Complete carotid artery reconstructed in a rare operation

Chandigarh, Feb 10 (UNI) Renowned cardiac interventionist, Dr Harinder Bali has reconstructed an entirely diseased and completely obstructed common carotid artery with the help of 4 stents on a teenaged girl for a second time in about a decade.

Dr Bali, Director, Cardiology, Fortis Hospital, told media persons here today that the case of rare disease termed as 'Pulseless disease' in layman's language and 'Takayasu arthritis' in medical terminology dates back to 1997 and was a pathbreaking example due to the magnitude of surgical drudgery and complexity of entire endovascular reconstruction.

In a pathbreaking operation ten years ago, he had operated upon Patna-girl Anu, suffering from severe symptoms of brain ischemia, with debilitating symptoms of postural loss of consciousness and blindness.

Anu, then seven-year-old, became the first person and youngest child in the world to be treated by a carotid stent to manage the disease, which causes blockage of blood supply to brain or its part due to partial or complete occlusion of carotid artery. The method later became the satandard treatment for the problem.

Recently, Anu, 17-year-old now, approached Dr Bali, with similar symptoms but the problem had assumed more serious dimension. About six months back she had started getting episodes of recurrent loss of consciosness and for past few months she had been bed-ridden.

Her angiography this time showed a total block of her right common carotid artery. The entire blood supply to the brain was occurring through multiple small collateral arteries trying to reconstruct the intracranial parts of the carotid and the vertebral arteries.

Considering the options, said Dr Bali, ''we decided to reconstruct the entire left carotid vessel by stenting. The three-hour-long procedure involved deployment of three self-expanding and one balloon expandable stent into the left carotid vessel.

The stented segment was almost 11 cm in length which means total reconstruction of left common carotid vessel from its origin to well beyond the bifurcation.

Dr Bali said that Anu was very fortunate that she had a very well developed Circle of Willis-a confluence of blood channels at the base of brain. Because of this the normalised blood supply through the left carotid artery is able to supply blood to her entire brain even though the other three arteries were still occluded.

Informing about the operation Dr Bali further added that the total occlusion in left carotid artery was crossed with a thin wire.

First balloon angioplasty was done using sequentially larger balloons. After angioplasty the entire diseased segment was stented.

Anu experienced some headache after the procedure, but is now in good health and leading a normal life.

Dr Bali was assisted by Dr Shiv Bagga during the procedure while Dr Harsh Batra, Incharge CCU and his team took care of the patient after the procedure.

UNI JN BP1709