CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 3, April 2013
e14
AFRICA
On the other hand, for the posterior circle, clinical evidence
appears more fragmentary. Surgery may be performed, but it
brings more difficulties than the ‘simple’ carotid endarterectomy,
possibly requiring hard artefacts as extra-anatomical bypasses
or the re-implantation of VAs over CCAs. Similarly, there are
positive reports on endovascular treatment of these lesions.
2,3,6
However, there are no randomised clinical trials reporting on
surgery or stenting.
With regard to the pathology of SATs, it is not rare to observe
bilateral carotid stenosis or the co-existence of obstructions
involving both the anterior and posterior circulation. These
patients generally have an aggressive form of atherosclerotic
disease, due to multiple, severe risk factors and individual
predisposition; ischaemic cardiopathy and claudication
intermittens are often associated.
Management of these clinical patients is critical and is partly
assisted by the guidelines. Decision making is complex, many
aspects need to be considered (risk factors, feasibility, chance of
success, problems and hazards of revascularisation, co-morbidity,
life expectancy, patient’s compliance with antiplatelet therapy,
etc) and each patient is assessed independently.
Conclusions
This was an unusual case of a patient whose cerebral circulation
was supported by poor vicariate collaterals and a severe
atherosclerotic right vertebral artery, with no brain perfusion
abnormalities. We took an extremely cautious approach regarding
revascularisation. An accurate imaging analysis together with
clinical features allowed us to decide on a strategy based on
optimal medical therapy and careful clinical monitoring.
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