Reversible cerebral vasoconstriction complicated with brain infarction immediately after carotid artery stenting

Abstract

<jats:p> Reversible cerebral vasoconstriction is a very rare complication after carotid artery stenting (CAS). It has been reported to occur more than several hours after CAS and to have a good clinical course. A 73-year-old man underwent CAS for a high-grade symptomatic stenosis of his left carotid artery. Immediately after CAS, he had consciousness disturbance and right hemiparesis. We first suspected hyperperfusion syndrome, but antihypertensive therapy exacerbated his symptoms. On repeated postoperative angiography, the middle cerebral artery (MCA) appeared to become progressively narrower. Perfusion computed tomography indicated hypoperfusion in the left MCA territory, so we diagnosed the patient with ischemic symptoms due to hypoperfusion associated with MCA vasoconstriction. Although these findings were temporary, right weakness and cognitive dysfunction lingered and caused severe disability. As vasoconstriction after CAS may result in a poor outcome, it must be promptly distinguished and treated accordingly. </jats:p>

Asymptomatic Cerebral Vasoconstriction after Carotid Artery Stenting

“…It should be differentiated and treated appropriately. In previous reports, administration of calcium channel blockers, such as oral lomerizine hydrochloride 10 or intra-arterial verapamil, 8,11 was effective in the treatment of vasoconstriction after CAS. This study had some limitations.…”

“…[1][2][3][4][5][6] In contrast, cerebral vasoconstriction cases after CAS have rarely been reported. [7][8][9][10][11][12] The purpose of this retrospective study is to present our observation on cerebral vasoconstriction in the ipsilateral anterior circulation during immediate poststenting angiography in patients with near-total occlusion (NTO) of the proximal ICA.…”

“…This caused severe disability in the patient. 10 Therefore, when the patient's symptoms worsen after CAS, the possibility of cerebral vasoconstriction should be considered. It should be differentiated and treated appropriately.…”

Intra-arterial infusion of fasudil hydrochloride for cerebral vasospasm secondary to carotid artery stenting: illustrative case

“…It has been reported that cerebral vasospasm occurs within 24 hours 2 , 3 , 5 and a few weeks after CAS. 6 , 7 The mechanism of vasospasm may differ between the two groups.…”

“…2,4,6 Vascular endothelial cell dysfunction and abnormal sympathetic nerve excitement cause cerebral vasospasm. [5][6][7] Watanabe et al reported that RCVS after CAS often occurs more than 2 weeks later. 7 However, our case occurred several hours after surgery.…”