2019 Volume 41 Issue 4 Pages 304-310
We report a case of symptomatic chronic total occlusion of the common carotid artery after bilateral fronto-temporal craniotomies treated by carotid artery stenting (CAS). In June 2016, a 61-year-old man developed a subarachnoid hemorrhage. Neck clipping was performed on the ruptured cerebral aneurysm in the right internal carotid artery. In September 2016, neck clipping was performed on the unruptured cerebral aneurysm in the left internal carotid artery. In June 2017, the same person complained of dysarthria and left hemiplegia. Magnetic resonance imaging (MRI) showed a cerebral infarction in the corona radiata on the right side and cervical magnetic resonance angiography (MRA) showed an occlusion spanning from the right common carotid artery to the internal carotid artery. Medical therapy was performed; however, transient ischemic attack (TIA) occurred repeatedly, so the patient was transferred to our hospital, where percutaneous CAS for the chronic total occlusion (CTO) spanning from the right common carotid artery to the internal carotid artery was performed. No abnormal neurological findings were exacerbated postoperatively, and the repeated TIA also disappeared. At this time, the patient was transferred to the initial hospital (mRS 1). There is no established treatment for CTO spanning from the common carotid artery to the internal carotid artery. As in this case, the patient may be resistant to medical treatment, but the extracranial-intracranial bypass is difficult to perform, CAS is considered to be a feasible treatment for CTO.
