Unstable atherosclerotic plaque of the internal carotid artery in the case of a patient with high surgical risk treated endovascularly

Michał Jerzy Terpiłowski, Jędrzej Tkaczyk, Barbara Klatka, Klaudia Brożyna, Magdalena Hołowczuk, Jan Jakub Kęsik, Marek Iłżecki

Abstract


Introduction: Internal carotid artery (ICA) stenosis in a majority is caused by atherosclerotic plaque. Symptoms of ICA stenosis manifest most likely a transient ischemic attack (TIA). The dynamics of ICA stenosis progression is unpredictable, the disease may progress quickly or slowly or remain stable for many years. The method of treatment implemented also depends on it. The task of pharmacological treatment is to reduce the progression of the disease and protect against the onset of stroke. Among the invasive methods of treating ICA stenosis, the standard procedure is endarterectomy of a carotid artery (CEA), i.e. surgical removal of atherosclerotic plaque. Another method of treatment is endovascular carotid artery stenting (CAS). CAS should be considered especially in the case of re-operated patients, also after radiotherapy and tracheostomy. CAS is a less invasive procedure, it avoids complications typical for CEA such as cranial nerve palsy or complications at the site of the wound. On the other hand, the risk of postoperative ischemic stroke is greater in the case of CAS. In recent years, the improved CAS method seems to be the implantation of dual-layered mesh-covered carotid stent systems (DLS).

Case report: We present the case of a 69 old man, long-term smoker, with hypertension and coronary heart disease. In 2001 diagnosed with larynx cancer and underwent surgical laryngectomy and radiotherapy. He was admitted in scheduled mode due to symptomatic carotid artery stenosis. In USG examination there was visible stenosis of the right internal carotid artery (80%) caused by an unstable atherosclerotic plaque with irregular structure and thrombotic clots. Due to the obvious difficulties of performing endarterectomy following radiotherapy in the neck area and laryngectomy, the endovascular method has been considered. In spite of the unstable plaque, which is a contraindication to perform the endovascular procedures CAS has been decided to perform. The patient underwent implantation of a dual-layered carotid stent in the combination with proximal balloon occlusion protection with a MoMa device. After procedure arteriography confirmed the optimization of the carotid artery flow and the correct position of the stent. The treatment was carried out without complications. After a few days of hospitalization, the patient was discharged home.

Discussion: The method of treatment of internal carotid artery stenosis is selected taking into consideration morphology and localization of atherosclerotic plaque, anatomical conditions and the local condition of the surgical area as well as the general condition of the patient and coexisting diseases. On the one hand, the patient underwent cervical radiotherapy and laryngectomy which are contraindications for CEA. On the other hand, an atherosclerotic plaque was unstable with the features of stratification which is a contraindication to the performance of CAS. In the described case it was decided to make implantation of dual-layered carotid stent system (DLS) connected with proximal balloon occlusion protection with a MoMa device allowed to reduce the risk of embolization.

Keywords


carotid artery; stenosis; stenting; atherosclerotic plaque; mesh

Full Text:

PDF

References


Dyken M: Stroke risk factors in the prevention of stroke. W: Noris JW, Hachinski VC (red.): Prevention of Stroke. Springer-Verlag, New York 1991: 83–102.

Bicknell CD, Cheshire NJ. The relationship between carotid atherosclerotic plaque morphology and the embolic risk during endovascular therapy. Eur J Vasc Endovasc Surg. 2003 Jul;26(1):17-21.

Guidelines on myocardial revascularization Guidelines on myocardial revascularization. The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2010; 31: 2501-2555

C.D. Liapis, Sir P.R.F. Bell, D. Mikhailidis, J. Sivenius, A. Nicolaides, J. Fernandes e Fernandes, G. Biasi, L. Norgren: European Society of Vascular Surgery (ESVS) guidelines. Invasive treatment for carotid stenosis: indications, techniques Eur J Vasc Endovasc Surg 2009; 37: S1–S19

Ścibisz A, Michalak M, Kochman J. Angioplastyka tętnic szyjnych w świetle najnowszych wytycznych Kardiologia po Dyplomie 2011; 10 (6): 70-75

Silver FL, Mackey A, Clark WM, Brooks W, Timaran CH, Chiu D, et al. Safety of

stenting and endarterectomy by symptomatic status in the Carotid Revascularization

Endarterectomy Versus Stenting Trial (CREST). Stroke. 2011 Mar;42(3):675-80.

Schneider, P. A., Kasirajan, K. (2007). Difficult Anatomy: What Characteristics Are Critical to Good Outcomes of Either CEA or CAS? Seminars in Vascular Surgery, 20(4), 216–225. doi:10.1053/j.semvascsurg.2007.10.005

Yamada K., Yoshimura, S., Kawasaki, M., Enomoto, Y., Asano, T., Hara, A., … Iwama, T. (2011). Embolic complications after carotid artery stenting or carotid endarterectomy are associated with tissue characteristics of carotid plaques evaluated by magnetic resonance imaging. Atherosclerosis, 215(2), 399–404.

Tatli E, Buturak A, Grunduz Y, et al. Comparison of anti-embolic protection with proximal balloon occlusion and filter devices during carotid artery stenting: clinical and procedural outcomes. Postepy Kardiol Interwencyjnej. 2013;9(3):221-7.

Stabile E, Tesorio T, Esposito G. The modern

approach to endovascular carotid revascularisation.

EuroIntervention 2016;12:e538–40

Carly N. Richards and Peter A. Schneider, Will Mesh-covered stents help reduce stroke associated with carotid stent-angioplasty?, Seminars in Vascular Surgery, ISSN: 1558-4518, Vol: 30, Issue: 1, Page: 25-30

Bosiers M, Deloose K, Torsello G, Scheinert D, Maene L, Peeters P, Müller-Hülsbeck S, Sievert H, Langhoff R, Callaert J, Setacci C, Wauters J. :Evaluation of a new dual-layer micromesh stent system for the carotid artery: 12-month results from the CLEAR-ROAD study. EuroIntervention. 2018 Nov 20;14(10):1144-1146




DOI: http://dx.doi.org/10.5281/zenodo.2642844

Refbacks





Copyright (c) 2019 © The Author(s)

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Journal of Education, Health and Sport formerly Journal of Health Sciences

Declaration on the original version.

Editors indicates that the main version of the magazine is to issue a "electronic".

The journal has had 5 points in Ministry of Science and Higher Education parametric evaluation. § 8. 2) and § 12. 1. 2) 22.02.2019.

1223 Journal of Education, Health and Sport eISSN 2391-8306 7

ISSN 2391-8306 formerly ISSN: 1429-9623 / 2300-665X

Archives 2011 - 2014

PBN 2011 - 2014

https://pbn.nauka.gov.pl/sedno-webapp/search?search&searchCategory=WORK&filter.inJournal=36616

POL-index 2011 - 2014

https://pbn.nauka.gov.pl/polindex-webapp/browse/journal/journal-32a319c5-a850-4f44-ba70-1418a6087655

BASE 2011 - 2014

https://www.base-search.net/Search/Results?lookfor=Journal+of+Health+Sciences+%28Radom%29&type=all&oaboost=1&ling=1&name=&thes=&refid=dcrespl&newsearch=1

http://elibrary.ru/contents.asp?titleid=37467

http://journal.rsw.edu.pl/index.php/JHS/issue/archive

Indexed in Bases, Bazy indeksacyjne: ERIH Plus, Worldcat, PBN/POL-Index, ICI Journals Master List, Directory of Open Access Journals (DOAJ), ZBD, Ulrich's periodicals, Google Scholar, Polska Bibliografia Lekarska

US NLM = 101679844

101679844 - NLM Catalog Result - NCBI

https://www.ncbi.nlm.nih.gov/nlmcatalog/101679844

Find a library that holds this journal: http://worldcat.org/issn/23918306

Journal Language(s): English 

PBN Poland

https://pbn.nauka.gov.pl/sedno-webapp/journals/49068

POL-index

https://pbn.nauka.gov.pl/polindex-webapp/browse/journal/journal-c39c8169-88d2-45db-9e7f-d948ce9981c4

BASE

https://www.base-search.net/Search/Results?join=AND&bool0[]=AND&lookfor0[]=2391-8306&type0[]=all&page=11&l=pl&oaboost=1&refid=dcpagepl

Redaction, Publisher and Editorial Office

Instytut Kultury Fizycznej Uniwersytet Kazimierza Wielkiego w Bydgoszczy, Institute of Physical Education Kazimierz Wielki University in Bydgoszcz, Poland 85-091 Bydgoszcz ul. Sportowa 2  www.ukw.edu.pl Copyright by Instytut Kultury Fizycznej UKW w Bydgoszczy http://ojs.ukw.edu.pl/index.php/johs  Open Access ISSN 2391-8306 formerly ISSN: 1429-9623 / 2300-665X

The journal has been approved for inclusion in ERIH PLUS.

The ERIH PLUS listing of the journal is available at https://dbh.nsd.uib.no/publiseringskanaler/erihplus/periodical/info?id=485984

SIC Science citation index (calculated on the basis of TCI and Page Rank) 0

Russian Impact factor 0.16

Indexed in Index Copernicus Journals Master List.

http://journals.indexcopernicus.com/Journal+of+Education+Health+and+Sport,p24782242,3.html

ICV 2018 = 95.95 ICV 2017 = 91.30 ICV 2016 = 84.69 ICV 2015 = 93.34 ICV 2014 = 89.51 Standardized Value: 8.27 ICV 2013: 7.32 ICV 2012: 6.41 ICV 20115.48

The InfoBase Index IBI Factor for the year 2015 is 3.56 in InfoBase Index.com.

Website: www.infobaseindex.com

Universal Impact Factor 1.78 for year 2012. (http://www.uifactor.org/AppliedJournals.aspx)

Indexed in Polish Scholarly Bibliography (PBN) (PBN Polska Bibliografia Naukowa) (https://pbn.nauka.gov.pl/journals/36616)

is a portal of the Polish Ministry of Science and Higher Education, collecting information on publications of Polish scientists and on Polish and foreign scholarly journals. Polish Scholarly Bibliograhpy is a part of POL-on - System of Information on Higher Education. It is operated by the Interdisciplinary Centre for Mathematical and Computational Modelling, University of Warsaw.

Indexed in Russian Sciences Index Российский индекс научного цитирования (РИНЦ) http://elibrary.ru/contents.asp?titleid=37467

Indexed in Arianta Polish scientific and professional electronic journals Aneta Drabek i Arkadiusz Pulikowski

(http://www1.bg.us.edu.pl/bazy/czasopisma/czasop_full.asp?id=3595)