Primary and Repeat Arterial Reconstructions by Sachinder Singh Hans & Mitchell R. Weaver & Timothy J. Nypaver

Author:Sachinder Singh Hans & Mitchell R. Weaver & Timothy J. Nypaver
Language: eng
Format: epub
ISBN: 9783031138973
Publisher: Springer International Publishing

Carotid Interposition Graft for Failed Carotid Stenting

Carotid interposition graft for failed carotid stenting often requires exposure of the distal end of the stent in the ICA. This exposure may be difficult if the cephalad end of the stent extends above the level of the body of the second cervical vertebrae. The operative intervention should be performed under general anesthesia. It is important that any monitoring equipment does not obstruct the potential radiological imaging of the stent in the ICA in the event intraoperative imaging is necessary. The operative dissection is usually more difficult than the standard CEA because of the scar tissue in the area and the inflammatory response due to the presence of the stent. Sharp dissection with a 15-blade scalpel keeping the angle of the blade slightly more horizontal and finding a plane very next to the adventitia of the common and internal carotid artery as well as the external carotid artery (ECA) is necessary (Fig. 19.1). Exposure of the distal ICA is like the one described in the chapter of CEA. We prefer EEG monitoring as well as median nerve-evoked potentials to determine the need for shunt in patients who do not tolerate carotid cross clamping.

Fig. 19.1 Exposure of distal CCA, ICA and ECA in the neck. ICA has a previous stent

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