The case with hard calcified carotid plaque causing balloon rupture during carotid artery stenting

초록

Purpose: Deposition of calcium-phosphate complexes in the carotid artery indicates vascular aging. Intimal calcification is associated with atherosclerosis and plaque stability. Medial calcification can be related to arterial stiffening and reduced compliance. Several studies showed that calcification in carotid artery is associated with the risk of stroke and coronary events, especially in seventy-year old people or younger. It is also interesting that the carotid artery calfication can increase the procedural risk during carotid artery stenting. Here, we described the case with hard calcified calcification, causing the rupture of balloon during carotid artery stenting. Methods: A 78-year old woman was admitted to our hospital for the recurrent transient Lt hemiparesis under the administration of dual antiplatelet agents and intense statin. She suffered from the congestive heart failure and coronary artery disease associated with the history of several coronary interventios. She also had the dyslipidemia, hypertension and diabetes mellitus. The MR scans and diamox SPECT reveals the occlusion of Rt ICA with collateral flow via A-com and tight stenosis(>95% on NASCET criteria with the inner diameter at the most stenosis portion of 0.13mm ) in the left carotid artery at upper cervical levels with severe perfusion defect in right hemisphere. There were also moderate to severe stenosis in Rt MCA, bilateral vertebral arteries and basilar artery. Vascular surgeon and neurosurgeon did not recommend the carotid endarterectomy due to high cervical level of stenosis or bypass due to heart failure.