One Case of Suspected Angiostenosis Revealed by MRA Following Carotid Endarterectomy Due to a Rare Cause

Abstract

We herein report on a case in which magnetic resonance angiography (MRA) following carotid endarterectomy revealed the appearance of angiostenosis due to an artifact of metallic powder, which was thought to have come from an old surgical instrument. The patient was a 77-year-old male. Carotid endarterectomy (CEA) was performed for stenosis in the internal carotid artery of his left neck (82%). Upon observing a decline in renal function following CEA surgery, a postoperative cervical MRA revealed the appearance of high-grade stenosis at the common carotid artery on which surgery was performed. No stenosis was revealed upon carotid ultrasonography and angiography. In the original MRA image, an orbicular low intensity area was observed in concordance with the narrow segment. 3D computed tomography (3D-CT) revealed a metallic finding, suggesting it was an artifact caused by metal powder. Close inspection of the metal surgical instruments used during surgery revealed slight damage to a suture snare which had been used for 30 years. Going forward, it is necessary to pay attention to old surgical instruments, introduce a system by which the number of years and the frequency of use of each surgical instrument can be learned, and replace them with new equipment as necessary.