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The prevalence of atherosclerotic stenotic disease involving the proximal brachiocephalic arteries is significantly less than that in the extracranial carotid arteries. Additionally, only 10% of patients with hemodynamically significant proximal subclavian artery stenoses develop symptoms. This probably reflects the robust…
Vertebrobasilar ischemia (VBI) is a syndrome with different etiologies. The term insufficiency, which is still commonly used, should be abandoned because it implies only a low-flow condition affecting the vertebrobasilar territory and ignores the important mechanism of microembolization that constitutes…
Treatment of carotid fibromuscular dysplasia (FMD) in the past has been open graduated rigid carotid dilatation for symptomatic stenoses or segmental resection with saphenous vein interposition for aneurysms. The results of contemporary open surgical reports have shown the risk of…
Most patients with carotid artery fibrodysplasia are likely to be asymptomatic, although the number reported without symptoms is small because most reported series are surgical experiences encompassing more advanced disease. Complications of this disease include embolization, dissections, and rupture with…
Multiple indications exist for constructing an extracranial–intracranial (EC-IC) bypass. The indications that are encountered most frequently in contemporary practice are symptomatic occlusion of the internal carotid artery (ICA), stenosis or occlusion of the intracranial vasculature, usually at the level of…
The management of patients with coexistent carotid and coronary artery disease (CAD) depends upon the circumstances of clinical presentation. Most surgeons would agree that symptomatic carotid stenosis requires prompt, if not urgent, surgical therapy based on presentation. In such patients,…
Carotid endarterectomy (CEA) is the gold standard in the treatment of carotid occlusive disease and prevention of stroke. However, the benefit of carotid revascularization is hampered by restenosis, which is associated with a modestly increased risk for stroke. Symptomatic recurrent…
Restenosis at the site of previous atherosclerotic plaque removal or dilatation commonly accompanies mechanical methods to reopen an artery. This often follows balloon angioplasty, atherectomy, endarterectomy, or arterial stenting. In arterial stenting, tissue grows inside the stent, causing a luminal…
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