title: External carotid stenting for symptomatic stenosis in a patient with patent EDAS for Moyamoya disease.
abstract: BACKGROUND
  Moyamoya disease is characterized by progressive narrowing of the internal carotid artery (ICA). Symptomatic patients typically undergo cerebrovascular intervention via extracranial-intracranial (EC-IC) bypass, most often with the use of the superficial temporal artery. This case of Moyamoya disease is of particular interest as the patient presented with a unilateral atherosclerotic external carotid artery (ECA) stenosis after EC-IC bypass that eliminated the benefit of his original surgery, resulting in a symptomatic presentation.
  
  
  METHODS
  A 53-year-old man presenting with Moyamoya disease and known left ICA occlusion had received a bilateral encephaloduroarteriosynangiosis (EDAS) bypass 10 years previously. He re-presented complaining of right-sided tingling, weakness, and numbness radiating up the arm. CT angiography indicated significant stenosis of the left ECA. ECA angioplasty and stenting with a distal protection device resulted in resolution of his symptoms.
  
  
  CONCLUSIONS
  This case illustrates that a patient presenting with Moyamoya disease and concurrent symptomatic ECA stenosis post-EDAS can be effectively and safely treated with ECA stenting.
authors.affiliation: College of Medicine, University of Kentucky, Lexington, Kentucky, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Schmidt
authors.affiliation: Department of Neurological Surgery, University of Kentucky, Lexington, Kentucky, USA.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Parker
authors.affiliation: Department of Neurological Surgery, University of Kentucky, Lexington, Kentucky, USA.
authors.forename: Justin F
authors.initials: JF
authors.lastname: Fraser
mesh_terms: D017536:Carotid Artery, Common / Q000000981:diagnostic imaging / Q000601:surgery; D002342:Carotid Artery, External / Q000000981:diagnostic imaging / Q000601:surgery; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D002548:Cerebral Revascularization / Q000379:methods; D016894:Endarterectomy, Carotid / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009072:Moyamoya Disease / Q000150:complications*; D011859:Radiography; D015607:Stents
keywords: Angioplasty; Intervention; Stenosis; Stent