Carotid Stent Fracture due to Eagle Syndrome after Endovascular Stenting for the Treatment of Acute Ischemic Stroke Caused by Internal Carotid Artery Dissection: Case Report

• Published in: Journal of Neuroendovascular Therapy Vol. 13; no. 11; pp. 454 - 461
• Main Authors: Yano, Tatsuya, Sasaki, Isao, Kiyohara, Kanako, Kawanishi, Masahiko
• Format: Journal Article
• Language: English; Japanese
• Published: The Japanese Society for Neuroendovascular Therapy 2019
• Subjects: acute revascularization; Eagle syndrome; elongated styloid process; internal carotid artery dissection; stent fracture
• ISSN: 1882-4072; 2186-2494
• DOI: 10.5797/jnet.cr.2019-0032

Objective: We report a case of stent fracture caused by an elongated styloid process, a form of Eagle syndrome.Case Presentation: A 58-year-old man presented with sudden right hemisensation disturbance and aphasia. MRI revealed multiple acute cerebral infarction in the left parietal and insula cortex. MRA revealed a left-sided internal carotid artery (ICA) occlusion distal to the carotid bifurcation. Digital subtraction angiography (DSA) revealed a left-sided ICA dissection distal to the carotid bifurcation. We performed acute revascularization with aspiration of the thrombus and stenting to treat the carotid dissection. Recanalization with thrombolysis in cerebral infarction (TICI) grade III was achieved. We performed DSA 3 months after an operation, it showed stent fracture and aneurysmal formation in the stent fractured department. From CT findings, the carotid artery dissection and stent fracture appeared to be triggered by the elongated styloid process. We performed stent-assisted coil embolization. After conducting percutaneous transluminal angioplasty (PTA) at high pressure after coil embolization, the elongated styloid process was fractured, and accepted a shift to the outside of the stent contact department. The patient was discharged without medical problems, and no recurrence was observed for 2 months after the surgery.Conclusion: We experienced a rare case of ICA dissection and carotid stent fracture from Eagle syndrome. Eagle syndrome is an important disease to consider in the differential diagnosis of extracranial carotid artery dissection.