Acute occlusion of internal carotid artery after carotid endarterectomy and successful recanalization with stent assisted angioplasty

초록

background & Significance : Carotid endarterectomy(CEA) is effective method in reducing the risk of stroke in symptomatic patients with severe carotid artery stenosis. However, acute occlusion of carotid artery occurs in 0.5% of cases immediately after CEA. Here, we introduce acute occlusion of internal carotid artery(ICA), one day after CEA and then successful recanalization of carotid artery by angioplasty assisted with stent. Case : A-76-year old man was admitted with left hemiparesis. He had a history of diabetic mellitus and he was current smoker. Initial neurologic examination revealed mild dysarthria and left sided central type facial palsy. He had also hemiparesis and hypoesthesia. Brain magnetic resonance images(MRI) showed multiple embolic infarctions in territory of right middle cerebral artery(MCA). Conventional angiography indicated tight stenosis of both carotid arteries(Right 82% and Left 81% on NASCET criteria) with calcified plaques. He underwent CEA of right symptomatic carotid artery. Eighteen hours after surgery, left hemiparesis and alertness worsened suddenly. Followup MRI and CT angiogram showed newly appeared acute infarction in right MCA territory and occlusion