Abstract
BackgroundCommon complications of carotid artery stenting (CAS) are cerebral ischemia and hyperperfusion syndrome. To date, only a few cases of late-onset cerebral vasoconstriction occurring several hours after CAS have been reported. However, there are no reports of developed vasoconstriction and hyperperfusion syndrome.Case presentationA 79-year-old man developed vasoconstriction 1 day after carotid artery stenting. Vasoconstriction improved immediately with glucocorticoid. However, a week later, the patient developed hyperperfusion syndrome.ConclusionsPostoperative vasoconstriction and hyperperfusion syndrome is an unrecognized complication and surgeons should be aware of it.
Highlights
Common complications of carotid artery stenting (CAS) are cerebral ischemia and hyperperfusion syndrome
CAS was performed for the right internal carotid artery (ICA) stenosis 4 years ago, during which a left extracranial ICA stenosis was noted that progressed gradually
The second hypothesis was the occurrence of reversible cerebral vasoconstriction syndrome (RCVS)
Summary
Common complications of carotid artery stenting (CAS) are cerebral ischemia and hyperperfusion syndrome [1]. CAS was performed for the right internal carotid artery (ICA) stenosis 4 years ago, during which a left extracranial ICA stenosis was noted that progressed gradually. Infarctions in the left cerebral cortex were observed on magnetic resonance imaging (MRI) (Fig. 1A). MRI performed immediately after the surgery revealed new microcortical infarctions, but those were not serious and cannot explain the patient’s condition. Computed tomography (CT) angiography, CT perfusion, and MRI revealed decreased blood flow in the left middle cerebral artery (MCA), and digital subtraction angiography (DSA) revealed vasoconstriction mainly in the left MCA (Fig. 1D, E). Blood pressure was controlled without restriction and systolic blood pressure was observed to be approximately 140 mmHg. Seven days after surgery, aphasia and right paralysis reappeared. The patient was transferred to a rehabilitation hospital with a modified Rankin scale score of 4
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