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Keywords:
Interventional vascular, CNS, Arteries / Aorta, Catheter arteriography, CT-Angiography, Angioplasty, Embolism / Thrombosis, Ischaemia / Infarction
Authors:
A. Elmokadem1, S. A. Ansari2, S. Prabhakaran2, A. Shaibani2, M. C. Hurley2; 1Mansoura/EG, 2chicago/US
DOI:
10.1594/ecr2016/C-0140
Methods and materials
Both cases were admitted to our institution in the last two years with history of recurrent stroke confined to a single arterial territory. Ischemic strokes were confirmed by MRI.
Computed tomographic angiography (CTA) and contrast enhanced magnetic resonance angiography (MRA) were conducted.
The initial diagnosis of the carotid web in both patients was established by CTA as a non calcified shelf like hypodense projection at the ICA bulb prior to DSA confirmation.
Patient (1) initially managed conservatively with medical therapy (figure 1) while Patient (2) presented emergently with an acute left MCA M1 occlusion was managed by emergent mechanical thrombectomy restoring near complete distal reperfusion yet the procedure was complicated by a non flow limiting iatrogenic dissection (figure 2). After patient consent,
carotid stenting was performed under monitored anesthesia care.
Carotid stenting was performed using a self-expandable closed cell stent (Xact stent,
both 8 x 20 mm,
Abbott Vascular).
Patients were monitored in an intensive care unit for a period of 24 hours after the procedure.
Aspirin 81mg and clopidogrel 75mg therapy was continued for 3 months followed by aspirin 81mg indefinitely.
Early clinical follow-up included a neurological examination and a Doppler ultrasound study for at least 3 months after the procedure.