Frequency and Significance of Maneuvers to Dissect the Distal Internal Carotid Artery During Carotid Endarterectomy
| Autor: | Anastasia Zotou, Konstantinos M. Nikolakopoulos, Marios Salmas, John Ellul, Anastasia Kouri, Chrysanthi P. Papageorgopoulou, Stavros K. Kakkos, Ioannis A. Tsolakis, Athina Siampalioti, Spyros Papadoulas |
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| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Dissection (medical) Carotid endarterectomy 030204 cardiovascular system & hematology Risk Assessment 03 medical and health sciences 0302 clinical medicine Risk Factors Internal medicine medicine.artery medicine Humans Carotid Stenosis Stroke Aged Retrospective Studies Endarterectomy Carotid business.industry Dissection Smoking General Medicine Middle Aged medicine.disease Treatment Outcome Ischemic Attack Transient Cardiology Female Surgery Internal carotid artery Cardiology and Cardiovascular Medicine business Vocal Cord Paralysis Carotid Artery Internal 030217 neurology & neurosurgery |
| Zdroj: | Vascular and Endovascular Surgery. 55:342-347 |
| ISSN: | 1938-9116 1538-5744 |
| DOI: | 10.1177/1538574420985767 |
| Popis: | Objectives: To describe the frequency, factors associated with, and significance of surgical dissection maneuvers of the distal internal carotid artery (ICA) during carotid endarterectomy (CEA). Methods: In this retrospective analysis of prospectively collected information in patients undergoing CEA, we recorded information on demographics, risk factors and comorbidities, dissection maneuvers of the distal ICA, other operative variables and neurological outcome measures. Results: During the period July 2008 and February 2020 inclusive, 218 consecutive patients (180 males, median age 69.5 years) underwent 240 CEAs. In 117 (48.8%) of them, CEA was performed for a symptomatic stenosis. Dissection maneuvers of the distal ICA were required in 77 cases (32.1%), including division and ligation of the sternocleidomastoid vessels in 66 cases (27.5%), mobilization of the XII cranial nerve in 69 cases (28.7%, with concomitant transection of the superior root of the ansa cervicalis in 11 cases, 4.6%) and division of the posterior belly of the digastric muscle in 8 cases (3.3%). Styloid osteotomy was not required in any case. Smoking was the single predictive factor associated with the use of an adjunctive dissection maneuver (odds ratio 2.23, p = 0.009). The use of a patch was more common in smokers (16% vs 7.1% in non-smokers, odds ratio 2.48, p = 0.05). Perioperative stroke and/or death rate was 0%, not allowing testing for associations with maneuver performance. Two patients (0.8%) developed a transient ischemic attack and 4 patients (1.7%) a cranial nerve injury (CNI), including 2 patients with recurrent laryngeal nerve palsy, diagnosed on routine laryngoscopy during planning of a contralateral CEA. There was no association between CNI and dissection of the distal ICA using an operative adjunct (p = 0.60). Conclusions: Several surgical maneuvers are often required to accomplish dissection of the distal ICA beyond the point of atherosclerotic disease. When dictated by operative findings, such maneuvers are deemed safe. |
| Databáze: | OpenAIRE |
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