Transcarotid Artery Stenting After Carotid Endarterectomy Complicated By Neck Hematoma And Stroke
Luis F. Gomez, MD, Alan B. Lumsden, MD.
Houston Methodist Hospital, Houston, TX, USA.
OBJECTIVES: Cerebrovascular disease complications include death and disabling stroke. According to the CDC, it is estimated that there are 161 years of potential life lost before age 75 per 100,000 persons in the US, and the annual cost for the healthcare system is in the billions. This comes at a very expensive price not only for the system but also for the patients and their families. About one-third of all ischemic strokes are a direct consequence of disease in the internal carotid artery. And it is because of this, that carotid interventions have been paramount in helping minimize the impact of this disease. With any surgical intervention, whether it is open or endovascular, there can be complications, sometimes a different approach can help us manage these difficulties, improving outcomes for the patients. As it is the case of this case we are presenting. METHODS: Here we present the case of a 69 year-old male with past medical history significant for, hypertension, hyperlipidemia, type 2 diabetes mellitus, asymptomatic high grade carotid stenosis, who underwent left carotid endarterectomy at an outside hospital, complicated by the development of a neck hematoma at the surgical site with thrombosis of the endarterectomy with right-sided weakness and aphasia. He underwent left neck exploration and unsuccessful attempt at revascularization. He was transferred to our institution where a transfemoral approach for revascularization was attempted unsuccessfully. We then were able to successfully treat him with transcarotid stenting with flow reversal and transcranial doppler monitoring
RESULTS: Successful revascularization with transcarotid artery stenting of acute thrombosis after carotid endarterectomy and failed revascularization with surgical reexploration. After the successful revascularization and stenting, the patient continued to work with speech pathology and physical therapy and had significant improvement in the aphasia and regained some of the strength in his right side CONCLUSIONS:
Transcarotid artery stenting with flow reversal for embolic protection and intraoperative transcranial Doppler monitoring can be used for salvage of complications like acute thrombosis after carotid endarterectomy in patients with suitable anatomy
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