Two Patients with Reversible Cerebral Vasoconstriction after Carotid Artery Stenting

• Published in: Journal of Neuroendovascular Therapy Vol. 16; no. 2; pp. 106 - 115
• Main Authors: Yoshida, Yoichi, Kobayashi, Eiichi, Kubota, Masaaki, Adachi, Akihiko, Iwadate, Yasuo
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society for Neuroendovascular Therapy 01.01.2022
• Subjects: carotid artery stenting; carotid sinus reflex; Case Report; hyperperfusion; ischemic complication; reversible cerebral vasoconstriction syndrome; carotid artery stenting; carotid sinus reflex; hyperperfusion; ischemic complication; reversible cerebral vasoconstriction syndrome
• ISSN: 1882-4072; 2186-2494
• DOI: 10.5797/jnet.cr.2019-0123

Objective: We herein report two cases of transient cerebral vasoconstriction after carotid artery stenting (CAS).Case Presentation: An 81-year-old man presented with asymptomatic severe stenosis in the right carotid artery accompanied by a slight reduction in cerebrovascular reactivity. CAS was performed, but the patient had a generalized seizure because of transient cerebral ischemia caused by intolerance to carotid artery occlusion with balloon protection. Confusion and left hemiparesis persisted. DSA suggested cerebral ischemia due to vasoconstriction as the cause of these prolonged symptoms. A 66-year-old man presented with asymptomatic severe stenosis in the right carotid artery with slight hypoperfusion. CAS was performed. The patient developed left hemispatial neglect, dysarthria, and left hemiparesis 12 hours after the procedure. DSA revealed cerebral vasoconstriction in the responsible territory. The conditions of both patients improved within several days with medical treatment and they were discharged without neurological deficits.Conclusion: The cases presented herein show that transient ischemic complications caused by cerebral vasoconstriction may develop after CAS.