Extracranial Carotid and Vertebral Artery Disease PDF
Preview Extracranial Carotid and Vertebral Artery Disease
Extracranial Carotid and Vertebral Artery Disease Contemporary Management Sachinder Singh Hans Editor 123 Extracranial Carotid and Vertebral Artery Disease Sachinder Singh Hans Editor Extracranial Carotid and Vertebral Artery Disease Contemporary Management Editor Sachinder Singh Hans Wayne State University School of Medicine Detroit, MI USA ISBN 978-3-319-91532-6 ISBN 978-3-319-91533-3 (eBook) https://doi.org/10.1007/978-3-319-91533-3 Library of Congress Control Number: 2018950454 © The Editor(s) (if applicable) and The Author(s) 2018 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Printed on acid-free paper This Springer imprint is published by the registered company Springer International Publishing AG part of Springer Nature The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland This book is dedicated to the memory of the late Dr. Herbert J. Robb—a pioneering vascular surgeon who guided me through my vascular surgery training in the late 1970s, a time when vascular surgery was just becoming established as an independent specialty. Foreword I thank my colleague Dr. Sachinder Singh Hans for inviting me to write this foreword. It is a pleasure to welcome a book dealing with the carotid and vertebral arteries. In the cerebrovascular field, most of what is published today deals with the new endovascular techniques. This makes this book timely because it reminds us of the prominent role that surgery continues to have in the management of these conditions. The many endovascular procedures being done in the carotid and vertebral arteries have decreased the training we can offer to the newer generations of vascular surgeons in the operative techniques described here. And these are procedures that require refined technique and, indeed, repetition if they are to be done with the levels of safety that patients deserve. Another positive effect of this multiauthored text is to reflect the different criteria and also the conflicting opinions that different specialties have about how to manage the diseases that affect the supra-aortic trunks, the carotid, and the vertebral arteries. One view with which I disagree is the tendency to lump vertebral and carotid disease in the neurological studies where a comparison is made between medical and interventional/surgical treatments. My disagreement is founded on a single fact: these two pathologies are apples and oranges that should not be combined in clinical studies. Mixing two different pathologies blurs the validity of any conclusion drawn from the study. The mechanism of brain damage is different: 75% of hemispheric infarcts are embolic while only 30% of those in the posterior brain have this mechanism. In terms of brain infarction, those in the vertebrobasilar territory are three times more likely to result in death. In the carotid population the laterality of the lesion is easily inferred by the side of the brain that has been injured. In vertebral pathology, particularly when dealing with microembolization, the side originating the embolus can only be presumed by some appearance of the arterial lesion. Furthermore, it has been shown that in a large number of normal people one vertebral artery occluded temporarily with neck rotation, leaving the other vertebral artery as the only temporary supply to the posterior brain. There are patients in whom this temporary occlusion of a dominant vertebral with neck rotation/exten- sion will result in physical impairment and occasionally in severe trauma (from severe dizziness or syncope); their outcome will not be accounted for in the usual categories of death and stroke. Symptomatic vertebral occlusion caused by rotation/extension of the head can only be positively identified vii viii Foreword when, as we elicit the symptom in the angiogram table by rotating/extending the head, we can see simultaneously the occlusion of the vertebral artery on the angiography screen. This finding is a common indication for distal verte- bral reconstruction at the level of C2 or C1. I am aware of how reluctant angiographers are about this maneuver, but I nevertheless missed an entry for this dynamic vertebral arteriography in the corresponding chapter. Neurology, as a medical specialty, inherited an all-consuming interest in the cerebral hemispheres from the revolutionary work of Hughlings Jackson at the end of the nineteenth century. As a result, the understanding of disease of the posterior brain has lagged two decades behind that in the anterior brain. And in terms of their surgical treatment, the first reconstructions of the verte- bral (proximal) artery took place in 1979, a quarter of a century after the first carotid endarterectomy. I enjoyed the historical summary that precedes most chapters; it enriches our comprehension and enlightens our appreciation for the many individuals in various specialties that contributed to what we can offer to our patients. Ramon Berguer, MD, PhD Emeritus Professor of Vascular Surgery University of Michigan Ann Arbor, MI, USA Preface Carotid and vertebral artery disease affects a large segment of population with the potential of causing severe disability from a major stroke. Although successful internal carotid surgery dates from 1954, vertebral artery surgery has lagged behind carotid surgery by almost twenty years and this delay was due in large part to the difficulty in establishing accurate clinical and radio- graphic diagnosis of vertebral-basilar insufficiency. In this book emphasis is placed on the medical, endovascular, and surgical approaches in managing patients with extracranial carotid and vertebral artery disease following perti- nent diagnostic studies. Besides surgical anatomy, physiology, and pathology, strong emphasis was placed on the imaging techniques such as duplex ultra- sound, computed tomography head, CTA neck and brain, MRI brain, MRA neck and brain, and diagnostic arteriography. In contrast to similar book pub- lications on this topic, this book reflects the contributions of many interre- lated specialties: cerebrovascular physiology, pathology, neuro-radiology, neuro-interventions, stroke neurology, and, more importantly, vascular sur- gery whose varying perspectives have significantly enhanced our knowledge of carotid and vertebral artery disease. It is my sincere hope that the reader will find the scholarship of their contributions not only informative but of a great practical value. In addition, multiple-choice questions have been added at the end of each chapter in order to improve the comprehension of the material. Our intent has been to provide a comprehensive text and publish it in a timely fashion so as to anticipate the rapid pace of progress in this field. Warren, MI, USA Sachinder Singh Hans ix Acknowledgements The editor wishes to acknowledge the contributions of all the authors who gave up valuable time from their busy schedules to assist with this endeavor and their help is highly appreciated. I also wish to acknowledge the unflinch- ing support of my wife Dr. Bijoya Hans, MD-Interventional Radiologist, in providing practical and sage advice in challenging times encountered during publication. Last but not least, my sincere thanks and gratitude to Springer Publishing, particularly executive editor Richard Hruska, editorial assistant clinical medicine Lillie Mae Gaurano, and Connie Walsh, developmental edi- tor, for providing the guidance and professional support in getting this project completed. xi Contents 1 Surgical Anatomy of Carotid and Vertebral Arteries . . . . . . . . 1 Sachinder Singh Hans 2 Physiology of the Cerebrovascular System . . . . . . . . . . . . . . . . . 9 Heidi L. Lujan, Robert A. Augustyniak, and Stephen E. DiCarlo 3 Pathology of the Extracranial Carotid and Vertebral Arteries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Wendy N. Wiesend and Mitual Amin 4 History of Carotid Artery Surgery . . . . . . . . . . . . . . . . . . . . . . . 45 Praveen C. Balraj, Ziad Al Adas, and Alexander D. Shepard 5 History of Vertebral Artery Surgery . . . . . . . . . . . . . . . . . . . . . . 63 Sachinder Singh Hans 6 Noninvasive Vascular Lab Testing for Carotids, Vertebrals, and Transcranial Doppler . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Hosam Farouk El Sayed, Nicolas J. Mouawad, and Bhagwan Satiani 7 Cerebrovascular Imaging (CT, MRI, CTA, MRA) . . . . . . . . . . 85 Brent Griffith, Brendan P. Kelley, Suresh C. Patel, and Horia Marin 8 Carotid and Vertebral Arteriography . . . . . . . . . . . . . . . . . . . . . 113 Muneer Eesa 9 Medical Therapy for Carotid and Vertebral Artery Stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 Moayd M. Alkhalifah, Paul M. Gadient, and Seemant Chaturvedi 10 Carotid Endarterectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Sachinder Singh Hans 11 Carotid Endarterectomy for High Plaque . . . . . . . . . . . . . . . . . 147 Sachinder Singh Hans xiii
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