[Restenosis of carotid artery after stenting associated bleeding in the vascular wall].
Stenting is an alternative procedure to the endarterectomy in patients with severe (> 70 %) symptomatic stenosis of the carotid artery. Its value is actually tested in large controlled randomised multicenter studies. Many vascular surgeons postulate no benefits for the patients but a higher complication rate for the stenting procedure. Especially the possibility of mechanical irritations of the endothel caused by the stent itself seems to be a major problem. Despite thousands of stenting procedures of the carotid artery, there exist no reports of patients with direct mechanical irritation of the carotid artery through the stent itself. It is only published a higher risk of embolisation. This case of a 71-years old patient, who had a irradiation of the head and neck region 5 years ago for cancer therapy, is presented here. After the irradiation (60 gr) the stent was not so fixed in the carotid wall as usually. Therefore the stent caused a mechanical irritation of the sclerotic plaque with a bleeding in the carotid wall and subsequent severe stenosis at the end of the stent with higher level of infarction volume. This case demonstrates the risk of the theoretical postulated irritation of the endothel through the stent itself in a high movement region.
Omlor
G
G
Klinik für Allgemeine, Viszeral- und Gefässchirurgie, Katholische Kliniken Essen-Nord gGmbH. g.omlor@kken.de
Kruschke
A
A
Müller
K
K
Kastrup
O
O
D000368:Aged; D000792:Angiography; D002343:Carotid Artery, Internal / Q000528:radiation effects; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery* / Q000628:therapy; D016894:Endarterectomy, Carotid; D005500:Follow-Up Studies; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000532:radiotherapy; D008297:Male; D011878:Radiotherapy / Q000009:adverse effects; D011879:Radiotherapy Dosage; D012008:Recurrence; D015607:Stents / Q000009:adverse effects*; D013997:Time Factors; D018608:Ultrasonography, Doppler