Management of Symptomatic Carotid Stenosis in AGS Patients—A Case Study

Shriya Kane; Crystal Rodriguez

doi:10.1016/j.jvs.2026.06.127

Introduction Alpha gal syndrome or AGS is a rare, delayed allergic reaction to nonmammalian meat products including medications like heparin and surgical prosthetics such as bovine patches that are a mainstay in cardiac and vascular surgery. The data on the implications of an AGS diagnosis on surgical outcomes are scarce, with only a few reports from cardiac surgery. This case report describes the successful execution of a carotid endarterectomy with an autologous vein patch due to prior knowledge of AGS allergy. Case Study A 73-year-old man with coronary artery disease presented for evaluation of symptomatic carotid stenosis after a transient ischemic attack 2 months prior. He had a known history of AGS, which was diagnosed due to episodes of generalized pruritus 4 to 6 hours after meals that contained red meat. His noninvasive studies revealed moderate stenosis of the right carotid artery, and he was scheduled for a right carotid endarterectomy. Because of his history of AGS and the consequent risk of heparinization and potential adverse reactions to a bovine patch, he was planned for an endarterectomy with an autologous great saphenous vein patch. Argatroban was used perioperatively for anticoagulation. The patient underwent the intervention successfully without any immediate or long-term complications. Discussion The enigmatic nature of AGS has made it a challenging condition to evaluate and treat. Very limited data exist in the field of surgery, in both cardiothoracic and vascular literature, that can guide perioperative considerations that are imperative to providing successful care to these patients. Our case serves as a review of a successful intervention with modifications that could be made in a planned manner due to a preestablished AGS diagnosis. Standardized screening recommendations to gauge the prevalence of AGS with desensitization protocols for heparin use among patients with this condition could greatly improve outcomes and decrease complications in vascular surgery patients with this underlying condition. Conclusions AGS is a rare condition that has been noted to adversely affect patient outcomes if they are treated with biomedical products such as heparin or bovine patches as a part of their surgical care. Continued analysis of this condition and reproducible methods to use bovine and porcine products for these patients could solidify a new paradigm for vascular intervention in AGS patients.

Management of Symptomatic Carotid Stenosis in AGS Patients—A Case Study

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