Korean J Radiol.  2006 Dec;7(4):292-296. 10.3348/kjr.2006.7.4.292.

Carotid Artery Stenting in a Patient with Spontaneous Recanalization of a Proximal Internal Carotid Artery Occlusion: a Case Report

• Kim EJ
• Koh JS
• Choi WS

• KMID: 1092554
• DOI: http://doi.org/10.3348/kjr.2006.7.4.292

Abstract

We report here on a rare case of carotid artery angioplasty and stenting in a patient with spontaneous recanalization after complete occlusion of the proximal internal carotid artery (ICA). The patient initially showed severe stenosis at the left proximal ICA on MR angiography (MRA). Digital subtraction angiography (DSA) performed three days after MRA showed complete occlusion of the proximal ICA. The follow-up DSA after four weeks showed recanalization of the ICA, and then carotid artery stenting was successfully performed. There has been no neurologic complication during more than one year follow-up.

Keyword

Carotid arteries, occlusion; Recanalization; Stents

MeSH Terms

*Stents
Recurrence
Middle Aged
Male
Magnetic Resonance Angiography
Humans
Carotid Stenosis/*therapy
*Carotid Artery, Internal
Angioplasty, Balloon

Figure

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  Fig. 1 The initial diffusion weighted image (A) showed bright signal intensity at the left frontoparietal lobe cortex. Focal severe stenosis is visible at the left proximal internal carotid artery on MR angiography (B).

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  Fig. 2 Left common carotid arteriography (A) obtained three days after initial ictus revealed complete occlusion of the left proximal internal carotid artery. The delayed phase of left common carotid angiography (B) showed transdural intracranial collateral flow through the ophthalmic artery and retrograde contrast media filling of the distal cervical internal carotid artery.

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  Fig. 3 Follow-up digital subtraction angiography obtained four weeks after the initial attack showed recanalization of the left proximal internal carotid artery with a remaining tight stenosis at the proximal internal carotid artery.

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  Fig. 4 After carotid artery stenting, a well deployed carotid stent was seen at the left proximal internal carotid artery and the distal common carotid artery on digital subtraction angiography.

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  Fig. 5 Follow-up Doppler ultrasound one year after carotid artery stenting shows no evidence of significant recurrent stenosis and a well positioned stent at the proximal internal carotid artery and distal common carotid artery.

Reference

1. Meyer FB, Sundt TM Jr, Piepgras DG, Sandok BA, Forbes G. Emergency carotid endarterectomy for patients with acute carotid occlusion and profound neurological deficits. Ann Surg. 1986. 203:82–89.

2. Meves SH, Muhs A, Federlein J, Buttner T, Przuntek H, Postert T. Recanalization of acute symptomatic occlusions of the internal carotid artery. J Neurol. 2002. 249:188–192.

3. Nguyen-Huynh MN, Lev MH, Rordorf G. Spontaneous recanalization of internal carotid artery occlusion. Stroke. 2003. 34:1032–1034.

4. Bogousslavsky J, Despland P-A, Regli F. Spontaneous carotid dissection with acute stroke. Arch Neurol. 1987. 44:137–140.

5. Steinke W, Rautenberg W, Schwartz A, Henerici M. Noninvasive monitoring of internal carotid artery dissection. Stroke. 1994. 25:998–1005.

6. Sturzenegger M, Mattle HP, Rivoir A, Baumgartner RW. Ultrasound findings in carotid artery dissection: Analysis of 43 patients. Neurology. 1995. 45:691–698.

7. Pryor JC, Setton A, Nelson PK, Berenstein A. Complications of diagnostic cerebral angiography and tips on avoidance. Neuroimaging Clin N Am. 1996. 6:751–758.

8. Ringlelstein EB, Biniek R, Weiller C, Ammeling B, Nolte PN, Thron A. Type and extent of hemispheric brain infarctions and clinical outcome in early and delayed middle cerebral artery recanalization. Neurology. 1992. 42:289–298.

9. Wholey MH, Al-Mubarek N, Wholey MH. Updated review of the global carotid artery stent registry. Catheter Cardiovasc Interv. 2003. 60:259–266.

10. Malek AM, Higashida RT, Phtouros CC, Lempert TE, Meyers PM, Smith WS, et al. Stent angioplasty for cervical artery stenosis in high-risk symptomatic NASCET-ineligible patients. Stroke. 2000. 31:3029–3033.