1. RADIATION-INDUCED CAROTID ARTERY STENOSIS:
A CASE OF TANDEM CAROTID LESIONS TREATED WITH HYBRID PROCEDURE
Francesca Fratesi, Mauro Gargiulo, Federica Giovanetti,
Vascular Surgery Unit – Policlinico Sant'Orsola MalpighiAlma Mater Sudiorum, Bologna
Natascia Muccini, GianLuca Faggioli, Andrea Stella
Introduction
Carotid artery stenosis is one of the most common complication after radiotherapy (RT).
We describe a case of radiation-induced tandem carotid artery stenosis treated with a hybrid procedure.
59 yo man
Case presentation
- hypertension
Risk-factors:
- 2001: laryngectomy followed by 34 RT sessions in the neck and chest district
- ex-smoker
Asymptomatic 80% left internal carotid artery stenosis associated with an ostial 90% common carotid artery stenosis, defined as “complicated plaque” because of the low echolucency and the surface morphology at CT and Dupplex Scann (DS).
Pre-operative CT
Intervention
- 2500UI Heparin
- General anesthesia
- Left internal carotid endarterectomy and Dacron-patch.
Retrograde common carotid artery puncture. Insertion of a 7F x 11cm sheath and .018’ glidewire.
Balloon-expandable stainless-steel (Biotronic-DynamicTM 9x38mm) PTA-stenting of left common carotid artery.
Follow-up
The patient was discharged at second post-opervative day.
The post-operative period was free from neurological and clinical complications.
The patient was followed with DS at 3, 6, 12 months and yearly afterwards. No restenosis of the treated arteries were found at 3 years follow-up.
The medical treatment was ASA (100mg/day) indefinitely.
The patient is asymptomatic.
Conclusions
RT of the neck is a risk factor for TIA and Major stroke due to the development of extensive and complicated carotid artery stenosis1. Carotid artery stenosis occur in almost 22% of post-RT patients2. The presentation of tandem carotid lesions is also uncommon and the management of such a disease can be challenging to plan and perform. The “hybrid approch” has been already proposed with good perioperative results3.
We showed a case of hybrid treatment of radiation-induced carotid artery tandem lesions with good short and long term results.
References
2. Carmody BJ, Arora S, Avena R, et al. Accelerated carotid artery disease after high-dose head and neck radiotherapy: is there a role for routine carotid duplex surveillance? J Vasc Surg 1999; 30: 1045–1051
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3. Moore JD, Schneider PA Management of simultaneous common and internal cqrotid artery occlusive disease in the endovascular era. Semin vasc Surg 2011; 24: 2-