Abstract
The author have had an experience of 13 cases of carotid thrombectomy or thromboendarterectomy for totally occluded internal carotid artery, 8 in Toronto and 5 in Japan. Retrospective analysis was done angiographically and clinically.
Angiographically there were 2 types of occlusion: lower type (8 patients) and upper type (5 patients).Of 8 patients with lower type of occlusion, all of 3 days after onset were restored in blood flow, but 3 of 5 patients operated after 4 days of onset were restored in blood flow. Of 5 patients with upper type of occlusion, 2 of 3 patients operated within 3 days after onset were restored in blood flow and one of 2 patients operated after 4 days of onset was restored in blood flow.
Postoperative angiography at 6 months time after operation was performed on 6 patients with flow restoration and all had patency. 9 patients with restoration of carotid blood flow have been excellent.
Unfortunately, 3 of 13 patients were died postoperatively. The cause of death in 2 patients was hemorrhagic infarction, one in Toront after thrombectomy and the other in Japan after STA-MCA anastomosis for MCA occlusion, and the other was hypertensive intracerebral hemorrhage during STA-MCA anastomosis for failed flow restration of internal carotid artery. One more hemorrhagic infarction was encountered after thrombectomy, however he was treated conservatively and has been excellent.
After STA-MCA anastomosis was developed carotid thrombectomy and/or thromboendarterectomy for the carotid occlusion have been forgotten because of high mortality and unreliability of revascularization. However, there are several reports with good results in carotid surgery for occlusion. From the retrospective point of view our selection of patients was not strict and further strict selection of patients for carotid thrombectomy and/or thromboendarterectomy should be necessary.
We believe when we can see the lower type of totally occluded internal carotid artery within 3 days after onset carotid surgery should be attempted before STA-MCA anastomosis for the patients with minor neurological risk factor.
