Carotid stenting for symptomatic radiation-induced arteritis complicated by recurrent aneurysm formation.
We describe a 56-year-old male who underwent successful carotid stenting (CS) with adjuvant distal protection in response to symptomatic radiation-induced carotid disease. During the CS procedure, it was incidentally noted that the lesion yield pressure was surprisingly low (2 atm). The patient returned with local symptoms from common carotid aneurysmal dilation at the proximal edge of the stent that was successfully treated with a stent graft. A second aneurysm developed proximal to the stent graft and, based on intravascular ultrasound mapping, he ultimately underwent venous bypass covered by a free-muscle graft. We believe the low lesion yield pressure in this case reflected loss of vessel integrity and it may be prudent to avoid oversizing the stent in such patients.
Bates
Mark C
MC
Cardiovascular Research Charleston Area Medical Center (CAMC), Health Education and Research Institute, Charleston, WV, USA. mark.bates@camc.org.
Almehmi
Ammar
A
D000016:Abnormalities, Radiation-Induced / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D000783:Aneurysm / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D015901:Angiography, Digital Subtraction; D001167:Arteritis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging / Q000601:surgery*; D016893:Carotid Stenosis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011878:Radiotherapy / Q000009:adverse effects; D012008:Recurrence; D015607:Stents; D014057:Tomography, X-Ray Computed; D014067:Tonsillar Neoplasms / Q000532:radiotherapy; D018616:Ultrasonography, Doppler, Duplex