Abstract
Open operative balloon angioplasty is a treatment alternative for certain nonatherosclerotic lesions of the internal carotid artery (ICA) including fibromuscular dysplasia (FMD). Standard operative exposure of the carotid bifurcation is performed with atraumatic passage of a guidewire and balloon through a carotid bulb arteriotomy. Under direct fluoroscopic guidance, precise dilatation of the involved area is possible with minimal risk of intimal tear/flap or distal embolization as compared with graduated intraluminal dilatation or percutaneous balloon angioplasty. Vascular control of the common and external carotid arteries lessens the risk of embolization resulting from the constant backflow of blood through the ICA before, during, and after balloon angioplasty, adding to the overall safety and efficacy of the procedure. We report a case of asymptomatic critical carotid artery stenosis associated with FMD successfully treated with open operative balloon angioplasty and review the current literature regarding treatment options for FMD of the ICA.
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References
Moore WS. Extracranial cerebral vascular disease. In Moore WS, ed. Vascular Surgery: A Comprehensive Review, 4th ed. Philadelphia: WB Saunders, 1993, pp 532–576.
Rose FC. Epidemiology and costs of stroke. In Bernstein EF, Callow AD, Nicolaides AN, Shifrin EG, eds. Cerebral Revascularisation. London: Med-Orion, 1993, pp 3–13.
Towne JB, Weiss DG, Hobson RW. First phase report of cooperative veterans administration asymptomatic carotid stenosis study—operative morbidity and mortality. J Vasc Surg 1990;11:252–284.
European Carotid Surgery Trialists' Collaborative Group. MRC European Carotid Surgery Trial: Interim results for symptomatic patients with severe (70%–99%) or with mild (0%–29%) carotid stenosis. Lancet 1991;337:445–453.
NASCET Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 1991;325:445–453.
Balaji MR, DeWeese JA. Fibromuscular dysplasia of the internal carotid artery: Its occurrence with acute stroke and its surgical reversal. Arch Surg 1980;115:984–986.
Levien LJ, Fritz VU, Lurie D, et al. Fibromuscular dysplasia of the extracranial carotid arteries. S Afr Med J 1984;65:261–265.
Lord RSA, Graham AR, Benn IV. Radiologic control of operative carotid dilatation. Aneurysm formation following balloon dilatation. J Cardiovasc Surg 1984;27:158–162.
Smith LL, Smith DC, Killeen JD, et al. Operative balloon angioplasty in the treatment of internal carotid artery fibromuscular dysplasia. J Vasc Surg 1987;6:482–487.
Stewart MT, Moritz MW, Smith RB, et al. The natural history of carotid fibromuscular dysplasia. J Vasc Surg 1986;3:305–310.
Effeney DJ, Ehrenfeld WK, Stoney RJ, et al. Why operate on carotid fibromuscular dysplasia? Arch Surg 1980;115:1261–65.
van den Hoven RW, Mali WPTH, Theodorides T. Transluminal dilatation of the internal carotid artery in fibromuscular dysplasia—a case history. Angiology 1988;3:272–275.
Jooma R, Bradshaw JAR, Griffith HB. Intimal dissection following percutaneous transluminal carotid angioplasty for fibromuscular dysplasia. Neuroradiology 1985;27:181–182.
Starr DS, Lawrie GM, Morris GC. Fibromuscular disease of carotid arteries: Long-term results of graduated internal dilatation. Stroke 1981;12:196–199.
Welch EL, Lemrin JA, Geary JE. Gruentzig balloon dilatation for fibromuscular dysplasia of the internal carotid arteries. NY State J Med 1985;85:115–117.
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Ballard, J.L., Guinn, J.E., Killeen, J.D. et al. Open operative balloon angioplasty of the internal carotid artery: A technique in evolution. Annals of Vascular Surgery 9, 390–393 (1995). https://doi.org/10.1007/BF02139412
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DOI: https://doi.org/10.1007/BF02139412