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Treatment Strategy for Bilateral Carotid Stenosis: 2 Cases of Carotid Endarterectomy for the Symptomatic Side Followed by Carotid Stenting

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Please use this identifier to cite or link to this item:http://hdl.handle.net/2115/57788

Title: Treatment Strategy for Bilateral Carotid Stenosis: 2 Cases of Carotid Endarterectomy for the Symptomatic Side Followed by Carotid Stenting
Authors: Hokari, Masaaki Browse this author
Isobe, Masanori Browse this author
Asano, Takeshi Browse this author
Itou, Yasuhiro Browse this author
Yamazaki, Kazuyoshi Browse this author
Chiba, Yasuhiro Browse this author
Iwamoto, Naotaka Browse this author
Isu, Toyohiko Browse this author
Keywords: Carotid endarterectomy
carotid stenting
hyperperfusion syndrome
bilateral
Issue Date: Dec-2014
Publisher: Elsevier
Journal Title: Journal of stroke & cerebrovascular diseases
Volume: 23
Issue: 10
Start Page: 2851
End Page: 2856
Publisher DOI: 10.1016/j.jstrokecerebrovasdis.2014.07.014
Abstract: Since the introduction of carotid stenting (CAS), a combined treatment for bilateral lesions using carotid endarterectomy (CEA) and CAS has been developed. However, there has been only 1 report about CEA then CAS. Herein we describe 2 patients with bilateral severe carotid stenosis who were treated by CEA for the symptomatic side and CAS for the contralateral asymptomatic side. A 71-year-old man underwent CEA for the symptomatic side. Although the patient suffered hyperperfusion syndrome after CEA, he recovered fully after 3 weeks of rehabilitation. Two months later, CAS was performed for the asymptomatic side, and he was discharged with no deficit. A 67-year-old man underwent CEA for the symptomatic side. The patient developed no postoperative neurologic deficits except for hoarseness. Four weeks later, CAS was performed for the contralateral asymptomatic side. After the procedure, however, severe hypotension occurred, and treatment by continuous injection of catecholamine was necessary to maintain systematic blood pressure. The patient was ultimately discharged with no deficit. The combined therapy of CAS for the asymptomatic side and then CEA for the symptomatic side has been recommended by several authors. However, one of the problems of this strategy is the higher incidence of postprocedural hemodynamic complications, and hypotension after CAS may be dangerous for the symptomatic hemisphere. We suggest a combined therapy using CEA for the symptomatic side and then CAS for the asymptomatic side can be 1 beneficial treatment option for patients with bilateral carotid stenosis without coronary artery disease.
Type: article (author version)
URI: http://hdl.handle.net/2115/57788
Appears in Collections:北海道大学病院 (Hokkaido University Hospital) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

Submitter: 穂刈 正昭

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