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Published on: July 9, 2020
[Carotid endarterectomy preceding distal plaque-end dissection followed by internal shunt insertion: a case report]
Hideki Endo1, Kenji Kamiyama, Hidekazu Takada
1Department of Neurosurgery, Nakamura Memorial Hospital, Minami 1, Nishi 14, Chuo-ku, Sapporo, Hokkaido 060-8570, Japan.
Insights
A novel carotid endarterectomy technique involving distal plaque-end dissection and internal shunt insertion successfully treated a patient with severe carotid artery stenosis and stroke. This approach prevented embolic complications during the surgical procedure.
Area of Science:
- Vascular Surgery
- Neurology
- Interventional Cardiology
Background:
- A 60-year-old male presented with right hemiparesis and multiple left hemisphere infarcts.
- Angiography revealed high-grade left internal carotid artery stenosis with calcification.
- The patient also had anemia due to bladder cancer-related hematuria.
Observation:
- Surgical planning for carotid endarterectomy was complicated by the extensive progression of atheromatous plaque.
- Concerns existed regarding potential embolic complications with standard internal shunt insertion.
- A modified technique of distal plaque-end dissection followed by internal shunt insertion was employed.
Findings:
- The modified surgical approach allowed for successful plaque removal and revascularization.
- The procedure avoided embolic complications despite the challenging plaque morphology.
- Successful revascularization was achieved in this complex case.
Implications:
- This case demonstrates a viable alternative surgical strategy for complex carotid artery stenosis.
- The technique may be beneficial in preventing embolic events during carotid endarterectomy.
- Further research could explore the broader applicability of this modified approach in vascular surgery.
Abstract:
We report a case of carotid endarterectomy preceding distal plaque-end dissection followed by internal shunt insertion. A 60-year-old man was admitted to hospital with right hemiparesis. Magnetic resonance imaging detected multiple fresh infarcts in the left hemisphere, and the patient was transferred to our hospital. Angiography revealed high-grade stenosis in the left internal carotid artery at the level of the second cervical vertebra. Computed tomography angiography showed calcification in the proximal and the distal side of the stenotic lesion in the left carotid artery. The lesion was thought to be high position though an accurate assessment of the distal tip was difficult. The patient also received a blood transfusion for advanced anemia due to gross hematuria associated with bladder cancer. Carotid endarterectomy was performed one month after onset. Because atheromatous plaque had progressed far from the incision, we considered that arterial shunt insertion would induce embolic complications. Thus, we proceeded with distal plaque-end dissection, and then inserted the internal shunt and removed the plaque. This procedure resulted in successful revascularization.
