The curative effect of carotid endarterectomy
Authors:
J. Mraček 1; I. Holečková 1; J. Mork 1; P. Ševčík 2
Authors‘ workplace:
Univerzita Karlova v Praze, Lékařská fakulta a FN Plzeň, Neurochirurgické oddělení
1; Univerzita Karlova v Praze, Lékařská fakulta a FN Plzeň, Neurologická klinika
2
Published in:
Čas. Lék. čes. 2009; 148: 326-329
Category:
Case Report
Overview
The preventive effect of carotid endarterectomy in the reduction of ischemic stroke was reliably confirmed. Carotid endarterectomy may also be a curative method, but it has not been confirmed yet. In our case report we illustrate the curative effect of carotid endarterectomy in a patient after a combined embolic and hemodynamic stroke. The administration of intravenous thrombolysis did not have the expected clinical response. Neuroimaging showed ischemia and homolateral hypoperfusion of the brain hemisphere caused by critical internal carotid artery stenosis. On the 8th day after thrombolysis a carotid endarterectomy was performed with beneficial effect. Normalization of hemodynamic in the altered hemisphere was demonstrated by perfusion examination along with the clinical improvement.
A curative effect of endarterectomy appears more probable in a hemodynamic ischemic stroke. For the improvement of a neuronal function the existence of penumbra is a condition. While a positive influence of hemodynamic by carotid endarterectomy is confirmed, the possibility of an increase in neuronal activity after repair of vasomotor activity is not documented. The curative effect and itʼs connection to the timing of the carotid endarterectomy require testing in the further studies.
Key words:
carotid endarterectomy, curative, hemodynamic stroke, ischemic penumbra, cerebrovascular reserve.
Sources
1. European Carotide Surgery Trialists’ Collaborative Group. MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70–90%) or with mild (0–29%) carotid stenosis. Lancet 1991; 337: 1235–1243.
2. North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 1991; 325: 445–453.
3. Barnett HJ, et al. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis: North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med 1998; 339: 1415–1425.
4. The European Stroke Organisation (ESO) Executive Comittee and the ESO Writing Committee. Guidelines for management of ischemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis 2008; 25: 457–507.
5. Ševčík P, et al. Cerebrovaskulární rezerva bazilární a střední mozkové tepny. Komparativní studie s použitím transkraniální dopplerometrie a CO2. Cesk Slov Neurol N 2005; 68/101: 378–381.
6. Mraček J, et al. Timing karotické endarterektomie. Cesk Slov Neurol N 2008; 71/104 (4): 414–421.
7. McPherson CHM, et al. Early carotid endarterectomy for critical carotid artery stenosis after thrombolysis therapy in acute ischemic stroke in the middle cerebral artery. Stroke 2001; 32: 2075–2080.
8. Mraček J, et al. Časná karotická endarterektomie pro reziduální kritickou stenózu krkavice po intravenózní trombolýze. Cesk Slov Neurol N 2009; 72: 173–177.
9. Blaser T, et al. Risk of stroke, transient ischemic attack, and vessel occlusion before endarterectomy in patients with symptomatic severe carotid stenosis. Stroke 2002; 33: 1057–1062.
10. Inao S, et al. Neural activation of the brain with hemodynamic insufficiency. J Cereb Blood Flow Metab 1998; 18: 960–967.
11. Visser GH, et al. Bilateral increase in CO2 reactivity after unilateral carotid endarterectomy. Stroke 1997; 28: 899–905.
12. Heeger DJ, et al. Spikes versus BOLD: what does neuroimaging tell us about neuronal activity? Nature Neurosci 2000; 3: 631–633.
13. Stejskal L, et al. Vazomotorická versus neuronální aktivita (stav při stenóze vnitřní karotidy a po endarterektomii). Neurol pro praxi 2007; (8)6: 371–375.
14. Rossini PM, et al. Does cerebrovascular disease affect the coupling between neuronal activity and local haemodynamics? Brain 2004; 127: 99–110.
15. Krahulík D, et al. Extra-intrakraniální arteriální mikroanastomóza. Cesk Slov Neurol N 2009; 72: 142–146.
16. Stejskal L, et al. Somatosenzorické evokované odpovědi n. medianus před a po karotické endarterektomii. Cesk Slov Neurol N 2001; 64: 114–123.
17. Vriens EM, et al. Increase in alpha rhythm frequency after carotid endarterectomy. Clinical Neurophysiology 2000; 111: 1505–1513.
18. Irvine CD, et al. Cognitive testing in patients undergoing carotid endarterectomy. Eur J Vasc Endovasc Surg 1998; 15: 195–204.
19. Vriens EM, et al. Changes in health-related quality of life after carotid endarterectomy. Eur J Vasc Endovasc Surg 1998; 16: 395–400.
20. Beneš V. Ischemie mozku (chirurgická a endovaskulární terapie). Praha: Galén 2003.
21. Jörgensen HS, et al. Outcome and time course of recovery in stroke. Part II: Time course of recovery. The Copenhagen Stroke Study. Arch Phys Med Rehab 1995; 76: 406–412.
22. Heiss WD, et al. Penumbral probability thresholds of cortical flumazenil binding and blood flow predicting tissue outcome in patients with cerebral ischaemia. Brain 2001; 124: 20–29.
23. Heiss WD, et al. Progressive derangement of periinfarct viable tissue in ischemic stroke. J Cereb Blood Flow Metab 1992; 12: 193–203.
Labels
Addictology Allergology and clinical immunology Angiology Audiology Clinical biochemistry Dermatology & STDs Paediatric gastroenterology Paediatric surgery Paediatric cardiology Paediatric neurology Paediatric ENT Paediatric psychiatry Paediatric rheumatology Diabetology Pharmacy Vascular surgery Pain managementArticle was published in
Journal of Czech Physicians
Most read in this issue
- Bilateral spontaneous pneumothorax – wrong therapies
- Human genome sequencing – next generation technology or will the routine sequencing of human genome be possible?
- Eosinophils in the gastrointestinal tract
- On human ageing and longevity – 2. internal determinants