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10 - Carotid, subclavian and vertebral disease

By
A. Ross Naylor
Edited by
Vish Bhattacharya  and
Gerard Stansby
A. Ross Naylor
Affiliation:
Leicester Royal Infirmary, UK
Vish Bhattacharya
Affiliation:
Queen Elizabeth Hospital
Gerard Stansby
Affiliation:
Freeman Hospital
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Summary

Key points

  • The extracranial arteries are prone to involvement with a number of important atherosclerotic and non-atherosclerotic conditions

  • The provision of best medical therapy should not be delegated to the most junior member of the team. It is an essential component of care

  • Patients with symptomatic carotid disease benefit from very rapid intervention. Investigative strategies and rapid access to the operating theatre should be geared to ensuring all patients are treated within 2 weeks of suffering their index symptom

  • Relatively few patients with asymptomatic carotid disease benefit from intervention (especially females and patients aged >75 years). It is essential that trials identify high-risk subgroups

  • The role of several technical aspects of carotid surgery has been guided by large randomised trials

  • Patients with symptomatic vertebral stenoses may have a much worse prognosis than was previously thought

Radiation arteritis

Demographics

Despite the widespread use of radiotherapy in the treatment of head and neck cancers, there is still insufficient data regarding the incidence of symptomatic radiation arteritis.

Pathology

  • Acute phase: fibrin deposition/endothelial swelling followed by intimal necrosis.

  • Subacute phase: endothelial regeneration with destruction of the internal elastic lamina. Inflammatory cell infiltration of the media and adventitia.

  • Chronic phase: intima becomes thickened with a tendency towards accelerated atherosclerosis. The media and adventitia become progressively fibrotic.

Clinical features

False aneurysm or vessel rupture (acute/subacute phase), stroke due to carotid/vertebral thrombosis, or upper limb ischaemia following subclavian thrombosis (sub-acute phase).

Type
Chapter
Information
Postgraduate Vascular Surgery
The Candidate's Guide to the FRCS
 , pp. 129 - 145
Publisher: Cambridge University Press
Print publication year: 2011

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References

Olin, JW. Recognizing and managing fibromuscular dysplasia. Cleveland Clin J Med 2007; 74: 273–82.CrossRefGoogle ScholarPubMed
Kawasaki, A, Purvin, V. Giant cell arteritis: an updated review. Acta Ophth 2009; 87: 13–32.CrossRefGoogle Scholar
Johnston, SL, Lock, RJ, Gompels, MM. Takayasu arteritis: a review. J Clin Pathol 2002; 55: 481–86.CrossRefGoogle ScholarPubMed
Sajid, MS, Hamilton, G, Baker DM on behalf of the Joint Vascular Research Group. Eur J Vasc Endovasc Surg 2007; 34: 127–30.CrossRefGoogle Scholar
Wardlaw, JM, Chappell, FM, Stevenson, M et al. Accurate, practical and cost-effective assessment of carotid stenosis in the UK. Health Technol Assess 2006; 10: no. 30. Available at: http://www.hta.ac.uk/fullmono/mon1030.pdf.CrossRef
,The European Stroke Initiative Executive Committee and the EUSI Writing Committee. European Stroke Initiative Recommendations for Stroke Management – Update 2003. Cerebrovasc Dis 2003; 16: 311–37.CrossRefGoogle Scholar
Rothwell, PM, Eliasziw, M, Gutnikov, SA et al. for the Carotid Endarterectomy Trialists Collaboration. Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet 2003; 361: 107–16.CrossRefGoogle ScholarPubMed
Rothwell, PM, Eliasziw, M, Gutnikov, SA, Warlow CP, Barnett HJM for the Carotid Endarterectomy Trialists Collaboration. Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery. Lancet 2004; 363: 915–24.CrossRefGoogle ScholarPubMed
,International Carotid Stenting Study Investigators. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis. Lancet 2010; 375(9719): 985–97.Google Scholar
Brott, TG, Hobson, RW, Howard, G et al. Stenting versus endarterectomy for treatment of carotid artery stenosis. N Engl J Med 2010; 363(1): 11–23.CrossRefGoogle Scholar
Naylor, AR, Gaines, PA, Rothwell, PM. Who benefits most from intervention for asymptomatic carotid stenosis: patients or professionals?Eur J Vasc Endovasc Surg 2009; 37(6): 625–32.CrossRefGoogle Scholar
Marquardt, L, Kuker, W, Chandratheva, A, Geraghty, O, Rothwell, PM. Incidence and prognosis of >50% symptomatic vertebral or basilar artery stenosis: prospective population based study. Brain 2009; 132: 982–8.CrossRefGoogle ScholarPubMed

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