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[Percutaneous transluminal angioplasty for cervical internal carotid artery stenosis: case report]
A Yamamura1, K Shibata, T Okuyama
1Department of Neurosurgery, Hakodate Municipal Hospital.
Insights
Percutaneous transluminal angioplasty (PTA) effectively treated severe internal carotid artery (ICA) stenosis with ulcerative plaque in a stroke patient. This interventional procedure offers a viable alternative for patients unsuitable for surgery.
Area of Science:
- Vascular Neurology
- Interventional Cardiology
- Cerebrovascular Disease
Background:
- Cervical internal carotid artery (ICA) stenosis with ulcerative plaque poses a significant risk for ischemic stroke.
- Conservative management is often considered for patients with comorbidities or complex anatomy.
Observation:
- A 70-year-old male presented with acute neurological deficits suggestive of stroke.
- Initial imaging revealed no abnormalities, but subsequent angiography demonstrated severe right ICA stenosis with an ulcerative plaque.
- Despite initial conservative treatment, the patient's condition worsened, indicating progression of the ischemic event.
Findings:
- The patient underwent successful percutaneous transluminal angioplasty (PTA) using a balloon dilatation catheter for the stenosed right ICA.
- The procedure achieved adequate dilatation without any immediate complications.
- Post-procedural outcomes were favorable, resolving the critical stenosis.
Implications:
- PTA is a safe and effective treatment option for internal carotid artery stenosis, particularly in patients with ulcerative plaque.
- This endovascular approach provides a valuable alternative to surgical intervention for high-risk patients.
- The findings support the expanded use of PTA in managing cerebrovascular disease, including vertebral artery interventions.
Abstract:
We encountered one case of right cervical internal carotid artery (ICA) stenosis with ulcerative plaque. The patient was treated using percutaneous transluminal angioplasty (PTA). A 70 year-old man complained of left motor weakness and left hemidysesthesia. CT scan on the day of admission showed no abnormal findings. Angiographical findings revealed a severe right ICA stenosis with ulcerative plaque. We first treated the patient conservatively because of high-positioned carotid bifurcation, bronchial asthma and hypertension. 20 hours after the stroke, left motor weakness gradually worsened and CT scan revealed multiple low-density areas in the right fronto-parieto-occipital watershed region. Because of this, we treated the stenosed ICA by PTCA balloon dilatation catheter, and successfully obtained adequate dilatation with no complications. We propose that PTA of ICA stenosis, as well as PTA of the vertebral region, is a useful method for patients who have conditions which would make surgical operations risky.