[A case of recurrent internal carotid stenosis, after carotid endarterectomy, due to strangulation by scarring].
A case of recurrent internal carotid stenosis, one year after carotid endarterectomy, due to strangulation by scarring composed of digastric muscle, hypoglossal nerve and a branch of external carotid artery (ECA) is reported in this paper. A 34-year-old male suddenly became nauseated and developed right hemiplegia and dysphasia. He was admitted to a hospital, and the symptoms and signs improved gradually during a period of several weeks. A left carotid angiography, performed in another hospital, revealed a stenosis and wall irregularity around the highly-situated carotid bifurcation. He was transferred to our clinic with a view to being operated on. On admission, neurological examination disclosed a mild right motor weakness and motor dysphasia. A right carotid angiography revealed good cross circulation to the opposite. An EEG monitoring under the Matas test showed no outbreaks. With diagnosis of an embolism arising from carotid atheromatous plaque, a carotid endarterectomy was performed successfully. A postoperative angiography revealed good patency without stenosis nor wall irregularity around the carotid bifurcation. The postoperative and out-clinic condition was uneventful. However, one year after the operation, a left carotid angiography revealed recurrent internal carotid stenosis in a high degree. A second operation was performed and the operative findings showed an internal carotid stenosis due to strangulation by scarring composed of digastric muscle, hypoglossal nerve, a branch of ECA and connective tissue. The scarring was decompressed and a postoperative angiography revealed an improvement of the stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)
Department of Neurosurgery, Prefectural Gifu Hospital.
S
S
Niikawa
H
H
Yamakawa
H
H
Kobayashi
T
T
Hattori
A
A
Ohkuma
D000328:Adult; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000601:surgery*; D002921:Cicatrix / Q000150:complications*; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D004691:Endarterectomy; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D011859:Radiography; D012008:Recurrence; D012086:Reoperation