Carotid transluminal angioplasty with evidence of distal embolization

Case report

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✓ A 57-year-old woman presented with symptomatic triple tandem stenosis of the left carotid artery. Transluminal angioplasty of an atherosclerotic stenosis at the origin of the common carotid artery was performed retrogradely through a distal arteriotomy after endarterectomy. The postangioplasty effluent was collected and analyzed. Cholesterol crystals and amorphous plaque debris were identified, indicating a source for distal embolization. The clinical significance of this small amount of debris embolizing to the intracranial circulation is uncertain, but should be of concern when considering angioplasty of the cerebral circulation.

Article Information

Address reprint requests to: Franco DeMonte, M.D., Division of Neurosurgery, Department of Clinical Neurological Sciences, Faculty of Medicine, University of Western Ontario, London, Ontario N6A 5A5, Canada.

© AANS, except where prohibited by US copyright law.

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Figures

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    Preoperative angiogram showing the tandem stenosis of the left carotid artery (arrows), occlusion of the left vertebral artery, and lesser degrees of stenosis of the right carotid and innominate arteries, and both subclavian arteries.

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    Schematic representation of the technique of retrograde transluminal angioplasty used in this case.

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    Cholesterol crystals collected by filtration of the post-angioplasty effluent. × 85.

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