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

Abstract

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.

Carotid artery dissection due to elongated styloid process treated by acute phase carotid artery stenting: A case report

“…e elongated styloid process is defined as that longer than 25-30 mm [1,6,13] and it sometimes compresses the cervical nerves or arteries, leading to symptomatic conditions named Eagle's syndrome. Although Eagle's syndrome is famous for being one of the causes of ICA dissection, symptomatic vascular Eagle's syndrome is rarely encountered.…”

“…On the other hand, endovascular treatment was chosen only for seven cases. [1,[4][5][6]10,11,13] Styloid process resection was not chosen as the first-line treatment.…”

“…[3,4,6,10,11] In addition, there were two case reports where the elongated styloid process and calcified ligament compressed the stent resulting in its fracture. [4,13] Continuous compression of the carotid artery after CAS could cause intra-stent thrombosis and thromboembolism of the distal cerebral artery. [6] us, it might be necessary to subsequently resect the styloid process after CAS.…”

Recurrence of internal carotid artery dissection associated with elongated styloid process: A case report

“…Moreover, some cases of ischemic event recurrence have led us to identify the underlying etiology of elongated styloid process. [ 4 - 6 , 8 , 20 ]…”

Eagle Syndrome: Pathophysiology, Differential Diagnosis and Treatment Options

“…There are cases reported in the literature of endovascular stenting being performed at the site of carotid stenosis, and on follow-up or presentation of a new cerebrovascular event, the stent had been fractured by an elongated SP that was present yet overlooked on initial imaging. 24,25 While cranial nerve palsies are common in Eagle Syndrome, involvement of the vagus nerve is one of the less frequently involved nerves. This leads to cases in which patients complain of hoarseness that can be subacute to insidious onset and can easily steer diagnosis in another direction.…”