Delayed Intracranial Vasospasm following Carotid Endarterectomy

Dagher, Hikmat N.; Shum, M.; Campellone, Joseph V.

doi:10.1159/000087327

Cited by 13 publications

(6 citation statements)

References 12 publications

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“…Previously reported cases of reversible vasculopathy after carotid endarterectomy were diagnosed with RCVS, and characteristics of these cases have been summarized in Table 1. [3][4][5][6][7][8][9] Headache, typically present in RCVS, was the most common presenting symptom but was notably absent in our patient and 2 other previous cases making the diagnosis of RCVS less certain, and classic triggers for RCVS such as vasoconstrictive agents may be absent. Reported cases of post-procedural RCVS have all been either ipsilateral to the revascularized artery or bilateral, and subsequent cerebral infarction in the affected territory is common.…”

Section: Discussionmentioning

confidence: 69%

Ipsilateral Reversible Cerebral Vasculopathy Secondary to Carotid Artery Revascularization: A Case Report

Shoskes

Mullaguri

Purohit

et al. 2020

The Neurohospitalist

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Background: The emergence of neurologic symptoms after carotid revascularization is not uncommon and typically caused by perioperative ischemic stroke or hyperperfusion. Postoperative vasculopathy, including reversible cerebral vasoconstriction syndrome (RCVS) is a rare complication of carotid intervention and may be an under-identified cause of neurologic deficit after revascularization. We report a case of reversible postoperative vasculopathy following carotid revascularization as well as its management. Case Presentation: A 74 year old right-handed woman presented to the emergency department with sudden onset left arm weakness and episodic shaking while hypotensive. Computed tomography angiography revealed total occlusion of her right internal carotid artery. Transcranial Doppler monitoring demonstrated active embolic events in her right middle cerebral artery raising concern for continued stump embolization. She underwent carotid revascularization with carotid endarterectomy, mechanical thrombectomy, and carotid angioplasty and initially did well postoperatively. On postoperative day 5, she developed a fixed right gaze and left hemiparesis. Computed tomography revealed new right frontal lobe and basal ganglia infarcts, and angiography showed new right internal carotid, middle cerebral, and anterior cerebral artery vasoconstriction consistent with postoperative vasculopathy. Despite treatment with pressure augmentation and vasodilator therapy, her symptoms persisted resulting in left hemiplegia at discharge. Discussion: This case highlights postoperative vasculopathy (including RCVS) as a rare potential complication after carotid revascularization that should be considered in a patient with persistent acute neurologic symptoms. Information regarding incidence and predisposing risk factors is limited. Multiple diagnostic and therapeutic modalities may be necessary in the recognition and treatment of postoperative vasculopathy.

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Section: Discussionmentioning

confidence: 69%

Ipsilateral Reversible Cerebral Vasculopathy Secondary to Carotid Artery Revascularization: A Case Report

Shoskes

Mullaguri

Purohit

et al. 2020

The Neurohospitalist

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“…It may arise spontaneously, but is more often associated with a trigger, particularly sympathomimetic over the counter remedies and other vasoactive substances, such as pseudoephedrine,8 phenylpropanolamine,9 ergot derivatives,10 cocaine11 and drugs that modulate the dopamine or serotonin systems 12 – 14. Non-pharmacological triggers include childbirth,2 , 3 porphyria,15 pheochromocytoma,16 carotid endarterectomy17 and intravenous immunoglobulins 7…”

Section: Discussionmentioning

confidence: 99%

Call-Fleming syndrome associated with subarachnoid haemorrhage: three new cases

Moustafa

Allen²

2009

Case Reports

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The Call-Fleming syndrome (CFS) comprises acute severe recurrent (thunderclap) headaches, occasional transient or fluctuating neurological abnormalities and reversible segmental cerebral vasoconstriction. It is a benign condition with an excellent prognosis, yet because it is often clinically and radiologically similar to a number of commonly encountered conditions, diagnostic difficulties may arise, leading to inappropriate, and even potentially harmful, investigative and therapeutic approaches. Three personal cases are presented to highlight the occurrence of subarachnoid haemorrhage (SAH) as part of CFS. In two patients with a positive CT head, SAH involved the sulci in the upper cerebral convexity, an unusual location in aneurysmal SAH. SAH is not an uncommon feature of CFS, occurring in approximately 25% of reported cases, and may pose a diagnostic challenge. CFS has a relatively characteristic spectrum of features, allowing a confident diagnosis in most cases, even when atypical features such as SAH are present. Recognising the spectrum of abnormalities seen in CFS, including particularly SAH, allows a sound approach to a safe diagnosis.

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“…To the best of our knowledge, nine patients with cerebrovascular spasm after CEA have been reported to date (Table 2). 1,2,[11][12][13][14][15] Similar to CAS, there was no involvement of sex, the affected side, or the presence of symptoms. Vasoconstriction occurred on the treated side, except for one patient in whom bilateral vasoconstriction was noted.…”

Section: Case Reports On Cerebral Vasoconstriction After Ceamentioning

confidence: 99%

Two Patients with Reversible Cerebral Vasoconstriction after Carotid Artery Stenting

Yoshida

Kobayashi

Kubota

et al. 2022

JNET

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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.

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Delayed Intracranial Vasospasm following Carotid Endarterectomy

Cited by 13 publications

References 12 publications

Ipsilateral Reversible Cerebral Vasculopathy Secondary to Carotid Artery Revascularization: A Case Report

Ipsilateral Reversible Cerebral Vasculopathy Secondary to Carotid Artery Revascularization: A Case Report

Call-Fleming syndrome associated with subarachnoid haemorrhage: three new cases

Two Patients with Reversible Cerebral Vasoconstriction after Carotid Artery Stenting

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