Two Patients with Reversible Cerebral Vasoconstriction after Carotid Artery Stenting

Abstract

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.

A Case of Cerebral Hyperperfusion Syndrome during Treatment of Transient Cerebral Vasospasm Following Carotid Artery Stenting

“…Symptoms are typically localized to cerebral ischemia and infarction, but headache has also been reported. 5,10) Complete recovery is a common outcome of symptomatic cerebral vasospasm, [4][5][6][7][8][9][10][11][12] but, as in the present case, moderate disability has been described. 3,12) No treatment for post-CAS cerebral vasospasm has been established in the literature.…”

“…5,10) Complete recovery is a common outcome of symptomatic cerebral vasospasm, [4][5][6][7][8][9][10][11][12] but, as in the present case, moderate disability has been described. 3,12) No treatment for post-CAS cerebral vasospasm has been established in the literature. The asymptomatic case series reported by Kang et al 4) did not include any details of how patients were treated.…”

“…CAS is an established treatment for ICA stenoses, 1,2) and post-CAS CHS and cerebral embolism are well-known complications of this procedure. 13) To the best of our knowledge, 10 case reports have described post-CAS symptomatic transient cerebral vasospasm 3,[5][6][7][8][9][10][11][12] in the literature, with only one case series reporting asymptomatic disease (Table 1). 4) Two of those cases 6,7) were mentioned in poster presentations referenced in other previous reports.…”

“…vasospasm have been described, suggesting that it is a rare complication. Time of onset has varied among these reports from the time of angiography immediately after CAS 4) to between 10 hours and 1.5 days, [3][4][5]12) and even more than 2 weeks after CAS. 5,6,10) Including the present case, 6 of these 9 cases experienced onset within 2 days of CAS.…”

“…1,2) Post-CAS transient cerebral vasospasm is a rare complication, with a scattering of case reports in the literature. [3][4][5][6][7][8][9][10][11][12] Consensus remains lacking on the optimal method or duration of treatment. Reports of cerebral hyperperfusion syndrome (CHS) following cerebral vasospasm are even more scarce.…”