Treatment of carotid tandem stenosis by combined carotid endarterectomy and balloon angioplasty: technical case report.
OBJECTIVE
Cervical internal carotid artery disease associated with high-grade carotid siphon stenosis poses a therapeutic challenge. This report describes the combination therapy of carotid end-arterectomy and intraoperative transluminal balloon angioplasty of the carotid siphon.


METHODS
A 67-year-old man sustained repeated left hemispheric and retinal transient ischemic attacks. Results of a diagnostic examination, including angiography, disclosed a 70% ulcerative stenosis of the left extracranial internal carotid artery as well as a 90% stenosis of the left intracavernous carotid artery. The decision was made for combined open and endovascular therapy.


METHODS
After standard endarterectomy, an introducer for the dilation catheter was placed into the common carotid artery before final closure of the arteriotomy and recirculation. Under intraoperative fluoroscopy, a 3-mm dilation balloon was navigated into the carotid siphon stenosis and inflated several times. A 30% residual stenosis in the carotid siphon was obtained as a final result. The intervention was completed without complications. No further neurological symptoms were observed during the follow-up period of 30 months.


CONCLUSIONS
Carotid endarterectomy, combined with intraoperative transluminal angioplasty of carotid siphon stenosis, is a feasible procedure for selected patients with carotid tandem stenosis.
Department of Neurosurgery, Academic Hospital Bogenhausen, Munich, Germany.
D C
DC
Widenka
A
A
Spuler
H J
HJ
Steiger
D000368:Aged; D000800:Angioplasty, Balloon / Q000295:instrumentation*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000601:surgery; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D002533:Cerebral Angiography; D003131:Combined Modality Therapy; D016894:Endarterectomy, Carotid / Q000295:instrumentation*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D013525:Surgical Instruments