Takahashi Toshihide, Ikeda Go, Igarashi Haruki, Konishi Takahiro, Araki Kota, Hara Kei, Akimoto Ken, Miyamoto Satoshi, Shiigai Masanari, Uemura Kazuya, Ishikawa Eiichi, Matsumaru Yuji
Department of Neurosurgery Tsukuba Medical Center Hospital, Tsukuba, Japan.
Department of Radiology, Tsukuba Medical Center Hospital, Tsukuba, Japan.
Surg Neurol Int. 2021 Mar 17;12:109. doi: 10.25259/SNI_806_2020. eCollection 2021.
Carotid endarterectomy (CEA) has been the standard preventive procedure for cerebral infarction due to cervical internal carotid artery stenosis, and internal shunt insertion during CEA is widely accepted. However, troubleshooting knowledge is essential because potentially life-threatening complications can occur. Herein, we report a case of cervical internal carotid artery injury caused by the insertion of a shunt device during CEA.
A 78-year-old man with a history of hypertension, diabetes, and hyperuricemia developed temporary left hemiplegia. A former physician had diagnosed the patient with a transient cerebral ischemic attack. The patient's medical history was significant for the right internal carotid artery stenosis, which was severe due to a vulnerable plaque. We performed CEA to remove the plaque; however, there was active bleeding in the distal carotid artery of the cervical region after we removed the shunt tube. Hemostasis was achieved through compression using a cotton piece. Intraoperative digital subtraction angiography (DSA) revealed severe stenosis at the internal carotid artery distal to the injury site due to hematoma compression. The patient underwent urgent carotid artery stenting and had two carotid artery stents superimposed on the injury site. On DSA, extravascular pooling of contrast media decreased on postoperative day (POD) 1 and then disappeared on POD 14. The patient was discharged home without sequela on POD 21.
In the case of cervical internal carotid artery injury during CEA, hemostasis can be achieved by superimposing a carotid artery stent on the injury site, which is considered an acceptable troubleshooting technique.
颈动脉内膜切除术（CEA）一直是治疗颈内动脉狭窄所致脑梗死的标准预防性手术，并且在CEA期间插入内分流器已被广泛接受。然而，由于可能发生危及生命的并发症，故障排除知识至关重要。在此，我们报告一例在CEA期间因插入分流装置导致颈内动脉损伤的病例。
一名78岁男性，有高血压、糖尿病和高尿酸血症病史，出现暂时性左半身瘫痪。之前的医生诊断该患者为短暂性脑缺血发作。患者的病史显示右颈内动脉狭窄，因易损斑块而严重。我们进行了CEA以清除斑块；然而，在移除分流管后，颈部区域的颈内动脉远端出现活动性出血。通过用棉片压迫实现了止血。术中数字减影血管造影（DSA）显示由于血肿压迫，损伤部位远端的颈内动脉严重狭窄。患者接受了紧急颈动脉支架置入术，在损伤部位叠加了两个颈动脉支架。在DSA上，术后第1天造影剂的血管外积聚减少，然后在术后第14天消失。患者在术后第21天出院，无后遗症。
在CEA期间发生颈内动脉损伤的情况下，通过在损伤部位叠加颈动脉支架可实现止血，这被认为是一种可接受的故障排除技术。
