Carotid stenosis and carotid plaque analysis relevant to carotid endarterectomy and stent-assisted angioplasty

Simple item page
dc.contributor.authorDu Toit D.F.
dc.contributor.authorSaaiman U.A.
dc.contributor.authorVorster W.
dc.contributor.authorLabuschagne B.C.J.
dc.contributor.authorVan Beek F.J.
dc.contributor.authorBoden B.H.
dc.contributor.authorMuller C.J.F.
dc.contributor.authorGeldenhuys K.M.
dc.date.accessioned2011-05-15T15:56:42Z
dc.date.available2011-05-15T15:56:42Z
dc.date.issued2005
dc.description.abstractThe primary objective of this cadaveric study was to review the morphological variations of the anatomy of the human carotid artery bifurcation relevant to carotid endarterectomy (CEA) and carotid artery stent-supported angioplasty (CSSA). We quantify carotid bifurcation plaque morphology. Results showed that the angle of deviation at the origin of the internal carotid artery (ICA), in relation to the common carotid artery (CCA), measured a mean of 21.8 degrees with a range from seven to 45 degrees. This anatomical finding is important for the interventionalist concerned with insertion of a carotid stent. The angle of the ICA origin may be an independent risk factor for early atherosclerotic changes at the ICA bulb. Carotid bifurcation plaque was observed in a small, random cohort of seven out of 13 cadavers, and contributed to a mean stenosis of 15.2% (range 5.0-34.8%). Plaque morphology (n = 7) showed haemorrhage (29%), superficial thrombosis (57%), calcification (71%), areas of focal necrosis (71%), neovascularisation (14%) and infiltrates (29%). Ulcerations were not detected. Although four out of 13 patients (31%) died of a cerebrovascular accident, the cause of cerebral apoplexy was thought not to be associated with the carotid bifurcation pathology. 'Re-boring' of occluding plaque, as in CEA, offers potential volumetric anatomical advantage over CSSA within the carotid bifurcation and bulb. In conclusion, precise and applied knowledge of carotid bifurcation anatomy is critical to reduce technical complications during CEA or CSSA. This information may reduce potential dangers of iatrogenic thrombo-embolism and ensuing neurologic deficits. Patients with low-grade carotid stenosis, evidence of focal plaque necrosis, are at risk of spontaneous plaque cap rupture, distal thrombo-embolism and stroke.
dc.description.versionReview
dc.identifier.citationCardiovascular Journal of South Africa
dc.identifier.citation16
dc.identifier.citation1
dc.identifier.issn10159657
dc.identifier.urihttp://hdl.handle.net/10019.1/9994
dc.subjectadult
dc.subjectaged
dc.subjectangioplasty
dc.subjectatherosclerotic plaque
dc.subjectbleeding
dc.subjectcadaver
dc.subjectcalcification
dc.subjectcarotid artery bifurcation
dc.subjectcarotid artery obstruction
dc.subjectcarotid artery stent supporter angioplasty
dc.subjectcarotid endarterectomy
dc.subjectcause of death
dc.subjectcerebrovascular accident
dc.subjectcohort analysis
dc.subjectcommon carotid artery
dc.subjectfemale
dc.subjecthigh risk patient
dc.subjecthuman
dc.subjecthuman tissue
dc.subjectiatrogenic disease
dc.subjectinternal carotid artery
dc.subjectinterventional cardiovascular procedure
dc.subjectmale
dc.subjectmorphology
dc.subjectnecrosis
dc.subjectneovascularization (pathology)
dc.subjectneurological complication
dc.subjectquantitative analysis
dc.subjectreview
dc.subjectrisk factor
dc.subjectrupture
dc.subjectstent
dc.subjectstroke
dc.subjectsurgical anatomy
dc.subjectthromboembolism
dc.subjectthrombosis
dc.subjectulcer
dc.subjectAged
dc.subjectAged, 80 and over
dc.subjectAngioplasty, Balloon
dc.subjectCarotid Artery, Internal
dc.subjectCarotid Stenosis
dc.subjectEndarterectomy, Carotid
dc.subjectFemale
dc.subjectHumans
dc.subjectMale
dc.subjectMiddle Aged
dc.subjectStents
dc.titleCarotid stenosis and carotid plaque analysis relevant to carotid endarterectomy and stent-assisted angioplasty
dc.typeReview
Files
Collections
Stellenbosch University - Scopus Publications