Key result
Emergency carotid stenting achieves complete recanalization and clinical recovery in acute post-endarterectomy occlusion.
Why the study?
Emergency treatment options for symptomatic acute carotid artery occlusion following carotid endarterectomy are not well established.
Case Report (n=1)
No
Emergency stent placement may be considered as an alternative method of treatment for acute carotid artery occlusion or dissection following carotid endarterectomy.
May support emergency stenting after post-CEA occlusion; leaves open need for prospective trials before practice change.
The authors report a case of emergency carotid artery (CA) stent placement for a symptomatic acute CA occlusion following carotid endarterectomy (CEA). This 43-year-old man underwent a right-sided CEA for an asymptomatic 80% CA stenosis detected using duplex ultrasound testing. The patient experienced hypotension and possibly a myocardial infarction intraoperatively and a left hemiplegia immediately postoperatively. He was referred to the authors' institution for consideration of emergency coronary intervention and evaluation of stroke. A computerized tomography scan of the head demonstrated subtle early ischemic changes in the right posterior parietal region. Cerebral angiography revealed occlusion of the right common CA (CCA) at the CA bifurcation. Two coronary stents (Magic Wall; Boston Scientific Scimed, Maple Grove, MN) were placed in tandem in the right CCA and internal CA (ICA), overlapping at the proximal cervical ICA. Complete recanalization of the CA was achieved, and the patient made a clinically significant recovery. Diagnostic angiography can provide important information about CA and intracranial circulation that will aid in the evaluation of postoperative stroke after CEA. Stent placement should be considered as an alternative method of treatment for acute CA occlusion or dissection following CEA.
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Kim et al. (2004) conducted a case report in Symptomatic acute carotid artery occlusion following carotid endarterectomy (n=1). Emergency carotid artery stent placement was evaluated on Recanalization and clinical recovery. Emergency carotid artery stent placement achieved complete recanalization and clinically significant recovery in a 43-year-old man with acute carotid artery occlusion following endarterectomy.