A case of complex Cervical Carotid Artery Stenosis

A middle-aged female with diabetes and hypertension came to Max Super Speciality Hospital, Shalimar Bagh. She was brought to ER from another hospital and presented with complaints of headache and numbness over the left half of her body. Her MRI of the brain stroke protocol showed acute Ischaemic Infarct in the right thalamus and sub-thalamic region. Her angiography revealed critical stenosis (97%) of the ipsilateral right cervical carotid artery. She had a major risk of further stroke in future, considering the degrees of stenosis.

She was put on dual anti-platelets and was taken up for surgery the next day. She underwent right-sided carotid angioplasty and stenting under MAC.

Post-operatively, the patient was shifted to ICU for a day for regular monitoring. The patient responded well. After stabilisation, she was shifted to the ward the next day and discharged in stable condition.

The patient's surgery in the form of carotid angioplasty and stenting was also a challenge as negotiation of a wire, balloon or stent could dislodge the plaque and cause stroke. The case was managed successfully using a distal protection device for stroke. So, early detection and timely intervention in such critical stenosis can prevent secondary strokes in future.