COMBINED INTRAOPERATIVE STENT IMPLANTATIO N AND THROMBENDARTERECTOMY OF THE CAROTID-ARTERY

History and clinical findings: A 63-year-old man developed recurrent t ransitory ischaemic episodes of vertigo and weakness in the legs 6 wee ks before admission. 3 weeks later he had a left amaurosis fugax. A st enotic murmur was heard over the left carotid artery. Investigation: I ntraarterial digital subtraction angiography of the arteries to the he ad revealed occlusion of the right internal carotid artery (RICA) and marked narrowing at the origin of the left common carotid artery (LCCA ), which could not be passed by catheter. Treatment and course: As a c atheter could not be passed into the LCCA, a stent was at operation pl aced retrogradely into it. Intraoperative angiography showed subtotal stenosis of the left ICA, which was treated by thrombendarterectomy an d dacron patch-plasty. The postoperative course was without complicati on and the patient was free of symptoms. Follow-up angiography was unr emarkable. Conclusion: If a stenosis of the carotid artery cannot be p assed by catheter, intraoperative retrograde placement of a stent is a n alternative to percutaneous antegrade transluminal angioplasty or su rgical bypass.