Carotid Endarterectomy for Treating Carotid Artery Stenosis with a Tortuous Distal Internal Carotid Artery

Abstract

Summary: Carotid artery stenosis with high tortuosity is a known risk factor for carotid artery stenting CAS) and carotid endarterectomy (CEA). We report two cases in which CEA was performed to reat carotid artery stenosis that presented with remarkable tortuous distal internal carotid arteries ICA).

Case 1: A 70-year-old man presented with right transient ischemic attack (TIA) attributable to right arotid artery stenosis. Preoperative angiography revealed 75% stenosis and advanced calcification. ase 2: A 74-year-old man presented with asymptomatic, severe carotid artery stenosis. Preoperative ngiography revealed 80% stenosis and moderate calcification. CAS was deemed too difficult and CEA as performed in both cases. In Case 1, the end-to-end plication technique was used to reconstruct a elatively short segment of the tortuous vessel. In Case 2, a shunt tube was placed intraoperatively in a anner similar to an external shunt, and primary closure was performed. The preoperative modified ankin Scale score did not worsen in both cases. Both patients recovered satisfactorily, with no recurrence. ngenious surgical procedures, such as angioplasty or shunt insertion, are required after plaque emoval when performing CEA.