Ipsilateral hypoperfusion caused by intracerebral steal phenomenon after carotid artery stenting: a case report

• Published in: BMC neurology Vol. 21; no. 1; pp. 188 - 4
• Main Authors: Yan, Zhizhong, Shi, Zhonghua, Wang, Yuhai, Zhang, Chunlei, Liu, Huize, Cai, Jin, Zhang, Xin
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 08.05.2021; BioMed Central; BMC
• Subjects: Arteries; Blood pressure; Cardiovascular disease; Care and treatment; Carotid arteries; Carotid artery; Carotid artery diseases; Case Report; Case studies; Causes of; Cerebral blood flow; Complications; Complications and side effects; Computed tomography; Endovascular stents; Endovascular treatment; Flow velocity; Hemiplegia; Hemispheric laterality; Hemorrhage; Implants; Intracerebral steal phenomenon; Ischemia; Medical imaging; Patients; Perfusion; Stenosis; Stenting; Stents; Stroke; Surgery; Ultrasound; Vascular hemostatic disorders; China; Stenting; Carotid artery; Intracerebral steal phenomenon; Endovascular treatment
• DOI: 10.1186/s12883-021-02208-6
• ISSN: 1471-2377

Abnormal hypoperfusion on the surgical side after carotid artery stenting is rare. Neurological deterioration caused by it is deceptive, which can easily lead to misdiagnosis. The mechanism of hypoperfusion has rarely been demonstrated. We present here a fully studied case with a high probability of intracerebral steal phenomenon. A 68-year-old male with severe right internal carotid artery stenosis and left internal carotid artery occlusion underwent right stenosis stent implantation. Restlessness and left limb hemiplegia occurred within 24 h after the procedure, which was similar to hyperperfusion syndrome. However, postoperative computerized tomography perfusion (CTP) revealed abnormal hypoperfusion in the right hemisphere. Transcranial Doppler (TCD) also showed decreased flow velocity in the right middle cerebral artery, and increased flow velocity in the right anterior cerebral artery. We considered that intracerebral steal phenomenon might be the cause, then hypervolemic therapy was accepted and the symptoms completely resolved after 3 days. Ipsilateral hypoperfusion is rarely seen after carotid artery stenting. Intracerebral steal phenomenon may be the underlying mechanism. CTP or TCD is helpful for the early detection of this adverse event.