Minimally invasive surgical treatment of a patient with pathological tortuosity of the carotid artery using endoscopic assistance

Abstract

The study objective is to describe a clinical case of surgical treatment of a patient with pathological distal tortuosity of the left internal carotid artery (ICA) and present a comprehensive description of a proposed surgical technique, as well as compare advantages and disadvantages of the chosen and alternative surgery types.Materials and methods. At the 1st stage, we performed computed angiography and triplex scanning of the main head arteries and modelled operative approach. At the 2nd stage, we mapped the ICA approach, redressing and resection. At the 3rd stage, using endoscopic assistance we separated the ICA along its entire length, found its pathological kink, performed ICA redressing and resection with subsequent reanastomosis with high accuracy and minimal injury.Results. ICAblood flow was 320 ml/min (prior to surgery: 140 ml/min). In the postoperative period, positive dynamics of the patient’s neurological status were observed. Computed angiography and triplex scanning confirmed removal of pathological tortuosity. Compared to the proposed technique, other surgery types (open access) are characterized by high risk of injury of the cranial nerve branches, submandibular and parotid glands, necessity of dissection of the digastric, stylohyoid muscles, subluxation of the mandibula, etc.Conclusion. The method of allocation of hard to reach tortuosities of the carotid artery developed based on previously known endoscopic manipulations on the vessels of the extremities using endoscopic assistance allows to decrease injury during the intervention and achieve maximal technical and clinical effect.