Stenting for subclavian steal phenomenon to restore cerebral perfusion due to acute carotid occlusion following carotid endarterectomy: a case report.
Carotid artery occlusion
Carotid endarterectomy
Case report
Subclavian artery stenting
Subclavian steal
Journal
Journal of medical case reports
ISSN: 1752-1947
Titre abrégé: J Med Case Rep
Pays: England
ID NLM: 101293382
Informations de publication
Date de publication:
08 May 2024
08 May 2024
Historique:
received:
27
02
2024
accepted:
08
04
2024
medline:
8
5
2024
pubmed:
8
5
2024
entrez:
7
5
2024
Statut:
epublish
Résumé
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. 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. 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.
Sections du résumé
BACKGROUND
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
METHODS
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
CONCLUSIONS
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.
Identifiants
pubmed: 38715146
doi: 10.1186/s13256-024-04546-8
pii: 10.1186/s13256-024-04546-8
doi:
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
226Informations de copyright
© 2024. The Author(s).
Références
Rerkasem K, Rothwell PM. Systematic review of randomized controlled trials of patch angioplasty versus primary closure and different types of patch materials during carotid endarterectomy. Asian J Surg. 2011;34(1):32–40. https://doi.org/10.1016/s1015-9584(11)60016-x .
doi: 10.1016/s1015-9584(11)60016-x
pubmed: 21515211
Bond R, Rerkasem K, Naylor AR, Aburahma AF, Rothwell PM. Systematic review of randomized controlled trials of patch angioplasty versus primary closure and different types of patch materials during carotid endarterectomy. J Vasc Surg. 2004;40(6):1126–35. https://doi.org/10.1016/j.jvs.2004.08.048 .
doi: 10.1016/j.jvs.2004.08.048
pubmed: 15622366
Pappadà G, Vergani F, Parolin M, Cesana C, Pirillo D, Pirovano M, et al. Early acute hemispheric stroke after carotid endarterectomy. Pathogenesis and management. Acta Neurochir (Wien). 2010;152(4):579–87. https://doi.org/10.1007/s00701-009-0542-8 .
doi: 10.1007/s00701-009-0542-8
pubmed: 19841855
Anzuini A, Briguori C, Roubin GS, Pagnotta P, Rosanio S, Airoldi F, et al. Emergency stenting to treat neurological complications occurring after carotid endarterectomy. J Am Coll Cardiol. 2001;37(8):2074–9. https://doi.org/10.1016/s0735-1097(01)01284-0 .
doi: 10.1016/s0735-1097(01)01284-0
pubmed: 11419890
Findlay JM, Marchak BE. Reoperation for acute hemispheric stroke after carotid endarterectomy: is there any value? Neurosurgery. 2002;50(3):486–92. https://doi.org/10.1097/00006123-200203000-00010 . (discussion 92–3).
doi: 10.1097/00006123-200203000-00010
pubmed: 11841715
Spiotta AM, Vargas J, Zuckerman S, Mokin M, Ahmed A, Mocco J, et al. Acute stroke after carotid endarterectomy: time for a paradigm shift? Multicenter experience with emergent carotid artery stenting with or without intracranial tandem occlusion thrombectomy. Neurosurgery. 2015;76(4):403–10. https://doi.org/10.1227/neu.0000000000000642 .
doi: 10.1227/neu.0000000000000642
pubmed: 25621982
Patel RAG, White CJ. Brachiocephalic and subclavian stenosis: current concepts for cardiovascular specialists. Prog Cardiovasc Dis. 2021;65:44–8. https://doi.org/10.1016/j.pcad.2021.03.004 .
doi: 10.1016/j.pcad.2021.03.004
pubmed: 33744380
Ginsburg R, Thorpe P, Bowles CR, Wright AM, Wexler L. Pull-through approach to percutaneous angioplasty of totally occluded common iliac arteries. Radiology. 1989;172(1):111–3. https://doi.org/10.1148/radiology.172.1.2525789 .
doi: 10.1148/radiology.172.1.2525789
pubmed: 2525789
Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL, et al. ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery. Developed in collaboration with the American Academy of Neurology and Society of Cardiovascular Computed Tomography. Catheter Cardiovasc Interv. 2013;81(1):E76-123. https://doi.org/10.1002/ccd.22983 .
doi: 10.1002/ccd.22983
pubmed: 23281092
Brountzos EN, Petersen B, Binkert C, Panagiotou I, Kaufman JA. Primary stenting of subclavian and innominate artery occlusive disease: a single center’s experience. Cardiovasc Intervent Radiol. 2004;27(6):616–23. https://doi.org/10.1007/s00270-004-0218-y .
doi: 10.1007/s00270-004-0218-y
pubmed: 15578138
Policha A, Baldwin M, Lee V, Adelman MA, Rockman C, Berland T, et al. Clinical significance of reversal of flow in the vertebral artery identified on cerebrovascular duplex ultrasound. J Vasc Surg. 2018;67(2):568–72. https://doi.org/10.1016/j.jvs.2017.07.113 .
doi: 10.1016/j.jvs.2017.07.113
pubmed: 28935292
Saha T, Naqvi SY, Ayah OA, McCormick D, Goldberg S. Subclavian artery disease: diagnosis and therapy. Am J Med. 2017;130(4):409–16. https://doi.org/10.1016/j.amjmed.2016.12.027 .
doi: 10.1016/j.amjmed.2016.12.027
pubmed: 28109967
Jadhav A, Panczykowski D, Jumaa M, Aghaebrahim A, Ranginani M, Nguyen F, et al. Angioplasty and stenting for symptomatic extracranial non-tandem internal carotid artery occlusion. J Neurointerv Surg. 2018;10(12):1155–60. https://doi.org/10.1136/neurintsurg-2018-013810 .
doi: 10.1136/neurintsurg-2018-013810
pubmed: 29706606
Baig AA, Lai PMR, Turner RC, Donnelly BM, Kuo CC, Lim J, et al. Hyperacute stenting and angioplasty for acute extracranial non-tandem internal carotid artery strokes within the first 48 h: a 20-year experience and a systematic review and meta-analysis. Interv Neuroradiol. 2023;2023:15910199231164510. https://doi.org/10.1177/15910199231164510 .
doi: 10.1177/15910199231164510
Mohammaden MH, Stapleton CJ, Brunozzi D, Khedr EM, Theiss P, Atwal G, Alaraj A. Risk factors for distal clot migration during mechanical thrombectomy of anterior circulation large vessel occlusion. Cerebrovasc Dis. 2020;49(2):185–91. https://doi.org/10.1159/000507341 .
doi: 10.1159/000507341
pubmed: 32224607
Bradaric C, Kuhs K, Groha P, Dommasch M, Langwieser N, Haller B, et al. Endovascular therapy for steno-occlusive subclavian and innominate artery disease. Circ J. 2015;79(3):537–43. https://doi.org/10.1253/circj.CJ-14-0855 .
doi: 10.1253/circj.CJ-14-0855
pubmed: 25746537
Mousa AY, AbuRahma AF, Bozzay J, Broce M, Barsoum E, Bates M. Anatomic and clinical predictors of reintervention after subclavian artery stenting. J Vasc Surg. 2015;62(1):106–14. https://doi.org/10.1016/j.jvs.2015.01.055 .
doi: 10.1016/j.jvs.2015.01.055
pubmed: 25864043
Che WQ, Dong H, Jiang XJ, Peng M, Zou YB, Qian HY, et al. Stenting for left subclavian artery stenosis in patients scheduled for left internal mammary artery-coronary artery bypass grafting. Catheter Cardiovasc Interv. 2016;87(Suppl 1):579–88. https://doi.org/10.1002/ccd.26477 .
doi: 10.1002/ccd.26477
pubmed: 26914391
Xin WQ, Li MQ, Li K, Li QF, Zhao Y, Wang WH, et al. Systematic and comprehensive comparison of incidence of restenosis between carotid endarterectomy and carotid artery stenting in patients with atherosclerotic carotid stenosis. World Neurosurg. 2019;125:74–86. https://doi.org/10.1016/j.wneu.2019.01.118 .
doi: 10.1016/j.wneu.2019.01.118
pubmed: 30710719
Müller MD, Lyrer P, Brown MM, Bonati LH. Carotid artery stenting versus endarterectomy for treatment of carotid artery stenosis. Cochrane Database Syst Rev. 2020;2(2): Cd000515. https://doi.org/10.1002/14651858.CD000515.pub5 .
doi: 10.1002/14651858.CD000515.pub5
pubmed: 32096559
Sekihara Y, Saito Y, Takada Y, Ishii N. Usefulness of hybrid surgery combining CEA and CAS for carotid artery stenosis with a large amount of vulnerable plaque. J Neuroendovascular Ther. 2021;15(7):429–37. https://doi.org/10.5797/jnet.oa.2020-0187 .
doi: 10.5797/jnet.oa.2020-0187
Meershoek AJA, Velde HM, Toorop RJ, Hazenberg S, de Borst GJ. Long-term outcome of symptomatic patients undergoing hybrid revascularisation for extracranial carotid artery tandem stenosis. Eur J Vasc Endovasc Surg. 2019;57(5):627–31. https://doi.org/10.1016/j.ejvs.2018.11.016 .
doi: 10.1016/j.ejvs.2018.11.016
pubmed: 30987818
Kargiotis O, Psychogios K, Safouris A, Spiliopoulos S, Karapanayiotides T, Bakola E, et al. Diagnosis and treatment of acute isolated proximal internal carotid artery occlusions: a narrative review. Ther Adv Neurol Disord. 2022;15:17562864221136336. https://doi.org/10.1177/17562864221136335 .
doi: 10.1177/17562864221136335
pubmed: 36437850
pmcid: 9685148
Bang OY, Chung JW, Kim SK, Kim SJ, Lee MJ, Hwang J, et al. Therapeutic-induced hypertension in patients with noncardioembolic acute stroke. Neurology. 2019;93(21):e1955–63. https://doi.org/10.1212/wnl.0000000000008520 .
doi: 10.1212/wnl.0000000000008520
pubmed: 31645472
pmcid: 6885575