• Journal of Cerebrovascular and Endovascular Neurosurgery
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• 제26권2호
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• pp.130-140
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• 2024

Objective: To assess whether local anesthetic infiltration could minimize the carotid baroreceptor reflex (CBR) which has an incidence after carotid artery stenting (CAS) that varies from 29% to 51%. Methods: This retrospective single-center study included 51 patients (mean age, 70.47 years) who underwent CAS for carotid stenosis. The groups included patients who underwent CAS for asymptomatic ischemic stroke (n=41) or symptomatic disease (n=10). Preprocedural percutaneous lidocaine injections (PPLIs) were administered to 70.6% and 5.9% of patients who underwent elective CAS and emergency CAS, respectively. Results: Among patients who received PPLIs, the mean degree of stenosis was 80.5% (95% confidence interval [CI]: ±10.74, 51-98%). The mean distance from the common carotid artery bifurcation to the most stenotic lesion (CSD) was 8.3 mm (95% CI: ±0.97, 6.3-10.2 mm); the mean angle between the internal carotid artery and common carotid artery (CCA) trunk (IAG) was 65.6° (95% CI: ±2.39, 61-70°). Among patients who did not receive PPLIs, the mean degree of stenosis was 84.0% (95% CI: ±8.96, 70-99%). The mean CSD was 5.9 mm (95% CI: ±1.83, 1.9-9.9 mm); the mean IAG was 60.4° (95% CI: ±4.41, 51-70°). The procedure time was longer in the PPLI group than in the no PPLI group (28.19 [n=39] vs. 18.88 [n=12] days) (P=0.057); the length of intensive care unit stay was shorter in the PPLI group (20.01 [n=36] vs. 28.10 [n=5] days) (P=0.132). Conclusions: Targeted PPLI administration to the carotid bulb decreased aberrant heart rates and blood pressure changes induced by carotid stent deployment and balloon inflation. As CBR sensitivity increases with decreasing distance to the stenotic lesion from the CCA bifurcation, PPLIs may help stabilize patients during procedures for stenotic lesions closer to the CCA.

• 대한두경부종양학회지
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• 제14권2호
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• pp.175-181
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• 1998

Objectives: The authors tried to analyze the results of carotid artery sacrifice with or without preoperative carotid evaluation. Materials and Methods: Thirteen patients undergone carotid sacrifice were evaluated. Carotid balloon occlusion test (BOT) and single-photon emission computed tomography (SPECT) with technetium-99m-labeled hexamethylpropyleneamineoxime ($^{99m}Tc-HMPAO$) were used for preoperative carotid evaluation. Results: The causes of carotid artery sacrifice consisted of the neck mass involving the carotid artery, spontaneous aneurysmal rupture, and traumatic pseudoaneurysm. Five patient had postoperative neurologic complications and two of them had permanent neurologic deficits. Conclusion: The authors stress that the preoperative evaluation in carotid artery sacrifice is imperable, and the BOT with SPECT can be used in selecting the method of treatment. But since these tests cannot predict the postoperative outcome perfectly, careful perioperative care of the patients should be exercised regardless of the results of the preoperative evaluation.

• Journal of Korean Neurosurgical Society
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• 제49권5호
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• pp.257-261
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• 2011

Objective : Successful coil embolization of anterior communicating (A-com) artery aneurysms requires good visualization and understanding of the entire H complex. Bilateral carotid angiography may optimize anatomical understanding and visualization of the H complex. We therefore assessed the efficacy of simultaneous bilateral internal carotid angiography during coil embolization for A-com artery aneurysms. Methods : Of the 153 patients with intracranial saccular aneurysms who underwent embolization between July 2008 and December 2009, 12 had A-com artery aneurysms and were embolized under bilateral carotid angiography. Patients were evaluated angiographically, immediately and 6 months (n=11) after embolization, using a 3-point scale (complete, residual neck, residual aneurysm). The safety, performance and efficacy of this approach were retrospectively evaluated. Results: In all patients, bilateral internal carotid artery angiography provided more detailed anatomical information and understanding around the A-com artery, and, in complex situations, it allowed for more effective coil embolization through bilateral routes to the A-com artery. Angiography immediately after embolization showed occlusion of 11 of the 12 (92%) aneurysms, with none of these 11 showing evidence of recanalization at 6 months. Conclusion : These findings indicate that simultaneous bilateral carotid angiography during coil embolization of selected complex A-com artery aneurysms provided improved anatomical understanding, and resulted in more effective and safer procedures than typical unilateral angiography.

• 대한두경부종양학회지
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• 제20권2호
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• pp.177-180
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• 2004

Objectives: To completely excise a malignant tumor which invades carotid artery walls, the resection and reconstruction of the carotid artery is essentially required. In most of the cases, interposition graft using a saphenous vein has been performed, however the vessel caliber discrepancy between a common carotid artery and the saphenous vein can result in a problem on surgical technique. We have introduced and evaluated a new titanium hemoclip tailing method to overcome vessel caliber discrepancy in interposition saphenous vein graft for carotid artery resection in the treatment of head and neck cancers. Method: After carotid artery resection, the calibers of the proximal common carotid artery and the vein were compared, and an orifice of the common carotid artery was gradually reduced to a little larger than or the same size as the orifice of the vein by using the titanium hemostatic clip. Subsequently, the common carotid artery was connected to the vein through anastomosis. The same method was also applied to the distal anastomosis site. There after, the vessels were connected through the anastomosis, and a circulation was restored by releasing a vascular clamp. Then, a titanium hemostatic clip-applied redundant portion on the outside of carotid artery was sutured by the blanket edge suture method, using 6-0 Prolene. Results: We have experienced this method in two patients with recurrent squamous cell carcinoma and neuroblostoma, respectively. The interposition saphenous vein graft of these patients was found to maintain good patency on the follow up angiography after one year, and they had no specific vascular complication, such as atherosclerosis. Conclusion: This method made it possible to simply perform the interposition saphenous vein graft (ISVG) within a short time and, therefore, was very useful for shortening the duration to block circulation.

• 대한의생명과학회지
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• 제21권4호
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• pp.198-207
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• 2015

ST-segment elevation myocardial infarction (STEMI) and chronic total occlusion (CTO) of coronary artery are well-known atherosclerotic vascular diseases. However, the difference of intima-media thickness and plaque characteristics of carotid arteries between STEMI and CTO patients were not directly compared in previous studies. Medical records of a total of 158 (101 STEMI, 57 CTO) patients, who underwent carotid artery ultrasonography, were selected for the analysis. The baseline characteristics, ultrasonography findings, and clinical outcomes of the two groups were compared. The prevalence of hypertension, diabetes mellitus, and dyslipidemia was significantly higher in CTO patients. Carotid intima-media thickness ($0.97{\pm}0.13$ vs. $0.78{\pm}0.17cm$, P < 0.0001) and number of plaques ($2.2{\pm}1.0$ vs. $1.7{\pm}1.2$, P < 0.0001) were greater in CTO than STEMI patients. Multiple (${\geq}3$) or echogenic plaques were more frequently observed in CTO patients. During the median follow-up duration of 27 months, major adverse cardiovascular events occurred in 31% of CTO and 14% of STEMI patients (P = 0.008). We found that, compared with STEMI, CTO patients have higher burden of carotid artery atherosclerosis associated with more comorbid diseases and poor clinical outcomes.

• 동의생리병리학회지
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• 제26권5호
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• pp.610-614
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• 2012

This study was done to identify correlates of carotid artery ultrasonography's measurement and Inyoung pulse in college students. We measured the amplitude of Inyoung pulse, Chongu pulse, ratio of Inyoung to Chongu and ratio of Chongu to Inyoung on 30 college students. Also, We measured the Distance, Diameter), RI(resistivity index), S/D(systolic, diastolic ratio), PI(pulsatility index), PSV(peak systolic velocity), EDV(End diastolic velocity), Vmean using carotid artery ultrasonography. The data was analyzed by Pearson's correlation coefficient using SAS program. The results were as follow. Results showed a positive correlation between Inyoung pulse and diameter by carotid artery. It showed a positive correlation between Inyoung pulse and S/D. Also, It showed a positive correlation between Inyoung pulse and PSV. As a result, the strength of Inyoung pulse related with the diameter of carotid artery and blood flow velocity.

• Anatomy and Cell Biology
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• 제51권4호
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• pp.284-291
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• 2018

The role of androgens in the development of cardiovascular diseases remains controversial. The current study therefore sought to determine the changes in the histomorphology of the common carotid artery of the male rat in orchidectomy-induced hypogonadism. Twenty-two Rattus norvegicus male rats aged 2 months were used. The rats were randomly assigned into baseline (n=4), experimental (n=9), and control (n=9) groups. Hypogonadism was surgically induced in the experimental group by bilateral orchiectomy under local anesthesia. At experiment weeks 3, 6, and 9, three rats from each group (experimental and control) were euthanized, their common carotid artery harvested, and routine processing was done for paraffin embedding, sectioning, and staining. The photomicrographs were taken using a digital photomicroscope for morphometric analysis. Orchidectomy resulted in the development of vascular fibrosis, with a significant increase in collagen fiber density and decrease in smooth muscle and elastic fiber density. Moreover, there was development of intimal hyperplasia, with fragmentation of medial elastic lamellae in the common carotid artery of the castrated rats. Orchidectomy induces adverse changes in structure of the common carotid artery of the male rat. These changes may impair vascular function, therefore constituting a possible structural basis for the higher incidences of cardiovascular diseases observed in hypogonadism.

• Journal of Chest Surgery
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• 제26권11호
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• pp.833-837
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• 1993

In an effort to reduce the stroke rate of patients after coronary artery bypass, many authors have studied the prevalence of the extracranial carotid disease and its role in determining neurologic morbidity and mortality rates. From April 1992 to August 1993, Seventy-five patients undergoing coronary artery bypass were preoperatively evaluated for presence of carotid and femoral stenosis by Duplex sono. Among them, fourteen patients was positive by Duplex sono and overall prevalence of carotid or femoral stenosis was 18.7%. And significant carotid stenosis [ > 60% ] had proved to be in 3 patients [ 4.0% ].Prophylatic bilateral carotid endarterectomy was performed in one patient, at 5 months prior to and , 1 week prior to coronary artery bypass respectively. Their mean age was 57.6 years [ ranged from 40 to 70 years] and were composed of 10 males and 4 females. There was no postoperative morbidiry and mortality related to neurologic complications. Our data, although small, suggest that preoperative carotid screening is helpful to determine patients at high risk of stroke, and significant simultaneous carotid and coronary atherosclerosis should be corrected in selected patients by staged operations when feasible.

• Journal of Chest Surgery
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• 제14권1호
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• pp.63-66
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• 1981

True aneurysm of the carotid artery is relatively rare in comparison with the total number of aneurysms of the arterial system. The threat of rupture and embolization from mural thrombi are indications for treatment even though no symptoms may be present. Resection of the aneurysm and restoration of arterial continuity is the treatment of choice. A case of aneurysm of the Lt. common carotid artery of a 21 year-old male patient is presented. The confirmatory diagnosis was made by left carotid angiogram, and the aneurysmectomy & reconstruction with woven dacron vascular prosthesis was done, while cerebral circulation was maintained by internal shunt.

• Journal of Korean Neurosurgical Society
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• 제44권3호
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• pp.159-162
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• 2008

Stenting is a useful alternative treatment modality in carotid artery stenosis patients who are too high-risk to undergo carotid endarterectomy (CEA). We report a case of contralateral cerebral infarction after stenting for extracranial carotid stenosis. A 78-year-old woman was admitted to the hospital with left-sided weakness. Based on magnetic resonance imaging (MRI) of the brain and conventional angiography, she was diagnosed with an acute watershed infarct of the right hemisphere secondary to severe carotid stenosis. Stenting was performed for treatment of the right carotid artery stenosis after a one-week cerebral angiogram was completed. Thirty minutes after stent placement, the patient exhibited a generalized seizure. Four hours later, brain MRI revealed left hemispheric cerebral infarction. Complex aorta-like arch elongation, tortuosity, calcification, and acute angulation at the origin of the supra-aortic arteries may increase the risk of procedural complications. In our case, we suggest that difficult carotid artery catheterization, with aggressive maneuvering during stenting, likely injured the tortuous, atherosclerotic aortic arch, and led to infarction of the contralateral cerebral hemisphere by thromboemboli formed on the wall of the atherosclerotic aorta.