Surgical approach to left common carotid arterial dissection complicated during endovascular intervention in a patient with takayasu disease: Case report and review of literature

Abstract

Takayasu arteritis is a rare vasculitis of unknown etiology. Inflammation primarily involves aorta and its branches in this disease. In our case, multislice computerized tomographic angiography showed total occlusion of right, and critical stenosis of left internal carotid and proximal part of left subclavian arteries. A conventional angiography was planned to implant a stent to left internal carotid artery, and to screen any coronary lesions. There was osteal stenosis of left anterior descending artery (LAD) on coronary angiography. Takayasu arteritis was diagnosed regarding Ishikawa criteria, and the patient was administered corticosteroids. After 3 weeks of corticosteroid treatment, it was decided to implant a stent to LAD and left internal carotid artery. Although coronary intervention was successful, the carotid intervention with stent was unsuccessfully due to rupture of the intimal plaque. The patient was taken into operating room urgently due to stent failure. First, saphenous vein was prepared from upper segment of knee of left leg. However diameter of the vein was insufficient to be used as a vascular graft. Left internal carotid artery was reconstructed with a patch of saphenous vein. Additionally, a cross over bypass was performed from right common carotid artery to left common carotid artery using a 7 mm polytetrafluoroethylene graft over saphenous vein. [Turk J Vasc Surg 2019; 28(1.000): 42-5]

Keywords

• carotid dissection; endovascular intervention; takayasu disease