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Hybrid approach in tandem high-grade carotid stenoses: A case report
Valentin Govedarski1, Elitsa Dimitrova1, Dimiter Chernev1
1Department of Vascular Surgery, University Hospital Saint Ekaterina, Sofia, Bulgaria.
Insights
A 79-year-old man with a history of stroke experienced dizziness and syncope due to severe carotid artery stenosis. Successful carotid endarterectomy and retrograde stenting resolved his symptoms and restored blood flow.
Area of Science:
- Vascular Surgery
- Neurology
- Cardiology
Background:
- A 79-year-old male patient presented with dizziness and syncopal episodes.
- Medical history included arterial hypertension, multifocal atherosclerosis, two prior ischemic strokes, coronary artery bypass grafts, and peripheral artery disease.
Observation:
- Imaging revealed severe stenosis of the left internal carotid artery and high-grade ostial stenosis of the left common carotid artery.
- The patient experienced neurological symptoms including dizziness and syncope.
Findings:
- A surgical procedure involving carotid endarterectomy with patch angioplasty and retrograde stenting of the left common carotid artery was performed.
- Postoperative computed tomography angiography showed no residual carotid stenosis.
Implications:
- The successful intervention resolved the patient's neurological symptoms.
- This case highlights a combined surgical approach for complex carotid artery disease presenting with transient ischemic symptoms.
Abstract:
A 79-year-old male patient who presented with dizziness and several syncopal episodes was admitted to our clinic. Medical history of the patient revealed arterial hypertension and multifocal atherosclerosis with a history of two ischemic left middle cerebral artery strokes within the last year, without residual deficits, two coronary artery bypass grafts 22 years ago, and Stage IIB peripheral artery disease. The imaging studies revealed severe stenosis of the left internal carotid artery and high-grade ostial stenosis of the left common carotid artery. After clamping of the internal carotid artery and endarterectomy with patch angioplasty, before the patch was completely sutured, a sheath was placed through it and dilation and retrograde stenting of the proximal segment of the left common carotid artery were performed. The neurological symptoms of the patient disappeared and on postoperative computed tomography angiography, there was no residual carotid stenosis.
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