Current management of the patient with internal carotid artery occlusion |
| |
Authors: | S G Friedman |
| |
Affiliation: | 1. Centre for Health Systems and Technology, University of Otago, 60 Clyde Street, Dunedin 9016, New Zealand;2. Department of Management, University of Otago, 60 Clyde Street, Dunedin 9016, New Zealand;1. Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA;2. Optum Labs at UnitedHealth Group, Minnetonka, MN, USA;3. Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA;4. Cancer Informatics Shared Resource, University of Florida Health Cancer Center, Gainesville, FL, USA;1. Department of Mathematics, University of Hormozgan, Bandarabbas, P. O. Box 3995, Iran;2. Engineering School (DEIM), University of Tuscia, Viterbo, Italy |
| |
Abstract: | Despite the recent controversy concerning surgical therapy of patients with carotid artery disease, rational therapeutic plans can be developed based on available data. The patient who is symptomatic from occlusion of one or both internal carotid arteries is at particularly high risk for development of stroke and can ill-afford indecision. All symptomatic patients, therefore, with any of the extracranial occlusive disease patterns described are potential surgical candidates. Conversely, among the asymptomatic patients with these same patterns of occlusion, only those with internal carotid occlusion and contralateral stenosis should be considered for surgical therapy. Treatment must be individualised and directed at revascularising stenotic (not occluded) internal carotid arteries, or important collateral vessels such as the external carotid artery and in fewer cases the vertebral artery. The asymptomatic patient with unilateral internal carotid artery occlusion and no contralateral lesions should be monitored closely with Duplex scanning for development of a contralateral stenosis. When a stenosis of 80% or greater is encountered, strong consideration should be given to prophylactic endarterectomy in these patients due to their high risk for stroke. Endarterectomy for a 50-60% stenosis may also be reasonable in a single patent internal carotid artery. In the absence of a significant contralateral stenosis, no treatment is necessary. Individuals with internal carotid artery occlusion and symptoms referable to a contralateral carotid stenosis should also be managed with endarterectomy of the stenotic carotid artery.(ABSTRACT TRUNCATED AT 250 WORDS) |
| |
Keywords: | |
本文献已被 ScienceDirect 等数据库收录! |
|