Two-Stage Revascularization Treatment of Symptomatic Bilateral Severe Internal Carotid Artery Stenosis-Consecutive Application of Carotid Artery Stenting and Carotid Endarterectomy in Same Patient

Abstract

Since carotid artery atherosclerosis is the main physiopathological mechanism underlying stroke; treatment strategy is focused on resolving carotid artery stenosis. Today, carotid artery endarterectomy and carotid artery stenting are applied as treatment options in carotid artery diseases. With the decision of Cardiovascular Surgery, Cardiology and Neurology joint council, two-stage revascularization procedure was decided to be performed in a 61-year-old male patient who had transient ischemic attack two weeks ago and had stenosis over 90% in both two internal carotid arteries. Because of high mortality risk due to carotid artery endarterectomy, carotid artery stenting was primarily performed in symptomatic left internal carotid artery. Mo.Ma® was preferred as the embolic protection device. Four weeks after stent implantation to left internal carotid artery, carotid endarterectomy was performed in right internal carotid artery by applying ultrasound-guided deep and superficial cervical plexus blockade. No permanent neurological damage was occurred during both two procedures. No new neurologic deficit was observed in postoperative 1st and 6th month controls. We treated bilateral internal carotid artery stenosis effectively and safely by performing two-stage revascularization treatment in our high operative risk case that had bilateral severe internal carotid artery stenosis.