Carotid Artery Stenting for Pseudo-occlusion of the Internal Carotid Artery

Abstract

The operative indication for pseudo-occlusion of the internal carotid artery is controversial. In this study, we report the technical aspects of and periprocedural care in carotid artery stenting (CAS) for the treatment of this condition. Nineteen cases of pseudo-occlusion of the internal carotid artery (17 symptomatic, 2 asymptomatic) were treated with stenting. Acetazolamide-enhanced singlephoton emission computed tomography revealed hemodynamic compromise in 14 of the 19 cases. To prevent postoperative hyperperfusion syndrome, staged angioplasty and stenting were performed in seven cases. All cases were treated with a flow reversal embolic protection technique during the initial treatment. We observed postoperative intracerebral hemorrhage in one patient due to postoperative hyperperfusion syndrome. Thereafter, we used dexmedetomidine (DEX), a selective α-adrenergic agent, as an intra-and postoperative sedative and analgesic agent, in nine cases to stabilize intraoperative hemodynamics. After staged percutaneous transluminal angioplasty and periprocedural use of DEX, we did not observe hyperperfusion syndrome after CAS. In five cases with extremely tight lesions, we experienced difficulties in crossing the guidewire. In such cases, we applied a 0.014-in coronary chronic total occlusion guidewire to cross the lesions. In this study, we demonstrated fairly positive outcomes of CAS in patients with pseudo-occlusion of the internal carotid artery. This was achieved by focusing on the prevention of hyperperfusion syndrome and proper management of perioperative procedures, especially with respect to blood pressure control.

A Patient with Stenosis of the Cervical Internal Carotid Artery in Whom Hyperperfusion Syndrome Occurred after Staged Angioplasty

“…Regarding the interval between PTA and CAS, Yoshimura et al 5) 16) weeks, respectively. However, a consensus has not been reached.…”