[Preoperative assessment of clamping in carotid artery surgery and adaptation of the operative technic].
A retrospective study of 150 consecutive patients undergoing revascularization of internal carotid artery for atheromatous lesion of carotid bifurcation, included analysis of collaterals being compressed by common carotid artery simulating clamping. Two exploratory procedures had been applied routinely: global suprasigmoid digital subtraction angiography and Doppler velocimetry. Two groups of patients could be defined: clamping without risk (95.4%) and clamping at risk (4.6%). For the group of clamping at risk a surgical strategy is proposed allowing clamping without shunt by bypass between subclavian and internal carotid arteries of by bypass between common and internal carotid arteries because of the external carotid artery collaterals left untouched. A shunt is only necessary when the latter artery is occluded. Results of this series of patients explored in this way and operated upon confirmed these data: no clamping accident in the 1st group, one transient ischemic accident in the 2nd.
Cormier
J M
JM
Service de Chirurgie Vasculaire de l'Hôpital Saint-Joseph, Paris.
Fermand
M
M
Massoni
J M
JM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D002340:Carotid Artery Diseases / Q000175:diagnosis / Q000601:surgery*; D003250:Constriction; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011379:Prognosis; D011446:Prospective Studies; D011859:Radiography; D012306:Risk; D013382:Subtraction Technique; D014463:Ultrasonography
Appréciation pré-opératoire du risque de clampage dans la chirurgie carotidienne et adaptation de la technique opératiore.