Limb-Shaking Transient Ischemic Attacks Successfully Treated with External Carotid Artery Stenting

Abstract

The external carotid artery (ECA) is one of the most important extracranial-to-intracranial sources of collateral circulation, contributing significantly to the cerebral blood flow especially when perfusion through the internal carotid artery (ICA) is compromised. Most of the endovascular studies so far have been dedicated to ICA, with little focus on the ECA. Limb-shaking transient ischemic attacks (TIAs) are a relatively rare manifestation of carotid artery disease that may present with repetitive shaking movements of the affected limbs. We report a case of an 80-year-old male with bilateral internal and contralateral external carotid artery occlusion who developed limb-shaking TIAs as a result of significant stenosis of the right ECA. Percutaneous revascularization of the ECA was performed by angioplasty and stenting. At the follow-up 12 months later, the patient remained neurologically intact with complete resolution of his symptoms. Stenting of the ECA should be considered as a reasonable alternative to conventional open repair especially in patients with contralateral carotid stenosis, insufficient circle of Willis, and significant comorbidities.

Endovascular Repair of External Carotid Artery Disease

“…The search identified 21 reports describing endovascular repair of ECA lesions encompassing 56 patients (35 men; mean age 62.6±10.5 years) and 58 arteries (Table 1). 3,6,9–27 The articles were scrutinized for the following variables: number of patients, age, sex, clinical presentation, indication for treatment, presence of ipsilateral or contralateral ICA occlusion, technical success, the use of a protection device, periprocedural complications, types of stents used, neurological events on follow-up, and any other morbidity or mortality.…”

Internal Carotid Artery Stenting in a Case of Recurrent Transient Ischemic Attacks: A Road Less Taken

“…Kouvelos GN, et al had recently reported a case of CAS in an external carotid artery in an 80-year-old patient experiencing limb-shaking TIAs. 11 To the best of our knowledge, this is the first case demonstrating successful CAS in a patient who presented with recurrent TIAs due to internal carotid artery stenosis. In addition, the prognosis of the patient has been favorable for one year.…”

External carotid stenting for symptomatic stenosis in a patient with patent EDAS for Moyamoya disease

“…Table 1 shows reports and reviews in which patients received ECA intervention, including endarterectomy or stenting. [3][4][5][6][7][8][9][10][11][12][13][14] The majority of patients receiving surgery or angioplasty had concurrent symptomatic ipsilateral ICA occlusion from underlying atherosclerotic disease. Presentation included signs and symptoms of ischemic stroke, transient ischemic attack, and amaurosis fugax.…”