Document Type
Poster
Version Deposited
Published Version
Publication Date
4-10-2024
Conference Name
Camden Scholar's Forum 2024
DOI
10.31986/issn.2689-0690_rdw.cmsru_fac_pub.1061
Abstract
Introduction Patients’ symptomatic carotid stenosis require urgent intervention to prevent a secondary event, the risk of which is highest in the first two weeks after the initial event. Multiple modalities for treatment including transfemoral carotid stenting (TFCS), transcarotid artery revascularization (TCAR) and carotid endarterectomy (CEA) have emerged. CEA remains the standard for treating carotid artery stenosis and preventing stroke, often including neurophysiological monitoring for cerebral perfusion. However, each method has its risks. Choosing between modalities of treatment depends on patient-specific factors, such as comorbid conditions, as well as anatomic suitability where unfavorable anatomy may favor CEA over TCAR or TFCS. Herein we present a symptomatic carotid treated with CEA. Case Description An 83-year-old male with a past medical history of hypertension, hyperlipidemia, Keppra-treated seizure disorder, type 2 diabetes, and chronic kidney disease was transferred from an outside institution, presenting with confusion, right upper extremity weakness and aphasia. MRI confirmed acute left internal capsule and parietal strokes. Upon transfer he underwent an angiogram revealing 99% stenosis of the left internal carotid artery with intraluminal thrombus, 70% stenosis of the right internal carotid artery and occlusion of the left vertebral artery. There was also an incomplete Circle of Willis. Due to the presence of intraluminal thrombus, TCAR and TFCS had an extremely high risk of embolic event during surgery. The decision was made to proceed with CEA. He underwent a left CEA with bovine pericardial patch angioplasty and cerebral monitoring. The CEA was technically successful, and the patient was discharged on post-operative day seven due to acute kidney injury and poor PO intake. Follow-up was arranged to address the patient’s right-sided ICA disease at a later time. Discussion CEA-related strokes often result from hypoperfusion during cross-clamping, which is riskier due to the incomplete circle of Willis in many people limiting alternative routes for blood flow. Taking into account our patient’s specific factors including anatomy and cerebral monitoring allowed for a successful plaque removal and reduced risk of further strokes for the patient.
Recommended Citation
Pruthi, Anika; Aziz, Antony; McMackin, Katherine; and Batista, Philip, "Carotid Endarterectomy for Severe Internal Carotid Artery Stenosis" (2024). Cooper Medical School of Rowan University Departmental Research. 58.
https://rdw.rowan.edu/cmsru_facpub/58
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This work is licensed under a Creative Commons Attribution 4.0 International License.
