Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy.
Interventional Neuroradiology, Emergency Care Department, University Hospital of Parma, Parma, Italy.
Acta Biomed. 2021 Apr 30;92(S1):e2021149. doi: 10.23750/abm.v92iS1.9811.
Restenosis after open carotid surgery (OCS) represents an issue that experts are very often facing nowadays, both after carotid endoarterectomy(CEA) and carotid bypass(CB). Yet, even if from one side carotid artery stenting (CAS) is currently recommended by most guidelines as treatment of choice for carotid restenosis after CEA, on the other side little is known regarding the best treatment of restenosis after CB. This clinical case report is aimed to empathize the endovascular treatment as an effective therapeutic option for restenosis after OCS.
A 75-year-old woman with severe comorbidities was admitted to our Unit for left carotid bypass graft restenosis. One year earlier, the patient had been treated with left carotid bypass grafting in saphenous vein for infectious complications occurred after CEA for symptomatic left carotid stenosis. The patient underwent a carotid Duplex ultrasonography scan (DUS) which showed a hemodynamically significant left carotid venous graft stenosis with peak systolic velocity of 315 cm/sec; in order to assess the grade of the stenosis a computed tomography angiography confirmed the presence of a significant narrowing of left carotid graft. A carotid artery angiography was performed after 20days, reconfirming the presence of a significant left carotid graft stenosis and was successfully treated with 7x40mm self-expanding stent.
The patient had an uneventful post-procedural course and was discharged the day after. After six months, the patient underwent a carotid DUS in our outpatient clinic which confirmed the overall graft and stent patency.
CAS represents a feasible therapeutic option for carotid restenosis in patients treated after CB. This clinical case demonstrates that CAS can be performed with acceptable risks and good early results.
开放颈动脉手术（OCS）后的再狭窄是当今专家经常面临的问题，无论是颈动脉内膜切除术（CEA）后还是颈动脉旁路术（CB）后。然而，尽管目前大多数指南都推荐颈动脉支架置入术（CAS）作为 CEA 后颈动脉再狭窄的首选治疗方法，但对于 CB 后再狭窄的最佳治疗方法知之甚少。本临床病例报告旨在强调血管内治疗作为 OCS 后再狭窄的有效治疗选择。
一名 75 岁的女性患者合并严重合并症，因左侧颈动脉旁路移植再狭窄入住我院。一年前，该患者因 CEA 后发生感染性并发症而行左侧颈动脉旁路移植术治疗，在左侧颈动脉旁路移植术中使用大隐静脉。患者接受了颈动脉双功能超声检查（DUS），显示左侧颈动脉静脉移植吻合口狭窄，收缩期峰值速度为 315cm/sec，具有血流动力学意义；为了评估狭窄程度，计算机断层血管造影术（CTA）证实左侧颈动脉旁路移植存在明显狭窄。20 天后进行了颈动脉血管造影术，再次证实左侧颈动脉旁路移植吻合口狭窄，成功置入 7x40mm 自膨式支架。
患者术后无并发症，次日出院。术后 6 个月，患者在我院门诊进行了颈动脉 DUS 检查，证实了整体旁路和支架通畅。
CAS 是 CB 后治疗的颈动脉再狭窄患者可行的治疗选择。本临床病例表明，CAS 可以在可接受的风险和良好的早期结果下进行。
