Late carotid restenosis with contralateral oclusion and no femoral axis – Tough case

76-year-old man with right internal carotid artery occlusion. In 2009, left carotid endarterectomy for symptomatic carotid stenosis.

Follow-up protocol with yearly carotid ultrasound and 10 years later an asymptomatic restenosis of 90-95% was diagnosed and proposed for re-intervention.

PAD with severe bilateral aorto-iliac disease. Femoral pulses were absent.

Under local anesthesia, stenting of the left carotid axis (Roadsaver® 8x40mm) by surgical approach of the left primitive carotid artery was performed. SpiderFx 6.0 filter for cerebral protection.

The procedure and the postoperative period were uneventful and the patient was discharged one day after surgery under double antiplatelet therapy. Control ultrasound showed patency of the stent as well as the downstream artery, with no evidence of thrombi or residual stenosis.