[Carotid Artery Stenting for Non-bifurcating Cervical Carotid Artery Stenosis:A Case Report]

Non-bifurcating cervical carotid artery(NBCCA)is a rare carotid artery anomaly, occurring at a rate of only 0.2%. We report a case in which carotid artery stenting(CAS)was performed for NBCCA stenosis.

In a 69-year-old man had noted bilateral carotid artery stenosis was noted by chance during treatment for myocardial infarction. Carotid angiography revealed stenosis in both cervical carotid arteries, and the right side did not bifurcate(i.e. it was an NBCCA). Silent ischemia was observed in the left cerebral hemispheres in an MRI, and CAS was performed. A subsequent ultrasound examination revealed an increase in the peak systolic velocity in the right carotid artery, and CAS was planned for the right side. As it was not possible to use a guide-wire to guide into the external carotid artery, we planned to introduce it directly, approaching from the right brachial artery using a 6Fr Simmons guiding sheath. Angiography during distal balloon occlusion revealed significant retrograde flow from the facial and maxillary arteries to the internal carotid artery via the ophthalmic artery. Considering this finding, we decided to perform CAS with a femoral artery approach and flow reversal using distal and proximal balloon occlusion. Intraoperative embolism was prevented, and a successful treatment outcome was obtained.

There are few reports of NBCCA stenosis treated with carotid endarterectomy or CAS. As CAS to treat NBCCA stenosis has several drawbacks, such as the impossibility of anchoring the wire in the external carotid artery. It is important to take appropriate steps to prevent distal embolism.