Approximately 2% of patients who are evaluated for symptomatic carotid artery disease have complete occlusion of a common carotid artery. Surgical management for the symptomatic carotid occlusion has various options. Surgical treatment for these patients should be decided according to the patient's condition causes of the obstruction and collateral circulations. We report our experience of surgical management for symptomatic carotid occlusion with contralateral carotid stenosis which were successfully treated with subclavian-carotid artery bypass and carotid endarterectomy.
Arteries* ; Carotid Arteries* ; Carotid Artery Diseases ; Carotid Artery, Common ; Carotid Stenosis ; Collateral Circulation ; Endarterectomy, Carotid* ; Humans

Dural carotid-cavernous fistula (CCF) is characterized by arteriovenous communications between the meningeal branches of the internal or external carotid arteries and the cavernous sinus. Although the triad of chemosis, proptosis, and ocular bruit has been regarded as a classic sign of CCF, dural CCF often lacks these features. Dural CCF is a rare cause of ophthalmoplegia, and so it may be overlooked when the classic symptoms are absent. We report herein a case of bilateral dural CCF that presented as unilateral isolated abducens nerve palsy.
Abducens Nerve ; Abducens Nerve Diseases ; Carotid Artery, External ; Cavernous Sinus ; Caves ; Diplopia ; Exophthalmos ; Fistula ; Ophthalmoplegia

This experimental study was performed to evaluate the correlation between the stenosis of common carotid artery and the change of velocity wave form in sixteen mongrel dogs. With continuous directional Doppler the velocity waves were recorded from the common carotid artery, which was experimentally stenosed by the graded constrictor. Grouped according to carotid angiogram, there were 16 normals(I), 21 stenoses of less than 35%(II), 16 stenoses of 36-59%(III), 10 stnoses of 60-79%(IV), and 10 stenoses of more than 80%(V). From the analysis of carotid artery velocity tracings, six most discriminating variables were obtained, which were statistically significant between intergroup comparison except between group I and group II. Four best fit discriminant equations for group II, III, IV, or V were derived through the analysis of the combination of these six variables. Using these equations and the values for six variables, the overall accuracy rate of placing it into appropriate group was 84.2%. The accuracy rate of separating normal, stenosis less than 60%, and stenosis more than 60% was 94.8%. The carotid stenosis of 36-59% (group III) showed some change of carotid velocity wave form and could be diagnosed appropriately using the velocity wave form analysis. Therefore it is concluded that the velocity wave form anlaysis would be a useful and handy mehtod to evaluate the occlusive carotid artery disease.
Animals ; Carotid Arteries* ; Carotid Artery Diseases ; Carotid Artery, Common ; Carotid Stenosis ; Constriction, Pathologic ; Diagnosis* ; Dogs

No abstract available.
Carotid Artery, Internal ; Carotid Stenosis ; Cranial Nerve Diseases ; Ophthalmoplegia

No abstract available.
Carotid Artery, Internal ; Carotid Stenosis ; Cranial Nerve Diseases ; Ophthalmoplegia

No abstract available.
Asymptomatic Diseases ; Carotid Artery, Internal ; Carotid Stenosis ; Fingers

OBJECTIVE: Recently, carotid artery stenting (CAS) has become as the first choice of treatment for carotid artery stenosis. Although there are many differences in the outcomes of patients receiving stents among many different study groups, some reports suggest that stenting can be performed with periprocedural complication rates similar to those of a carotid endarterectomy (CEA). In this study, we investigated 39 cases of CAS. METHODS: From May 2003 to March 2007, 39 patients undergoing CAS were reviewed. We analyzed the 30-day morbidity/mortality rate. A minor stroke was defined as a new neurological deficit that either resolved completely within 30 days or increased the NIH Stroke Scale by< or =3. A major stroke was defined as a new neurological deficit that persisted for 30 days and increased the NIH Stroke Scale by> or =4. RESULTS: Among 39 patients, a minor stroke was noted in three patients (7.7%), and there were no major strokes and deaths. The overall 30-day stroke and death rate was 7.7% (n = 3). CONCLUSION: With the evolution and maturation of equipment and technique, carotid angioplasty and stenting (CAS) is increasingly being used for the treatment of carotid artery disease.
Angioplasty ; Carotid Arteries* ; Carotid Artery Diseases ; Carotid Stenosis* ; Endarterectomy, Carotid ; Humans ; Mortality ; Stents* ; Stroke

Combined carotid endarterectomy (CEA) and coronary artery bypass graft (CABG) has been traditionally advocated for patients in whom symptomatic disease has been elicited in both vascular territories. This rationale has related to the concern for an increased myocardial infarction rate following CEA with untreated coronary artery disease and conversely, the potential for stroke in patients receiving CABG with untreated carotid stenosis. Although significant cardiac and cerebral complication rates have been identified in these combined cases, justification for the procedure has stemmed from combined rates obtained which were lower than those encountered for either procedure performed in isolation. There has been a trend toward performance of combined CEA/CABG in patients with asymptomatic carotid stenosis. Release of the Asymptomatic Carotid Atherosclerosis Study (ACAS) in 1995 appears to have played a significant role in changing trend. Interpreting the ACAS data finding is problematic for the combined procedure. Yet controversy continues concerning the most appropriate management for patients with severe coronary artery disease who also have asymptomatic carotid stenosis. Recently we have successfully managed two cases of coronary artery disease and asymptomatic carotid stenosis patients by combined CEA and CABG without any surgical complication. We report these 2 cases and briefly review the literature.
Carotid Artery Diseases ; Carotid Stenosis ; Coronary Artery Bypass* ; Coronary Artery Disease ; Coronary Vessels* ; Endarterectomy, Carotid* ; Humans ; Myocardial Infarction ; Stroke ; Transplants

Carotid cavernous sinus fistula(CCSF) is an abnormal communication at the base of the skull between the internal carotid artery and the cavernous sinus. Fistula is almost associated with extensive facial trauma as a result of direct or indirect forces. Most fistulas of traumatic origin develop as a result of fractures through the base of the skull, which cause the laceration of the internal carotid artery near the cavernous sinus. The signs and symptoms of CCSF are pulsating exophthalmosis, orbital headache, pain, orbital or frontal bruit, loss of visual acuity, diplopia and ophthalmoplegia. Angiography reveals a definite CCSF and a detachable balloon embolization is known to be the treatment of choice. Even though carotid cavernous sinus fistula is an uncommon complication after orthognathic surgery, several cases of CCSF due to congenital anomalies, pre-existing aneurysms and abnormally thickened maxillary posterior wall have been reported in the literature. We have experienced a case of CCSF after Le Fort I osteotomy for maxillary advancement in skeletal class III patient and the cause, pathogenesis, diagnosis and treatment of this case.]]>
Abducens Nerve Diseases ; Abducens Nerve ; Aneurysm ; Angiography ; Balloon Occlusion ; Carotid Artery, Internal ; Carotid-Cavernous Sinus Fistula ; Cavernous Sinus ; Diagnosis ; Diplopia ; Fistula ; Headache ; Humans ; Lacerations ; Ophthalmoplegia ; Orbit ; Orthognathic Surgery ; Osteotomy ; Skull ; Visual Acuity

Atherosclerotic carotid stenosis, as a major cause of stroke, increases in Korea due to westernized eating habit and increasing proportion of elderly people. Since carotid endarterectomy (CEA) has been proven to be beneficial to the medical treatment only, carotid artery stenting (CAS) revealed the results not inferior to CEA. Currently, the advent of Anti-Embolic devices (or protection devices) and accumulating evidence supports the safety and efficacy of these strategies in minimizing the risk of embolization during the procedure. Particularly important are the recent reports of two randomized trials (CAVATAS and SAPPHIRE) that demonstrated favorable outcomes of stenting as compared to CEA. Growing evidence also supports the late efficacy of CAS in preventing stroke resulting from obstructive extracranial carotid artery disease. This review summarized the results of published randomized trials and the directions of ongoing trials of revascularization treatment of atherosclerotic carotid artery stenosis. And the appropriate patient selection, current procedural technique and complications of CAS are also reviewed.
Aged ; Angioplasty ; Carotid Arteries ; Carotid Artery Diseases ; Carotid Stenosis* ; Eating ; Endarterectomy, Carotid ; Humans ; Korea ; Patient Selection ; Stents* ; Stroke