Urgent endarterectomy using pretreatment with free radical scavenger, edaravone, and early clamping of the parent arteries for cervical carotid artery stenosis with crescendo transient ischemic attacks caused by mobile thrombus and hemodynamic cerebral ischemia. Case report.
A 68-year-old man with left cervical internal carotid artery stenosis suffered crescendo transient ischemic attacks caused by mobile thrombus detected by carotid echography and secondary impairment of cerebral hemodynamic reserve demonstrated by positron emission tomography. Urgent carotid endarterectomy (CEA) was performed following pretreatment with edaravone and early clamping of the carotid arteries without intraluminal shunting. The postoperative course was uneventful, and postoperative magnetic resonance imaging and single-photon emission computed tomography revealed no new cerebral ischemic lesions and no findings of cerebral hyperperfusion, respectively. The risks associated with CEA are higher for patients with evolving stroke or crescendo transient ischemic attacks than that for patients with stable disease. This case demonstrates that urgent endarterectomy for cervical carotid artery stenosis with crescendo transient ischemic attacks caused by mobile thrombi and hemodynamic cerebral ischemia can be successfully performed following pretreatment with edaravone and early clamping of the carotid arteries.
Kobayashi
Masakazu
M
Department of Neurosurgery and Cyclotron Research Center, Iwate Medical University, Iwate, Japan.
Ogasawara
Kuniaki
K
Inoue
Takashi
T
Saito
Hideo
H
Komoribayashi
Nobukazu
N
Suga
Yasunori
Y
Ogawa
Akira
A
D000368:Aged; D000983:Antipyrine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016893:Carotid Stenosis / Q000150:complications / Q000628:therapy*; D000077553:Edaravone; D016894:Endarterectomy, Carotid / Q000379:methods*; D016166:Free Radical Scavengers / Q000627:therapeutic use*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology*; D008297:Male; D013927:Thrombosis / Q000150:complications*
D016166:Free Radical Scavengers; D000077553:Edaravone; D000983:Antipyrine