In mid- August 2015 the patient D.K. 67-years-old has admitted to the Neck and Heart Vessels Surgery Department with the diagnoses; neoplasm of carotid body left carotid artery, pathologic deformation of the right internal carotid artery (ICA), pathologic deformation of the left vertebral artery (left VA). The condition after the strokes of the right hemisphere of the brain and transient ischemic attacks, chronic vertebro-basilar insufficiency.
The patient complained of pains in the tumor area that has increased in size for the last 2 months numbness in the left extremities, constant dizziness, unsteadiness of gait, periodic speech disorders.
According to the results of duplex scanning and CT-angiography the carotid body left internal carotid artery with sizes 5 ×6 cm was revealed, pronounced deformities as tortuosity of the right internal carotid and left vertebral arteries with acute angles of less than 90° that was the cause of transient cerebrovascular accidents. Due to the presence of constant threat of ischemic stroke by the Head of the Neck and Heart Vessels Surgery Department Dr. Shatakhyan M.P. (MD, PhD) was decided to perform the simultaneous correction of neck vessels pathology and resection of tumor.
In 12.08.2015 by the surgical team (surgeons Shatakhyan M.P., Hayrapetyan A.A., Petrosyan P.R., anesthesiologist – Muradyan A.R.) under the general anesthesia was performed the first stage of surgical intervention - the resection of pathologic deformity of the right internal carotid artery with re-implantation to the common carotid artery by end to side anastomosis ( fig. 1)
Fig. 1. The pathologic deformity of the right ICA (indicated by arrow) before and after the correction
Then from the left side of the neck, carefully, in order to avoid damaging of cranial nerves, was carried out resection of the carotid body neoplasms – chemodectoma (later confirmed by the results of histological examination)(fig. 2)
Fig.2 . The process of resection of carotid body neoplasm and image after removal
And the last step, by separate incision from the left the left vertebral artery is exposed, which was cut off at the orifice from the subclavian artery with resection of deformation area (fig. 3). For restoration of physiological blood flow the end to the side carotid-vertebral anastomosis with the left common carotid artery is placed.
Fig. 3. Pathologic deformity of the left vertebral artery( indicated by arrow)
The surgery lasted 7.5 hours. The patient was extubated one hour after transfer to the ICU. On the second p/o day the patient was transferred to the ward. The symptoms of dizziness, unsteadiness of gait, speech disorder have disappeared. In the department the patient has pneumonia that was successfully treated with appropriate antibiotic therapy (doctor- cardiologist Hayrapetyan M.A.).
The results of duplex scanning before discharge showed the normal physiological blood flow in the operated vessels. The patient was discharged on the 9th p/o day.
The Neck and Heart Vessels Surgery Department of MC Erebouni has great experience in the simultaneous surgical treatment of complicated pathologies of neck vessels supplying the blood to the brain, as well as aneurysms and tumors. Due to this, the patients with extremely severe lesions of different localization are successfully operated by one stage. The outcomes and results of such surgical intervention are comparable to those of the leading clinics of the world.
