History of Carotid Occlusions: The Contribution of Egas Moniz.

OBJECTIVE: To describe the first cases of carotid occlusions identified by the Portuguese neurologist Egas Moniz while performing the cerebral angiography he invented. METHODS: We reviewed the publications of Egas Moniz on the subject of cerebral angiography and ischemic stroke. RESULTS: We identified the first description of carotid occlusion a situation unknown until then. Also, some of the carotid occlusions he described were suggestive of dissection an unknown situation. Nevertheless, he admitted the role of trauma in such cases by lesioning the intimal layer and he also described the characteristic post-bulbar "bezel-like" image of dissection. CONCLUSIONS: In 1936 Egas Moniz described, for the first time, one case of carotid occlusion a situation unknown until then. He also described some of the characteristic aspects of carotid dissections. Carotid occlusions were only thoroughly described in English literature more than a decade later with the well-known work of Miller Fisher, in 1951.

[Charles Miller Fisher: the grandmaster of neurological observation].

Charles Miller Fisher is widely regarded as the father of modern stroke neurology. He discovered almost all pathomechanisms of cerebral infarction, including embolism from atrial fibrillation, carotid artery disease, and lacunar infarcts and their syndromes, by the most meticulous clinico-pathological observations. Moreover, his work provided the basis for treatments such as anticoagulation, antiplatelet therapy, and carotid endarterectomy. He also contributed greatly to several topics of General Neurology; for example, migraine, normal pressure hydrocephalus, and Miller Fisher syndrome. In his late years, he tried to expand the neurological field to the more complex disorders of human behavior, including hysteria, dementia, and ill-defined pain syndromes. He thus became known as the grandmaster of refined neurological observation. His lifelong detailed studies were crucially important in helping neurologists all over the world recognize disorders and syndromes that had not previously been understood.

History of carotid surgery: from ancient greeks to the modern era.

A relationship between decreased carotid arterial flow and apoplectic manifestations was already suspected by the ancient Greeks. Early attempts at carotid surgery, however, were limited to emergency arterial ligation in patients with neck trauma. Attempts to suture arterial stumps together to restore blood flow paved the way for Carrel's revolutionary idea of reconstructing the resected or injured arterial segment with an interposition vein graft. DeBakey and Eastcott were the first to perform carotid endarterectomy in North America and the United Kingdom, respectively. In 1959, DeBakey proposed a cooperative study to assess the effectiveness of carotid endarterectomy in the treatment and prevention of ischemic cerebrovascular disease. The study was officially designated the Joint Study of Extracranial Arterial Occlusion and represented the first trial in the United States in which large numbers of patients were randomly allocated to surgical or nonsurgical therapy.

[Variants of reconstruction of carotid bifurcation in patients with atherosclerosis: history and current state of the art].

A historical review of reconstructive surgery for atherosclerotic lesions of carotid bifurcation is presented along with indications for the use of various methods of vascularization of internal carotid artery based on the experience gained at the Department of Vascular Surgery, A.V. Vishnevsky Institute of Surgery.

In memoriam of Michael Ellis DeBakey. Alternative reconstructions of carotid bifurcation for atherosclerosis: the history and the latest advances.

The paper overviews the history of reconstructive surgery for atherosclerotic lesions of carotid bifurcation, as well as indications for various revascularization procedures for internal carotid artery, based on the experience of the Vascular Surgery Department, A. V. Vishnevsky Institute of Surgery, and in particular, on 205 interventions that were carried out in 2006.

How did stroke become of interest to neurologists?: a slow 19th century saga.

It was not until the first half of the 19th century that the vascular nature of strokes was readily recognized and accepted. Brain "softenings" were distinguished from hemorrhagic "apoplexy," but stroke etiology remained unstudied. The terms artherosclerosis, thrombosis, embolism, and lacune were introduced to indicate etiology, but carotid occlusive disease was recognized later, in the second half of the 19th century. The development of knowledge of stroke was slow, likely corresponding to limited interest by the great early neurologists: stroke never was a field of critical interest in the Salpêtrière and Pitié Schools at the time of the local leading figures, Vulpian and Charcot. By contrast, scarce studies were due to isolated physicians, who did not contribute much to other fields, including Rochoux, Rostan, Durand-Fardel, or Dechambre; critical advances came from pathologists such as Rokitansky and Virchow. The interest in stroke among neurologists generally was clearly triggered by the development of clinical-topographic correlation studies, promoted by Déjerine and Marie, and followed by Foix, the father of modern clinical stroke research.

Vasovagal syncope in the Canon of Avicenna: the first mention of carotid artery hypersensitivity.

Ibn Sina, known as Avicenna in the West, was a celebrated Persian thinker, philosopher, and physician who is remembered for his masterpiece, The Canon of Medicine. The Canon that served as an essential medical encyclopedia for scholars in the Islamic territories and Europe for almost a millennium consisted of 5 books. In the third book, Avicenna described patients with symptoms of carotid hypersensitivity syndrome. These patients, who had excessive yawning, fatigue, and flushing, dropped following pressure on their carotids. Based on such history, it seems that Avicenna was the first to note the carotid sinus hypersensitivity, which presents with vasovagal syncope following compression of the carotid artery. In this paper, we presented a brief account of Avicenna's life and works and discuss his description of the so-called carotid hypersensitivity syncope. Notwithstanding his loyalty to the Greek theory of humoralism, Avicenna set forth his own version of "theory of spirits" to explain the mechanism of this disease. An account of the theory of spirits is also given.

From Hippocrates to Palmaz-Schatz, the history of carotid surgery.

The extracranial carotid artery is the most common site for peripheral vascular procedures. Although the association of carotid disease and neurologic dysfunction was understood by the ancient Greeks, over 1700 years would pass before the relevant anatomy was described. In the 16th and 17th centuries, attempts at treatment of carotid injury and aneurysm by ligation were met with extremely high rates of stroke and death. It is not until the mid 20th century, with the introduction of carotid angiography and improved vascular surgical techniques, that the era of reconstructive carotid surgery begins. We present a synopsis of the history of carotid surgery from ancient times to present day.

The neglected research of Egas Moniz of internal carotid artery (ICA) occlusion.

Egas Moniz is generally remembered for having discovered cerebral angiography in 1927, and having introduced lobotomy as a form of treatment for mental illness in 1935. Less well known is his pioneering research on occlusive cerebrovascular disease, namely internal carotid artery (ICA) occlusion, as documented by cerebral angiography. It is our contention that the medical community has, until recently, largely overlooked this research. His neglected observations on ICA occlusion and the important diagnostic role played by angiography are reviewed. We propose to show how our paper differs from previous publications regarding Moniz's ICA occlusion contributions. Whereas most previous reviews have focused on either the role played by cerebral angiography in the diagnosis of ICA occlusion, or on the importance of Moniz's internal carotid occlusion observations, our review attempts to integrate both topics. We will tie Moniz's ICA occlusion research to his documented use of angiography.

History of carotid surgery.

The history of carotid surgery begins not with the detailing of the various surgical procedures, as might be imagined, but with a history of the understanding of the nature of carotid occlusive disease. It was only through an understanding of the basis of this disease that a rational surgical treatment could be formulated. Following a well-characterized disease process, surgical strategies were developed and refined during the first half of the twentieth century. After these surgical techniques had been refined, a number of national and international trials were performed to better determine which patients were candidates for surgical intervention. Currently, endovascular treatment stands on the horizon as a new therapeutic modality with which carotid occlusive disease may be treated.