Endovascular reconstruction for a kinked internal carotid artery after carotid endarterectomy

Although different surgical techniques have been reported for repairing kinked stenosis of the internal carotid artery (ICA) after carotid endarterectomy (CEA), there are no reports using endovascular reconstruction. We present the details of a case successfully treated by carotid artery stenting (CAS).

A 73-year-old female was referred to our department with fugacious amaurosis and transient sensory disturbance in the left upper limb due to moderate stenosis of the right ICA that was treated by CEA 28 days after admission. However, postoperative angiography and carotid Doppler revealed a kinked ICA with a high-flow velocity that was not present intraoperatively. After 3 months, she had suffered transient ischemic attacks that were refractory to medical treatment, so we performed CAS to prevent future events. The kinked ICA was immediately resolved by stenting and there was no restenosis at a follow-up angiogram 19 months later.

This case shows that CAS could be a potential therapeutic option for the management of symptomatic kinking stenosis of the ICA after CEA.