title: Treatment strategy for bilateral carotid stenosis: 2 cases of carotid endarterectomy for the symptomatic side followed by carotid stenting.
abstract: Since the introduction of carotid stenting (CAS), a combined treatment for bilateral lesions using carotid endarterectomy (CEA) and CAS has been developed. However, there has been only 1 report about CEA then CAS. Herein we describe 2 patients with bilateral severe carotid stenosis who were treated by CEA for the symptomatic side and CAS for the contralateral asymptomatic side. A 71-year-old man underwent CEA for the symptomatic side. Although the patient suffered hyperperfusion syndrome after CEA, he recovered fully after 3 weeks of rehabilitation. Two months later, CAS was performed for the asymptomatic side, and he was discharged with no deficit. A 67-year-old man underwent CEA for the symptomatic side. The patient developed no postoperative neurologic deficits except for hoarseness. Four weeks later, CAS was performed for the contralateral asymptomatic side. After the procedure, however, severe hypotension occurred, and treatment by continuous injection of catecholamine was necessary to maintain systematic blood pressure. The patient was ultimately discharged with no deficit. The combined therapy of CAS for the asymptomatic side and then CEA for the symptomatic side has been recommended by several authors. However, one of the problems of this strategy is the higher incidence of postprocedural hemodynamic complications, and hypotension after CAS may be dangerous for the symptomatic hemisphere. We suggest a combined therapy using CEA for the symptomatic side and then CAS for the asymptomatic side can be 1 beneficial treatment option for patients with bilateral carotid stenosis without coronary artery disease.
authors.affiliation: Department of Neurosurgery, Kushiro Rousai Hospital, Kushiro-shi, Hokkaido, Japan. Electronic address: karimasa@med.hokudai.ac.jp.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Hokari
authors.affiliation: Department of Neurosurgery, Kushiro Rousai Hospital, Kushiro-shi, Hokkaido, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Isobe
authors.affiliation: Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa-shi, Hokkaido, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Asano
authors.affiliation: Department of Neurosurgery, Kushiro Rousai Hospital, Kushiro-shi, Hokkaido, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Itou
authors.affiliation: Department of Neurosurgery, Kushiro Rousai Hospital, Kushiro-shi, Hokkaido, Japan.
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Yamazaki
authors.affiliation: Department of Neurosurgery, Kushiro Rousai Hospital, Kushiro-shi, Hokkaido, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Chiba
authors.affiliation: Department of Neurosurgery, Kushiro Rousai Hospital, Kushiro-shi, Hokkaido, Japan.
authors.forename: Naotaka
authors.initials: N
authors.lastname: Iwamoto
authors.affiliation: Department of Neurosurgery, Kushiro Rousai Hospital, Kushiro-shi, Hokkaido, Japan.
authors.forename: Toyohiko
authors.initials: T
authors.lastname: Isu
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation*; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D002533:Cerebral Angiography / Q000379:methods; D002560:Cerebrovascular Circulation; D038524:Diffusion Magnetic Resonance Imaging; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D006439:Hemodynamics; D006801:Humans; D007022:Hypotension / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D018810:Magnetic Resonance Angiography; D008297:Male; D055420:Perfusion Imaging / Q000379:methods; D012720:Severity of Illness Index; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D014662:Vasoconstrictor Agents
keywords: Carotid endarterectomy; bilateral; carotid stenting; hyperperfusion syndrome