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Abstract: Carotid artery stenosis is one of the important causes of stroke, and annual carotid ultrasound examination is recommended for high-risk groups to reduce the occurrence of complications. This is a case of a 76-year-old male patient who came to the hospital with right-sided limb weakness for 1 day. MRI showed a new cerebral infarction in the left frontal lobe, and the limb weakness gradually improved after 14 days of hospitalization. Carotid ultrasound revealed severe stenosis of the left internal carotid artery, and the carotid stenosis was released after carotid balloon dilation stent implantation.
Basic information】Male, 76 years old
Disease Type】New infarction in the left frontal lobe and severe stenosis of the left internal carotid artery
Hospital】Xing’an Meng People’s Hospital of Inner Mongolia
Date of Consultation】April 2022
Treatment plan] Carotid balloon dilation stenting + medication (aspirin, clopidogrel, atorvastatin, isosorbide nitrate, nifedipine controlled release tablets)
[Treatment period] 20 days of hospitalization, 1 year of regular postoperative outpatient follow-up
Treatment effect] Carotid artery stenosis was released and the incision healed well
I. Initial consultation
We were informed that the patient came to the hospital with right-sided limb weakness for 1 day, and the MRI showed a new cerebral infarction in the left frontal lobe. After 14 days of hospitalization, the limb weakness gradually improved. Carotid ultrasound revealed severe stenosis of the left internal carotid artery, and further improvement of CTA of the neck confirmed the location of the left internal carotid artery lesion. The patient was seen at the bedside, and the patient indicated that the right limb weakness had improved significantly, while there were no other uncomfortable symptoms. After explaining the patient’s condition to his family, he was recommended to undergo carotid artery surgery and was transferred to our department after obtaining the patient’s consent.
II. Treatment process
After consultation, the patient continued to follow the neurology drug treatment plan, taking oral aspirin, clopidogrel, atorvastatin, isosorbide nitrate, and nifedipine controlled-release tablets, and introducing the surgical procedure and related risks to the patient and his family. Among them, carotid endarterectomy is the classic surgical procedure for treating carotid stenosis, which is suitable for most patients and has better long-term results. For patients over 70 years old, carotid endarterectomy is the preferred treatment. Carotid balloon dilatation stenting, however, can be used as a complement to open surgery and is suitable for patients with more underlying disease and those who cannot tolerate general anesthesia. The patient’s family opted for carotid balloon dilatation stent implantation because of the patient’s high and poorly controlled previous underlying disease and poor cardiac function. The operation was performed under local anesthesia, and the location of the carotid artery lesion and intracranial vascularity were clarified by imaging after right femoral artery puncture, and a protective umbrella was placed, and the carotid artery stenosis was dilated by applying a balloon, followed by implantation of a carotid artery stent.
III. Treatment effect
After the operation, the patient was given cardiac monitoring to monitor the changes of blood pressure and heart rate, and the patient was instructed to stay in bed with the right lower limb for 24 hours. As in the neurology department, oral aspirin, clopidogrel, atorvastatin, isosorbide nitrate, and nifedipine controlled-release tablets were continued. Twenty-four hours after the operation, the monitoring system was withdrawn from the patient, and the patient was discharged from bed with no discomfort and no abnormalities in routine blood and renal function and blood ions on the third day after the operation. The patient was discharged successfully on the third day after the operation. The patient returned by telephone afterwards and indicated that the incision was healing well and there were no uncomfortable symptoms such as dizziness, headache and nausea.
IV. Precautions
The very high heart patient’s condition was well controlled after active treatment. However, patients are advised to also closely observe blood pressure and heart rate after carotid artery stenting, because a few patients may experience a decrease in heart rate and blood pressure. It is also necessary to avoid excessive force on the limb on the puncture side in daily activities to prevent bleeding from the puncture site. Pay attention to a low-salt and low-fat diet, strictly abstain from smoking and alcohol, maintain a light diet, and avoid spicy and stimulating foods. The carotid ultrasound was reviewed in the first, third, sixth and twelfth months after the operation, and the carotid ultrasound was reviewed every year thereafter to observe the condition of the carotid stent.
V. Personal insight
Statistics show that patients with severe carotid artery stenosis without formal treatment have a 30% chance of having a stroke. Carotid endarterectomy and carotid stenting are effective in preventing strokes with good long-term results. As in the case of the patient, he was seen promptly after the onset of symptoms and treated aggressively, and his condition was well controlled after the procedure. Therefore, it is recommended that patients with a family history, or with high-risk factors such as hypertension, diabetes, or hyperlipidemia, should have annual carotid ultrasound examinations to detect problems early and intervene promptly to avoid adverse consequences.