Usefulness of Hybrid Surgery Combining CEA and CAS for Carotid Artery Stenosis with a Large Amount of Vulnerable Plaque

Abstract

For carotid artery stenosis with a large amount of vulnerable plaque in a wide range, we performed a hybrid surgery combining carotid endarterectomy (CEA) and carotid artery stenting (CAS), and report the results of treatment. Methods: Surgical treatment for carotid artery stenosis in 216 patients was performed between January 2016 and June 2018. Of these, 15 patients were treated in a hybrid operating room because both CEA and CAS were judged to be risky.We treated these patients with preparation of stenting for remote lesions far from the CEA arterial incision. The perioperative treatment results were retrospectively examined.Results: Of the 15 patients treated in a hybrid operating room, 10 were stented after CEA. All these cases were treated by retrograde stent placement in the proximal common carotid artery (CCA). Treatment was completed in all patients, and no cerebral infarction, myocardial infarction, or death was observed in the perioperative period. There were no cases of additional neurological events during the follow-up period, but asymptomatic restenosis was observed in one patient. Conclusion:Hybrid surgery combining CEA and CAS was considered to be an effective treatment for carotid artery stenosis with a large amount of vulnerable plaque.

Stenting for subclavian steal phenomenon to restore cerebral perfusion due to acute carotid occlusion following carotid endarterectomy: a case report

“…In this case, a combined therapeutic approach has been proposed for long lesions from the proximal CCA. In such an approach, CEA and stenting are performed from the same site toward the proximal region while preventing distal embolization by exposing the cervical carotid artery and clamping branches [ 21 , 22 ]. This approach takes advantage of the benefits of CEA, which prevents distal embolization by clamping cervical vessels while using radiologic imaging to treat long lesions outside of the exposed wound site.…”