A Clinical Case Report: Patient with Carotid Artery Thrombosis

Abstract

A 72-year-old male patient was admitted to the clinic on an urgent/emergency basis. The patient complained of dizziness, loss of balance, and ringing in the ears. In the medical history, he reported several episodes of loss of consciousness, with the most recent episode occurring approximately two weeks ago. He also experienced numbness in the right limbs, lasting for several hours.

Due to these complaints, a duplex ultrasound of the carotid arteries and a CT angiography of the extra- and intracranial vessels were performed. The investigation revealed up to 60% stenosis of the left internal carotid artery, caused by soft atherosclerotic plaques. The right internal carotid artery was calcified at the carotid sinus but without significant stenosis.
 Neurological examination: cranial nerves intact; motor strength and range of motion preserved in all four limbs; coordination tests were performed satisfactorily; pathological extensor reflex present on the right side. The patient was classified as high-risk for stroke.
 Cardiological consultation revealed essential (primary) hypertension. The patient had experienced a TIA one week prior.

Clinical diagnosis – Hemodynamically significant stenosis of the left internal carotid artery.
Comorbidities – Essential (primary) hypertension; transient ischemic attack (unspecified).
 Based on the patient's condition and diagnostic results, a decision was made in favor of surgical intervention. The goal of the operation was the prevention of ischemic stroke.

Under general balanced anesthesia, a 10 cm incision was made over the projection of the left carotid arteries. A longitudinal arteriotomy was performed on the anterior wall of the common carotid artery, extending into the internal carotid artery, 3 cm in length. Intraoperative revision showed atherosclerotic degeneration of the left common, external, and internal carotid arteries. The atherosclerotic plaque extended 1 cm into the internal carotid artery, causing hemodynamic stenosis.
 A temporary shunt (9Fr) was inserted from the common carotid artery into the internal carotid artery, and main arterial blood flow was restored. The clamping time was 01:30 minutes. An open endarterectomy was performed on the common, internal, and external carotid arteries.
 The temporary shunt was removed, and central blood flow was restored in the internal carotid artery. The total clamping time was 03:00 minutes. The anastomosis was hermetic, and pulsation of the arteries was confirmed within the wound. The wound was closed in layers.
Macroscopic specimen description: atherosclerotic plaque removed from the left common, internal, and external carotid arteries.

Expected postoperative complications: acute cerebral circulatory disorders, hemorrhage, infection, swelling, pain, adverse drug reactions, delayed wound healing, exacerbation of comorbidities, thrombosis in the reconstruction zone, myocardial infarction.
 Respiratory risks: respiratory distress syndrome, loss of work capacity, death, and risk of additional surgical interventions.

Prevention of postoperative complications: adequate anticoagulant and antiplatelet therapy, aseptic wound dressings, antibiotic therapy, syndrome-based and symptomatic treatment.
 The patient did not develop complications and was discharged home on the 4th day of hospitalization.

Therapeutic and work-related recommendations: daily wound care; follow-up carotid duplex ultrasound and vascular surgeon consultation after 3 weeks; ALT, AST, creatinine, and lipid profile testing after 1 month; cardiologist consultation, complete blood count and CRP after 5 days; physical rest for 2 weeks.