Internal to external carotid artery transposition to repair recurrent stenosis after carotid artery stenting

Recently, carotid artery stenting (CAS) has emerged as a treatment option f or carotid artery stenosis. Since the procedure is new, management of its c omplications is not standardized. This case report describes one method of arterial reconstruction after failed GAS. A 64-year-old male underwent CAS of his right internal carotid artery (ICA) for an asymptomatic 65% stenosis . Seven months later the stented area had narrowed to 95%. Arteriography re vealed that the common and external carotid arteries (ECA) were free of dis ease so we elected to perform a transposition of the distal ICA onto the pr oximal EGA. The ECA and its branches were completely mobilized and the asce nding pharyngeal and lingual arteries divided. The ICA was divided distal t o the stent. Transection of the occipital artery provided an arteriotomy fo r an end ICA to side ECA anastamosis, thus preserving ECA flow. Postoperati ve surveillance after 8 months has revealed no recurrent stenosis. Operativ e repair of restenosis after CAS may be challenging if standard endarterect omy is not possible. Other options for reconstruction are feasible but if t he common and external carotid arteries are disease-free, an ICA to ECA tra nsposition provides a simple all-arterial repair that avoids bypass and pro sthetic material.