Journal article
Hybrid Surgery for Internal Carotid Artery Revascularization
World neurosurgery, Vol.121, pp.137-144
01/2019
DOI: 10.1016/j.wneu.2018.09.230
PMID: 30312821
Abstract
The management of chronic complete internal carotid artery (ICA) occlusion (COICA) has been challenging. Endovascular procedures have been performed with variable success and risks, depending on the type of occlusion and distal revascularization. We present a novel hybrid procedure to recanalize the ICA when previous endovascular interventions have failed or been deemed too risky.
Two patients presented with symptomatic COICA after maximal medical management. They were deemed at high risk of endovascular intervention and/or previous endovascular attempts had failed. Thus, they had indications for a hybrid procedure.
A hybrid technique was used to create a stump by surgical endarterectomy, followed by recanalization using an endovascular approach via femoral access. We have described the technique in detail. Postoperative computed tomography perfusion scanning showed normalization of the mean transient time, cerebral blood volume, and cerebral blood flow compared with the preoperative findings. Cerebral angiography showed successful recanalization of the ICA. Neither patient experienced any complications.
A hybrid technique is feasible and should be considered for patients with COICA in whom maximal medical management has failed and who have a high-risk profile for endovascular intervention or in whom previous endovascular attempts have failed.
•A hybrid procedure can be used for COICA when endovascular attempts have failed or are considered too risky (e.g., type C).•Heparin should be give once the sheath is in place.•An endarterectomy is performed to create a stump in the ICA for easier endovascular access.•Endovascular angioplasty and stenting is then performed with the surgical wound still open.•IV tirofiban is started on deployments of the stents and DAPT on closure.
Details
- Title: Subtitle
- Hybrid Surgery for Internal Carotid Artery Revascularization
- Creators
- Mario Zanaty - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USAEdgar A Samaniego - Department of Neurology, Neurosurgery, and Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USANahom Teferi - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USADavid K Kung - Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USADaichi Nakagawa - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USAJoseph Hudson - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USASantiago Ortega-Gutierrez - Department of Neurology, Neurosurgery, and Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USALauren Allan - Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USAPascal Jabbour - Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USADavid M Hasan - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Resource Type
- Journal article
- Publication Details
- World neurosurgery, Vol.121, pp.137-144
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.wneu.2018.09.230
- PMID
- 30312821
- ISSN
- 1878-8750
- eISSN
- 1878-8769
- Language
- English
- Date published
- 01/2019
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Neurology; Radiology; Iowa Neuroscience Institute; Surgery; Neurosurgery; Otolaryngology
- Record Identifier
- 9984040284102771
Metrics
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