Synchronous endovascular treatment for serial tandem proximal common carotid artery and internal carotid lesions.

PURPOSE

To report simultaneous endovascular repair of tandem proximal common carotid artery and internal carotid artery in a patient with complex post-radiotherapy lesions.

CASE REPORT

A 67-year-old woman with a medical history of cervical and thoracic radiotherapy and claudication, was admitted with the diagnosis of critical inferior limb ischaemia (stage III-Fontaine) and two recents episodes of amaurosis fugax of the left eye. Duplex Scan and M.R. Angiography revealed high grade stenosis of the proximal left common and internal carotid artery and a complete bilateral iliac artery occlusion. A synchronous ante- and retro-grade carotid endovascular treatment was performed in the first stage of the treatment, allowed by an open minimal cervical access under cerebral filter protection (Angio-Guard system, Cordis corp.). The post-operative period was uneventful. The patient underwent a succesful aortobifemoral reconstruction soon afterwards. At 26 months, the patient was asymptomatic. Duplex Scan confirmed a good patency of the carotid stents with normal cerebral CT Scan.

CONCLUSIONS

Serial common and internal carotid lesions appear amenable to concomitant ante- and retro-grade endovascular repair in selected patients.