Transthoracic Echocardiogram Guided Hemodynamic Management to Maintain Cerebral Perfusion in an Extracranial–Intracranial Bypass Case: Case Report

Abstract

A 70-year-old man with transient ischemic attacks (TIAs) due to left internal carotid artery (ICA) occlusion underwent external carotid to ICA bypass which occluded postoperatively. He developed aphasia which resolved with induced hypertension optimized by using serial transthoracic echocardiography in the setting of left ventricle outflow tract obstruction.

Keywords

echocardiography - carotid stenosis - hypertrophic cardiomyopathy - transient ischemic attack - cerebrovascular circulation - cerebral revascularization

Publikationsverlauf

Eingereicht: 22. September 2023

Angenommen: 22. Juni 2025

Artikel online veröffentlicht:
22. Juli 2025

• References

• 1 Derdeyn CP, Chimowitz MI, Lynn MJ. et al; Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis Trial Investigators. Aggressive medical treatment with or without stenting in high-risk patients with intracranial artery stenosis (SAMMPRIS): the final results of a randomised trial. Lancet 2014; 383 (9914): 333-341
• 2 Turan TN, Nizam A, Lynn MJ. et al. Relationship between risk factor control and vascular events in the SAMMPRIS trial. Neurology 2017; 88 (04) 379-385
• 3 Steinberg GK, Anson JA. Carotid endarterectomy. West J Med 1993; 158 (01) 64-65
• 4 Hayden MG, Lee M, Guzman R, Steinberg GK. The evolution of cerebral revascularization surgery. Neurosurg Focus 2009; 26 (05) E17
• 5 Bose A, Hartmann M, Henkes H. et al. A novel, self-expanding, nitinol stent in medically refractory intracranial atherosclerotic stenoses: the Wingspan study. Stroke 2007; 38 (05) 1531-1537
• 6 Ferguson GG, Eliasziw M, Barr HW. et al. The North American Symptomatic Carotid Endarterectomy Trial: surgical results in 1415 patients. Stroke 1999; 30 (09) 1751-1758
• 7 Rosenfield K, Matsumura JS, Chaturvedi S. et al; ACT I Investigators. Randomized trial of stent versus surgery for asymptomatic carotid stenosis. N Engl J Med 2016; 374 (11) 1011-1020
• 8 Yadav JS, Wholey MH, Kuntz RE. et al; Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy Investigators. Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med 2004; 351 (15) 1493-1501
• 9 Bang OY, Chung JW, Kim SK. et al. Therapeutic-induced hypertension in patients with noncardioembolic acute stroke. Neurology 2019; 93 (21) e1955-e1963
• 10 Jiang B, Churilov L, Kanesan L. et al. Blood pressure may be associated with arterial collateralization in anterior circulation ischemic stroke before acute reperfusion therapy. J Stroke 2017; 19 (02) 222-228
• 11 Wang MY, Steinberg GK. Rapid and near-complete resolution of moyamoya vessels in a patient with moyamoya disease treated with superficial temporal artery-middle cerebral artery bypass. Pediatr Neurosurg 1996; 24 (03) 145-150
• 12 Powers WJ, Clarke WR, Grubb Jr RL, Videen TO, Adams Jr HP, Derdeyn CP. COSS Investigators. Extracranial-intracranial bypass surgery for stroke prevention in hemodynamic cerebral ischemia: the Carotid Occlusion Surgery Study randomized trial. JAMA 2011; 306 (18) 1983-1992
• 13 Group EIBS. EC/IC Bypass Study Group. Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke. Results of an international randomized trial. N Engl J Med 1985; 313 (19) 1191-1200
• 14 Reynolds MR, Grubb Jr RL, Clarke WR. et al; Carotid Occlusion Surgery Study Investigators. Investigating the mechanisms of perioperative ischemic stroke in the Carotid Occlusion Surgery Study. J Neurosurg 2013; 119 (04) 988-995
• 15 Rice CJ, Cho SM, Taqui A. et al. Early versus delayed extracranial-intracranial bypass surgery in symptomatic atherosclerotic occlusion. Neurosurgery 2019; 85 (05) 656-663
• 16 Gupta R, Sewani A, Ahmad M. Dynamic systolic left ventricular gradients: differential diagnosis and management. Echocardiography 2006; 23 (02) 168-171
• 17 Kaul S, Stratienko AA, Pollock SG, Marieb MA, Keller MW, Sabia PJ. Value of two-dimensional echocardiography for determining the basis of hemodynamic compromise in critically ill patients: a prospective study. J Am Soc Echocardiogr 1994; 7 (06) 598-606
• 18 Auer J, Berent R, Weber T, Lamm G, Eber B. Catecholamine therapy inducing dynamic left ventricular outflow tract obstruction. Int J Cardiol 2005; 101 (02) 325-328
• 19 Mingo S, Benedicto A, Jimenez MC, Pérez MA, Montero M. Dynamic left ventricular outflow tract obstruction secondary to catecholamine excess in a normal ventricle. Int J Cardiol 2006; 112 (03) 393-396