Analysis of Reserve Capacity and Subsequent Stenting in a Case of Subacute Occlusion of the Internal Carotid Artery
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Correspondence
Analysis of Reserve Capacity and Subsequent Stenting in a Case of Subacute Occlusion of the Internal Carotid Artery K. Kallenberg · J. Rühlmann · J. Baudewig · J. Larsen · S. Gröschel · P. Dechent · A. Kastrup · M. Knauth
Received: 10 May 2012 / Accepted: 13 August 2012 / Published online: 8 September 2012 © The Author(s) 2012. This article is published with open access at Springerlink.com
Introduction In stroke patients, an acute thrombotic occlusion of an internal carotid artery (ICA) is a poor predictor for clinical outcome [1]. It has occasionally been managed by carotid endarterectomy [2] (CEA) or percutaneous transluminal angioplasty (PTA) with [3] or without [4] stent protection (carotid angioplasty and stenting, CAS). On the other hand, a chronic thrombotic occlusion (CTO) of the ICA may be treated successfully by external–internal carotid artery (EC– K. Kallenberg, M.D. () · Dr. med. J. Rühlmann · Dr. J. Baudewig Department of Neuroradiology, MR-Research in Neurology and Psychiatry, University Medical Center Göttingen Robert-Koch-Str. 40, 37099 Göttingen, Germany e-mail: [email protected] Dr. J. Baudewig Department of Diagnostic Radiology, Christian-Albrechts-University Kiel, Kiel, Germany Dr. med. J. Larsen Department of Radiology, Evangelisches Krankenhaus Göttingen-Weende, Göttingen, Germany Dr. med. S. Gröschel Department of Psychiatry and Psychotherapy, University Medical Centre, Mainz, Germany PD Dr. P. Dechent Department of Cognitive Neurology, MR-Research in Neurology and Psychiatry, Universitymedicine Göttingen, Göttingen, Germany Prof. Dr. med. A. Kastrup Department of Neurology, Klinikum Bremen-Mitte, Bremen, Germany Prof. Dr. med. M. Knauth Department of Neuroradiology, University Medical Center Göttingen, Göttingen, Germany
IC) bypass surgery [5, 6]. However, EC–IC together with best medical treatment (BMT) does not reduce the risk of an ipsilateral stroke compared with BMT alone [7]. In addition, there have also been recent reports on CAS in patients with symptomatic CTO [8, 9] and CAS has a serious role in patients with high operative risk. We herein report on the diagnostic work-up and subsequent therapeutic management of a patient with symptomatic thrombotic occlusion of the left extracranial ICA and a pre-existing occlusion of the contralateral ICA [10]. Case Report A 65-year-old male with multiple cardiovascular risk factors presented with dysarthria and central right-sided facial palsy following an episode of syncope. The patient was admitted to our stroke unit where he experienced blood pressure-dependent right-sided weakness and sensorimotor aphasia, initially controllable by conservative therapy. Pre-Interventional Assessment Computed tomography (CT)-angiography (CTA; Aquilion, Toshiba Medical Systems Europa, Zoetermeer, Niederlande) showed bilateral ICA occlusion and the magnetic resonance (MR) scan on a 3Tesla MR-system (TIM TRIO®, Siemens Medical Solutions, Erlangen, Germany) demonstrated multiple chronic microvascular lesions bilaterally on T2
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