BILATERAL INTERNAL CAROTID ARTERY OCCLUSION SECONDARY TO CLOSED HEAD INJURIES

Bilateral Common Carotid Artery Ligation in Sheep. Could These Animals be Used as Human Models for Vascular and Cerebral Research?

Experimental animals are still used in today’s medicine to understand better physiological or pathological processes, or to develop, for example better vascular prostheses. For that reason, these animals must show some similarities with humans, from the anatomical to the physiological point of view. When developing vascular prostheses, we have to evaluate if the graft will react in the expected way and if during experimental research there will be some factors that might influence the proper functioning of vascular prostheses in the human body. We observed the consequences of bilateral common carotid artery ligation (BCCAL) or Sham operation in seventeen healthy Merinolandschaf / Württemberg sheep, aged between 2 and 4 years, after testing new types of carbon-coated ARTECOR® and ADIPOGRAFT Ra 1vk 7/350 vascular prostheses. After the follow-up period the prostheses were extirpated, so the blood supply was provided from the vertebral arteries. Sheep in both groups were not sacrificed, but were observed for 18 months. After the observation period all sheep showed no physical or neurological changes and all are still alive. Animal responses to BCCAL are different, depending on the animal species, age, and condition. In sheep, bilateral blocking of the blood fl ow in the carotid bed seems to be conceivable since the brain was sufficiently supplied with blood from the vertebral arteries.

Direct penetrating and indirect neck trauma as a cause of internal carotid artery thrombosis and secondary ischemic stroke

The following manuscript presents two cases of ischemic stroke secondary to traumatic internal carotid artery thrombosis with concomitant middle cerebral artery thrombosis occurring very rarely in the medico-legal practice. Penetrating neck trauma due to an occupational accident and multiple head and neck trauma secondary to battery were described. The autopsy and histopathological examination as well as the analysis of available medical records, including radiological examinations, and records of investigation indicated the sustained trauma to be the cause of the thrombosis.

Oscillating thrombi in bilateral extracranial internal carotid arteries demonstrated on ultrasonography: two autopsy cases of cardioembolic stroke

We herein report two autopsy cases of severe cardioembolic stroke with oscillating thrombi in the bilateral extracranial internal carotid arteries (ICAs) demonstrated on carotid ultrasonography performed on admission. An autopsy study of case 1 conducted on the third hospital day revealed no thrombi, while that of case 2 conducted on the 42nd hospital day revealed red thrombi in the extracranial ICAs. Our postmortem studies confirm that oscillating thrombi may be seen in the region of blood stasis caused by occlusion of the distal portion of the ICA, thus reflecting a pre-state of thrombus formation.

Bilateral internal carotid artery occlusions resulting in near total acute brain infraction

INTRODUCTION

Acute bilateral acute carotid arteries occlusion is a very rare condition. We describe a patient with initial right middle cerebral artery syndrome who developed coma and quadriplegia 1 h after thrombolysis with intravenous tPA and was found to have bilateral cervical internal carotid artery occlusion.

Sudden coma from acute bilateral internal carotid artery territory infarction

Six patients with bilateral internal carotid artery occlusion who presented with sudden loss of consciousness, quadriplegia, and initially intact brainstem reflexes are described. They soon lost brainstem reflexes and died within 3 days. The presumed causes of internal carotid artery occlusion were atherothrombosis in three patients and cardiogenic embolism in the others. This catastrophic stroke syndrome mimics severe brainstem stroke and has an extremely poor prognosis.

Basal skull fracture with traumatic polycranial neuropathy and occluded left carotid artery: significance of fractures along the course of the carotid artery

A patient who survived with traumatic multiple cranial nerve palsies and occluded internal carotid artery associated with a basal skull fracture that involved the carotid canal is described. A literature review indicates that a wide variety of injuries can occur to the carotid artery as it passes through a fractured skull base. Basal fractures involving the course of the carotid artery reflect a significant risk of carotid injury.

Traumatic bilateral carotid dissection

Traumatic dissection of the carotid artery is an infrequent but serious complication of blunt cranial-cervical injury. The typical patient presents with deficits attributable to cerebral ischemia in the distribution of the affected vascular supply. Key considerations in the clinical picture are a delay in symptom presentation, normal initial computed tomography scans, and potential for concomitant cerebral or visceral injury. Because the initial clinical and diagnostic picture may be normal, it is crucial for emergency physicians to aggressively search for this injury in the presence of blunt cranial trauma. We present an unusual case of bilateral high extracranial carotid dissection secondary to blunt trauma. The pathophysiology of carotid artery trauma, treatment options, and key acute care issues are discussed.

Traumatic rupture of the cervical carotid arteries: an autopsy and histopathological study of 200 cases

Over the 19-month period November 7th, 1984 to June 11th, 1986, 200 consecutive autopsies were conducted on victims of motor vehicle accidents. In each case, both common carotid arteries and their respective internal and external branches up to 2 cm beyond the bifurcation were examined for evidence of contusion, partial tearing or rupture. All lacerations or disruptions were excised together with a segment of surrounding arterial tissue, and processed, sectioned and examined by conventional light microscopy for the presence and extent of arterial tears. Several findings emerged: (i) in nearly one-third of subjects there was some degree of arterial disruption; (ii) dual or even triple vessel involvement in both an ipsilateral and contralateral distribution occurred in 38.6% of the 57 subjects in whom traumatic arterial lesions were found; (iii) the large number of intimal disruptions encountered, 44.7% of which showed extension of the tear to the internal elastic lamina with further longitudinal continuation of the tear along the lamina without breaching it; (iv) tears along the laminar planes of the media occurred in 52.6% of the 57 subjects and was particularly apparent at sites of subsidiary vessel bifurcation; (v) compound intimo-medial tears occurred in almost two-thirds (63.2%) of the 57 subjects, highlighting the dual involvement of these layers of the arterial wall in traumatic lesions; (vi) the occurrence of adventitial contusions in 70.2% of the 57 subjects; (vii) the occurrence of complete vessel wall transection in more than one-quarter (26.3%) of the vessels with positive findings and involving nearly one-third (31.6%) of subjects, indicating perhaps the severity of the trauma to which the victims were exposed.

Intracranial carotid artery injury in closed head trauma

Six patients with trauma to the intracranial internal carotid artery are reported. One patient died and two are permanently disabled due to ischemic sequelae. The incidence of this complication of trauma is unknown because of the infrequent use of angiography in head-injured patients. The pathology, clinical course, and management of this condition are discussed with reference to the 25 previously reported cases in addition to the six in this series.

Bitemporal compression injury caused by static loading mechanism. Report of two cases

The authors report two cases of bitemporal compression injury caused by a static loading mechanism. These head injuries resulted from gradual bitemporal compression of the head. Plain skull films showed multiple skull fractures, and carotid angiography revealed internal carotid artery obstruction at the base of the skull. Neurological examination disclosed a slight disturbance of consciousness, hemiparesis, multiple cranial nerve injuries, and Horner's syndrome. In comparison with impact head injury, the energy from this type of trauma tends to be transmitted to the foramina and hiati of the middle cranial fossa and results in multiple injuries to the cranial nerves, sympathetic nerves, and blood vessels.

Traumatic occlusion of both internal carotid arteries

Two cases of bilateral occlusion of the extracranial internal carotid artery after blunt trauma to the head and neck are presented. Sixteen similar cases have been reported in the literature, and at least 150 case reports exist on unilateral blunt trauma of carotid arteries. The 25-day post-traumatic latent interval in one of our cases is the longest to date. The diagnosis of both of our cases was established by directional cw-Dopplersonography, whereas previously the only diagnostic method available in cases with negative CT scan and latent interval was angiography. In the differential diagnosis of craniocerebral or craniocervical trauma, particularly following delay between injury and onset of neurological symptoms, Dopplersonography is a necessary test additional.

Traumatic dissection of the internal carotid artery treated by ECIC anastomosis

A patient with traumatic dissection of the left internal carotid artery (ICA) was treated by extracranial-intracranial (ECIC) anastomosis. Anastomosis was performed because the near total occlusion of the left ICA was associated with a cerebral transient ischemic attack. At surgery, an embolus was found in a cortical branch of the middle cerebral artery and was removed at the time of the ECIC. Traumatic dissection of the ICA is briefly reviewed.

Blunt carotid artery trauma: report of two cases and review of the literature

Blunt carotid artery trauma is uncommon but has been associated with severe, permanent neurologic deficits in 42% and mortality in 30% of 96 patients previously reported in the English literature. Since neurologic symptoms characteristically develop only after a latent interval and since physical evidence of significant cervical trauma often is absent, diagnosis of nonpenetrating carotid injuries with the use of arteriography usually is delayed until the appearance of obvious, frequently irreversible neurologic complications. Carotid injuries should be suspected in patients who develop monoplegia or hemiplegia following blunt craniocervical trauma, particularly if computerized tomography excludes the presence of intracranial hemorrhage. The cumulative results of a collected series of 96 patients suggest that early surgical correction of blunt carotid injuries is appropriate for patients with transient episodes of cerebral ischemia, strokes in evolution, or mild completed neurologic deficits.

Bilateral internal carotid artery thrombosis after closed head injury

A case of bilateral internal carotid artery thrombosis after blunt injury to the head in a 54 years old male is described. The literature is reviewed and comment is made on the causes. Unilateral thrombosis of the internal carotid artery after closed or blunt injury to the head and neck is well known but not common. There is only one previously recorded case of bilateral internal carotid artery thrombosis after such an injury (Yashon et al. 1964).

Non-penetrating trauma to the carotid artery with secondary thrombosis and embolism: treatment by thrombolysin

A case of partially occluding post-traumatic thrombosis of the internal carotid artery and secondary embolism of the middle cerebral artery is reported. The patient was treated with Thrombolysin with coincident resolution of clinical symptoms and signs and clearing of the lesions on arteriography. This may have been fortuitous. The subject of traumatic carotid artery thrombosis is reviewed in detail, and its pathophysiology is discussed, especially in relation to facts known about occlusive vascular disease secondary to atherosclerosis and related embolic phenomena. Suggestions are made concerning the treatment of this condition, especially with regard to developing rational criteria for opening vascular beds through evaluation of collateral cerebral blood flow. The uses of microvascular surgical techniques and thrombolytic therapy are considered.