Common carotid artery embolism treated distally with endovascular therapy and proximally with endoscopic hybrid surgery using the carotid endarterectomy technique: A case report

Abstract

Background: We herein report a case of common carotid artery occlusion in which the distal portion of the occlusion was treated endovascularly and the proximal portion was revascularized by neuro endoscopy using the carotid endarterectomy technique. Case presentation: The case involved an 80-year-old woman with right hemianopsia. Computed tomography revealed cerebral infarction in the left occipital lobe and occlusion of the left common carotid artery, but there was no difference in cerebral blood flow between the right and left hemispheres. Because of the large amount of thrombus, hybrid surgery was selected to prevent peripheral embolization. A suction catheter was inserted under direct visualization of the left internal carotid artery. After confirming the peripheral side of the thrombus, a stent retriever was used to retrieve the thrombus. Next, a flexible speculum was inserted on the cardiac side to remove the thrombus, and a plaque was identified and removed from the left common carotid artery wall under endoscopy. Conclusion: For revascularization of time-delayed common carotid artery occlusion requiring massive thrombectomy and prevention of peripheral embolization, a hybrid procedure using endovascular and neuro-endoscopic techniques in combination with carotid endarterectomy technique is useful.

Keywords

• Hybrid surgery
• Endovascular thrombectomy
• Endoscopic thrombectomy
• Common artery occlusion