History of Carotid Artery Reconstruction around the World and in Japan

Abstract

Since ancient times, physicians have been aware of correlations between the carotid artery and consciousness; however, carotid stenosis was only recently identified as the cause of atherothrombotic ischemic stroke. In 1658, Wepfer described the first suggestion of a link between symptoms of cerebral arterial insufficiency and carotid pathology. In 1951, Fisher reported details of the symptoms and pathological findings and emphasized that cervical atheromatous lesions induced cerebral infarction with various symptoms. The beginning of carotid artery surgery was ligation of the carotid artery for neck or head injury, but surgeons were aware that this operation induced cerebral symptoms due to lack of blood supply. Carotid endarterectomy (CEA) was first reported by Eastcott et al. in 1954, and in Japan, Kimoto performed a successful CEA in 1962. In 1979, percutaneous transluminal angioplasty (PTA) was performed for patients with fibromuscular dysplasia, and then, carotid artery stenting (CAS) was first performed in 1989 by Mathias. In Japan, Kuwana et al. were the first to perform carotid PTA, in 1981, whereas Yamashita et al. performed the first CAS in 1997. Yoshimura et al. proposed staged carotid stenting to prevent hyperperfusion syndrome. Some issues in carotid reconstruction are still debated today, which include conventional (standard) CEA versus the eversion technique, CEA versus CAS versus medical therapy, and medical economic problems. In the future, we must continue to develop more effective, safer, and less expensive therapeutic methods to prevent carotid stroke, carrying on the efforts of the ancient peoples who pioneered this research.

Keywords: carotid endarterectomy; carotid ligation; history; surgical treatment.

Fig. 1

The first surgeries on the carotid artery involved ligation of the carotid artery for patients with head or neck trauma to control massive bleeding.

Fig. 2

Historical transitions in surgical reconstruction of the carotid artery. A: Illustration of carotid artery stenosis due to atherosclerotic plaque. B: DeBakey et al. performed carotid endarterectomy with a primary closure. C: Eastcott et al. resected an atheromatous lesion in the internal carotid artery (ICA) and performed end-to-end reconstruction of the ICA and common carotid artery. D: Patch angioplasty as initially performed using the saphenous vein and then later using an artificial vascular membrane. E: The original eversion technique as first described by DeBakey et al., which involved cutting the carotid bifurcation and resecting the plaque. CCA: common carotid artery; ICA: internal carotid artery; ECA: external carotid artery; P: plaque. *Resected an atheromatous region of ICA.

Fig. 3

Historical transitions in the endovascular reconstruction of the carotid artery. A: Percutaneous transluminal angioplasty for patients with atherosclerotic carotid artery stenosis, initially without distal protection against embolism. B: Percutaneous transluminal angioplasty for patients with atherosclerotic carotid artery stenosis with a distal protection balloon to prevent embolism. C: Carotid artery stenting for patients with atherosclerotic carotid artery stenosis with distal protection balloon for the embolus. D: Carotid artery stent for patients with atherosclerotic carotid artery stenosis with distal filter protection device to protect against embolism. E: Carotid artery stenting for patients with atherosclerotic carotid artery stenosis using flow reversal methods with proximal common carotid and external carotid artery balloons. CCA: common carotid artery; ICA: internal carotid artery; ECA: external carotid artery; B: balloon; C: catheter; S: stent; DPB: distal protective balloon; F: distal filter protection device; PPB: proximal protection balloon; PB: protection balloon at the external carotid artery