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Published on: May 9, 2013
Hybrid surgery for symptomatic chronic complete occlusion of the internal carotid artery: A case report
1Department of Vascular Surgery, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Insights
A novel hybrid surgery combining carotid endarterectomy and stenting effectively treated a patient with complex chronic internal carotid artery occlusion. This approach offers a promising solution for challenging cases where single treatments fail.
Area of Science:
- Vascular Surgery
- Neurology
- Interventional Cardiology
Background:
- Symptomatic chronic internal carotid artery occlusion (CICAO) presents treatment challenges, especially with long occlusions and short initial stumps.
- Existing revascularization procedures like carotid endarterectomy (CEA) and endovascular intervention (EI) may be insufficient for complex CICAO.
- A 50-year-old male presented with neurological symptoms attributed to CICAO.
Purpose of the Study:
- To report a novel hybrid surgical technique for treating complex CICAO.
- To evaluate the efficacy and safety of combining CEA with internal carotid artery stenting in a challenging CICAO case.
Main Methods:
- A 50-year-old male diagnosed with symptomatic CICAO underwent a novel hybrid surgery.
- The procedure involved carotid endarterectomy (CEA) followed by internal carotid artery stenting.
- Post-operative follow-up included computed tomography angiography (CTA).
Main Results:
- The hybrid surgery successfully revascularized the occluded internal carotid artery.
- Computed tomography angiography (CTA) at 6 months confirmed an unobstructed artery.
- The patient experienced significant relief from neurological symptoms.
Conclusions:
- A hybrid approach of CEA combined with stenting is a viable and effective treatment for complex CICAO.
- This technique addresses limitations of single treatment modalities in challenging anatomical presentations.
- The reported case demonstrates successful symptom resolution and arterial patency post-intervention.
Abstract:
Currently, there are antiplatelet drugs, extracranial-intracranial (EC-IC) vascular bypass, carotid endarterectomy (CEA), endovascular intervention (EI), and other revascularization procedures for symptomatic chronic internal carotid artery occlusion (CICAO). In consulting the literature, we found that existing techniques for single treatments cannot achieve satisfactory results when there is a long segment occlusion with plaque attached to the intracranial segment and a short stump at the initial segment. We reported the case of a 50-year-old male patient with blurred vision, headache, and weakness in the right upper limb. After the exclusion of other neurological diseases, he was diagnosed with symptomatic CICAO; the occlusion segment was long and the stump was too short. We performed a novel hybrid surgery for the patient-a carotid endarterectomy combined with internal carotid artery stenting. After 6 months of follow-up, computed tomography angiography (CTA) confirmed that the left internal carotid artery was unobstructed, and the symptoms were relieved. A brief review of the literature is presented in addition to this report.
