Saphenous vein interposition graft of the carotid artery after endarterectomy: Case report

Abstract

Background

Strokes are the second cause of death worldwide, with over 12.2 million new cases per year. Ischemic strokes represent 62% of cases, primarily due to atherothrombotic or cardioembolic mechanisms. Surgical revascularization is often required in severe atherothrombotic cases and includes carotid endarterectomy or vascular endoprosthesis.

Methods

A hospital stroke code protocol was activated for a 62 years old female with critical carotid stenosis. Surgical intervention included carotid endarterectomy and interposition of a saphenous vein graft.

Results

Patient with history of diabetes mellitus type 2 and hypertension, presented with 90% occlusion of right carotid artery and 85% at the bulb. A right carotid endarterectomy was performed resulting in acute neurological improvement. 24 hours later cranial tomography and magnetic resonance revealed occlusion of the right internal carotid artery and dissection of common carotid artery. A second surgical procedure was performed, involving saphenous vein graft. Postoperative recovery was favorable, with improved neurological function.

Conclusion

This case highlights importance of institutional stroke code protocols for rapid identification, etiological classification, and timely surgical management of acute stroke. Structured response systems enhance clinical decision-making and improve patient outcomes in high-risk vascular events.