery var­ied ­from 1.2-2.8 cm (1.93±0.49 cm).
Results. All ­patients sur­vived sur­gery. One ­patient devel­oped a cer­e­bel­lar ­stroke on ­the ­third post­op­er­a­tive ­day. A post­op­er­a­tive carot­id ­duplex ­scan dem­on­strat­ed a wide­ly pat­ent ­repair. There ­were no cra­ni­al ­nerve inju­ries in ­this ­series. One ­patient ­died sev­en ­months ­after sur­gery ­from car­diac ­events ­with no fol­low-up ­duplex ­exam. There ­have ­been no ­long ­term ­strokes or anas­to­mot­ic com­pli­ca­tions. Follow-up ­duplex ­scans dem­on­strat­ed wide­ly pat­ent ­repairs (1-15% sten­o­sis) in sev­en ­patients ­and ­low ­end 15-49% sten­o­sis in ­five ­patients.
Conclusions. Resection of redun­dant ­ICA ­with re-anas­tom­o­sis of ­the pos­te­ri­or ­wall ­and ­patch recon­struc­tion of ­the ante­ri­or ­wall ­gives accept­able per­i­op­er­a­tive ­and ­long ­term ­results.

inizio pagina

Publication History

Per citare questo articolo

Corresponding author e-mail