Carotid artery stenting for symptomatic stenosis of cervical carotid artery with a persistent proatlantal artery: case report

Abstract

Objective: To report a case of symptomatic internal carotid artery stenosis with a persistent proatlantal artery (PPA), which was treated by carotid artery stenting (CAS) with a fi lter device by means of proximal occlusion of the common carotid artery (CCA) and the external carotid artery (ECA). Case presentation: A 77-year-old man suffering from loss of consciousness was referred to our hospital. Diffusion-weighted image showed a left cerebral infarction and MR angiography revealed a PPA. PPA type 1 was confirmed by 3D-CT angiography and digital subtraction angiography revealed the carotid stenosis, located just proximal to the origin of the PPA in the left internal carotid artery (ICA). Since the stenosis was more than 50% and the patient was elderly, CAS was scheduled. To protect both the ICA and the PPA, a guiding catheter with balloon was employed to occlude the CCA and the ECA simultaneously and to induce blood flow from the PPA to the ICA. Under such conditions, a fi lter device was positioned in the ICA and CAS was done in an orderly manner without any complications. Conclusion: To our knowledge, this is the fi rst reported case of PPA treated by CAS with a fi lter device by proximal occlusion both of CCA and ECA which induced blood fl ow from ICA to PPA.

Unilateral Aplasia versus Bilateral Aplasia of the Vertebral Artery: A Review of Associated Abnormalities

“…Vascular pathology in 24/46 cases was noted; aneurysms of different arteries, ICA [ 57 , 81 ], PCA [ 64 ], PICA [ 45 ], PPHA–PICA junction [ 48 ], PPHA-BA junction [ 52 ], ACA [ 52 ], SA [ 65 ], as well as stenosis of ICA [ 60 , 67 , 70 , 78 ], CCA [ 66 , 78 ], PPHA [ 78 , 79 ], or SA [ 65 , 69 ] and cerebral hemorrhagic lesions [ 46 , 61 , 65 , 68 , 69 , 74 ], angiographically were confirmed.…”

Stent Placement for Stenosis at the Origin of a Persistent Primitive Proatlantal Artery: A Case Report

“…8,9) Regarding stroke, there have been reports that cerebral infarction was caused by the occlusion of a persistent artery due to the dissection of the ICA or by an embolus carried through a persistent primitive artery, 10,11) but reports of the stenosis of a persistent primitive artery causing stroke are rare. In intracranial endovascular treatment, there have been sporadic reports of stenting for ICA stenosis complicated by PPHA or PPPA; [12][13][14] however, only two cases of stenting for stenosis of PPPA have been reported. 15,16) Concerning the two previous cases in the literature, one was of a 78-year-old man who presented with diplopia and disturbance of sensation and was found to have multifocal Regarding future problems, the risk of restenosis exists, and restenosis rates after stenting at the origin of the vertebral artery have been reported to range from 25% to 43.3%.…”

“…In stenting of the PPPA, more vessels must be protected than in the usual carotid artery stenting (CAS), and the procedure is more complicated. Hirota et al 12) emphasized that in CAS complicated by a persistent artery, embolic protection of the persistent artery is important for the prevention of cerebral infarction. In our patient, we also decided to protect the ICA and PPPA because distal embolism associated with manipulation of the catheter, balloon, and stent was considered possible in both vessels.…”