Vol. 23 No. 3 (2019)
CASE REPORTS

Surgical treatment of a patient with stent restenosis in the mouth of the general carotid artery and the proximal department of the internal carotid artery

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  • A. Kazantsev,
  • N. Burkov,
  • A. Shabayev,
  • A. Volkov,
  • E. Ruban,
  • R. Lider,
  • A. Anufriyev
A. Kazantsev
Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo
Bio
N. Burkov
Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo
A. Shabayev
Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo
A. Volkov
Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo
E. Ruban
Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo
R. Lider
Kemerovo State Medical University, Kemerovo
A. Anufriyev
Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo
DOI: https://doi.org/10.21688/1681-3472-2019-3-104-110

Published 2019-11-27

Keywords

  • carotid angioplasty,
  • carotid subclavian shunting,
  • case report,
  • internal carotid artery,
  • multifocal atherosclerosis,
  • prosthetic internal carotid artery,
  • stent restenosis
    • ...More
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How to Cite

Kazantsev, A., Burkov, N., Shabayev, A., Volkov, A., Ruban, E., Lider, R., & Anufriyev, A. (2019). Surgical treatment of a patient with stent restenosis in the mouth of the general carotid artery and the proximal department of the internal carotid artery. Patologiya Krovoobrashcheniya I Kardiokhirurgiya, 23(3), 104–110. https://doi.org/10.21688/1681-3472-2019-3-104-110

Copyright (c) 2019 Kazantsev A. N., Burkov N. N., Shabayev A. R., Volkov A. N., Ruban E. V., Lider R. Yu., Anufriyev A. I.

Creative Commons License

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

Abstract

The results of surgical intervention on a patient with stent restenosis at the mouth of the common carotid artery (CCA) and proximal internal carotid artery (ICA) are presented herein. In 2013, the patient underwent stenting of the CCA and ICA. One month later, the aortic valve was replaced with a mechanical prosthesis MedEng-23 (MedEng, Penza, Russia) and mammarocoronary anastomosis with an envelope artery was performed under extracorporeal circulation. After the intervention, the patient regularly received 3.75 mg of warfarin, and was under the observation of a cardiologist. In 2018, the patient suffered a transient ischaemic attack. Subsequent examination of the patient revealed sub-occlusion of the left subclavian artery and signs of vertebral–subclavian steal syndrome on the left, and confirmed patency of the mammarocoronary shunt in envelope artery. The patient underwent carotid–subclavian shunting using the BASEX (A.N. Bakulev National Medical Research Center of Cardiovascular Surgery, Moscow, Russia) (8-mm prosthesis. Nine months after the patient underwent carotid–subclavian shunting, 85% restenosis was observed in the stent of the left ICA using control multi-spiral computed tomography with angiography (MSCT AG). The patient also exhibited up to 94% restenosis of the stent of the left ICA, occlusion of the right ICA, and up to 81% stenosis of the proximal anastomosis of the carotid–subclavian shunt. The patient underwent surgery for the removal of the following: the stent from the ICA with endarterectomy from the CCA, ICA with arterial plastic patches from the xenopericardium and prosthesis on the left (8-mm Vascutek prosthesis, Vascutek Ltd., UK). The brain was protected by raising the patient’s systemic blood pressure to 180/90 mm Hg. During the postoperative period, MSCT AG was performed to image the ICA. The MSCT AG images indicated that the prosthesis was passable. Presently, no clear standards exist for achieving revascularisation in this category of patients. The present clinical case emphasised the requirement for the detailed observation of patients after reconstructive interventions in different arteries as well as the possibility of surgically correcting the revealed lesions.

Received 13 August 2019. Revised 8 November 2019. Accepted 9 November 2019.

Funding: The study did not have sponsorship.

Conflict of interest: Authors declare no conflict of interest.

Author contributions
Drafting the article: A.N. Kazantsev
Literature review: R.Yu. Lider
Illustrations: A.R. Shabayev, A.N. Volkov
Critical revision of the article: N.N. Burkov, A.I. Anufriyev
Preoperative patient preparation: A.R. Shabayev, E.V. Ruban
Postoperative care: A.N. Volkov
Neurological examination: E.V. Ruban
Final approval of the version to be published: A.N. Kazantsev, N.N. Burkov, A.R. Shabayev, A.N. Volkov, E.V. Ruban, R.Yu. Lider, A.I. Anufriyev

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