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Resolution of carotid stenosis pre-carotid intervention: A case for selective preoperative duplex ultrasound

INTRODUCTION: Spontaneous resolution of carotid stenosis is a phenomenon that has been described in literature in the past. At present it is not routine practise to scan patients prior to carotid endarterectomy surgery within the UK. PRESENTATION OF CASE: A 58 year old female presented to hospital w...

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Autores principales: Ali, Abid, Ashrafi, Mohammed, Zeynali, Iraj
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4429850/
https://www.ncbi.nlm.nih.gov/pubmed/25708134
http://dx.doi.org/10.1016/j.ijscr.2015.02.018
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author Ali, Abid
Ashrafi, Mohammed
Zeynali, Iraj
author_facet Ali, Abid
Ashrafi, Mohammed
Zeynali, Iraj
author_sort Ali, Abid
collection PubMed
description INTRODUCTION: Spontaneous resolution of carotid stenosis is a phenomenon that has been described in literature in the past. At present it is not routine practise to scan patients prior to carotid endarterectomy surgery within the UK. PRESENTATION OF CASE: A 58 year old female presented to hospital with a history of sudden onset headache and left sided weakness. CT head showed findings in keeping with an acute right MCA territory infarct. A duplex ultrasound scan showed echolucent material in the right internal carotid artery forming a greater than 95% stenosis. The scan was unable to visualise the patency of the vessel distally due to the position of the mandible. The patient was provisionally listed for carotid endarterectomy. An MRA was requested prior to surgery to assess the patency of the distal internal carotid artery. The MRA of the carotids showed normal appearance of the common carotid, internal and vertebral arteries with no definite stenosis. A repeat duplex ultrasound confirmed there was no significant stenosis. DISCUSSION: The finding of complete resolution of stenosis on MRA was an unexpected event. Had the initial duplex imaging allowed visualisation of the distal vessel patency, our patient would have undergone unnecessary carotid surgery with the associated morbidity and mortality. CONCLUSION: This case report draws attention to the benefits of selective preoperative scanning, in sparing patients from unnecessary surgery as a result of finding occlusion or resolution of a previously diagnosed carotid stenosis.
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spelling pubmed-44298502015-05-15 Resolution of carotid stenosis pre-carotid intervention: A case for selective preoperative duplex ultrasound Ali, Abid Ashrafi, Mohammed Zeynali, Iraj Int J Surg Case Rep Case Report INTRODUCTION: Spontaneous resolution of carotid stenosis is a phenomenon that has been described in literature in the past. At present it is not routine practise to scan patients prior to carotid endarterectomy surgery within the UK. PRESENTATION OF CASE: A 58 year old female presented to hospital with a history of sudden onset headache and left sided weakness. CT head showed findings in keeping with an acute right MCA territory infarct. A duplex ultrasound scan showed echolucent material in the right internal carotid artery forming a greater than 95% stenosis. The scan was unable to visualise the patency of the vessel distally due to the position of the mandible. The patient was provisionally listed for carotid endarterectomy. An MRA was requested prior to surgery to assess the patency of the distal internal carotid artery. The MRA of the carotids showed normal appearance of the common carotid, internal and vertebral arteries with no definite stenosis. A repeat duplex ultrasound confirmed there was no significant stenosis. DISCUSSION: The finding of complete resolution of stenosis on MRA was an unexpected event. Had the initial duplex imaging allowed visualisation of the distal vessel patency, our patient would have undergone unnecessary carotid surgery with the associated morbidity and mortality. CONCLUSION: This case report draws attention to the benefits of selective preoperative scanning, in sparing patients from unnecessary surgery as a result of finding occlusion or resolution of a previously diagnosed carotid stenosis. Elsevier 2015-02-17 /pmc/articles/PMC4429850/ /pubmed/25708134 http://dx.doi.org/10.1016/j.ijscr.2015.02.018 Text en © 2015 The Authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Case Report
Ali, Abid
Ashrafi, Mohammed
Zeynali, Iraj
Resolution of carotid stenosis pre-carotid intervention: A case for selective preoperative duplex ultrasound
title Resolution of carotid stenosis pre-carotid intervention: A case for selective preoperative duplex ultrasound
title_full Resolution of carotid stenosis pre-carotid intervention: A case for selective preoperative duplex ultrasound
title_fullStr Resolution of carotid stenosis pre-carotid intervention: A case for selective preoperative duplex ultrasound
title_full_unstemmed Resolution of carotid stenosis pre-carotid intervention: A case for selective preoperative duplex ultrasound
title_short Resolution of carotid stenosis pre-carotid intervention: A case for selective preoperative duplex ultrasound
title_sort resolution of carotid stenosis pre-carotid intervention: a case for selective preoperative duplex ultrasound
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4429850/
https://www.ncbi.nlm.nih.gov/pubmed/25708134
http://dx.doi.org/10.1016/j.ijscr.2015.02.018
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