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Published in: Acta Neurochirurgica 10/2019

01-10-2019 | Stroke | Original Article - Vascular Neurosurgery - Ischemia

Bypass strategies for common carotid artery occlusion

Authors: Nils Hecht, Lars Wessels, Lucius Fekonja, Paul von Weitzel-Mudersbach, Peter Vajkoczy

Published in: Acta Neurochirurgica | Issue 10/2019

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Abstract

Background

Common carotid artery occlusion (CCA-occlusion) is a rare condition where standard revascularization is not feasible. Here, we analyzed our experience with surgical revascularization of CCA-occlusion to develop an algorithm for selection of the most suitable bypass strategy according to the Riles classification.

Methods

During a 10-year period, 16 out of 288 patients with cerebrovascular disease and compromised hemodynamic reserve underwent revascularization for unilateral CCA-occlusion. The utilized bypass strategies included (1) a saphenous vein graft from the subclavian artery (SA) to the internal carotid artery (ICA), (2) a radial artery graft from the V3 segment of the vertebral artery (VA) to a superficial branch of the middle cerebral artery (MCA), or (3) a saphenous vein graft from the SA to a deep branch of the MCA.

Results

In CCA-occlusion with maintained external carotid artery (ECA)/ICA patency (Riles type 1A), an SA-ICA bypass was performed (25%). In cases without ECA/ICA patency (Riles type 1B or 2) but suitable VA, a VA-MCA bypass was grafted (31%). In cases with unsuitable VA, a long SA-MCA interposition bypass was performed (38%). Transient postoperative neurological deficits occurred in 5 patients (31%) with 1 patient (6%) suffering permanent neurological worsening and 1 mortality (6%). Overall, no difference was found between the median preoperative mRS (2; range, 1–4) and the mRS at the time point of the last follow-up (2; range, 1–6; p = 0.75). The long-term graft patency was 94%.

Conclusions

Although surgical revascularization for CCA-occlusion is feasible, it is associated with a higher risk than standard bypass grafting. Considering the poor natural history of CCA-occlusion, however, this risk may be justified in carefully selected patients.
Literature
1.
go back to reference Acker G, Goerdes S, Schmiedek P, Czabanka M, Vajkoczy P (2016) Characterization of clinical and radiological features of quasi-moyamoya disease among European Caucasians including surgical treatment and outcome. Cerebrovasc Dis 42(5–6):464–475CrossRefPubMed Acker G, Goerdes S, Schmiedek P, Czabanka M, Vajkoczy P (2016) Characterization of clinical and radiological features of quasi-moyamoya disease among European Caucasians including surgical treatment and outcome. Cerebrovasc Dis 42(5–6):464–475CrossRefPubMed
2.
go back to reference Ausman JI, Tiel RL, Mehta BA, Fuentes JD, Pearce JE, Diaz FG (1985) “Reverse” superficial temporal artery-middle cerebral artery bypass. Surg Neurol 23(6):614–616CrossRefPubMed Ausman JI, Tiel RL, Mehta BA, Fuentes JD, Pearce JE, Diaz FG (1985) “Reverse” superficial temporal artery-middle cerebral artery bypass. Surg Neurol 23(6):614–616CrossRefPubMed
3.
go back to reference Belczak S, Mulatti GC, Abrao SR, da Silva ES, Aun R, Puech-Leao P, de Luccia N (2016) Common carotid artery occlusion: a single-center experience in 40 cases. Int J Angiol 25(1):39–43PubMed Belczak S, Mulatti GC, Abrao SR, da Silva ES, Aun R, Puech-Leao P, de Luccia N (2016) Common carotid artery occlusion: a single-center experience in 40 cases. Int J Angiol 25(1):39–43PubMed
4.
go back to reference Belkin M, Mackey WC, Pessin MS, Caplan LR, O’Donnell TF (1993) Common carotid artery occlusion with patent internal and external carotid arteries: diagnosis and surgical management. J Vasc Surg 17(6):1019–1027CrossRefPubMed Belkin M, Mackey WC, Pessin MS, Caplan LR, O’Donnell TF (1993) Common carotid artery occlusion with patent internal and external carotid arteries: diagnosis and surgical management. J Vasc Surg 17(6):1019–1027CrossRefPubMed
5.
go back to reference Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL, Cates CU, Creager MA, Fowler SB, Friday G, Hertzberg VS, EB MI, Moore WS, Panagos PD, Riles TS, Rosenwasser RH, Taylor AJ, American College of Cardiology Foundation; American Stroke Association; American Association of Neurological Surgeons; American College of Radiology; American Society of Neuroradiology; Congress of Neurological Surgeons; Society of Atherosclerosis Imaging and Prevention; Society for Cardiovascular Angiography and Interventions; Society of Interventional Radiology; Society of NeuroInterventional Surgery; Society for Vascular Medicine; Society for Vascular Surgery (2011) 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery. Circulation 124(4):e54–e130CrossRefPubMed Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL, Cates CU, Creager MA, Fowler SB, Friday G, Hertzberg VS, EB MI, Moore WS, Panagos PD, Riles TS, Rosenwasser RH, Taylor AJ, American College of Cardiology Foundation; American Stroke Association; American Association of Neurological Surgeons; American College of Radiology; American Society of Neuroradiology; Congress of Neurological Surgeons; Society of Atherosclerosis Imaging and Prevention; Society for Cardiovascular Angiography and Interventions; Society of Interventional Radiology; Society of NeuroInterventional Surgery; Society for Vascular Medicine; Society for Vascular Surgery (2011) 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery. Circulation 124(4):e54–e130CrossRefPubMed
6.
go back to reference Deshmukh VR, Porter RW, Spetzler RF (2005) Use of “bonnet” bypass with radial artery interposition graft in a patient with recurrent cranial base carcinoma: technical report of two cases and review of the literature. Neurosurgery 56(1 Suppl):E202–discussion E202PubMed Deshmukh VR, Porter RW, Spetzler RF (2005) Use of “bonnet” bypass with radial artery interposition graft in a patient with recurrent cranial base carcinoma: technical report of two cases and review of the literature. Neurosurgery 56(1 Suppl):E202–discussion E202PubMed
7.
go back to reference Grubb RLJ, Derdeyn CP, Fritsch SM, Carpenter DA, Yundt KD, Videen TO, Spitznagel EL, Powers WJ (1998) Importance of hemodynamic factors in the prognosis of symptomatic carotid occlusion. JAMA 280(12):1055–1060CrossRefPubMed Grubb RLJ, Derdeyn CP, Fritsch SM, Carpenter DA, Yundt KD, Videen TO, Spitznagel EL, Powers WJ (1998) Importance of hemodynamic factors in the prognosis of symptomatic carotid occlusion. JAMA 280(12):1055–1060CrossRefPubMed
8.
go back to reference Guzman R, Lee M, Achrol A, Bell-Stephens T, Kelly M, Do HM, Marks MP, Steinberg GK (2009) Clinical outcome after 450 revascularization procedures for moyamoya disease. Clinical article. J Neurosurg 111(5):927–935CrossRefPubMed Guzman R, Lee M, Achrol A, Bell-Stephens T, Kelly M, Do HM, Marks MP, Steinberg GK (2009) Clinical outcome after 450 revascularization procedures for moyamoya disease. Clinical article. J Neurosurg 111(5):927–935CrossRefPubMed
9.
go back to reference Hass WK, Fields WS, North RR, Kircheff II, Chase NE, Bauer RB (1968) Joint study of extracranial arterial occlusion. II. Arteriography, techniques, sites, and complications. JAMA 203(11):961–968CrossRefPubMed Hass WK, Fields WS, North RR, Kircheff II, Chase NE, Bauer RB (1968) Joint study of extracranial arterial occlusion. II. Arteriography, techniques, sites, and complications. JAMA 203(11):961–968CrossRefPubMed
10.
go back to reference Hecht N, Muller M-M, Sandow N, Pinczolits A, Vajkoczy P, Woitzik J (2016) Infarct prediction by intraoperative laser speckle imaging in patients with malignant hemispheric stroke. J Cereb Blood Flow Metab 36(6):1022–1032CrossRefPubMed Hecht N, Muller M-M, Sandow N, Pinczolits A, Vajkoczy P, Woitzik J (2016) Infarct prediction by intraoperative laser speckle imaging in patients with malignant hemispheric stroke. J Cereb Blood Flow Metab 36(6):1022–1032CrossRefPubMed
11.
go back to reference Hecht N, Woitzik J, König S, Horn P, Vajkoczy P (2013) Laser speckle imaging allows real-time intraoperative blood flow assessment during neurosurgical procedures. J Cereb Blood Flow Metab 33(7):1000–1007CrossRefPubMedPubMedCentral Hecht N, Woitzik J, König S, Horn P, Vajkoczy P (2013) Laser speckle imaging allows real-time intraoperative blood flow assessment during neurosurgical procedures. J Cereb Blood Flow Metab 33(7):1000–1007CrossRefPubMedPubMedCentral
12.
go back to reference Kaku Y, Iihara K, Nakajima N, Kataoka H, Fukuda K, Masuoka J, Fukushima K, Iida H, Hashimoto N (2012) Cerebral blood flow and metabolism of hyperperfusion after cerebral revascularization in patients with moyamoya disease. J Cereb Blood Flow Metab 32(11):2066–2075CrossRefPubMedPubMedCentral Kaku Y, Iihara K, Nakajima N, Kataoka H, Fukuda K, Masuoka J, Fukushima K, Iida H, Hashimoto N (2012) Cerebral blood flow and metabolism of hyperperfusion after cerebral revascularization in patients with moyamoya disease. J Cereb Blood Flow Metab 32(11):2066–2075CrossRefPubMedPubMedCentral
13.
go back to reference Kazumata K, Ito M, Tokairin K, Ito Y, Houkin K, Nakayama N, Kuroda S, Ishikawa T, Kamiyama H (2014) The frequency of postoperative stroke in moyamoya disease following combined revascularization: a single-university series and systematic review. J Neurosurg 121(2):432–440CrossRefPubMed Kazumata K, Ito M, Tokairin K, Ito Y, Houkin K, Nakayama N, Kuroda S, Ishikawa T, Kamiyama H (2014) The frequency of postoperative stroke in moyamoya disease following combined revascularization: a single-university series and systematic review. J Neurosurg 121(2):432–440CrossRefPubMed
14.
go back to reference Klonaris C, Kouvelos GN, Kafeza M, Koutsoumpelis A, Katsargyris A, Tsigris C (2013) Common carotid artery occlusion treatment: revealing a gap in the current guidelines. Eur J Vasc Endovasc Surg 46(3):291–298CrossRefPubMed Klonaris C, Kouvelos GN, Kafeza M, Koutsoumpelis A, Katsargyris A, Tsigris C (2013) Common carotid artery occlusion treatment: revealing a gap in the current guidelines. Eur J Vasc Endovasc Surg 46(3):291–298CrossRefPubMed
15.
go back to reference Ogasawara K, Sakai N, Kuroiwa T, Hosoda K, Iihara K, Toyoda K, Sakai C, Nagata I, Ogawa A (2007) Intracranial hemorrhage associated with cerebral hyperperfusion syndrome following carotid endarterectomy and carotid artery stenting: retrospective review of 4494 patients. J Neurosurg 107(6):1130–1136CrossRefPubMed Ogasawara K, Sakai N, Kuroiwa T, Hosoda K, Iihara K, Toyoda K, Sakai C, Nagata I, Ogawa A (2007) Intracranial hemorrhage associated with cerebral hyperperfusion syndrome following carotid endarterectomy and carotid artery stenting: retrospective review of 4494 patients. J Neurosurg 107(6):1130–1136CrossRefPubMed
16.
go back to reference Pena-Tapia PG, Kemmling A, Czabanka M, Vajkoczy P, Schmiedek P (2008) Identification of the optimal cortical target point for extracranial-intracranial bypass surgery in patients with hemodynamic cerebrovascular insufficiency. J Neurosurg 108(4):655–661CrossRefPubMed Pena-Tapia PG, Kemmling A, Czabanka M, Vajkoczy P, Schmiedek P (2008) Identification of the optimal cortical target point for extracranial-intracranial bypass surgery in patients with hemodynamic cerebrovascular insufficiency. J Neurosurg 108(4):655–661CrossRefPubMed
17.
go back to reference Piepgras DG, Morgan MK, Sundt TMJ, Yanagihara T, Mussman LM (1988) Intracerebral hemorrhage after carotid endarterectomy. J Neurosurg 68(4):532–536CrossRefPubMed Piepgras DG, Morgan MK, Sundt TMJ, Yanagihara T, Mussman LM (1988) Intracerebral hemorrhage after carotid endarterectomy. J Neurosurg 68(4):532–536CrossRefPubMed
18.
go back to reference Powers WJ, Clarke WR, Grubb RL, Videen TO, Adams HP, Derdeyn CP, COSS Investigators (2011) Extracranial-intracranial bypass surgery for stroke prevention in hemodynamic cerebral ischemia: the Carotid Occlusion Surgery Study randomized trial. JAMA 306(18):1983–1992CrossRefPubMedPubMedCentral Powers WJ, Clarke WR, Grubb RL, Videen TO, Adams HP, Derdeyn CP, COSS Investigators (2011) Extracranial-intracranial bypass surgery for stroke prevention in hemodynamic cerebral ischemia: the Carotid Occlusion Surgery Study randomized trial. JAMA 306(18):1983–1992CrossRefPubMedPubMedCentral
19.
20.
go back to reference Schneider UC, Weitzel-Mudersbach v P, Hoffmann K-T, Vajkoczy P (2010) Extracranial posterior communicating artery bypass for revascularization of patients with common carotid artery occlusion. Neurosurgery 67(6):1783–1789CrossRefPubMed Schneider UC, Weitzel-Mudersbach v P, Hoffmann K-T, Vajkoczy P (2010) Extracranial posterior communicating artery bypass for revascularization of patients with common carotid artery occlusion. Neurosurgery 67(6):1783–1789CrossRefPubMed
21.
go back to reference Starke RM, Komotar RJ, Hickman ZL, Paz YE, Pugliese AG, Otten ML, Garrett MC, Elkind MS, Marshall RS, Festa JR, Meyers PM, Connolly ES Jr (2009) Clinical features, surgical treatment, and long-term outcome in adult patients with moyamoya disease. J Neurosurg 111(5):936–942CrossRefPubMedPubMedCentral Starke RM, Komotar RJ, Hickman ZL, Paz YE, Pugliese AG, Otten ML, Garrett MC, Elkind MS, Marshall RS, Festa JR, Meyers PM, Connolly ES Jr (2009) Clinical features, surgical treatment, and long-term outcome in adult patients with moyamoya disease. J Neurosurg 111(5):936–942CrossRefPubMedPubMedCentral
22.
23.
go back to reference Woitzik J, Horn P, Vajkoczy P, Schmiedek P (2005) Intraoperative control of extracranial-intracranial bypass patency by near-infrared indocyanine green videoangiography. J Neurosurg 102(4):692–698CrossRefPubMed Woitzik J, Horn P, Vajkoczy P, Schmiedek P (2005) Intraoperative control of extracranial-intracranial bypass patency by near-infrared indocyanine green videoangiography. J Neurosurg 102(4):692–698CrossRefPubMed
24.
go back to reference Yasargil MG, Yonekawa Y (1977) Results of microsurgical extra-intracranial arterial bypass in the treatment of cerebral ischemia. Neurosurgery 1(1):22–24CrossRefPubMed Yasargil MG, Yonekawa Y (1977) Results of microsurgical extra-intracranial arterial bypass in the treatment of cerebral ischemia. Neurosurgery 1(1):22–24CrossRefPubMed
Metadata
Title
Bypass strategies for common carotid artery occlusion
Authors
Nils Hecht
Lars Wessels
Lucius Fekonja
Paul von Weitzel-Mudersbach
Peter Vajkoczy
Publication date
01-10-2019
Publisher
Springer Vienna
Keyword
Stroke
Published in
Acta Neurochirurgica / Issue 10/2019
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-019-04001-4

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