Jost Dominik, Meissner Helfried, von Loewensprung Henning, Guethe Thomas, Hupp Thomas, Henkes Hans
Department of Vascular Surgery, Klinikum Stuttgart, Stuttgart, Germany.
J Med Case Rep. 2010 Dec 9;4:397. doi: 10.1186/1752-1947-4-397.
With the widespread use of carotid artery stenting, previously unknown technical mistakes of this treatment modality are now being encountered. There are multiple strategies for the treatment of in-stent restenosis. With regard to surgical management, endarterectomy and patch plasty are favored. To the best of our knowledge, this report is the first description of a complete stent removal by the eversion technique.
We report the case of a 63-year-old Caucasian man with misdeployment of two stents into his stenotic proximal internal carotid artery, resulting in a high-grade mechanical obstruction of the internal carotid artery lumen. With the contralateral internal carotid artery already occluded and associated stenoses of both proximal and distal vertebral arteries, an interdisciplinary therapeutic concept was applied. Bilateral balloon angioplasty and stenting of the proximal and distal stenotic vertebral arteries were carried out to provide sufficient posterior collateral blood flow, followed by successful surgical stentectomy and carotid endarterectomy using the eversion technique. Duplex scanning and neurological assessments were normal over a 12-month follow-up period.
Interdisciplinary treatment is a recommended option to protect patients from further impairment. Further evaluation in larger studies is highly recommended.
随着颈动脉支架置入术的广泛应用，这种治疗方式中以前未知的技术失误现在逐渐被发现。治疗支架内再狭窄有多种策略。在手术治疗方面，内膜切除术和补片成形术是首选。据我们所知，本报告是首次描述通过外翻技术完整取出支架的情况。
我们报告了一例63岁的白种男性病例，两枚支架错误植入其狭窄的颈内动脉近端，导致颈内动脉管腔严重机械性梗阻。由于对侧颈内动脉已闭塞，且椎动脉近端和远端均有相关狭窄，因此采用了多学科治疗方案。对椎动脉近端和远端狭窄进行了双侧球囊血管成形术和支架置入术，以提供足够的后交通侧支血流，随后采用外翻技术成功进行了手术支架取出术和颈动脉内膜切除术。在12个月的随访期内，双功超声扫描和神经学评估均正常。
多学科治疗是保护患者免受进一步损害的推荐选择。强烈建议在更大规模的研究中进行进一步评估。
