Abstract
We report a patient with carotid artery stenosis, presenting restenosis and rerestenosis after each successful percutaneous transluminal angioplasty (PTA) . A 66-year-old man had suffered several episodes of cerebral ischemic attack producing symptoms such as dysarthria and right-sided weakness for several years. Examinations revealed about 90% focal stenosis in the left internal carotid artery, which was most prominent 2-3 cm distal to the carotid bifurcation. Dilatation of the affected portion reduced to stenosis to 10% with one trial of PTA. He spent 3 months without any complaint after the operation. However, angiography 3 months after PTA showed severe restenosis at the same site. A second dilatation of this portion with a PTA balloon was also successful. Three months after the second PTA, we found re-restenosis and an ulcer-like lesion on the plaque by B-mode ultrasonography. The lesion appeared to resemble an aneurysm upon angiography. B-mode ultrasonography showed the plaque to be a mixed-echoic lesion before PTA. The low-echoic lesion progressed to ulceration following PTA balloon inflation, and the patient underwent STA-MCA anastomosis. This case indicates the necessity for follow-up by assessing plaque morphology by B-mode ultrasonography in patients treated by PTA.
