Emergency placement of stent-graft for symptomatic acute carotid artery occlusion after endarterectomy

Abstract

SUMMARYA patient underwent a left-sided carotid endarterectomy (CEA) for an asymptomatic 80% carotid artery (CA) stenosis. There were no signs of intolerance during the carotid cross-clamping and an initially uneventful awakening was observed. However, in the third postoperative hour he experienced left amaurosis and dysarthria. An urgent MRI showed an occluded internal CA on the operated site without evidence of acute infarction. To recanalize the occluded internal CA and minimize leakage from the arteriotomy site, a selfexpandable stent-graft was placed, covering the dissection and the distal atherosclerotic lesions. Complete recanalization of the left internal CA was achieved and the patient showed a dramatic improvement of his preoperative deficits. To our knowledge, this is the first case of stent-graft implantation for a symptomatic acute CA occlusion following CEA. Stent-graft placement should be considered as an alternative method of treatment for acute CA occlusion or dissection following CEA. BACKGROUND

Case of effective suction to secure the true lumen for acute occlusion after carotid endarterectomy

“…When dissection occurs, adhesion of a thrombus to the flap at the dissection site may cause acute occlusion. According to some reports, stent implantation is effective in treating arterial dissection following CEA [1 , 4 , 5] .…”