Skip to main content
SpringerLink
Log in

Surgery of the Carotid Bifurcation

  • Chapter
Operative Techniques in Arterial Surgery

  • 150 Accesses

Abstract

Approximately 75% of patients with an ischaemic stroke syndrome have at least one obstructive arterial lesion at an extracranial site1. By far the most important of these sites is the carotid bifurca¬tion and surgery of this area is considered in the present chapter. Reconstruction of the vertebral artery and aortic arch vessels is dealt with in Chapter 10.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Hass, W. K., Fields, W. S., North, R. R. et al. (1968). Joint study of extracranial arterial occlusion II. Arteriography, techniques, sites and complications. J.A.M.A., 203, 961–968

    Article  PubMed  CAS  Google Scholar 

  2. Millikan, C. H. (1971). Reassessment of anticoagulant therapy in various types of occlusive cerebrovascular diseases. Stroke, 2, 201–208

    Article  PubMed  CAS  Google Scholar 

  3. Thompson, J. E. and Talkington, C. M. (1976). Carotid endarterectomy. Ann. Surg., 184, 1–15

    Article  PubMed  CAS  Google Scholar 

  4. Thompson, J. E. and Talkington, C. M. (1979). Carotid surgery for cerebral ischemia. Surg. Clin. North Am., 59, 539–553

    PubMed  CAS  Google Scholar 

  5. Bernstein, E. F., Humber, P. B., Collins, G. M. et al (1983). Life expectancy and late stroke following carotid endarterectomy. Ann. Surg., 198, 80–86

    Article  PubMed  CAS  Google Scholar 

  6. Bardin, J. A., Bernstein, E. F., Humber, P. B. et al (1982). Is carotid endarterectomy beneficial in prevention of recurrent stroke? Arch. Surg., 117, 1401–1407

    PubMed  CAS  Google Scholar 

  7. Thompson, J. E. (1982). In Discussion of Bardin, J. A., Bernstein, E. F., Humber, P. B. et al. Is carotid endarterectomy beneficial in prevention of recurrent stroke? Arch. Surg., 117, 1401–1407

    Google Scholar 

  8. Goldstone, J. and Moore, W. S. (1976). Emergency carotid artery surgery in neurologically unstable patients. Arch. Surg., 111, 1284–1291

    PubMed  CAS  Google Scholar 

  9. Mentzer, R. M., Finkelmeier, B. A., Crosby, I. K. et al (1981). Emergency carotid endarterectomy for fluctuating neurologic deficits. Surgery, 89, 60–66

    PubMed  Google Scholar 

  10. Batson, R. C. (1984). The case for prophylactic carotid endarterectomy. In Barnes, R. W., Archie, J. P. and Batson, R. C. “Advocates in vascular controversies.” Panel Debate Part I. Surgery, 95, 739–748

    Google Scholar 

  11. Lusby, R. J., Ferrell, L. D., Ehrenfeld, W. K. et al (1982). Carotid plaque hemorrhage. Its role in production of cerebral ischemia. Arch. Surg., 117,1479– 1488

    PubMed  Google Scholar 

  12. Riles, T. S., Imparato, A. M. and Kopelman, I. (1980). Carotid artery stenosis with contralateral internal carotid occlusion: Long-term results in fifty-four patients. Surgery, 87, 363–368

    PubMed  CAS  Google Scholar 

  13. Sundt, T. M., Sandok, B. A. and Whisnant, J. P. (1975). Carotid endarterectomy. Complications and preoperative assessment of risk. Mayo Clin. Proc., 50, 301–306

    PubMed  CAS  Google Scholar 

  14. Burke, P. A., Callow, A. D., O’Donnell, T. F. et al (1982). Prophylactic carotid endarterectomy for asymptomatic bruit. A look at cardiac risk. Arch. Surg., 117, 1222–1227

    PubMed  CAS  Google Scholar 

  15. DeWeese, J. A. (1982). Management of acute strokes. Surg. Clin. North Am., 62, 467–472

    PubMed  CAS  Google Scholar 

  16. Kwaan, J. H., Connolly, J. E. and Sharefkin, J. B. (1979). Successful management of early stroke after carotid endarterectomy. Ann. Surg., 190, 676–678

    Article  PubMed  CAS  Google Scholar 

  17. Lindberg, B. (1980). Acute carotid occlusion. Indication for surgery? J. Cardiovasc. Surg., 21, 315–320

    CAS  Google Scholar 

  18. Schuler, J. J., Flanigan, D. P., Lim, L. T. et al. (1982). The effect of carotid siphon stenosis on stroke rate, death, and relief of symptoms following elective carotid endarterectomy. Surgery, 92, 1058–1067

    PubMed  CAS  Google Scholar 

  19. Roederer, G. O., Langlois, Y. E., Chan, A. R. et al(1983).Is siphon disease important in predicting outcome of carotid endarterectomyArch. Surg. 118, 1177–1181

    PubMed  CAS  Google Scholar 

  20. Caplan, L. R., Skillman, J., Ojemann, R. et al. (1978). Intracerebral hemorrhage following carotid endarterectomy: a hypertensive complication? Stroke, 9, 457–460

    Article  PubMed  CAS  Google Scholar 

  21. Reilly, L. M., Lusby, R. J., Hughes, L. et al. (1983). Carotid plaque histology using real-time ultrasonography. Clinical and therapeutic implications. Am. J. Surg., 146, 188–193

    Article  PubMed  CAS  Google Scholar 

  22. Glover, J. L., Bendick, P. J., Jackson, V. P. et al(1984). Duplex ultrasonography, digital subtraction angiography and conventional angiography in assessing carotid atherosclerosis. Arch. Surg. 119, 664–669

    PubMed  CAS  Google Scholar 

  23. O’Donnell, T. F., Erdoes, L., Mackey, W. C. et al(1985).Correlation of B-mode ultrasound imaging and arteriography with pathologic findings at carotid endarterectomy. Arch. Surg. 120, 443–449

    Google Scholar 

  24. Eikelboom, B. C., Ackerstaff, R. G., Ludwig, J. W. et al. (1983). Digital video subtraction angiography and duplex scanning in assessment of carotid artery disease: comparison with conventional angiography. Surgery, 94, 821–825

    PubMed  CAS  Google Scholar 

  25. Reilly, L. M., Ehrenfeld, W. K. and Stoney, R. J. (1984). Carotid digital subtraction angiography: The comparative roles of intra-arterial and intravenous imaging. Surgery, 96, 909–917

    PubMed  CAS  Google Scholar 

  26. Graber, J. N., Vollman, R. W., Johnson, W. C. et al. (1984). Stroke after carotid endarterectomy: risk as predicted by preoperative computerized tomography. Am. J. Surg., 147, 49 2497

    Article  PubMed  CAS  Google Scholar 

  27. Ennix, C. L., Lawrie, G. M., Morris, G. C. et al(1979). Improved results of carotid endarterectomy in patients with symptomatic coronary disease: an analysis of 1546 consecutive carotid operations. Stroke 10, 122–125

    Article  PubMed  Google Scholar 

  28. Craver, J. M., Murphy, D. A., Jones, E. L. et al (1982). Concomitant carotid and coronary artery reconstruction. Ann. Surg., 195, 712–720

    Article  PubMed  CAS  Google Scholar 

  29. Emery, R. W., Cohn, L. H., Whittemore, A. D. et al (1983). Coexistent carotid and coronary artery disease. Surgical management. Arch. Surg., 118, 1035–1038

    PubMed  CAS  Google Scholar 

  30. Imparato, A. M., Ramirez, A., Riles, T. et al. (1982). Cerebral protection in carotid surgery. Arch. Surg., 117, 1073–1078

    PubMed  CAS  Google Scholar 

  31. Kwaan, J. H., Peterson, G. J. and Connolly, J. E. (1980). Stump pressure. An unreliable guide for shunting during carotid endarterectomy. Arch. Surg., 115, 1083–1085

    PubMed  CAS  Google Scholar 

  32. Wells, B. A., Keats, A. S. and Cooley, D. A. (1963). Increased tolerance to cerebral ischemia produced by general anesthesia during temporary carotid occlusion. Surgery, 54, 216 - 223

    PubMed  CAS  Google Scholar 

  33. Asiddao, C. B., Donegan, J. H., Whitesell, R. C. et al (1982). Factors associated with perioperativelar dysplasia and the brain. I. Observations on angiographic, clinical and genetic characteristics. Stroke, 13, 46–52

    Article  Google Scholar 

  34. Boysen, G. (1973). Cerebral hemodynamics in carotid surgery. Acta Neurol. Scand., 49, Suppl. 52

    Google Scholar 

  35. Hunter, G. C., Sieffert, G., Malone, J. M. et al. (1982). The accuracy of carotid back pressure as an index for shunt requirements. A reappraisal. Stroke, 13, 319–326

    Article  PubMed  CAS  Google Scholar 

  36. Sundt, T. M., Sharbrough, F. W., Piepgras, D. G. et al. (1981). Correlation of cerebral blood flow and electroencephalographic changes during carotid endarterectomy with results of surgery and hemodynamics of cerebral ischemia. Mayo Clin. Proc., 56, 533–543

    PubMed  Google Scholar 

  37. McKay, R. D., Sundt, T. M., Michenfelder, J. D. et al. (1976). Internal carotid artery stump pressure and cerebral blood flow during carotid endarterectomy: modification by halothane, enflurane and innovar. Anesthesiology, 45, 390–399

    Article  PubMed  CAS  Google Scholar 

  38. Kelly, J. J., Callow, A. D., O’Donnell, T. F. et al (1979). Failure of carotid stump pressures. Its incidence as a predictor for a temporary shunt during carotid endarterectomy. Arch. Surg., 114, 1361–1366

    PubMed  CAS  Google Scholar 

  39. String, S. T. and Callahan, A. (1983). The critical manipulable variables of hemispheric low flow during carotid surgery. Surgery, 93, 46–49

    PubMed  CAS  Google Scholar 

  40. Ferguson, G. G. (1982). Intraoperative monitoring and internal shunts: are they necessary in carotid endarterectomy? Stroke, 13, 287–289

    Article  PubMed  CAS  Google Scholar 

  41. Ott, D. A., Cooley, D. A., Chapa, L. et al. (1980). Carotid endarterectomy without temporary intraluminal shunt. A Study of 309 consecutive operations. Ann. Surg., 191, 708–714

    Article  PubMed  CAS  Google Scholar 

  42. Andersen, C. A., Collins, G. J. and Rich, N. M. (1978). Routine operative arteriography during carotid endarterectomy: A reassessment. Surgery, 83, 67–71

    PubMed  CAS  Google Scholar 

  43. Holder, J., Binet, E. F., Flanigan, S. et al (1981). Arteriography after carotid endarterectomy. A.J.R., 137, 483–487

    CAS  Google Scholar 

  44. Cafferata, H. T., Merchant, R. F. and DePalma, R. G. (1982). Avoidance of postcarotid endarterectomy hypertension. Ann. Surg., 196, 465–472

    Article  PubMed  CAS  Google Scholar 

  45. Steed, D. L., Peitzman, A. B., Grundy, B. L. et al.(1983).Causes of stroke in carotid endarterectomy. Surgery, 92, 634–641

    Google Scholar 

  46. Towne, J. B. and Bernhard, V. M. (1980). The relationship of postoperative hypertension to complications following carotid endarterectomy. Surgery, 68, 575–580

    Google Scholar 

  47. Rosenthal, D., Zeichner, W. D., Lamis, P. A. et al (1984).Neurologic deficit after carotid endarterectomy: Pathogenesis and management. Surgery, 94, 776–780

    Google Scholar 

  48. Towne, J. B. and Bernhard, V. M. (1982). Neurological deficit following carotid endarterectomy. Surg. Gynecol. Obstet., 154, 849–852

    PubMed  CAS  Google Scholar 

  49. Ortega, G., Gee, W., Kaupp, H. A. et al (1981). Postendarterectomy carotid occlusion. Surgery, 90, 1093–1098

    PubMed  CAS  Google Scholar 

  50. Hertzer, N. R., Beven, E. G., Modic, M. T. et al (1982). Early patency of the carotid artery after endarterectomy: Digital subtraction angiography after two hundred sixty-two operations. Surgery, 92, 1049–21057

    PubMed  CAS  Google Scholar 

  51. Stoney, R. J. and String, S. T. (1976). Recurrent carotid stenosis. Surgery, 80, 705–710

    PubMed  CAS  Google Scholar 

  52. Callow, A. D. (1982). Recurrent stenosis after carotid endarterectomy. Arch. Surg., 117, 1082–1085

    PubMed  CAS  Google Scholar 

  53. Zierler, R. E., Bandyk, D. F., Thiele, B. L. et al (1982). Carotid artery stenosis following endarterectomy. Arch. Surg., 117, 1408–1415

    PubMed  CAS  Google Scholar 

  54. Glover, J. L., Bendick, P. J., Dilley, R. S. et al (1985). Restenosis following carotid endarterectomy. Evaluation by duplex ultrasonography. Arch. Surg., 120, 678–684

    PubMed  CAS  Google Scholar 

  55. Tievsky, A. L., Druy, E. M. and Mardiat, J. G. (1983). Transluminal angioplasty in postsurgical stenosis of the extracranial carotid artery. A.J.N.R., 4, 800–802

    CAS  Google Scholar 

  56. Baker, W. H. and Stern, M. E. (1980). Persistent cerebrovascular symptoms following carotid endarterectomy. In Bernhard, V. M. and Towne, J. B. (eds.) Complications in Vascular Surgery pp. 275– 294. ( New York: Grune & Stratton )

    Google Scholar 

  57. Ehrenfeld, W. K. and Hays, R. J. (1972). False aneurysm after carotid endarterectomy. Arch. Surg., 104, 288–291

    PubMed  CAS  Google Scholar 

  58. Samson, D. S., Gewertz, B. L., Beyer, C. W. et al(1981). Saphenous vein interposition grafts in the microsurgical treatment of cerebral ischemia. Arch. Surg., 116, 1578–1582

    PubMed  CAS  Google Scholar 

  59. Thompson, J. E., Austin, D. J. and Patman, R. D. (1967). Endarterectomy of the totally occluded carotid artery for stroke. Results in 100 operations. Arch. Surg., 95, 791–601

    PubMed  CAS  Google Scholar 

  60. Hugenholtz, H. and Elgie, R. G. (1980). Carotid thromboendarterectomy: a reappraisal. Criteria for patient selection. J. Neurosurg., 53, 776–783

    Article  PubMed  CAS  Google Scholar 

  61. Hafner, C. D. and Tew, J. M. (1981). Surgical management of the totally occluded internal carotid artery: A ten-year study. Surgery, 89, 710–717

    PubMed  CAS  Google Scholar 

  62. Riles, T. S., Posner, M. P., Cohen, W. S. et al(1982). The totally occluded internal carotid artery. Preliminary observations using rapid sequential computerized tomographic scanning. Arch. Surg., 117, 1185–1188

    PubMed  CAS  Google Scholar 

  63. Barnett, H. J., Peerless, S. J. and Kaufmann, J. C. (1978). “Stump” on internal carotid artery-a source for further cerebral embolic ischemia. Stroke, 9, 448–456

    Google Scholar 

  64. Zarins, C. K., DelBeccaro, E. J., Johns, L. et al. (1981). Increased cerebral blood flow after external carotid artery revascularizationSurgery, 89, 730–734

    PubMed  CAS  Google Scholar 

  65. Weibel, J. and Fields, W. S. (1965). Tortuosity, coiling and kinking of the internal carotid artery. II. Relationship of morphological variation to cerebrovascular insufficiency. Neurology, 15, 462–468

    PubMed  CAS  Google Scholar 

  66. Vannix, R. S., Joergenson, E. J. and Carter, R. (1977). Kinking of the internal carotid artery. Clinical significance and surgical management. Am. J. Surg., 134, 82–89

    Article  PubMed  CAS  Google Scholar 

  67. Mettinger, K. L. and Ericson, K. (1982). Fibromuscu- lar dysplasia and the brain. I. Observations on angiographic, clinical and genetic characteristics. Stroke, 13, 46 - 52

    Article  PubMed  CAS  Google Scholar 

  68. Stanley, J. C., Gewertz, B. L., Bove, E. L. et al. (1975). Arterial fibrodysplasia. Histopathologic character and current etiologic concepts. Arch. Surg., 110, 561–566

    PubMed  CAS  Google Scholar 

  69. Osborn, A. G. and Anderson, R. E. (1977). Angiographic spectrum of cervical and intracranial fibromu- scular dysplasia. Stroke, 8, 617–626

    Article  PubMed  CAS  Google Scholar 

  70. Effeney, D. J., Ehrenfeld, W. K., Stoney, R. J. et al (1980). Why operate on carotid fibromuscular dysplasia? Arch. Surg., 115, 1261–1265

    PubMed  CAS  Google Scholar 

  71. Ladowski, J. S., Webster, M. W., Yonas, H. O. et al (1984). Carotid endarterectomy in patients with asymptomatic intracranial aneurysm. Ann. Surg., 200, 70–73

    Article  PubMed  CAS  Google Scholar 

  72. Starr, D. S., Lawrie, G. M. and Morris, G. C. (1981). Fibromuscular disease of carotid arteries: Long term results of graduated internal dilatation. Stroke, 12, 196–199

    Article  PubMed  CAS  Google Scholar 

  73. Hasso, A. N., Bird, C. R., Zinke, D. E. et al. (1981). Fibromuscular dysplasia of the internal carotid artery: percutaneous transluminal angioplasty. A.J.R., 136, 955–960

    CAS  Google Scholar 

  74. Ehrenfeld, W. K. and Wylie, E. J. (1976). Spontaneous dissection of the internal carotid artery. Arch. Surg., 111, 1294–1301

    PubMed  CAS  Google Scholar 

  75. Zelenock, G. B., Kazmers, A., Whitehouse, W. M. et al (1982). Extracranial internal carotid artery dissections. Noniatrogenic traumatic lesions. Arch. Surg., 117, 425–432

    PubMed  CAS  Google Scholar 

  76. Bradac, G. B., Kaernbach, A., Bolk-Weischedel, D. et al (1981). Spontaneous dissecting aneurysm of cervical cerebral arteries. Report of six cases and review of the literature. Neuroradiology, 21, 149–154

    PubMed  CAS  Google Scholar 

  77. Wylie, E. J. (1982). Minisymposium: Unusual problems in carotid surgery. Overview. Surgery, 93, 297–298

    Google Scholar 

  78. McCollum, C. H., Wheeler, W. G., Noon, G. P. et al (1979). Aneurysms of the extracranial carotid artery. Twenty-one years’ experience. Am. J. Surg., 137, 196–200

    Article  PubMed  CAS  Google Scholar 

  79. Busuttil, R. W., Davidson, R. K., Foley, K. T. et al (1980). Selective management of extracranial carotid arterial aneurysms. Am. J. Surg., 140, 85–91

    Article  PubMed  CAS  Google Scholar 

  80. Fry, R. E. and Fry, W. J. (1980). Extracranial carotid artery injuries. Surgery, 88, 581–587

    PubMed  CAS  Google Scholar 

  81. Purdue, G. F., Pellegrini, R. V. and Arena, S. (1981). Aneurysms of the high internal carotid artery: A new approach. Surgery, 89, 268–270

    PubMed  CAS  Google Scholar 

  82. Hershey, F. B. (1974). Operation for aneurysm of the internal carotid artery high in the neck: a new and an old technique. Angiology, 25, 24–30

    Article  PubMed  CAS  Google Scholar 

  83. Dent, T. L., Thompson, N. W. and Fry, W. J. (1976). Carotid body tumors. Surgery, 80, 365–372

    PubMed  CAS  Google Scholar 

  84. Padberg, F. T., Cady, B. and Persson, A. V. (1983). Carotid body tumor. The Lahey Clinic experience. Am. J. Surg., 145, 526–528

    Article  PubMed  Google Scholar 

  85. Krupski, W. C., Effeney, D. J., Ehrenfeld, W. K. et al (1982). Cervical chemodectoma. Technical considerations and management options. Am. J. Surg., 144, 215–220

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Basingstoke and North Hampshire Health Authority, Basingstoke, England

    A. S. Ward MS,FRCS (Consultant Vascular Surgeon)

  2. St.Joseph’s Hospital, Paris, France

    J. M. Cormier MD (Professor and Head of Vascular Surgery)

Authors
  1. A. S. Ward MS,FRCS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. M. Cormier MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 1986 MTP Press Limited

About this chapter

Cite this chapter

Ward, A.S., Cormier, J.M. (1986). Surgery of the Carotid Bifurcation. In: Operative Techniques in Arterial Surgery. Springer, Dordrecht. https://doi.org/10.1007/978-94-009-4129-8_9

Download citation

  • DOI: https://doi.org/10.1007/978-94-009-4129-8_9

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-010-8331-7

  • Online ISBN: 978-94-009-4129-8

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation