Cervical Carotid Artery Vasospasms Causing Cerebral Ischemia

Arning, Christian; Schrattenholzer, Alexandra; Lachenmayer, L.

doi:10.1161/01.str.29.5.1063

Cited by 38 publications

(20 citation statements)

References 10 publications

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“…In contrast to other case reports [6, 7, 12] which reported positive effects of calcium channel inhibitors and corticoids, this treatment was not effective in our patient. In addition, neither oral anticoagulation nor platelet inhibitors prevented new stroke episodes in our case.…”

Section: Discussioncontrasting

confidence: 99%

“…Evidence is accumulating that recurrent vasospasms of the extracranial ICA are a rare but important cause of ischemic disorders mainly in young patients [6, 7, 8, 9, 10, 11, 12, 13, 14]. While previous cases have been associated with migraine [5, 10], we describe a patient with recurrent non-migrainous vasospasms of the extracranial ICA.…”

Section: Discussionmentioning

confidence: 89%

“…While previous cases have been associated with migraine [5, 10], we describe a patient with recurrent non-migrainous vasospasms of the extracranial ICA. Only a few such cases have been reported in the literature to date [6, 8, 11, 12, 13, 14]. It is noteworthy that the recurrent migrainous and non-migrainous vasospasms of the extracranial ICA vasospasms appear to occur exclusively in the intermediate portion of the ICA [8, 11, 13, 14].…”

Section: Discussionmentioning

confidence: 99%

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Recurrent Strokes due to Transient Vasospasms of the Extracranial Internal Carotid Artery

Wöpking

Kastrup

Lentschig³

et al. 2013

Case Rep Neurol

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Vasospasms of the intracranial arteries are a well-known complication of subarachnoid hemorrhage and are also frequently encountered in other disorders such as migraine, cerebral vasculitis or reversible cerebral vasoconstriction syndrome. In contrast, recurrent spontaneous vasospasms of the extracranial circulation appear to be extremely rare and have most often been associated with migraine. We present a patient with recurrent strokes due to spontaneous transient vasospastic occlusions of the internal carotid artery (ICA) without migraine over a time period of at least 13 years. Initially, the patient had presented with a bilateral ICA occlusion and a cerebral infarct on the right side. While the right ICA remained occluded, a reopening of the left ICA could be detected 3 days after this initial event. In subsequent years, both duplex sonography and magnetic resonance angiography revealed recurrent occlusions of the left ICA, which resolved spontaneously within days. This case and other rare previous reports indicate that recurrent non-migrainous vasospasms of the extracranial carotid artery likely reflect a distinct entity which can cause ischemic strokes.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

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Recurrent Strokes due to Transient Vasospasms of the Extracranial Internal Carotid Artery

Wöpking

Kastrup

Lentschig³

et al. 2013

Case Rep Neurol

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“…Furthermore, transesophageal echocardiography was obtained in only 18.2% patients, so that some cardiac or aortic arch lesions may have been missed. Also, our protocol did not include serial retinal imaging or transcranial Doppler testing to identify patients with vasospastic amaurosis fugax [17]. The true prevalence of each of these etiologies remains unknown.…”

Section: Discussionmentioning

confidence: 99%

Retinal Ischemia and Embolism

et al. 2001

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Objectives: To identify the most likely mechanisms of retinal ischemia and embolism in a hospital-referred population, and to determine the frequency of recurrent vascular events during the 3-month period following initial presentation. Methods: Consecutive patients presenting to 2 tertiary medical centers and their outpatient clinics were prospectively enrolled over a 22-month period. Eligible patients presented with histories of transient or permanent monocular visual loss, or had evidence of asymptomatic retinal embolism on routine ophthalmological examination. They underwent a rapid and standardized evaluation that included imaging studies as well as blood tests, and follow-up was obtained at 1 and 3 months. Results: Seventy-seven patients were enrolled. Enrollment diagnoses consisted of amaurosis fugax (n = 32), asymptomatic retinal embolism (n = 34), and central or branch retinal artery occlusion (n = 11). Eight different presumed etiologies of retinal artery distribution embolism or hypoperfusion were identified. Extracranial internal carotid artery occlusion or more than 50% stenosis was observed in 17/77 (22.1%) cases, making it the largest etiologic subgroup. Uncommon but treatable conditions were identified in 8/77 (10.4%) patients, and an etiologic diagnosis could not be made in 35/77 (45.5%) patients. Recurrent events occurred in, respectively, 14/77 (18.2%) and 6/73 (8.2%) patients at the 1- and 3-month follow-ups. They included 2 infarcts and 2 deaths; ischemic events of the retina were more common than those involving the brain. Conclusion: Severe stenosis of the extracranial internal carotid artery is the most common identified condition associated with retinal ischemia and embolism, but a variety of other, potentially treatable, conditions can be diagnosed if appropriate and specific evaluations are conducted. The frequency of recurrent vascular ischemic events is highest during the 1st month of follow-up and decreases during the 2nd and 3rd months. Recurrences range from relatively innocuous episodes of amaurosis fugax to vascular death.

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“…To date, several studies have reported transient and recurring stenosis of the extracranial internal carotid artery (ICA) [ Table 1 ]. [ 1 3 4 5 6 7 9 10 11 13 14 ] These cases usually showed completely resolved stenosis, to smooth and normal arterial walls, within hours to days, but had multiple recurrences. Thus, vasospasm has been presumed as the cause of the stenosis.…”

Section: Introductionmentioning

confidence: 99%

Idiopathic carotid and coronary vasospasm: A case treated by carotid artery stenting

Yoshimoto¹,

Asakuno²,

Matsuo³

et al. 2014

Surg Neurol Int

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Background:We previously reported a case of cerebral infarction complicated by myocardial infarction. The pathogenesis of both infarctions was thought to be vasospasm; thus, we named this condition ‘idiopathic carotid and coronary vasospasm’. Various medical treatments for the prevention of carotid vasospasm have been unsuccessfully tried. Thus, other effective treatments should be established for patients who frequently suffer cerebral ischemic attacks.Case Description:We treated the present case of ‘idiopathic carotid and coronary vasospasm’ by carotid artery stenting (CAS). The first stenting, of the carotid bifurcation, failed to prevent internal carotid artery (ICA) vasospasm. However, after an additional stent placement to the prepetrous portion, ischemic attacks were dramatically reduced.Conclusion:The effect of CAS for extracranial ICA vasospasm was dramatic and control of the spasm at the prepetrous portion seems to be essential. Further validation of the effectiveness and safety of CAS for ICA vasospasm will be necessary.

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Cervical Carotid Artery Vasospasms Causing Cerebral Ischemia

Cited by 38 publications

References 10 publications

Recurrent Strokes due to Transient Vasospasms of the Extracranial Internal Carotid Artery

Recurrent Strokes due to Transient Vasospasms of the Extracranial Internal Carotid Artery

Retinal Ischemia and Embolism

Idiopathic carotid and coronary vasospasm: A case treated by carotid artery stenting

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