Abstract
Carotid artery stenosis (CAS) is mainly caused by atherosclerosis. Intensive medical therapy is effective in preventing stroke in CAS. To date, there has been no published report of rapid regression of CAS. A woman with untreated hyperlipidemia visited our emergency room with left hemiparesis. She exhibited facial palsy, left hemiparesis, and dysarthria immediately after the visit. Brain magnetic resonance (MR) diffusion-weighted imaging confirmed acute infarction in the right middle cerebral artery (MCA) territory due to severe stenosis of the right internal carotid artery (ICA), which was revealed by MR angiography and carotid duplex ultrasonography. The patient started intensive statin therapy and dual antiplatelet agent therapy. Carotid artery stenting was not performed until hospitalization day 16 due to pleural effusion. On day 16, digital subtraction angiography was performed, and spontaneous regression of severe stenosis was observed. Only mild stenosis with ulcerative plaque was evident. The rapid CAS regression in this case may be caused by M2 macrophage polarization as a result of intensive statin therapy. This rapid regression may also result from reduced foam cell formation by statin and aspirin and thereby increased endogenous thrombolysis. Our patient demonstrated the efficacy of short-term intensive statin and aspirin therapy on atherosclerosis with untreated hyperlipidemia.
Highlights
Stroke is one of the major causes of death, with ischemic stroke accounting for71% globally
Ischemic strokes are commonly caused by embolic sources occluding the cerebral artery, such as atherosclerotic plaques [1]
A patient who presents with ischemic events, including retinal artery occlusion, transient ischemic attack, and stroke, is diagnosed with symptomatic carotid artery stenosis (CAS)
Summary
Stroke is one of the major causes of death, with ischemic stroke accounting for71% globally. Lowering low-density lipoprotein (LDL) to reduce foam cell formation is the current preventive treatment for atherosclerotic plaque and ischemic stroke. Intensive medical therapy is a highly effective treatment for secondary prevention of stroke in symptomatic CAS. Recent studies have shown regression of carotid artery stenosis by intensive medical therapy, but the findings were related to long-term treatment [6,7].
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