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Percutaneous transluminal angioplasty and stenting of tandem ipsilateral common carotid and petrous segment internal carotid artery lesions.

Author

Teoceles D. Olivar,
Fatima R. Collado,
Fabio Enrique B. Posas

Related Institution

Departments of Invasive Cardiology and Vascular Medicine, Heart Institute - St. Luke's Medical Center

Publication Information

Publication Type
Journal
Publication Sub Type
Case report
Title
Philippine Journal of Cardiovascular Medicine
Frequency
Semi-Annual
Publication Date
January-June 2005
Volume
16
Issue
1
Page(s)
43-48

Abstract

BACKGROUND: Atherosclerotic intracranial large artery stenosis is an important cause of stroke. It is usually heralded by episodes of transient ischemic attacks. Previous studies suggested that the annual stroke risk in patients with intracranial stenosis is 3 to 15%. Distal internal carotid artery and intracerebral artery lesions are currently considered as non-surgical disease because of its inaccessible locations. Endoluminal techniques such as angioplasty and stenting can be the only options for revascularizing patients with such disease and it is now considered a viable option for distal carotid artery lesions, middle cerebral artery stenosis, distal vertebral artery stenosis and basilar artery stenosis. Though there is relatively little experience with dilation at these sites, the number of intracranial angioplasty and stenting cases are growing considerably. _


CASE: The patient is an 83 year old, female, hypertensive, dyslipidemic,with 35 pack years smoking history who had multiple episodes of transient ischemic neurological events involving the right half of the lip and right arm starting 5 months prior to admission despite treatment with aspirin and clopidogrel. There was bilateral carotid bruit on physical examination, neurologic examination was normal. Digital subtraction cerebral angiography (DSA) showed a 70% stenosis of the left distal internal carotid artery and 60% stenosis at the left common carotid artery. The right internal carotid artery had evidence of mild to moderate disease with small right cavernous and distal basilar aneurysm. She was successfully revascularized with percutaneous transluminal angioplasty with stent implantation at the petrous segment of the left internal carotid artery using a 3.5 x 16 mm Express coronary stent. The left common carotid artery was then stented using a 9x 30 mm Precise stent and a 6 mm angioguard distal protection device. The patient tolerated the procedure well and was discharged after 72 hours. At 3 months follow-up, she remains asymptomatic.


CONCLUSION: To the best of our knowledge, this is the first reported case of petrous internal carotid artery stenting combined with common carotid artery stenting for the treatment of symptomatic distal internal carotid artery disease in the Philippines. We report a successful combined ipsilateral, multilesion, multisegment angioplasty and stenting of the common carotid and petrous segment of the internal carotid artery using a second generation, balloon-expandable, flexible coronary stent combined with stenting and distal protection of the pre-bifurcation common carotid artery. Endovascular balloon angioplasty and stenting may prove to be a safe and effective treatment option for distal internal carotid artery and intracranial atherosclerotic lesions which are otherwise inaccessible to standard surgical interventions. Our case report suggests that such combined complex vascular procedures can be successfully be performed.

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