A Case of Carotid Endarterectomy for a Patient with Pharyngooccipital Artery Directly Originating from the Stenosis of the Internal Carotid Artery

Abstract

We present a case of pharyngo-occipital artery (POA) originating from the stenosis of the internal carotid artery. The frequency of POA originating from the internal carotid artery is very rare. The patient was a 75-year-old male who was brought to our hospital due to sudden anarthria and drooping of the mouth corner. Cerebral infarction in the subcortical region of the right parietal lobe and stenosis of the right internal carotid artery greater than 70%, according to NASCET, were identified through brain magnetic resonance imaging (MRI) and computed tomography angiography (CTA). Because the MRI plaque imaging and ultrasound examination revealed a lesion with circumferential calcification and vulnerable plaque, we decided to perform a carotid endarterectomy (CEA). However, since POA was detected in the preoperative digital subtraction angiography (DSA) evaluation, we believed that we needed to devise a new technique. Due to concerns about regurgitation bleeding during surgery, we devised a method to block the branch vessels and improved the surgical steps. Here, we report a case in which CEA was safely performed without any intraoperative issues.