Unusual carotid enlargement after CEA

An 80-year-old patient with coronary disease, diabetes, and a history of stroke presents with a left carotid patch enlargement and tight stenosis before the venous patch—yet the carotid bifurcation and distal internal carotid remain patent.

With a complex vascular history, including previous carotid surgery and recurrent strokes, this case raises a critical question: How would you manage the next steps?

Caroline Caradu

Bordeaux, France

Éric Ducasse

Hospital Pellegrin - Bordeaux, France

Professor of vascular surgery

Professor of vascular surgery
Head of unit of vascular surgery CHU Bordeaux - France

Conflicts of interest:

Honoraria from: COOK Médical, Térumo-Vascutek, Siemens, GORE

Part I - Case presentation

A 80-year-old patient presented with :

Coronary diseases / Diabetic status / Dyslipidemia
Previous carotid surgical treatment on left side with venous patch closure in 2014 in another peripheral center
Previous history of stroke in 2016 and 2022 with excellent recovery. Clinical transient history of right brachial deficit and paresthesia
Recent investigation with Angio CT scan showing:
- Left carotid patch enlargement without thrombus
- Left common carotid tight stenosis before venous path
- Carotid bifurcation patent
- Distal left internal carotid patent without stenosis