Treatment of Recanalized Internal Carotid Artery after Occlusion from Iatrogenic Injury
Huong Truong, MD, Shih Yau Huang, MD
Rutgers University Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
DEMOGRAPHICS:
A 77-year-old Caucasian male presented to the emergency department with left-sided symptoms found to have right middle cerebral artery stroke. His stroke work-up was negative for carotid artery disease, and subsequently underwent mechanical thrombectomy with recovery of his neurological deficits. Repeat CTA neck, he was found to have a completely occluded right internal carotid artery. On follow-up, both carotid duplex and CTA neck showed recanalized right internal carotid artery with severe stenosis. He subsequently underwent an uneventful eversion carotid endarterectomy.
HISTORY:
Patient’s past medical history included hypertension, hyperlipidemia, who presented to the emergency department six months prior to elective symptomatic right carotid endarterectomy with right middle cerebral artery stroke. His symptoms on presentation were headache, slurred speech, left facial droop and left-sided weakness. Patient was not eligible for systemic tpa, but underwent emergent cerebral mechanical thrombectomy. Stroke work-up prior to cerebral thrombectomy was negative for bilateral carotid artery disease. A consequent CTA neck was performed, which showed an occluded right internal carotid artery. Post-procedure, he had complete recovery from neurologic symptoms.
PLAN:
Given that patient had no neurologic deficits after the procedure, he was followed-up outpatient with repeat carotid duplex and CTA neck showing recanalized right internal carotid artery with severe stenosis. Patient recovered fully post-stroke, and thus was scheduled for elective right carotid endarterectomy. An awake, eversion right carotid endarterectomy was performed. He had no neurological deficits as evidenced by following commands peri and post-operation.
DISCUSSION:
ICA occlusion, whether unilateral or bilateral, is responsible for 6-15% of all acute cerebrovascular events. Spontaneous recanalization (SR) of a previously occluded extra-cranial ICA is a rare phenomenon and the pathogenesis as well as treatment for such anomaly is largely
under-reported. The most common cause of SR of the ICA is secondary to iatrogenic injury. The pathogenesis and cause of SR ICA are largely unknown. Herein, we present an interesting case report for the treatment of asymptomatic, recanalized ICA with open endarterectomy with no neurologic sequelae.
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