Vascular Mind : 2018

BEHZAD FARIVAR MD and SEAN LYDEN MD

CLEVELAND CLINIC

The resected atherosclerotic carotid artery stent shown above was recently removed from a patient who had undergone a carotid endarterectomy in 1994 and then had a carotid stent placed in 2004 for recurrent carotid stenosis. The earlier procedures were done at outside institutions, but the patient was referred to Cleveland Clinic’s Department of Vascular Surgery at age 63 for greater than 90 percent stenosis within her stent, attributable to atherosclerosis.

We resected her carotid artery, including the stent with atherosclerotic plaque, and did an interposition bypass. This is a complex reoperative procedure that is not commonly performed due to a significant risk of nerve injury and stroke. The patient was at particularly high risk due to significant comorbidities including diabetes, chronic kidney disease and peripheral artery disease. Despite these risks, the danger of stroke was sufficiently great to justify the procedure, and the patient has fared very well since the surgery over one month ago. She has resumed all her activities from before without any limitations. She is now scheduled for routine follow-up at six months with carotid duplex ultrasound surveillance.

Drs. Farivar and Lyden are surgeons in Cleveland Clinic’s Department of Vascular Surgery.