Single-Stage Extracranial and Intracranial Stenting of the Internal Carotid Artery in a Patient with Open Circle of Willis and Associated Renovascular Hypertension

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Abstract

We describe a case of 72-year-old patient with recurrent transient ischemic attacks in the right internal carotid artery (ICA) territory associated with uncontrolled hypertension. Duplex ultrasonography und carotid angiography showed a < 60% stenosis with signs of a vulnerable plaque in the cervical segment, as well as a < 90% stenosis in the cavernous segment of the right ICA. After further examination the patient was diagnosed with an 80% renal artery stenosis. First, the patient had a single-stage stenting for extracranial and intracranial stenoses of the right ICA, then left renal artery stenting. No intraoperative and postoperative complications were observed. These results show that this surgical treatment is minimally invasive, safe, and effective in symptomatic patients and may be considered for the disease.

About the authors

Maksim V. Agarkov

Gusev Central District Hospital; Saint-Petersburg Institute of Bioregulation and Gerontology

Author for correspondence.
Email: Dr.agarkovmv@gmail.com
ORCID iD: 0000-0002-6304-2553
SPIN-code: 8861-6321

Chief, Department of interventional radiology

Russian Federation, Gusev; Saint-Petersburg

Alexey A. Safuanov

Gusev Central District Hospital

Email: annaly-nevrologii@neurology.ru
ORCID iD: 0000-0002-7878-2490

interventional radiologist, Department of interventional radiology

Russian Federation, Gusev

Svetlana T. Evreeva

Gusev Central District Hospital

Email: evreeva.sveta@yandex.ru
ORCID iD: 0000-0002-8915-3673

interventional radiologist, Department of interventional radiology

Russian Federation, Gusev

Olga B. Gertsog

Gusev Central District Hospital

Email: annaly-nevrologii@neurology.ru

Сhief doctor

Russian Federation, Gusev

Olga S. Safuanova

Gusev Central District Hospital

Email: annaly-nevrologii@neurology.ru
ORCID iD: 0000-0002-1333-0071

vascular surgeon

Russian Federation, Gusev

Vitaly V. Popov

City Hospital No. 40

Email: annaly-nevrologii@neurology.ru
ORCID iD: 0000-0003-2073-8080

Cand. Sci. (Med.), interventional radiologist, Department of interventional radiology

Russian Federation, Sestroretsk

Anton A. Khilchuk

City Hospital No. 40

Email: annaly-nevrologii@neurology.ru
ORCID iD: 0000-0002-7199-0502

Cand. Sci. (Med.), interventional radiologist, Department of interventional radiology

Russian Federation, Sestroretsk

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Supplementary files

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2. Fig. 1. Plain brain multislice computed tomography of patient M. on admission. ASPECTS 10.

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3. Fig. 2. The schematic view of the patient M.' circle of Willis. А — type O (fully closed CoW, with blue arrows indicating blood flow in the Circle of Willis — possible reverse arterial blood flow if extracranial arteries are stenosed or occluded), incidence 11.9%); В — type Ас2Рс (fully open CoW, with uncompensatable blood flow if extracranial arteries are involved), incidence 9.3%.

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4. Fig. 3. Patient M.' cerebral angiography. Right ICA C1 stenosis to 60% with signs of floating intima and contrast agent leakage into the plaque core (black arrows) in. ICA C4 stenosis to 90% (white arrows).

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5. Fig. 4. Patient M.'s MSCT scan in 24 h after admission. ASPECTS 10, no signs of hemorrhagic transformation.

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6. Fig. 5. Transcarotid artery revascularization in patient M. А — guidewire positioning in MCA; В — ICA C4 angioplasty; С — ICA post C4 angioplasty; D — stent positioning in the area of ICA residual stenosis; Е — ICA post C4 stenting; F — С1 ICA stenting.

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7. Fig. 6. Patient M.'s angiography before (А) and after (В) revasculari- zation. Increased MCA blood flow (В black outline) post stenting.

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8. Fig. 7. Left renal artery angiography and stenting. А — right renal artery stenosis 30%; В — left renal artery stenosis up to 80%; С — pre-stenting left renal artery angiography; D — left renal artery stenting.

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Copyright (c) 2023 Agarkov M.V., Safuanov A.A., Evreeva S.T., Gertsog O.B., Safuanova O.S., Popov V.V., Khilchuk A.A.

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This work is licensed under a Creative Commons Attribution 4.0 International License.

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