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: D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D002533:Cerebral Angiography; D002548:Cerebral Revascularization / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009072:Moyamoya Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D015607:Stents
keywords: Angioplasty; Intervention; Stenosis; Stent
references.citation: J Vasc Surg. 2013 Jul;58(1):145-51.e1
references.pmid: 23490297
references.citation: J Korean Neurosurg Soc. 2009 Nov;46(5):488-91
references.pmid: 20041061
references.citation: J Endovasc Ther. 2004 Dec;11(6):727-33
references.pmid: 15615564
references.citation: J Neurosurg. 2007 Dec;107(6):1217-22
references.pmid: 18077961
references.citation: Acta Pathol Jpn. 1991 Jul;41(7):521-30
references.pmid: 1755318
references.citation: Neurosurgery. 2008 May;62(5 Suppl 2):ONS395-9; discussion ONS399
references.pmid: 18596520
references.citation: Int Angiol. 2012 Feb;31(1):16-21
references.pmid: 22330620
references.citation: Acta Neurochir (Wien). 2000;142(4):421-4
references.pmid: 10883339
references.citation: Neurosurgery. 2010 Aug;67(2):314-21
references.pmid: 20644416
references.citation: Neurol Med Chir (Tokyo). 2012;52(12):906-9
references.pmid: 23269047
references.citation: Clin Neurol Neurosurg. 2009 Oct;111(8):695-8
references.pmid: 19559521
references.citation: Stroke. 2000 Mar;31(3):733-7
references.pmid: 10700512
references.citation: J Vasc Surg. 2005 Dec;42(6):1210-2
references.pmid: 16376216
references.citation: Case Rep Med. 2012;2012:532329
references.pmid: 22567018
references.citation: Stroke. 1991 Nov;22(11):1358-62
references.pmid: 1750042
references.citation: J Endovasc Ther. 2007 Jun;14(3):304-6
references.pmid: 17723022
references.citation: Acta Neurochir (Wien). 1999;141(3):323-4
references.pmid: 10214491
references.citation: Neurol Med Chir (Tokyo). 2007 Aug;47(8):356-9
references.pmid: 17721051
references.citation: Stroke. 1996 Oct;27(10):1750-4
references.pmid: 8841323
references.citation: Neurosurgery. 1992 Sep;31(3):398-400
references.pmid: 1407420
references.citation: J Vasc Surg. 2001 Nov;34(5):943-6
references.pmid: 11700499
references.citation: Cardiovasc Surg. 1997 Oct;5(5):457-8
references.pmid: 9464598