Balakrishnan Pranav, Anderson Jamie, Arcand Christina M, Krantz Matthew, Kitchen James C
General Surgery, Marshall University Joan C. Edwards School of Medicine, Huntington, USA.
Vascular Surgery, Marshall University Joan C. Edwards School of Medicine, Huntington, USA.
Cureus. 2024 Jun 25;16(6):e63087. doi: 10.7759/cureus.63087. eCollection 2024 Jun.
We present the case of an 80-year-old man who underwent a subclavian-to-distal internal carotid artery bypass with a reversed saphenous vein due to symptomatic in-stent restenosis, following a carotid endarterectomy 20 years ago and carotid artery stenting 10 years ago. The patient presented with right-sided hemiparesis and dysarthria. Imaging suggested in-stent restenosis of the internal carotid artery stent. He was also found to have stenosis of the common carotid artery origin stent. An initial transfemoral attempt by interventional radiology was unsuccessful. Due to the stenosed common carotid artery origin stent, a common carotid-to-internal carotid artery bypass was not feasible. Therefore, a subclavian-distal carotid artery bypass with a reversed saphenous vein was performed. He did well in the postoperative period and has been seen in the clinic since. Surveillance ultrasound demonstrated a patent graft with non-stenotic proximal and distal anastomoses. We include an in-depth review of the management of recurrent carotid artery stenosis as well.
我们报告了一例80岁男性患者的病例，该患者因有症状的支架内再狭窄，在20年前接受颈动脉内膜剥脱术和10年前接受颈动脉支架置入术后，采用大隐静脉倒置进行了锁骨下动脉至颈内动脉远端搭桥术。患者表现为右侧偏瘫和构音障碍。影像学检查提示颈内动脉支架内再狭窄。还发现其颈总动脉起始部支架存在狭窄。介入放射科最初经股动脉进行的尝试未成功。由于颈总动脉起始部支架狭窄，颈总动脉至颈内动脉搭桥术不可行。因此，采用大隐静脉倒置进行了锁骨下动脉至颈动脉远端搭桥术。他术后恢复良好，此后一直在门诊随访。超声监测显示移植血管通畅，近端和远端吻合口无狭窄。我们还对复发性颈动脉狭窄的治疗进行了深入综述。
