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

Abstract

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.

Treatment of Idiopathic Recurrent Internal Carotid Artery Vasospasms with Bilateral Carotid Artery Stenting: A Case Report

“…Vasospasms reduced within a few hours to a few days in most patients, and the proportion of patients with bilateral vasospasms was reportedly 69%. 4) In the present case, ocular and ischemic hemispheric symptoms appeared after vascular murmurs and intermittent headache was observed. The frequency of attacks was 5 to 6 times a month (maximum: 24 times), and the symptoms persisted for a few hours to 7 days; therefore, both the frequency of attacks and severity of symptoms were more advanced than previously reported ( Table 1).…”

“…However, these drug therapies did not completely reduce vasospastic attacks in some patients. [1][2][3][4] Some studies indicated the efficacy of CAS 3,4) although the number of patients was small. In the present case, drug-resistant attacks had repeatedly occurred 5 to 6 times a month for 10 years or more, and cerebral infarction developed during the course, leading to a severe condition; therefore, bilateral CAS was performed.…”

“…3,4) All patients were females, ranging from 40 to 49 years. They showed repeated vasospasms resistant to drug therapies with antithrombotic drugs or calcium antagonists.…”

“…As a concomitant symptom, migraine is not specific, 6) and some young patients without arteriosclerotic changes develop coronary spastic angina or myocardial infarction. 2,4,[7][8][9][10] Diseases to be differentiated from idiopathic recurrent internal carotid artery vasospasms include antiphospholipid antibody syndrome, angitis syndrome, hemiplegic migraine, and vascular dissection. In the present case, the blood levels of biochemical/coagulation system parameters and catecholamines, which are involved in vasospasm induction, were within the normal ranges, and the patient was negative for anti-cardiolipin-b2GPI and antinuclear antibodies; therefore, the possibilities of antiphospholipid antibody syndrome and angitis syndrome were ruled out based on the clinical symptoms and hematological data.…”

“…There have been a few case reports, but drug therapy did not completely reduce the attacks in some patients. [1][2][3][4] According to several case reports, unilateral carotid artery stenting (CAS) was effective. 2,3) However, to our knowledge, no study has reported bilateral CAS.…”