Treatment of idiopathic cervical internal carotid artery vasospasms with carotid artery stenting: a report of 2 cases

Abstract

Objective Case 1 Case 2 ConclusionKey Words

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

“…On attacks, stellate ganglion block, 8) arterial papaverine hydrochloride injection, 1) and steroid therapy 1,6) have been used. For prevention, calcium antagonists, 1,3,4,6-8,10,11) antiplatelet durgs, [1][2][3]7) anticonvulsive drugs, 8) and oral steroids 1) have been selected. Several studies reported the efficacy of these treatments.…”

“…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.…”

“…For one patient, percutaneous angioplasty for marked stenosis of the internal carotid artery was performed at the time of an attack, and CAS later. For percutaneous angioplasty, a Jackal OTW measuring 3.5 × 30 mm (Kaneka Medix Corp., Osaka, Japan) was used, facilitating dilatation of the stenotic site at 1 air pressure; therefore, Fujimoto et al 3) speculated that vascular contractility on vasospasm might be weak. In all the three patients, self-expandable stents were used.…”

“…[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. In this study, we report a patient who underwent bilateral CAS, showing a favorable outcome, and review the literature.…”