Carotid endarterectomy with contralateral carotid artery occlusion: is this a higher risk subgroup?

OBJECTIVE: to evaluate early and mid-term term results of carotid endarterectomy (CEA) in patient with and without contralateral carotid occlusion. METHODS: between 1996 and 1999, 1324 CEAs were performed. In 82 patients contralateral carotid artery occlusion was present (group I); 1242 patients had patent contralateral carotid (group II). All patients were operated under general anaesthesia, and selective shunting was based on somatosensory evoked potentials (SEPs). Ultrasonographic follow-up was performed at 1, 6 and 12 months and then once a year. Early results and follow-up data were analysed retrospectively. RESULTS: in group I there was a significantly higher incidence of SEPs reduction and shunt insertion; however, there were no differences in terms of perioperative complications. The cumulative stroke and death rate at 30 days in group 1 and group 2 were 2.4% vs 1.4% (p=n.s.), respectively. At a mean follow-up of 15 months there were no differences between the two groups in terms of cumulative symptom-free survival. CONCLUSIONS: the presence of contralateral carotid occlusion caused an increased use of shunt, but not in early complications rates.

Diagnosis and surgical treatment of the carotid body tumors.

Resection of carotid body tumors can be difficult to perform because of its site, vascularity, arterial adherence and local cranial nerve involvement. Advances in vascular surgical technique have reduced the risks of perioperative complications such as carotid injury, stroke and death. From January 1980 to May 1994 20 patients (22 carotid body tumors) were examined. All patients except one were evaluated with a preoperative angiography. No preoperative embolization was performed. Thirteen patients underwent ultrasonography, nine a CT scan of the neck, 5 magnetic resonance scanning and two magnetic resonance angiography. One old patient refused operation. The authors report their experience on 21 carotid body tumor resections (14 Shamblin group I and 7 group II paragangliomas). Surgical technique is based on subadventitial resection (18 excisions) and 3 resections were performed from the medial surface of the carotid bifurcation which had been partially absorbed into the mass. In the last 15 operations intraoperative Somatosensorial Evoked Potential (SEP) monitoring has been used. Only two patient required arterial repair because intimal dissection and another patient needed vagus nerve section. The ligation of external carotid artery and internal carotid resection with graft replacement were never necessary in these patients. No early or late deaths occurred and no recurrences were detected at follow-up.

[The choice of approach in the surgical therapy of the superior thoracic outlet syndrome]. / La scelta della via di approccio nella terapia chirurgica della sindrome dello stretto toracico superiore.

The symptoms of thoracic outlet syndrome (TOS) may be improved or cured either by physiotherapy or by a surgical operation. The choice of patients to be submitted to surgery must be performed on the basis of clinical picture and of non invasive and invasive assessment. Moreover the surgeon must choose the best procedure to relieve symptoms. The Authors on the basis of their experience and of a literature review refer to the various surgical approaches used in the treatment of TOS.