World Neurosurg
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Letter Historical Article
Standardization of surgical procedures: beyond checklists?
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Although the healing response after carotid balloon injury and carotid patch angioplasty injury has been well-documented in animal models, there is limited information about this process after carotid endarterectomy (CEA) in human patients. ⋯ This case report is the first to describe an entire carotid artery specimen in the acute stage after CEA with patch angioplasty. These findings suggest that an α-SMA-rich neointima with prominent proliferative activity covers the inner surface of the treated carotid artery, but patch grafts are left uncovered. The intrinsic arterial wall may have an important role in intimal regeneration after CEA, although the nature of the neointima and the mechanism by which it regulates proliferative activity remain unclarified.
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Case Reports
Surgical decompression for optic neuropathy from carotid artery ectasia: case report with technical considerations.
Symptomatic compression of the optic nerve (ON) through its intracranial course or within the orbit may occur at several locations by abnormalities of adjacent soft tissue, bony, or vascular structures. Compressive optic neuropathy secondary to vascular ectasia is a rare phenomenon. ⋯ We present a patient with severe monocular visual loss and significant anatomic displacement of the ON by an ectatic internal carotid artery-ophthalmic artery complex with dramatic and rapid visual improvement after surgical decompression. Complete untethering of the nerve and total cessation of transmitted pulsatility may not be necessary for symptomatic improvement. Optic nerve contact or displacement by the ipsilateral carotid artery is common in asymptomatic patients, therefore ruling out other etiologies of monocular visual loss before surgical decompression is paramount.
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Safe and complete surgical excision of carotid plaque in carotid endarterectomy (CEA) is essential for preventing postoperative embolic stroke and restenosis. We considered the dissection plane for the plaque according to pathological findings of carotid atherosclerosis. We report our experiences with inner-intimal dissection in CEA. ⋯ Microsurgical interintimal dissection could accomplish good surgical outcome, including absence of significant early restenosis.