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A Case of Percutaneous Transluminal Angioplasty and Stenting for Dacron Bypass Graft Stenosis with Cerebral Infarction Hiroyuki MATSUMOTO 1 , Hideki TAKEMOTO 1 , Hirokazu NISHIYAMA 1 , Yoshiaki TETSUO 1 , Shinichi HIGASHIUE 2 , Naoyuki NAKAO 3 1Department of Neurological Surgery, Kishiwada Tokushukai Hospital 2Department of Cardiovascular Surgery, Kishiwada Tokushukai Hospital 3Department of Neurological Surgery, Wakayama Medical University Keyword: thoracic endovascular aortic repair , carotid-subclavian bypass , graft stenosis , angioplasty , stenting pp.1011-1018
Published Date 2015/11/10
DOI https://doi.org/10.11477/mf.1436203170
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 A 62-year-old man presented to the emergency room with mild dysarthria and right motor weakness. The patient was diagnosed with aortic dissection(DeBakey type Ⅲ)in the cardiovascular department of our institution two years ago and was then treated with left carotid-bilateral subclavian bypass with collagen-seated Dacron graft followed by thoracic endovascular aortic repair(TEVER)with stent-graft placement. Magnetic resonance imaging on admission showed cerebral infarction with left proximal middle cerebral artery occlusion in the left cerebral hemisphere. Three-dimensional computed tomography angiography(3D-CTA)demonstrated a stenotic lesion at the anastomosis of the right subclavian artery and the bypass graft. It also showed the partial left common carotid artery, suggestive of an endoleak in the thoracic stent graft. The patient was diagnosed with artery-to-artery embolism due to bypass graft stenosis or endoleak in the thoracic stent graft and was treated with conservative therapy. He gradually recovered from the neurological deficit and underwent endovascular angioplasty with a balloon-expandable stent for bypass graft stenosis by using the distal balloon protection method and the left proximal common carotid artery occlusion with coils 1 month later. One-year follow-up 3D-CTA showed good patency of the stent in the bypass graft. No recurrence of cerebral infarction was observed during the postoperative course.


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電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院

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