Carotid Arteries ; surgery ; Endarterectomy, Carotid ; Endovascular Procedures ; Humans ; Stents

OBJECTIVE: To analyze clinical features, surgical treatment and outcomes of neurilemmoma and carotid body tumors in bifurcation of carotid artery. METHODS: The clinical data of 17 patients with neurilemmomas and 76 patients with carotid body tumors at the bifurcation of carotid artery, who were surgically treated in Zhongshan Hospital of Fudan University from March 2012 to November 2016, were retrospectively analyzed. The clinicopathological characteristics, surgical procedures and outcomes were compared between two groups. RESULTS: No difference of preoperative clinical demographic data was found between two groups. Operation time of the neurilemmoma group was significantly shorter than that of the carotid body tumor group[(93.9±30.8) min vs. (159.3±52.9) min, <0.01]. The neurilemmoma group had lower volume of intra-operative blood loss[(110±96) mL vs. (356±239) mL, <0.01] and lower rate of external carotid artery resection (11.8% vs. 68.4%, <0.01) than the carotid body tumor group. In the neurilemmoma group, 17 tumors were completely resected and no malignant disease was found. In the carotid body tumor group, 76 patients underwent complete surgical resection for the tumor, of which 5 (6.6%) were malignant. Tumor size of the neurilemmoma group was larger than that of the carotid body tumor group[(4.5±1.4) cm vs. (3.1±1.0) cm, <0.01]. There was no significant difference in the incidence of peri-operative complications and length of hospital stay between two groups (>0.05). CONCLUSIONS The clinical manifestations of neurilemmoma and carotid body tumors at carotid artery bifurcation are similar. The carotid body tumor group has a longer operating time, larger intra-operative blood loss, higher external carotid resection rate and relative higher incidence of malignancy. More cautions should be given when carotid body tumors at carotid artery bifurcation are treated.
Carotid Arteries ; surgery ; Carotid Body Tumor ; pathology ; surgery ; Humans ; Neurilemmoma ; pathology ; surgery ; Retrospective Studies ; Treatment Outcome

Ocular ischemic syndrome is a chronic ischemic eye disease including a series of ischemic ocular and brain syndromes caused by carotid artery occlusion or stenosis. Because of the different degrees of ischemia, clinical manifestations of ocular ischemic syndrome are diverse, and it is difficult to diagnose in the initial stage. The main strategy to treat ocular ischemic syndrome is elimination of carotid stenosis. We presented a patient who recovered dramatically after carotid artery stenting. The pre-stenting arm-retinal circulation time of the patient’s left eye was prolonged, and a large amount of microaneurysm appeared at the posterior polar and mid-peripheral aspects of the left retina. The post-stenting arm-retinal circulation time of the left eye decreased to 16.3 seconds, and the microaneurysm almost disappeared.
Angioplasty ; Carotid Arteries ; surgery ; Carotid Stenosis ; surgery ; Female ; Humans ; Ischemia ; diagnosis ; Middle Aged ; Retinal Artery Occlusion ; surgery ; Retinal Diseases ; surgery

OBJECTIVE: To explore the risk factors, clinical characteristics, precaution and treatment of hyper perfusion syndrome (HPS) after carotid artery stenting (CAS). METHODS: From September 2014 to March 2018, the clinical data of 226 patients with severe carotid stenosis (70%-99%) treated with carotid artery stenting (CAS)at Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, were analyzed retrospectively．Five of them developed HPS after CAS．The relationship between the clinical baseline data, imaging characteristics, perioperative management and HPS were assessed. RESULTS: In this group, 5 patients of them (2.21%, 5/226) developed HPS after CAS, and 2 patients of them (0.88%, 2/226) were hyper perfusion induced intracranial hemorrhage (HICH). The 5 patients consisted of 4 men and 1 woman whose age ranged from 58 to 74 years. The symptoms of HPS occurred within 4 hours to 3 days after CAS. Among the 5 cases, the clinical manifestations were that 2 cases with headache, 1 case with delirium,1 case with hemiparesis of left limbs, and 1 case with coma(died ultimately).The main manifestations of case 1 and case 2 were headache in the frontal parietal temporal region of the operative side, accompanied by nausea and vomiting. The symptoms were relieved after blood pressure lowering treatment and mannitol dehydration. The main manifestations of case 3 were excitement and delirium. The symptoms were relieved by a small dose of sedatives, also with blood pressure lowering treatment and mannitol dehydration. The initial symptoms of case 4 were excitement and delirium, accompanied by mild headache of the operative side, and hemiplegia of the contralateral limb occurred within a short time. The main manifestation of case 5 was severe headache and went into deep coma within a short time. This patient died of massive cerebral hemorrhage ultimately. CONCLUSION HPS is an uncommon but serious complication after CAS. Improving our understanding and heightening vigilance of HPS is necessary. The earlier diagnosis, the earlier treatment.
Aged ; Carotid Arteries ; Carotid Artery, Common ; Carotid Stenosis/surgery* ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Stents

Aneurysm, False ; etiology ; surgery ; Blood Loss, Surgical ; Carcinoma ; Carotid Arteries ; Carotid Artery Diseases ; etiology ; surgery ; Humans ; Nasopharyngeal Neoplasms ; radiotherapy ; Rupture

Hemodynamic situation is an important factor of recurrence of postoperative carotid artery aneurysm. In order to investigate the hemodynamic factors of postoperative carotid artery aneurysm affect carotid artery aneurysm recurrence, we established a 3D finite element carotid artery aneurysm for the preoperative and postoperative periods using the three-dimensional reconstruction techniques. And then we measured the hemodynamic factors of carotid artery aneurysm of preoperative and postoperative by the finite element method. The carotid artery aneurysm model has an accurate and realistic shape; the pressure of the recurrence of aneurysm was reduced significantly after surgery,wall shear stress increased significantly at residual neck, and blood flow velocity increased significantly, which will increase the risk of recurrence. The hemodynamic analysis provides a reference for development of aneurysm clinical treatment programs and prevention of recurrence.
Aneurysm ; pathology ; surgery ; Blood Flow Velocity ; Carotid Arteries ; pathology ; surgery ; Computer Simulation ; Hemodynamics ; Humans ; Stress, Mechanical

Aneurysm ; surgery ; Aneurysm, Infected ; surgery ; Aneurysm, Ruptured ; surgery ; Carotid Arteries ; surgery ; Carotid Artery Diseases ; surgery ; Humans ; Male ; Middle Aged ; Reconstructive Surgical Procedures

OBJECTIVETo evaluate the safety and feasibility of simultaneous bilateral carotid stenting for treating patients with bilateral atherosclerotic carotid stenosis.

METHODSThe clinical data of 39 consecutive patients with bilateral atherosclerotic carotid stenosis undergoing simultaneous bilateral carotid artery stenting in Fuwai hospital from January 2005 to December 2009 were collected and analyzed retrospectively. The reduction of the angiographic diameter stenosis after stenting and clinical outcomes of 30 days after stenting including hyperperfusion syndrome, hemodynamic depression, stroke, myocardial infarction and death were assessed.

RESULTSThe patients were 43 - 78 (65.9 ± 8.5) years old, and there were 25 (64.1%) male. Carotid stenting procedure success rate was 100%. Distal embolic protection devices were used in all patients, and 20 (51.3%) out of 39 patients underwent coronary artery bypass surgery after carotid stenting. The angiographic diameter stenosis reduced from (87.0 ± 5.8)% to (10.2 ± 5.6)% after stenting (P < 0.01). Up to 30 days after carotid artery stenting, the incidence of hyperperfusion syndrome, hemodynamic depression, minor stroke, major stroke, myocardial infarction and death was 2.6% (1/39), 28.2% (11/39), 5.1% (2/29), 0, 2.6% (1/39), 2.6% (1/39), respectively.

CONCLUSIONThe data show that simultaneous bilateral carotid stenting is a technically feasible and safe alternative for patients with severe bilateral atherosclerotic carotid stenosis.

Adult ; Aged ; Angioplasty, Balloon ; Carotid Arteries ; Carotid Stenosis ; surgery ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Stents ; Treatment Outcome

Animals ; Carotid Arteries ; surgery ; Carotid Artery Injuries ; etiology ; Disease Models, Animal ; Female ; Mice ; Mice, Inbred C57BL ; Microsurgery ; Random Allocation

Extensive surgical resection of the aerodigestive track can result in a large and complex defect of the oropharynx, which represents a significant reconstructive challenge for the plastic surgery. Development of microsurgical techniques has allowed for free flap reconstruction of oropharyngeal defects, with superior outcomes as well as decreases in postoperative complications. The reconstructive goals for oral and oropharyngeal defects are to restore the anatomy, to maintain continuity of the intraoral surface and oropharynx, to protect vital structures such as carotid arteries, to cover exposed portions of internal organs in preparation for adjuvant radiation, and to preserve complex functions of the oral cavity and oropharynx. Oral and oropharyngeal cancers should be treated with consideration of functional recovery. Multidisciplinary treatment strategies are necessary for maximizing disease control and preserving the natural form and function of the oropharynx.
Carotid Arteries ; Free Tissue Flaps* ; Head and Neck Neoplasms ; Mouth ; Oropharyngeal Neoplasms ; Oropharynx ; Postoperative Complications ; Surgery, Plastic