Simultaneous percutaneous coronary intervention and carotid artery stenting for severe coronary and symptomatic carotid artery disease: a report of two cases

Abstract

We report two cases where carotid artery stenting (CAS) and percutaneous coronary intervention (PCI) were performed at the same time on patients with advanced carotid artery stenosis, with impending symptoms of transient ischemic attack (TIA) complicated by advanced coronary artery stenosis. Case 1 was a 78-year-old male suffering from frequent occurrence of intermittent paralysis of the right upper and lower extremities. Advanced stenosis of his left internal carotid artery and left anterior descending (LAD) coronary artery was demonstrated in catheter angiography. Semi-urgent treatment of carotid artery stenosis was deemed necessary and, as the subject’s coronary artery stenosis was also advanced, CAS was performed immediately following PCI. Case 2 was a 77-year-old female whose angina symptoms persisted despite undergoing PCI at another hospital. She visited our hospital after she began to experience amaurosis fugax. Advanced bilateral carotid stenosis and lesions in three coronary artery vessels were observed in catheter angiography. PCI and CAS were performed on three coronary artery vessels and her right internal carotid artery on the same day. CAS was performed on her left internal carotid artery at a later date, and her treatment was completed with no sequellae. We believe that the aforementioned method should be selected in the treatment of advanced carotid artery stenosis complicated by severe coronary artery disease if the patient’s background and situation of the facility renders it appropriate.