Less invasive carotid endarterectomy with balloon thrombectomy for proximal common carotid artery occlusion in a patient with C4 spinal cord Injury: A case report.

BACKGROUND

Cerebral ischemia associated with common carotid artery (CCA) occlusion is a relatively rare condition, and the optimal surgical strategy remains controversial, with no established consensus. Herein, we report the first case of carotid endarterectomy combined with balloon thrombectomy for proximal CCA occlusion.

CASE DESCRIPTION: The patient was a 66-year-old male with orthostatic hypotension after C4 spinal cord injury who presented with posture-induced right hemiparesis and aphasia. Magnetic resonance imaging revealed left CCA occlusion proximally to the clavicle. Arterial spin labeling revealed a significant reduction in cerebral blood flow in the left hemisphere. In light of the emergence of new cerebral infarctions despite maximal medical therapy, surgical revascularization was deemed necessary. During the actual surgical procedure, recanalization was successfully achieved by advancing a balloon catheter through the arteriotomy and retrieving the thrombus. No complications occurred, and the patient experienced neurological improvement, being discharged to a rehabilitation facility.

CONCLUSION

This combined technique is less invasive and feasible for treating CCA occlusion located in anatomically challenging regions below the clavicle.