Acute Stroke After Carotid Endarterectomy

Spiotta, Alejandro M; Vargas, Jan; Zuckerman, Scott L.; Mokin, Maxim; Ahmed, Azam; Mocco, J; Turner, Raymond D; Turk, Aquilla S; Chaudry, M Imran; Myers, Phil

doi:10.1227/neu.0000000000000642

Cited by 10 publications

(3 citation statements)

References 23 publications

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“…In carotid catheter intervention, these are considered risk factors for thoracic and cervical artery dissection, sutured vessel rupture, and distal embolism. While thrombectomy with re-exploration [ 3 , 5 ] and CAS [ 4 , 6 ] have been reported as treatments for post-CEA carotid artery occlusion, the complications of intracranial lesions determine the prognosis for both treatment strategies. Pappada reported seven cases treated with reopening; of these, with good prognosis noted in only three cases without intracranial lesions [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…Pappada reported seven cases treated with reopening; of these, with good prognosis noted in only three cases without intracranial lesions [ 3 ]. Spiotta reported good recanalization in nine patients treated with endovascular therapy and good prognosis in three of six patients without intracranial lesions [ 6 ]. Endovascular treatment in 107 symptomatic extracranial ICA occlusive patients reported good outcomes in only 65%; moreover, distal emboli occurred in 22% [ 13 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…Perioperative symptomatic carotid artery occlusion after carotid endarterectomy (CEA) is a rare but severe complication reported in 0.5–3.6% of patients undergoing CEA [ 1 , 2 ], with severe disability in 15–28% and fatality in 5.6–44% of patients [ 3 – 5 ]. Thrombus removal through wound re-exploration [ 3 , 5 ] and carotid artery stenting (CAS) [ 4 , 6 ] have been reported as revascularization methods for such cases. However, the necessity and appropriate method of bailout intervention for post-CEA carotid occlusion remain unclear.…”

Section: Introductionmentioning

confidence: 99%

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

Hirota,

Yoshimura,

Cho

et al. 2024

J Med Case Reports

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Background Perioperative symptomatic carotid artery occlusion after carotid endarterectomy is a rare complication. In this study, we present a case of symptomatic acute carotid artery occlusion that occurred after carotid endarterectomy in a patient with coexistent subclavian artery steal phenomenon, which was successfully treated with subclavian artery stenting. Case presentation A 57-year-old East Asian female presented with stenosis in the left common carotid artery and left subclavian artery along with subclavian steal. The proximal segment of the left anterior cerebral artery was hypoplastic, and the posterior communicating arteries on both sides were well-developed. Left internal carotid artery stenosis progressed during the follow-up examination; therefore, left carotid endarterectomy was performed. On the following day, symptoms of cerebral perfusion deficiency appeared due to occlusion of the left carotid artery. The stenotic origin of the left common carotid artery and the suspected massive thrombus in the left carotid artery posed challenges to carotid revascularization. Therefore, left subclavian artery stenting for the subclavian steal phenomenon was determined to be the best option for restoring cerebral blood flow to the whole brain. Her symptoms improved after the procedure, and the postprocedural workup revealed improved cerebral blood flow. Conclusion Subclavian artery stenting is safe and may be helpful in patients with cerebral perfusion deficiency caused by intractable acute carotid occlusion coexisting with the subclavian steal phenomenon. Revascularization of asymptomatic subclavian artery stenosis is generally not recommended. However, cerebral circulatory insufficiency as a comorbidity may be worth considering.

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