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Published in: Journal of Medical Case Reports 1/2024

Open Access 08-05-2024 | Carotid Endarterectomy | Case report

Stenting for subclavian steal phenomenon to restore cerebral perfusion due to acute carotid occlusion following carotid endarterectomy: a case report

Authors: Shin Hirota, Masataka Yoshimura, Junshi Cho, Toshihiko Hayashi, Azumi Kaneoka, Kei Ito, Juri Kiyokawa, Shinji Yamamoto

Published in: Journal of Medical Case Reports | Issue 1/2024

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Abstract

Background

Perioperative symptomatic carotid artery occlusion after carotid endarterectomy is a rare complication. In this study, we present a case of symptomatic acute carotid artery occlusion that occurred after carotid endarterectomy in a patient with coexistent subclavian artery steal phenomenon, which was successfully treated with subclavian artery stenting.

Case presentation

A 57-year-old East Asian female presented with stenosis in the left common carotid artery and left subclavian artery along with subclavian steal. The proximal segment of the left anterior cerebral artery was hypoplastic, and the posterior communicating arteries on both sides were well-developed. Left internal carotid artery stenosis progressed during the follow-up examination; therefore, left carotid endarterectomy was performed. On the following day, symptoms of cerebral perfusion deficiency appeared due to occlusion of the left carotid artery. The stenotic origin of the left common carotid artery and the suspected massive thrombus in the left carotid artery posed challenges to carotid revascularization. Therefore, left subclavian artery stenting for the subclavian steal phenomenon was determined to be the best option for restoring cerebral blood flow to the whole brain. Her symptoms improved after the procedure, and the postprocedural workup revealed improved cerebral blood flow.

Conclusion

Subclavian artery stenting is safe and may be helpful in patients with cerebral perfusion deficiency caused by intractable acute carotid occlusion coexisting with the subclavian steal phenomenon. Revascularization of asymptomatic subclavian artery stenosis is generally not recommended. However, cerebral circulatory insufficiency as a comorbidity may be worth considering.
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Metadata
Title
Stenting for subclavian steal phenomenon to restore cerebral perfusion due to acute carotid occlusion following carotid endarterectomy: a case report
Authors
Shin Hirota
Masataka Yoshimura
Junshi Cho
Toshihiko Hayashi
Azumi Kaneoka
Kei Ito
Juri Kiyokawa
Shinji Yamamoto
Publication date
08-05-2024

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