[Carotid endarterectomy preceding distal plaque-end dissection followed by internal shunt insertion: a case report].

ABSTRACT

We report a case of carotid endarterectomy preceding distal plaque-end dissection followed by internal shunt insertion. A 60-year-old man was admitted to hospital with right hemiparesis. Magnetic resonance imaging detected multiple fresh infarcts in the left hemisphere, and the patient was transferred to our hospital. Angiography revealed high-grade stenosis in the left internal carotid artery at the level of the second cervical vertebra. Computed tomography angiography showed calcification in the proximal and the distal side of the stenotic lesion in the left carotid artery. The lesion was thought to be high position though an accurate assessment of the distal tip was difficult. The patient also received a blood transfusion for advanced anemia due to gross hematuria associated with bladder cancer. Carotid endarterectomy was performed one month after onset. Because atheromatous plaque had progressed far from the incision, we considered that arterial shunt insertion would induce embolic complications. Thus, we proceeded with distal plaque-end dissection, and then inserted the internal shunt and removed the plaque. This procedure resulted in successful revascularization.