Carotid treatment: principles and techniques
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| Previous Title: | Loftus, Christopher M. Carotid endarterectomy |
|---|---|
| Main Authors: | , , |
| Format: | Book |
| Language: | German |
| Published: |
Boca Raton ; London ; New York
CRC Press
2023
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| Edition: | Third edition |
| Subjects: | |
| Online Access: | Inhaltsverzeichnis Klappentext |
| Physical Description: | xiii, 426 Seiten Illustrationen |
| ISBN: | 9780367465711 036746571X 9781032047706 |
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| adam_text | Contents Preface to the Third Edition.............................................................................................................................. xiii CHAPTER 1 Foundation and Evidence for Carotid Reconstruction................................................................ 1 History..................... 2 Scientific Foundation for Carotid Artery Treatments.................................................................. 2 Best Medical Therapy (Asymptomatic or Symptomatic)........................................................ 3 Asymptomatic Carotid Disease.............................................................................................. 3 Asymptomatic Bruit............................................................................................................ 3 Contralateral Carotid Stenosis............................................................................................ 5 Carotid Risks in Non-Carotid Pre-Operative Patients........................................................ 6 Hollenhorst Plaque............................................................................................................. 6 Symptomatic Carotid Disease.................... 7 Transient Ischemic Attacks.................................................................................................. 8 Acute Neurological Deficit.................................................................................................. 9 Subacute Complete Carotid Occlusion............................................................................. 10 Stump
Syndromes............................................................................................................. 11 Special Considerations with Recent Stroke....................................................................... 11 Clinical Evaluation................................................................................................................. 11 Special Surgical Considerations.............................................................................................12 Plaque Ulceration and Stroke Risk Markers...................................................................... 12 Critical Stenosis.................................................................................................................12 Intra-Luminal Thrombus (ILT).......................................................................................... 12 Contralateral Carotid Occlusion....................................................................................... 13 Tandem Lesions of the Carotid Siphon............................................................................. 14 Concurrent Carotid Disease and Intra-Cranial Aneurysm............................................... 14 Recurrent Carotid Stenosis................................................................................................ 14 Concurrent Coronary/Carotid Disease............................................................................ 15 Technical Considerations........................................................................................................... 16 Anesthesia
Choice................................................................................................................. 16 Local/Regional Anesthesia............................................................................................... 16 General Anesthesia........................................................................................................... 18 Monitoring Techniques during Carotid Cross-Clamping......................................................18 Monitoring Techniques under GA.................................................................................... 19 Intra-Operative Shunting.................................................................................................. 27 Is the Shunt Needed?........................................................................................................ 28 Insertion of the Shunt....................................................................................................... 28 Is the Shunt Working?....................................................................................................... 29 Arteriotomy Techniques........................................................................................................ 29 Patch Grafting................................................................................................................... 29 Tacking Sutures................................................................................................................. 30
Heparinization.................................................................................................................. 30 Surgical Technique of Cervical Carotid Reconstruction............................................................. 30 Indications............................................................................................................................. 30 Pre-Operative Studies and Preparation.................................................................................31 Surgical Technique................................................................................................................ 31 vii
viii CONTENTS Special Considerations................................................................................................................ 36 Micro-Surgical Endarterectomy..............................................................................................36 Bilateral Carotid Endarterectomy........................................................................................... 37 Complete Occlusion................................................................................................................ 37 Acute Stroke........................................................................................................................... 37 Post-Operative Considerations................................................................................................... 38 Complications of Carotid Revascularization............................................................................. 38 Rationale................................................................................................................................. 38 Complications Following Surgery.......................................................................................... 39 Endovascular Treatment of Carotid Stenosis........................................................................... 40 Best Outcomes with CEA....................................................................................................... 41 Best Outcomes with CAS..................................................................................................... .,41 High-Risk
Patients.......................................................................................................... 43 References................................................................................................................................ ..44 CHAPTER 2 Historical Perspective and Current Practice of Carotid Artery Stenting (CAS)........................ 57 Historical Review and Recent Evidence..................................................................................... 58 (1) Less Favorable Studies for CAS..................................................................................... .,58 (2) More Favorable Studies for CAS....................................................................................... 59 (3) Meta-Analysis................................................................................................................. 60 (4) Comparative Study with Medical Treatments.................................................................. 60 Techniques for Carotid Artery Stenting...................................................................................... 61 Techniques to Address Peri-Procedural Risk Management in CAS.......................................61 (1) Antiplatelet Therapy (Thromboembolic Risk).................................................................. 61 (2) 3D-CTAfor Evaluation of Access Routes (Anatomical Risk)........................................... 62 (3) Assessment of Cardiac Function (Cardiac Risk)............................................................... 62 (4) Plaque Images (Plaque
Risk)............................................................................................ 64 (5) Evaluation of Cerebral Blood Flow (CBF) Risk................................................................. 64 Technical Considerations during the CAS Procedure................................................................ 66 (1) Monitoring........................................................................................................................ 66 (2) Approach Routes.............................................................................................................. 66 (3) Embolic Protection Methods............................................................................................. 66 (4) Stent Selection................................................................................................................... 67 (5) Standard Procedure of CAS.............................................................................................. 69 Summary of Settings and Monitoring............................................................................... 69 Procedures.............................................................. 70 Post-Operative Monitoring................................................................................................ 70 Follow-Up of the Patients..................................................................................................70 (6) Special Considerations...................................................................................................... 70 Two-Staged Angioplasty for
Patients with High Risk for Post-Procedural Hyperperfusion Syndrome................................................................................................ 70 Complications of CAS................................................................................................................ 70 References.................................................................................................................................. 71 CHAPTER 3 Radiographic Studies................................................................................................................. 75 3-1 Low Bifurcation of the Carotid Artery with Symptomatic Plaque Just at the Origin of the Internal Carotid Artery.......................................................... 76 3-2 High Bifurcation of the Cervical Carotid Artery............................................................. 78 3-3 Side-by-Side.....................................................................................................................80 3-4 Focal Internal Carotid Artery Ulcer................................................................................. 82 3-5 Deep Ulceration of a Carotid Plaque............................................................................... 84 3-6 Benign Arteriogram—Bad Ulceration............................................................................. 86
CONTENTS ІХ Ninety-Five Percent Lesion..............................................................................................88 Extensive Plaque in Common Carotid Artery with Long Arteriotomy...........................90 String Sign....................................................................................................................... 92 X-Ray Identification of an Ascending Pharyngeal Artery Originating at the Carotid Bifurcation..................................................................................... 94 3-11 Tandem Stenosis.............................................................................................................. 96 3-12 Cross Filling into Contralateral Middle Cerebral Artery................................................ 98 3-13 Can We Predict the Need for Shunting?........................................................................ 100 3-14 Pre-Operative External Carotid Artery Occlusion......................................................... 102 3-15 Internal Carotid Stump...................................................................................................104 3-16 Carotid Kink................................................................................................................... 106 3-17 Carotid Stenosis with Distal Cervical Aneurysm...........................................................108 3-18 Intra-Luminal Thrombus............................................................................................... 110 3-19 Complication—Clot along Suture
Line.......................................................................... 112 3-20 Complication—Complete Post-Operative Occlusion.................................................... 114 3-21 Complication—External Carotid Artery Dissection....................................................... 116 3-22 Morphology and Plaque Content.................................................................................. 118 Carotid Ultrasound................................................................................................... 118 Plaque MRI................................................................................................................ 118 18F-Fluorodeoxyglucose (FDG) PET.......................................................................... 120 Cerebral Hemodynamics.............................................................................................. 120 15O Positron Emission Tomography (PET)................................................................ 120 Single Photon Emission Tomography (SPECT)........................................................ 122 Hyperperfusion Syndrome after CEA/CAS............................................................. 123 Non-Invasive MRA and СТА for Surgical Planning......................................................124 References................................................................................................................................ 129 3-7 3-8 3-9 3-10 CHAPTER 4A Surgical Technique - Christopher
Loftus................................................................................. 131 4-1 Surgical Instruments...................................................................................................... 132 4-2 Surgical Positioning....................................................................................................... 134 4-3 Alternate Incisions......................................................................................................... 136 4-4 Side-by-Side Positioning.............................................................................................. 138 4-5 Incision for High Bifurcation..........................................................................................140 4-6 Ease of Dissection and Exposure................................................................................. 142 4-7 Draped and Ready for Incision.................................................................................... 144 4-8 Platysma with Michel Clips..........................................................................................146 4-9 External Jugular Vein....................................................................................................148 4-10 Sternocleidomastoid Muscle......................................................................................... 150 4-11 Jugular Vein—Common Facial Vein............................................................................. 152 4-12 Ligation of the Common Facial Vein............................................................................ 154
4-13 Secure Ligation of the Common Facial Vein................................................................ 156 4-14 Minor Branches of Facial Vein...................................................................................... 158 4-15 Dissection behind the Parotid Gland........................................................................... 160 4-16 First Demonstration of Common Carotid Artery with Control................................... 162 4-17 First CCA Control with 0 Silk Tie and Rummel Tourniquet......................................... 164 4-18 Exposure of Carotid Artery with Retractors................................................................ 166 4-19 Ring Clamp and Blunt Fish-Hook Retraction for Total Carotid Exposure................... 168 4-20 Four Sutures in the Carotid Sheath............................................................................... 170 4-21 Unexpected Internal Carotid Artery Atresia................................................................ 172 4-22 Thyroid Mass Found at Time of CEA—Right-SidedExposure..................................... 174 4-23 Major Nerve Structures Potentially Injured during Carotid Endarterectomy.................................................................................................. 176
X CONTENTS 4-24 Other Nerves at Risk during Carotid Endarterectomy................................................... 178 4-25 Low Bifurcation with Omohyoid Muscle....................................................................... 182 4-26 Isolation of Omohyoid.................................................................................................. 184 4-27 Retracted Omohyoid..................................................................................................... 186 4-28 Division of Omohyoid Muscle to Secure Adequate Low Carotid Exposure.................. 188 4-29.... Hypoglossal Nerve.......................................................................................................190 4-30 Sternomastoid Artery—An External Carotid Artery Branch.........................................192 4-31 High Bifurcation with Digastric Muscle and Hypoglossal Nerve—Left Carotid Exposure.............................................................................................................. 194 4-32 High Bifurcation with Digastric Muscle and Hypoglossal Nerve—Right Carotid Exposure..................................................................................................196 4-33 Side-by-Side Carotid Anatomy—Exposure.................................................................... 198 4-34 Isolation of Superior Thyroid Artery—Right Carotid Exposure................................... 200 4-35 Isolation of Superior Thyroid Artery—Left Carotid Exposure...................................... 202 4-36 Isolation of Ascending Pharyngeal Artery
(Left)........................................................... 204 4-37 Isolation of Ascending Pharyngeal Artery (Right)........................................................ 206 4-38 Clues to the End of the ICA Plaque............................................................................... 208 4-39 Tactile and Visual End of Plaque—Left Carotid Exposure.............................................210 4-40 Tactile and Visual End of Plaque—Right Carotid Exposure.......................................... 212 4-41 Doppler Auscultation for Extent of Plaque.................................................................... 214 4-42 Extensive Plaque Erosion into the Adventitial Layer.................................................... 216 4-43 Javid Clamp around Internal Carotid Artery................................................................. 218 4-44 Loftus Shunt Clamps..................................................................................................... 220 4-45 Placement of Cross-Clamp below Rummel Tourniquet................................................ 222 4-46 Incision along Common and Internal Carotid Arteries (Blue Line)—Left Carotid Exposure................................................................................................. 224 4-47 Potts Scissors Opening—Left Carotid Exposure............................................................226 4-48 Potts Scissors Opening Vessel—Left Carotid Exposure..................................................228 4-49 False Plane Demonstrated with Penfield Retractor—Right Carotid
Exposure............. 230 4-50 Focal Plaque in Proximal Internal Carotid Artery—Left Carotid Exposure.................. 232 4-51 Long, Extensive Common Carotid Artery/Internal Carotid Artery Plaque................. 234 4-52 Shunt in Common Carotid Artery/Internal Carotid Artery.......................................... 236 4-53 Initial Placement of Shunt Down Common Carotid Artery.......................................... 238 4-54 Securing of Shunt in Common Carotid Artery...............................................................240 4-55 Bleeding and Evacuation of Shunt before Placement in Internal Carotid Artery.......... 242 4-56 Placement of Shunt in Distal Internal Carotid Artery.................................................... 244 4-57 Potential for Intimal Damage from Placement of Shunt................................................246 4-58 Securing of Shunt in Internal Carotid Artery................................................................. 248 4-59 Loftus-Type Carotid Shunt in Place—Two Views.......................................................... 250 4-60 Evaluation of Shunt Function......................................................................................... 252 4-61 Repair with Shunt in Place..............................................................................................254 4-62 Plaque Removal Begins at Lateral Edge—Left Carotid Exposure................................. 256 4-63 Sharp Transection in Common Carotid Artery—Right Carotid Exposure.................... 258 4-64 Sharp Scissors Transection of CCA
Plaque..................................................................... 260 4-65 Plaque Removal from Internal Carotid Artery (Feathered Edge)—Right Carotid Exposure................................................................................................. 262 4-66 Plaque Removal from External Carotid Artery—Left Carotid Exposure...................... 264 4-67 Opening of External Carotid Artery—Part 1: Inadequate Feathering............................ 266 4-68 Opening of External Carotid Artery—Part 2: Inadequate Feathering............................ 268 4-69 Opening of External Carotid Artery Because of Poor Doppler Signal........................... 270 4-70 Opening of External Carotid Artery—Repair................................................................ 272 4-71 Completed External Carotid Artery Repair in a Case with Internal Carotid Artery Hemashield Patch...................................................................... 274
CONTENTS 4-72 4-73 4-74 4-75 4-76 4-77 4-78 4-79 4-80 4-81 4-82 4-83 4-84 4-85 4-86 4-87 4-88 4-89 4-90 4-91 4-92 4-93 4-94 4-95 4-96 4-97 4-98 4-99 4-100 ХІ Removal of Fragments in Circumferential Fashion—Right Carotid Exposure............ 276 Left Carotid Endarterectomy—Completed Removal, Sharp Margins.......................... 278 Completed Removal, Sharp Margins—Left Carotid Exposure.................................... 280 Placement of Tacking Sutures in Internal Carotid Artery..............................................282 ICA Single Posterior Tacking Suture............................................................................ 284 Clean Edges at Both CCA and ICA—Ready for Repair................................................ 286 Anatomic Variant—Atherosclerotic Web on Posterior Wall of Vessel........................... 288 Repair Beginning in Internal Carotid Artery: Left Carotid Exposure—No Patch Graft.......................................................................................................... 290 No Touch Technique for the Prolene Suture...............................................................292 Microscopic Internal Carotid Artery Repair................................................................. 294 Repair Beginning in External Carotid Artery: Right Carotid Exposure—No Patch Graft..........................................................................................................296 Repair of External Carotid Artery: Left Carotid Exposure—No Patch Graft............... 298 Second Limb of Repair Coming Up Common Carotid
Artery—No Patch Graft...........................................................................................................300 Suture Sequence and Placement of the Hemashield Roof Patch Graft on the Internal Carotid Artery....................................................................................... 302 Removal of Shunt.........................................................................................................306 Tying Together—Evacuation of Air: Right Carotid Exposure......................................308 Blunt Needle to Evacuate Air and Debris as Final Step—Patch Graft......................... 310 Four Rip-Stop Free Sutures in the Patch Repair.......................................................... 312 Sequence of Clamp Removal at Completion of Arteriotomy....................................... 314 Doppler Examination of Repair: Left Carotid Exposure.............................................. 316 Completed Dry Repair without and with Hemashield Patch Graft.............................318 Y-Shaped Suture Line—No Patch Graft....................................................................... 326 FloSeal for Hemostasis in the Carotid Bed.................................................................. 328 Surgicel on Dry Repair................................................................................................ 330 Closure of Sheath......................................................................................................... 332 Closure of
Platysma..................................................................................................... 334 Skin and Hemovac....................................................................................................... 336 Skin Closure................................................................................................................. 338 Placement of Saphenous Vein Patch Graft................................................................... 340 CHAPTER 4B Surgical Technique - Satoshi Kuroda....................................................................................... 343 4-101 4-102 4-103 4-104 4-105 4-106 4-107 4-108 4-109 4-110 4-111 4-112 4-113 4-114 4-115 4-116 4-117 4-118 General Anesthesia and Skin Incision.......................................................................... 344 Platysma Incision.........................................................................................................345 Sternocleidomastoid Muscle and Great Auricular Nerve............................................ 346 Carotid Sheath and Internal Jugular Vein.................................................................... 347 Opening of Carotid Sheath.......................................................................................... 348 Common Facial Vein.................................................................................................... 349 Hypoglossal Nerve...................................................................................................... 350 Part 1: Dissection of Common Carotid Artery from
Carotid Sheath............................351 Part 2: Dissection of Common Carotid Artery from Carotid Sheath............................352 Carotid Sinus Nerve Blockade.................................................................................... 353 Carotid Clamping.........................................................................................................354 Incision along Common and Internal Carotid Arteries............................................... 355 Insertion of Shunt Tube into Internal Carotid Artery.................................................. 356 Insertion of Shunt Tube into Common Carotid Artery................................................ 357 Observation of Plaque Content.................................................................................... 358 Start of Endarterectomy............................................................................................... 359 Endarterectomy on the Opposite Side......................................................................... 360 Sharp Transection in Common Carotid Artery............................................................ 361
ХІІ CONTENTS 4-119 4-120 4-121 4-122 4-123 4-124 4-125 Sharp Transection in Internal Carotid Artery............................................................... 362 Sharp Transection in External Carotid Artery............................................................... 363 Placement of Tacking Suture in Internal Carotid Artery................................................ 364 Primary Closure in Internal Carotid Artery................................................................... 365 Primary Closure in Common Carotid Artery.................................................................366 Removal of Internal Shunt Tube.................................................................................... 367 Final View of Operative Field......................................................................................... 368 CHAPTER 5 Complications........................................................................................................................... 369 5-1 Stab Wound of Posterior Carotid Wall.............................................................................370 5-2 Acute Post-Operative Internal Carotid Artery Thrombosis.............................................372 5-3 Technique for Exploration of Complete Carotid Occlusion.............................................374 5-4 Use of Fogarty Catheters to Re-Open Thrombosed Internal Carotid Artery.................. 376 5-5 Post-Operative Wound Hematoma................................................................................ 378 5-6 Aneurysm Formation 4 Years Post-
Operatively.............................................................. 380 5-7 Post-CEA Hyperperfusion Syndrome............................................................................ 382 5-8 Post-CEA Occlusion of External Carotid Artery............................................................. 384 5-9 Post-CEA/CAS DWI-Positive Lesions........................................................................... 386 5-10 Femoral Artery Pseudo-Aneurysm afterCatheter Insertion.......................................... 388 References................................................................................................................................. 390 CHAPTER 6 Special Cases............................................................................................................................. 391 6-1 Treatment of Isolated Common Carotid Artery Stenosis................................................. 392 6-2 Treatment of Stump in an Occluded Internal Carotid Artery.......................................394 6-3 Repair and Straightening of a Large Left Carotid Kink....................................................398 6-4 Rapid Recurrence of Stenosis from Myointimal Hyperplasia......................................... 400 6-5 Scarring in the Carotid Sheath in a Case of Recurrent Stenosis.......................................402 6-6 Re-Operation in a Case Previously Repaired with a Saphenous Vein Roof Patch......... 404 6-7 Mild Carotid Stenosis with Repeated Stroke..................................................................407 6-8 Invasion of
Inflamed Plaque into the Media and Adventitia.......................................... 411 6-9 Cervical Carotid Aneurysm Associated with Marfan Syndrome................................... 415 Reference.................................................................................................................................. 419 Index.......................................................................... 421
CAROTID TREATMENT Principles and Techniques THIRD EDITION Scientific and epidemiologic progress surrounding carotid artery surgery continues to evolve, and for the better, for both surgeons and patients. Carotid surgery, performed by skilled surgeons with quantifiable results, prevents stroke in asymptomatic and symptomatic patients. The challenge is to continually refine the techniques to ensure the greatest possible margins of safety, and to educate surgeons around the world to ensure uniform standards of care. Carotid artery stenting, again performed by skilled practitioners with quantifiable results, has developed as a viable alternative to CEA in chosen cases. Carotid Treatment, Third Edition represents the current state of the art in carotid treatment. Coverage includes a comprehensive and practical new chapter on carotid stenting, increased coverage of radiography, and highly illustrated surgical technique case examples reflecting international practice. Throughout the book numerous case examples, and interesting examples of anatomical variants are illustrated and explained. An expanded section on complications further increases the value of this resource for all practitioners. • Highly illustrated text to aid understanding of best practice in carotid treatment • Reflects international best practice • Useful in clinical practice and to improve patient care Neurosurgeons, Vascular surgeons, and Neuro-lnterventionalists will benefit from the experience and wisdom shared in the third edition of this acclaimed text. ABOUT THE AUTHORS Christopher Miranda Loftus, MD,
Dr.h.c.(Hon), FAANS First Vice President - Immediate Past - World Federation of Neurosurgical Societies and Professor and Former Chairman, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania Satoshi Kuroda, MD, PhD, IFAANS Professor and Chairman, Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan Naoya Kuwayama, MD, PhD Professor, Division of Neuroendovascular Therapy and Associate Professor, Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
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Contents Preface to the Third Edition. xiii CHAPTER 1 Foundation and Evidence for Carotid Reconstruction. 1 History. 2 Scientific Foundation for Carotid Artery Treatments. 2 Best Medical Therapy (Asymptomatic or Symptomatic). 3 Asymptomatic Carotid Disease. 3 Asymptomatic Bruit. 3 Contralateral Carotid Stenosis. 5 Carotid Risks in Non-Carotid Pre-Operative Patients. 6 Hollenhorst Plaque. 6 Symptomatic Carotid Disease. 7 Transient Ischemic Attacks. 8 Acute Neurological Deficit. 9 Subacute Complete Carotid Occlusion. 10 Stump
Syndromes. 11 Special Considerations with Recent Stroke. 11 Clinical Evaluation. 11 Special Surgical Considerations.12 Plaque Ulceration and Stroke Risk Markers. 12 Critical Stenosis.12 Intra-Luminal Thrombus (ILT). 12 Contralateral Carotid Occlusion. 13 Tandem Lesions of the Carotid Siphon. 14 Concurrent Carotid Disease and Intra-Cranial Aneurysm. 14 Recurrent Carotid Stenosis. 14 Concurrent Coronary/Carotid Disease. 15 Technical Considerations. 16 Anesthesia
Choice. 16 Local/Regional Anesthesia. 16 General Anesthesia. 18 Monitoring Techniques during Carotid Cross-Clamping.18 Monitoring Techniques under GA. 19 Intra-Operative Shunting. 27 Is the Shunt Needed?. 28 Insertion of the Shunt. 28 Is the Shunt Working?. 29 Arteriotomy Techniques. 29 Patch Grafting. 29 Tacking Sutures. 30
Heparinization. 30 Surgical Technique of Cervical Carotid Reconstruction. 30 Indications. 30 Pre-Operative Studies and Preparation.31 Surgical Technique. 31 vii
viii CONTENTS Special Considerations. 36 Micro-Surgical Endarterectomy.36 Bilateral Carotid Endarterectomy. 37 Complete Occlusion. 37 Acute Stroke. 37 Post-Operative Considerations. 38 Complications of Carotid Revascularization. 38 Rationale. 38 Complications Following Surgery. 39 Endovascular Treatment of Carotid Stenosis. 40 Best Outcomes with CEA. 41 Best Outcomes with CAS. .,41 "High-Risk"
Patients. 43 References. .44 CHAPTER 2 Historical Perspective and Current Practice of Carotid Artery Stenting (CAS). 57 Historical Review and Recent Evidence. 58 (1) Less Favorable Studies for CAS. .,58 (2) More Favorable Studies for CAS. 59 (3) Meta-Analysis. 60 (4) Comparative Study with Medical Treatments. 60 Techniques for Carotid Artery Stenting. 61 Techniques to Address Peri-Procedural Risk Management in CAS.61 (1) Antiplatelet Therapy (Thromboembolic Risk). 61 (2) 3D-CTAfor Evaluation of Access Routes (Anatomical Risk). 62 (3) Assessment of Cardiac Function (Cardiac Risk). 62 (4) Plaque Images (Plaque
Risk). 64 (5) Evaluation of Cerebral Blood Flow (CBF) Risk. 64 Technical Considerations during the CAS Procedure. 66 (1) Monitoring. 66 (2) Approach Routes. 66 (3) Embolic Protection Methods. 66 (4) Stent Selection. 67 (5) Standard Procedure of CAS. 69 Summary of Settings and Monitoring. 69 Procedures. 70 Post-Operative Monitoring. 70 Follow-Up of the Patients.70 (6) Special Considerations. 70 Two-Staged Angioplasty for
Patients with High Risk for Post-Procedural Hyperperfusion Syndrome. 70 Complications of CAS. 70 References. 71 CHAPTER 3 Radiographic Studies. 75 3-1 Low Bifurcation of the Carotid Artery with Symptomatic Plaque Just at the Origin of the Internal Carotid Artery. 76 3-2 High Bifurcation of the Cervical Carotid Artery. 78 3-3 Side-by-Side.80 3-4 Focal Internal Carotid Artery Ulcer. 82 3-5 Deep Ulceration of a Carotid Plaque. 84 3-6 Benign Arteriogram—Bad Ulceration. 86
CONTENTS ІХ Ninety-Five Percent Lesion.88 Extensive Plaque in Common Carotid Artery with Long Arteriotomy.90 String Sign. 92 X-Ray Identification of an Ascending Pharyngeal Artery Originating at the Carotid Bifurcation. 94 3-11 Tandem Stenosis. 96 3-12 Cross Filling into Contralateral Middle Cerebral Artery. 98 3-13 Can We Predict the Need for Shunting?. 100 3-14 Pre-Operative External Carotid Artery Occlusion. 102 3-15 Internal Carotid Stump.104 3-16 Carotid Kink. 106 3-17 Carotid Stenosis with Distal Cervical Aneurysm.108 3-18 Intra-Luminal Thrombus. 110 3-19 Complication—Clot along Suture
Line. 112 3-20 Complication—Complete Post-Operative Occlusion. 114 3-21 Complication—External Carotid Artery Dissection. 116 3-22 Morphology and Plaque Content. 118 Carotid Ultrasound. 118 Plaque MRI. 118 18F-Fluorodeoxyglucose (FDG) PET. 120 Cerebral Hemodynamics. 120 15O Positron Emission Tomography (PET). 120 Single Photon Emission Tomography (SPECT). 122 Hyperperfusion Syndrome after CEA/CAS. 123 Non-Invasive MRA and СТА for Surgical Planning.124 References. 129 3-7 3-8 3-9 3-10 CHAPTER 4A Surgical Technique - Christopher
Loftus. 131 4-1 Surgical Instruments. 132 4-2 Surgical Positioning. 134 4-3 Alternate Incisions. 136 4-4 Side-by-Side Positioning. 138 4-5 Incision for High Bifurcation.140 4-6 Ease of Dissection and Exposure. 142 4-7 Draped and Ready for Incision. 144 4-8 Platysma with Michel Clips.146 4-9 External Jugular Vein.148 4-10 Sternocleidomastoid Muscle. 150 4-11 Jugular Vein—Common Facial Vein. 152 4-12 Ligation of the Common Facial Vein. 154
4-13 Secure Ligation of the Common Facial Vein. 156 4-14 Minor Branches of Facial Vein. 158 4-15 Dissection behind the Parotid Gland. 160 4-16 First Demonstration of Common Carotid Artery with Control. 162 4-17 First CCA Control with 0 Silk Tie and Rummel Tourniquet. 164 4-18 Exposure of Carotid Artery with Retractors. 166 4-19 Ring Clamp and Blunt Fish-Hook Retraction for Total Carotid Exposure. 168 4-20 Four Sutures in the Carotid Sheath. 170 4-21 Unexpected Internal Carotid Artery Atresia. 172 4-22 Thyroid Mass Found at Time of CEA—Right-SidedExposure. 174 4-23 Major Nerve Structures Potentially Injured during Carotid Endarterectomy. 176
X CONTENTS 4-24 Other Nerves at Risk during Carotid Endarterectomy. 178 4-25 Low Bifurcation with Omohyoid Muscle. 182 4-26 Isolation of Omohyoid. 184 4-27 Retracted Omohyoid. 186 4-28 Division of Omohyoid Muscle to Secure Adequate Low Carotid Exposure. 188 4-29. Hypoglossal Nerve.190 4-30 Sternomastoid Artery—An External Carotid Artery Branch.192 4-31 High Bifurcation with Digastric Muscle and Hypoglossal Nerve—Left Carotid Exposure. 194 4-32 High Bifurcation with Digastric Muscle and Hypoglossal Nerve—Right Carotid Exposure.196 4-33 Side-by-Side Carotid Anatomy—Exposure. 198 4-34 Isolation of Superior Thyroid Artery—Right Carotid Exposure. 200 4-35 Isolation of Superior Thyroid Artery—Left Carotid Exposure. 202 4-36 Isolation of Ascending Pharyngeal Artery
(Left). 204 4-37 Isolation of Ascending Pharyngeal Artery (Right). 206 4-38 Clues to the End of the ICA Plaque. 208 4-39 Tactile and Visual End of Plaque—Left Carotid Exposure.210 4-40 Tactile and Visual End of Plaque—Right Carotid Exposure. 212 4-41 Doppler Auscultation for Extent of Plaque. 214 4-42 Extensive Plaque Erosion into the Adventitial Layer. 216 4-43 Javid Clamp around Internal Carotid Artery. 218 4-44 Loftus Shunt Clamps. 220 4-45 Placement of Cross-Clamp below Rummel Tourniquet. 222 4-46 Incision along Common and Internal Carotid Arteries (Blue Line)—Left Carotid Exposure. 224 4-47 Potts Scissors Opening—Left Carotid Exposure.226 4-48 Potts Scissors Opening Vessel—Left Carotid Exposure.228 4-49 False Plane Demonstrated with Penfield Retractor—Right Carotid
Exposure. 230 4-50 Focal Plaque in Proximal Internal Carotid Artery—Left Carotid Exposure. 232 4-51 Long, Extensive Common Carotid Artery/Internal Carotid Artery Plaque. 234 4-52 Shunt in Common Carotid Artery/Internal Carotid Artery. 236 4-53 Initial Placement of Shunt Down Common Carotid Artery. 238 4-54 Securing of Shunt in Common Carotid Artery.240 4-55 Bleeding and Evacuation of Shunt before Placement in Internal Carotid Artery. 242 4-56 Placement of Shunt in Distal Internal Carotid Artery. 244 4-57 Potential for Intimal Damage from Placement of Shunt.246 4-58 Securing of Shunt in Internal Carotid Artery. 248 4-59 Loftus-Type Carotid Shunt in Place—Two Views. 250 4-60 Evaluation of Shunt Function. 252 4-61 Repair with Shunt in Place.254 4-62 Plaque Removal Begins at Lateral Edge—Left Carotid Exposure. 256 4-63 Sharp Transection in Common Carotid Artery—Right Carotid Exposure. 258 4-64 Sharp Scissors Transection of CCA
Plaque. 260 4-65 Plaque Removal from Internal Carotid Artery (Feathered Edge)—Right Carotid Exposure. 262 4-66 Plaque Removal from External Carotid Artery—Left Carotid Exposure. 264 4-67 Opening of External Carotid Artery—Part 1: Inadequate Feathering. 266 4-68 Opening of External Carotid Artery—Part 2: Inadequate Feathering. 268 4-69 Opening of External Carotid Artery Because of Poor Doppler Signal. 270 4-70 Opening of External Carotid Artery—Repair. 272 4-71 Completed External Carotid Artery Repair in a Case with Internal Carotid Artery Hemashield Patch. 274
CONTENTS 4-72 4-73 4-74 4-75 4-76 4-77 4-78 4-79 4-80 4-81 4-82 4-83 4-84 4-85 4-86 4-87 4-88 4-89 4-90 4-91 4-92 4-93 4-94 4-95 4-96 4-97 4-98 4-99 4-100 ХІ Removal of Fragments in Circumferential Fashion—Right Carotid Exposure. 276 Left Carotid Endarterectomy—Completed Removal, Sharp Margins. 278 Completed Removal, Sharp Margins—Left Carotid Exposure. 280 Placement of Tacking Sutures in Internal Carotid Artery.282 ICA Single Posterior Tacking Suture. 284 Clean Edges at Both CCA and ICA—Ready for Repair. 286 Anatomic Variant—Atherosclerotic Web on Posterior Wall of Vessel. 288 Repair Beginning in Internal Carotid Artery: Left Carotid Exposure—No Patch Graft. 290 "No Touch" Technique for the Prolene Suture.292 Microscopic Internal Carotid Artery Repair. 294 Repair Beginning in External Carotid Artery: Right Carotid Exposure—No Patch Graft.296 Repair of External Carotid Artery: Left Carotid Exposure—No Patch Graft. 298 Second Limb of Repair Coming Up Common Carotid
Artery—No Patch Graft.300 Suture Sequence and Placement of the Hemashield Roof Patch Graft on the Internal Carotid Artery. 302 Removal of Shunt.306 Tying Together—Evacuation of Air: Right Carotid Exposure.308 Blunt Needle to Evacuate Air and Debris as Final Step—Patch Graft. 310 Four Rip-Stop Free Sutures in the Patch Repair. 312 Sequence of Clamp Removal at Completion of Arteriotomy. 314 Doppler Examination of Repair: Left Carotid Exposure. 316 Completed Dry Repair without and with Hemashield Patch Graft.318 Y-Shaped Suture Line—No Patch Graft. 326 FloSeal for Hemostasis in the Carotid Bed. 328 Surgicel on Dry Repair. 330 Closure of Sheath. 332 Closure of
Platysma. 334 Skin and Hemovac. 336 Skin Closure. 338 Placement of Saphenous Vein Patch Graft. 340 CHAPTER 4B Surgical Technique - Satoshi Kuroda. 343 4-101 4-102 4-103 4-104 4-105 4-106 4-107 4-108 4-109 4-110 4-111 4-112 4-113 4-114 4-115 4-116 4-117 4-118 General Anesthesia and Skin Incision. 344 Platysma Incision.345 Sternocleidomastoid Muscle and Great Auricular Nerve. 346 Carotid Sheath and Internal Jugular Vein. 347 Opening of Carotid Sheath. 348 Common Facial Vein. 349 Hypoglossal Nerve. 350 Part 1: Dissection of Common Carotid Artery from
Carotid Sheath.351 Part 2: Dissection of Common Carotid Artery from Carotid Sheath.352 Carotid Sinus Nerve Blockade. 353 Carotid Clamping.354 Incision along Common and Internal Carotid Arteries. 355 Insertion of Shunt Tube into Internal Carotid Artery. 356 Insertion of Shunt Tube into Common Carotid Artery. 357 Observation of Plaque Content. 358 Start of Endarterectomy. 359 Endarterectomy on the Opposite Side. 360 Sharp Transection in Common Carotid Artery. 361
ХІІ CONTENTS 4-119 4-120 4-121 4-122 4-123 4-124 4-125 Sharp Transection in Internal Carotid Artery. 362 Sharp Transection in External Carotid Artery. 363 Placement of Tacking Suture in Internal Carotid Artery. 364 Primary Closure in Internal Carotid Artery. 365 Primary Closure in Common Carotid Artery.366 Removal of Internal Shunt Tube. 367 Final View of Operative Field. 368 CHAPTER 5 Complications. 369 5-1 Stab Wound of Posterior Carotid Wall.370 5-2 Acute Post-Operative Internal Carotid Artery Thrombosis.372 5-3 Technique for Exploration of Complete Carotid Occlusion.374 5-4 Use of Fogarty Catheters to Re-Open Thrombosed Internal Carotid Artery. 376 5-5 Post-Operative Wound Hematoma. 378 5-6 Aneurysm Formation 4 Years Post-
Operatively. 380 5-7 Post-CEA Hyperperfusion Syndrome. 382 5-8 Post-CEA Occlusion of External Carotid Artery. 384 5-9 Post-CEA/CAS DWI-Positive Lesions. 386 5-10 Femoral Artery Pseudo-Aneurysm afterCatheter Insertion. 388 References. 390 CHAPTER 6 Special Cases. 391 6-1 Treatment of Isolated Common Carotid Artery Stenosis. 392 6-2 Treatment of "Stump" in an Occluded Internal Carotid Artery.394 6-3 Repair and Straightening of a Large Left Carotid Kink.398 6-4 Rapid Recurrence of Stenosis from Myointimal Hyperplasia. 400 6-5 Scarring in the Carotid Sheath in a Case of Recurrent Stenosis.402 6-6 Re-Operation in a Case Previously Repaired with a Saphenous Vein Roof Patch. 404 6-7 Mild Carotid Stenosis with Repeated Stroke.407 6-8 Invasion of
Inflamed Plaque into the Media and Adventitia. 411 6-9 Cervical Carotid Aneurysm Associated with Marfan Syndrome. 415 Reference. 419 Index. 421
CAROTID TREATMENT Principles and Techniques THIRD EDITION Scientific and epidemiologic progress surrounding carotid artery surgery continues to evolve, and for the better, for both surgeons and patients. Carotid surgery, performed by skilled surgeons with quantifiable results, prevents stroke in asymptomatic and symptomatic patients. The challenge is to continually refine the techniques to ensure the greatest possible margins of safety, and to educate surgeons around the world to ensure uniform standards of care. Carotid artery stenting, again performed by skilled practitioners with quantifiable results, has developed as a viable alternative to CEA in chosen cases. Carotid Treatment, Third Edition represents the current state of the art in carotid treatment. Coverage includes a comprehensive and practical new chapter on carotid stenting, increased coverage of radiography, and highly illustrated surgical technique case examples reflecting international practice. Throughout the book numerous case examples, and interesting examples of anatomical variants are illustrated and explained. An expanded section on complications further increases the value of this resource for all practitioners. • Highly illustrated text to aid understanding of best practice in carotid treatment • Reflects international best practice • Useful in clinical practice and to improve patient care Neurosurgeons, Vascular surgeons, and Neuro-lnterventionalists will benefit from the experience and wisdom shared in the third edition of this acclaimed text. ABOUT THE AUTHORS Christopher Miranda Loftus, MD,
Dr.h.c.(Hon), FAANS First Vice President - Immediate Past - World Federation of Neurosurgical Societies and Professor and Former Chairman, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania Satoshi Kuroda, MD, PhD, IFAANS Professor and Chairman, Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan Naoya Kuwayama, MD, PhD Professor, Division of Neuroendovascular Therapy and Associate Professor, Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan |
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| discipline | Medizin |
| discipline_str_mv | Medizin |
| edition | Third edition |
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| spelling | Loftus, Christopher M. Verfasser (DE-588)135711177 aut Carotid treatment principles and techniques Christopher Miranda Loftus, MD, Dr.h.c. (Hon), FAANS, Satoshi Kuroda, MD, PhD, FAANS, Naoya Kuwayama, MD, PhD Third edition Boca Raton ; London ; New York CRC Press 2023 xiii, 426 Seiten Illustrationen txt rdacontent n rdamedia nc rdacarrier Carotischirurgie (DE-588)4147359-0 gnd rswk-swf Endarteriektomie (DE-588)4201526-1 gnd rswk-swf Carotischirurgie (DE-588)4147359-0 s Endarteriektomie (DE-588)4201526-1 s DE-604 Kuroda, Satoshi Verfasser (DE-588)1277690545 aut Kuwayama, Naoya Verfasser (DE-588)1277690642 aut Erscheint auch als Online-Ausgabe 978-1-003-04217-4 Vorangegangen ist Loftus, Christopher M. Carotid endarterectomy Digitalisierung UB Regensburg - ADAM Catalogue Enrichment application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=033915396&sequence=000001&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis Digitalisierung UB Regensburg - ADAM Catalogue Enrichment application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=033915396&sequence=000003&line_number=0002&func_code=DB_RECORDS&service_type=MEDIA Klappentext |
| spellingShingle | Loftus, Christopher M. Kuroda, Satoshi Kuwayama, Naoya Carotid treatment principles and techniques Carotischirurgie (DE-588)4147359-0 gnd Endarteriektomie (DE-588)4201526-1 gnd |
| subject_GND | (DE-588)4147359-0 (DE-588)4201526-1 |
| title | Carotid treatment principles and techniques |
| title_auth | Carotid treatment principles and techniques |
| title_exact_search | Carotid treatment principles and techniques |
| title_exact_search_txtP | Carotid treatment principles and techniques |
| title_full | Carotid treatment principles and techniques Christopher Miranda Loftus, MD, Dr.h.c. (Hon), FAANS, Satoshi Kuroda, MD, PhD, FAANS, Naoya Kuwayama, MD, PhD |
| title_fullStr | Carotid treatment principles and techniques Christopher Miranda Loftus, MD, Dr.h.c. (Hon), FAANS, Satoshi Kuroda, MD, PhD, FAANS, Naoya Kuwayama, MD, PhD |
| title_full_unstemmed | Carotid treatment principles and techniques Christopher Miranda Loftus, MD, Dr.h.c. (Hon), FAANS, Satoshi Kuroda, MD, PhD, FAANS, Naoya Kuwayama, MD, PhD |
| title_old | Loftus, Christopher M. Carotid endarterectomy |
| title_short | Carotid treatment |
| title_sort | carotid treatment principles and techniques |
| title_sub | principles and techniques |
| topic | Carotischirurgie (DE-588)4147359-0 gnd Endarteriektomie (DE-588)4201526-1 gnd |
| topic_facet | Carotischirurgie Endarteriektomie |
| url | http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=033915396&sequence=000001&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=033915396&sequence=000003&line_number=0002&func_code=DB_RECORDS&service_type=MEDIA |
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