[Combined intraoperative retrograde stent implantation and thrombendarterectomy of the carotid artery].

HISTORY AND CLINICAL FINDINGS

A 63-year-old man developed recurrent transitory ischaemic episodes of vertigo and weakness in the legs 6 weeks before admission. 3 weeks later he had a left amaurosis fugax. A stenotic murmur was heard over the left carotid artery.

INVESTIGATION

Intraarterial digital subtraction angiography of the arteries to the head revealed occlusion of the right internal carotid artery (RICA) and marked narrowing at the origin of the left common carotid artery (LCCA), which could not be passed by catheter.

TREATMENT AND COURSE

As a catheter could not be passed into the LCCA, a stent was at operation placed retrogradely into it. Intraoperative angiography showed subtotal stenosis of the left ICA, which was treated by thrombendarterectomy and dacron patch-plasty. The postoperative course was without complication and the patient was free of symptoms. Follow-up angiography was unremarkable.

CONCLUSION

If a stenosis of the carotid artery cannot be passed by catheter, intraoperative retrograde placement of a stent is an alternative to percutaneous antegrade transluminal angioplasty or surgical bypass.