Unusual Clinical Course after Carotid Artery Stenting using a Filter Device: A Case Report

Abstract

： Carotid artery stenting (CAS)for severe internal carotid artery stenosis has recently been intro − duced as an a】 ternative to carotid endarterectomy ． Here ， we present an unusual clinical course of a patient after CAS using the Angioguard filter device ． Case ： We present the case of a 75 − year − 01d 皿 an who suffered f め m cerebral infarctiQn in the left thalalnus ． Three − dinlensional computed tomography confirmed asymptomatic stenosis (83％)in the lef し internal carotid arter ￥ Carotid artery stenting (CAS)was performed lls｛ ng a distal protection 丘1ter device (Angioguard ， Cordis ， Miarni Lakes ， FL ， USA) ． Following poststenting dilatat ｛ n ， the patient became drowsy and he developed left hemiplegia ． Cerebral angiography showed no slowing or stopping of blood flow ， and no delayed filling to the venous phase ． Diffusion − weighted magnetic resonance imaging (DW − MRI)demonstrated rnultiple tiny cortical infarctions in the left frontal − parietal lobes ipsilateral to the operated side ． The symptoms of the patient appeared more seri − ous than the DW − MRI findings suggested ． After CAS ， the patient showed good recovery after receiving medical treatments for about 2 weeks ． Conclusion ：We suspected that liquified microplaques (く 100μm)passed through the pores of the filter device and embolized cerebral arterioles or capillaries ， which might have caused the symptomatic cerebral infarction ． Although most cerebral infarctions following CAS are asymptomatic ， the filter device used here could not ensure complete absence of the development of symptomatic cerebral infarction ． Therefore ， f皿 ther improve − ment of the filter device is necessary in order to reduce the incidence of microembo1 ｛ sms causing symptomatic cerebral infarction ． Moreover， the characteristics of carotid plaques and the hemodynamics of the carotid artery must be evaluated before performing CAS ， and then the most appropriate treatment 丘om the various therapeutic options should be selected ．

Two Patients with Reversible Cerebral Vasoconstriction after Carotid Artery Stenting

“…Tanaka et al 18) reported a patient in whom cerebral ischemic symptoms were more prominent than debris embolism on MRI after CAS; however, complete recovery was achieved. Regarding thromboembolism after CAS, Ishibashi et al 19) examined four patients with reversible cerebral ischemic complications a few hours after surgery.…”