Macroscopic and pathohistological investigation of endarterial plaque after intraoperative balloon dilatation of the carotid artery during carotid endarterectomy Masahiro NISHIDA 1 , Takeshi SHIMA 1 , Yoshikazu OKADA 2 , Kanji YAMANE 1 , Takashi HATAYAMA 1 , Chie YAMANAKA 1 , Akihiro TOYOTA 1 , Toshihiro NISHIDA 3 1Department of Neurosurgery, Chugoku Rousai Hospital 2Department of Neurosurgery, Shimane Medical College 3Department of Pathology, Chugoku Rousai Hospital Keyword: carotid endarterectomy , percutaneous transluminal angioplasty , pathohistology , intraoperative investigation pp.1075-1082
Published Date 1998/12/10
DOI https://doi.org/10.11477/mf.1436901647
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Twelve patients associated with stenosis of the extracranial carotid artery underwent intraluminal bal-loon dilatation during carotid endarterectomy (CEA). There were 11 men and 1 woman, and age rangedfrom 56 to 73 years old. The rate of stenosis, shown by angiography, in each patient was from 60 to 85%in width. After securing carotid blood flow by a T-shaped shunt tube, a balloon catheter was inserted fromthe exposed common carotid artery into the internal carotid artery. The balloon was inflated three or fourtimes with 2.5-3.5 atm. for 30-40 seconds. Immediately after balloon dilatation, endoscopic investigationwas performed (Wolf; hard type emloscope, 2.7mm diameter). Then CEA was performed using the usualprocedure. The removed endarterial plaque was investigated pathohistologically.

In macroscopic and encloscopic findings, there were 6 patients with mural thrombosis, 4 patients withlaceration of the intima, and one patient with outflow of atheroma from the intima. Only 3 patients had in-crease in lumen after balloon dilatation. In pathohistological appearance, all patients had a moderate de-gree of fibrosis, calcification, and atheroma in the cross section of the plaque. Ten patients had intramuralhemorrhage.

Three typical patients were revealed by the use of angiographical, ultrasonographical, endoscopic, andpathohistological presentation. Case 10 showed laceration of the intima by balloon dilatation, and had mod-erate increase in lumen size macroscopically and endoscopically. There were moderate cases of fibrosis,calcification, atheroma, and intramural hemorrhage. Dilatation of the lumen seemed to be accomplished bya decrease in thickness of the atheroma and intramural hemorrhage. Case 8 demonstrated an increase in lu-men size, but also laceration of the intima and outflow of atheroma from the arterial wall. There weremuch atheroma and large intramural hemorrhage in the intima, which might become a source of enbolism.Case 7 revealed no laceration of the intima and no increase in lumen size. Preoperative ultrasonography

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