[A case of emergency carotid endarterectomy to cope with vertebrobasilar insufficiency]
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A Hirano1, S Matsumura, Y Maeda
1Department of Neurosurgery, Hakodate City Hospital.
Insights
Emergency carotid endarterectomy successfully treated a patient with severe carotid stenosis and vertebral artery occlusion, preventing brain infarction. The procedure restored blood flow, resolving neurological deficits from vertebrobasilar insufficiency.
Area of Science:
- Vascular Surgery
- Neurology
- Interventional Cardiology
Background:
- Transient ischemic attack (TIA) and vertebrobasilar insufficiency indicate critical cerebrovascular disease.
- Severe carotid stenosis and vertebral artery occlusion pose a high risk of acute ischemic stroke.
- Neurological deterioration following angiography suggests compromised cerebral perfusion.
Abstract:
This is a report of an emergency carotid endarterectomy preformed on a 59 year-old male. He had been suffering from TIA of vertebrobasilar insufficiency since 1 day prior to admission. Angiography revealed severe stenosis and ulceration of the left cervical carotid bifurcation and occlusion of the bilateral vertebral arteries. Six hours after angiography, he showed hemiparesis, decerebrated posture and consciousness disturbance. These neurological signs were considered to be derived from occlusion of the left carotid bifurcation and disappearance of the collateral circulation via the left posterior communicating artery. Emergency carotid endarterectomy was performed to prevent brain infarction of the anterior and posterior circulation. Postoperative angiography showed disappearance of the stenosis of the carotid bifurcation and the recanalization of the left vertebral artery, and of the atherosclerotic stenosis of the left intracranial vertebral artery. It was considered that the left vertebral artery had been occluded by growth of a local thrombosis at the left intracranial vertebral artery.