Carotid angioplasty and stenting in a patient with high grade stenosis of Internal Carotid Artery associated with both vertebral arteries and contralateral carotid occlusion

Document Type: Case Report

Authors

1 Endovascular Neurosurgeon, Department of Neurosurgery, Ghaem Hospital, Mashhad University of Medical Sciences,Mashhad,Iran

2 Interventional Cardiologist, Department of Cardiology, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

3 Neuro-interventionist, Department of Neurology, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

4 Neuroendovascular Division, Department of Neuro endovascular Surgery, Razavi Hospital, Mashhad, Iran.

Abstract

Severe internal carotid artery (ICA) stenosis is a common cause of cerebrovascular accident (CVA) in middle-aged patients. Contralateral carotid occlusion (CCO) in patients with severe ICA stenosis is associated with high risk of CVA. Carotid endarterectomy (CEA) is associated with more complications in patients with CCO than those without CCO. In this study, we present the case of a 61-year-old patient who presented with multiple transient ischemic attack and severe ICA stenosis associated with CCO and occlusion of vertebral arteries. The patient was treated successfully with carotid angioplasty and stenting.

Keywords


1.North American Symptomatic Carotid Endarterectomy Trial Collaborators, Barnett HJM, Taylor DW, Haynes RB, Sackett DL, Peerless SJ, et al. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med. 1991; 325:445-53.
2. Meerwaldt R, Hermus L, Reijnen MM, Zeebregts CJ. Carotid endarterectomy: current consensus and controversies. Surg Technol Int. 2010; 20:283-91.
3. Baker WH, Howard VJ, Howard G, Toole JF. Effect of contralateral occlusion on the long-term efficacy of endarterectomy in the asymptomatic carotid atherosclerosis study (ACAS). ACAS Investigators. Stroke. 2000; 31:2330-4.
4. AbuRahma AF, Metz MJ, Robinson PA. Natural history of > or =60% asymptomatic carotid stenosis in patients with contralateral carotid occlusion. Ann Surg. 2003; 238:551-61.
5. Ricotta JJ 2nd, Upchurch GR Jr, Landis GS, Kenwood CT, Siami FS, Tsilimparis N, et al. The influence of contralateral occlusion on results of carotid interventions from the Society for Vascular Surgery Vascular Registry. J Vasc Surg. 2014; 60:958-64.
6. Gonzalez A, Gonzalez-Marcos JR, Martinez E, Boza F, Cayuela A, Mayol A, et al. Safety and security of carotid artery stenting for severe stenosis with contralateral occlusion. Cerebrovasc Dis. 2005; 20:123-8.