History of Carotid Artery and Vertebral Artery Surgery

Document Type

Book

Publication Date

3-12-2025

Publication Title

Extracranial Carotid and Vertebral Artery Disease

Abstract

Over the last century, advances in vascular surgery and surgical technology have changed both our understanding and treatment of cerebrovascular disease. The diagnosis and management of extracranial carotid artery disease have undergone a tremendous evolution of thought and technique. From the days of frequently lethal attempts at carotid artery ligation to current precise surgical techniques, this chapter describes the most significant events and landmark discoveries that have led to the current standards of care in carotid artery surgery. This chapter starts by describing how the association between carotid artery disease and neurological injury was discovered. The progression of carotid surgery from early ligations for bleeding and aneurysms to carotid endarterectomy is detailed along with the evolution of modern techniques of endarterectomy. The subsequent development of endoluminal techniques for treating carotid disease and enhancements such as cerebral protection devices and transcervical access are also outlined. And finally, the most important clinical trials that have shaped today’s practice of carotid surgery are described. Vertebral artery (VA) surgery is uncommon as compared to operations on extracranial common carotid artery (CCA) and internal carotid artery (ICA). The symptoms of hindbrain ischemia secondary to vertebrobasilar artery insufficiency are difficult to diagnose. The best surgical option for the management of vertebral artery stenosis in its first portion (V1) is reimplantation of the VA into the CCA. For lesions of V2 and V3 segments, a bypass from the CCA, occipital artery, or external carotid artery to vertebral artery in its third segment (V3) is the most commonly performed procedure.

First Page

1

Last Page

17

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