Stepwise revascularization by carotid endarterectomy after balloon angioplasty for symptomatic severe carotid artery stenosis.
The authors report a novel stepwise carotid revascularization method to prevent perioperative complication. A 68-year-old man presented with left hemiparesis and dysarthria caused by severe stenosis of the right cervical internal carotid artery. According to the preoperative cerebral blood flow evaluation and plaque characterization, the patient was at risk for postoperative hyperperfusion and ischemic complications after carotid artery stenting. Initially, the patient underwent percutaneous angioplasty using an undersized balloon. Fifteen days later, the patient underwent a carotid endarterectomy. The surgical specimen obtained during the carotid endarterectomy showed the presence of typical vulnerable plaque. Of note was the complete preservation of the thin fibrous cap. The postoperative single-photon emission tomography images showed no signs of hyperperfusion, and the patient developed no neurological symptoms after each of the procedures.
Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Japan. egashi@gifu-u.ac.jp
Yusuke
Y
Egashira
Shinichi
S
Yoshimura
Kiyofumi
K
Yamada
Yukiko
Y
Enomoto
Takahiko
T
Asano
Toru
T
Iwama
D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D016893:Carotid Stenosis / Q000150:complications / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D002533:Cerebral Angiography; D002560:Cerebrovascular Circulation; D003131:Combined Modality Therapy; D038524:Diffusion Magnetic Resonance Imaging; D004401:Dysarthria / Q000209:etiology; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D010291:Paresis / Q000209:etiology; D058226:Plaque, Atherosclerotic; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D012720:Severity of Illness Index; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome