Key result
Staged carotid endarterectomy following balloon angioplasty successfully treated a symptomatic double-lumen carotid plaque without causing hyperperfusion syndrome or ischemic complications.
Case Report (n=1)
No
Staged angioplasty with PTA followed by CEA may be a safe and effective strategy for treating symptomatic double-lumen carotid plaques while preventing hyperperfusion syndrome.
May support staged PTA-CEA in select double-lumen carotid plaques; hypothesis-generating and requires prospective validation.
症例は81歳，男性．右頚部内頚動脈狭窄の診断で内科的治療を行われていたが，左limb shakingが出現，progressive strokeと診断され当科紹介となった．magnetic resonance angiography（MRA）で右頚部内頚動脈狭窄の進行を認め，diffusion weighted imaging（DWI）で急性期梗塞を認めなかったものの，arterial spin labeling（ASL）では右大脳半球で著明な血流の遅延を認めた．脳血管撮影検査では右頚部内頚動脈は起始部が重複し，合流し1本となる所見で，MRI所見ともあわせdouble-lumen carotid plaqueと思われた．合流直後で最狭窄部（NASCET 80％）を形成，最狭窄部以遠の描出遅延を呈し，Willis輪を介した側副血行は認めなかった．過灌流症候群が懸念されたためstaged angioplasty（SAP）の方針とし，経皮経管的拡張術をまず施行した．拡張術翌日のASLで右大脳半球の血流は改善した．症候性かつ不整形の病変であり，2週後に頚動脈内膜剝離術（CEA）を行った．虚血性合併症，過灌流症候群ともにきたさず，limb shakingは消失し，症状なく自宅退院となった．
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Mano et al. (2024) conducted a case report in Symptomatic double-lumen carotid plaque (n=1). Staged angioplasty followed by carotid endarterectomy was evaluated on Clinical outcome (resolution of symptoms and absence of complications). Staged carotid endarterectomy following balloon angioplasty successfully treated a symptomatic double-lumen carotid plaque without causing hyperperfusion syndrome or ischemic complications.
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