OCCLUSION OF UNILATERAL CAROTID ARTERY: A RETROSPECTIVE STUDY OF 16 CASES

Objective Sacrifice of a carotid artery is a frequent event during the treatment of carotid lesions, certain complex aneurysms or removal of a tumor encasing this vessel. This paper reported 16 consecutive patients with their carotid artery ligated , resected or embolized, with the emphasis on methods of predicating the safe handling of the carotid artery.Methods 16 patients who underwent elective carotid artery occlusion, ligation or resection were included in this study. Three patients had cerebral aneurysms, ten patients had neoplasms arising from various sites in the head and neck, and of the remaining three, one each had an arteriovenous fistula (AVF) of the right cavernous sinus, a paraganglioma and a pseudoaneurysm of the carotid artery. 5 patients underwent emergency ligation or resection of the carotid artery. 11 patients had various examinations as a part of their preoperative assessment, including Matas test, gradual occlusion by artery clamps, by pass procedure, cerebral angiography, somatosensory evoked cortical potentials (SSEP), transcranial Doppler monitoring (TCD), measurement of rSO 2 and carotid stump pressure. All the examinations were performed in the usual way.Results Of the 16 patients, who underwent occlusion of the carotid artery, 4 patients had complications (25%) postoperatively. One patient underwent gradual occlusion of the carotid artery with vascular clips. When the clips were removed 3 days postoperatively, the patient developed hemiplegia suddenly. Hemiplegia and/or aphasia were present in the other 3 patients immediately after operation, postoperative 48h and 5 days, respectively.Conclusion The carotid artery can be sacrificed whenever necessary, but careful preoperative assessment and preparation must be undertaken. Although there have been many methods to predict the cerebral crossover blood flow, no prediction methods thus far have been completely reliable. Temporary balloon occlusion test is advocated at present. In addition to decreased cerebral perfusion, thrombus is another major factor for cerebral ischemia after occlusion of the carotid artery.