1. Carotid Endarterectomy with Stent Graft Removal and End to End Bypass in the Treatment of In-Stent Occlusion after Endovascular Therapy of Carotid Gunshot Injury
- Author
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Yun-Peng Ling, Yun-Feng Han, Hong Zhao, and Tao Wang
- Subjects
medicine.medical_specialty ,Fistula ,medicine.medical_treatment ,Carotid endarterectomy ,030204 cardiovascular system & hematology ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Pseudoaneurysm ,0302 clinical medicine ,Restenosis ,Occlusion ,medicine ,cardiovascular diseases ,Computed tomography angiography ,medicine.diagnostic_test ,business.industry ,Stent ,General Medicine ,equipment and supplies ,medicine.disease ,Surgery ,Stenosis ,surgical procedures, operative ,cardiovascular system ,Cardiology and Cardiovascular Medicine ,business - Abstract
Carotid jugular fistula and pseudoaneurysm are easy to form after gunshot injury of carotid artery. Endovascular therapy, such as stent graft implantation, can successfully block the fistula and pseudoaneurysm cavity. However, the possibility of in-stent restenosis or occlusion will lead to treatment failure. The authors describe the case of a 30-year-old man with carotid jugular fistula and pseudoaneurysm after gunshot injury of left carotid artery who had received stent graft placement. However, two years after stent graft, the stenosis of proximal carotid artery near stent was found and gradually aggravated. During the follow-up, transient amaurosis of his left eye occurred intermittently and in-stent occlusion and severe stenosis of proximal carotid artery were found by computed tomography angiography (CTA) in our center. Carotid endarterectomy (CEA)with stent graft removal and end to end bypass using vascular graft was performed to reconstruct the blood flow of left carotid artery. To the extent of the authors’ knowledge, this case illustrates a rare CEA and vascular graft bypass in the treatment of in-stent occlusion following the gunshot injury to the carotid artery. The successful treatment of this rare case provides an option to deal with this kind of tricky problem.
- Published
- 2021
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