Delayed progressive restenosis of the supraclinoid internal carotid artery treated with percutaneous transluminal angioplasty in a patient with aneurysmal subarachnoid hemorrhage

Abstract

Typically occurring between 3 days and 3 weeks post-hemorrhage, cerebral vasospasm in the acute stage after aneurysmal subarachnoid hemorrhage is a major contributor to the morbidity and mortality associated with patient outcomes, despite advances in aneurysm treatment and vasospasm management. Though incompletely understood, cerebral vasospasm is well described in the immediate post-hemorrhage patient. Less detailed descriptions exist of delayed or progressive restenosis after aneurysmal subarachnoid hemorrhage and resultant vasospasm. We report a case of delayed progressive supraclinoid internal carotid artery restenosis treated with angioplasty 10 weeks after initial hemorrhage.

Delayed progressive bilateral supraclinoid internal carotid artery stenosis in a patient with a ruptured basilar artery aneurysm

“…As mentioned previously, restenosis after vasospasm-associated balloon angioplasty is quite rare and this report, to our knowledge, serves as the fourth [12][13][14]. We tried to find similarities between these reports to further our understanding of this phenomenon (Table 1).…”

“…Restenosis after angioplasty for both intracranial and coronary atherosclerosis has been reported to occur in 30-50% [15][16][17][18] of cases but reports of it occurring in a delayed fashion after cerebral vasospasm are uncommon [12][13][14]. Although balloon angioplasty has become established in the treatment of medically and pharmacologically refractory vasospasm, it is not a benign procedure.…”

“…In addition, the supraclinoid ICA was much more likely than any other location to have a propensity for developing a greater degree of restenosis. Interestingly, in the report by Hsu et al [13], delayed stenosis occurred in a supraclinoid ICA that did not undergo balloon angioplasty, suggesting that delayed stenosis may or may not be directly linked to balloon angioplasty and that the supraclinoid ICA may have a significant underlying propensity for restenosis. Finally, in all cases (Table 1), compliant and softer balloons were used for treatment.…”

“…Restenosis after balloon angioplasty for atherosclerosis is a well-known phenomenon [9][10][11], however, its occurrence in a delayed fashion following its use for cerebral vasospasm is rare [12][13][14]. We report a patient who underwent successful angioplasty for internal carotid artery (ICA) post-SAH vasospasm, who went on to develop delayed progressive severe focal restenosis.…”