[A case of acute occlusion of the cervical portion of the right internal carotid artery with successful stepwise vascular dilatation by rescue PTA and deferred PTA].

A case is reported of acute occlusion of the cervical portion of the internal carotid artery, which was recanalized and dilated by steps through rescue percutaneous transluminal angioplasty (PTA) and deferred PTA. A 53-year-old man, complaining of progressive disturbance of consciousness and hemiplegia, was admitted to our department at about 7 hours after onset. CT demonstrated no abnormality. Digital subtraction angiography revealed an occlusion of the right cervical internal carotid artery. After intra-arterial injection of t-PA, a guide wire was able to be passed through the artery. Recanalization of internal carotid artery was performed by rescue PTA with Stealth FS angioplastic balloons of small diameter. Residual stenosis ratio was about 80%. After rescue PTA, his symptoms improved. On the following day, deferred PTA with Stealth FS angioplastic balloons of larger diameter was performed. Stenosis ratio was 30%. After the procedure, his palsy was relieved. DSA in the 3rd week after the PTA revealed that the stenosis ratio had changed from 30% to 13%. Rescue PTA is very effective for prompt recanalization. Stepwise vascular dilatation by rescue PTA with small balloons followed by deferred PTA can improve symptoms and prevent fatal hemorrhagic infarction. This method is especially useful for high risk patients of cervical internal carotid artery occlusion.