Surgery of extracranial cerebrovascular disease Gbor Menyhei MD

Surgery of extracranial cerebrovascular disease Gábor Menyhei MD Professor of Vascular Surgery

Stroke • third leading cause of death in the U. S. • 160/100000 population/year • socioeconomic disability and financial impact of

History • 1875 Gowers – first description of link between symptoms of stroke and carotid artery occlusion • 1937 Moniz – arteriography for diagnosis • 1954 Eastcott – first successfull surgical procedure for transient ischaemic attack (TIA)

Pathophysiology of ischaemic attacks • Atheromatous plaques at carotid bifurcation (due to turbulent flow) • Ulceration • Thrombus formation • Dislodgement distal embolisation

Clinical presentation of embolisation to ophtalmic artery • Retinal infarct • Amaurosis fugax Symptoms loss of vision for a few minutes unilateral

Clinical presentation of embolisation to middle cerebral artery • Transient ischaemic if < 24 hours attack (TIA) • Stroke if >24 hours Symptoms weakness, numbness and clumsiness of the limbs contralateral to the side of the lesion dysphasia global symptoms (faintness, vertigo, syncope)

Investigation for cerebrovascular disease • Duplex scan • Angiography • CT scan • CT angiogram • MRI

Management of cerebrovascular ischaemia • Conservative • Surgery (carotid endarterectomy) • Intraluminal angioplasty, stenting PREVENTION!

Indication for carotid endarterectomy >70% stenosis >50% stenosis with ulceration Symptomatic • TIA • Previous stroke • Evolving stroke Asymptomatic

Monitoring of cerebral ischaemia • Locoregional anaesthesia • Electroencephalography • Transcranial Doppler • Stump pressure • Intraluminal shunting

Complications of carotid endarterectomy • Stroke • Myocardial infarction • Haematoma • Nerve paresis (Hypoglossal, Glossopharingeal, Facial, Recurrent laryngeal) • Wound infection

Subclavian steal syndrome Carotico-subclavian transposition

Subclavian steal syndrome Carotico-subclavian interposition

Uncommon disorders of carotid artery • Carotid kinks • Carotid body tumor • Aneurysm of carotid artery

Carotid kinking

Carotid body tumor

Carotid body tumor

Carotid aneurysm

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