Causey Marlin Wayne, Amans Matthew R, Han Sukgu, Higashida Randall T, Conte Michael
Department of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, Calif.
Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif.
J Vasc Surg. 2016 Dec;64(6):1847-1850. doi: 10.1016/j.jvs.2016.01.020. Epub 2016 Feb 28.
Neurologic events after carotid endarterectomy (CEA) require prompt diagnosis and management to avoid potentially catastrophic sequelae. This report describes a 69-year-old gentleman who underwent a left CEA for a high-grade asymptomatic carotid stenosis with concomitant contralateral carotid occlusion. He had transient and crescendo neurologic events in the first 3 postoperative weeks that culminated in right hand weakness and paresthesia, despite dual antiplatelet therapy, maximal anticoagulation, and undergoing stenting of the endarterectomy site. Neurologic events recurred despite these measures and subsequent angiography showed reversible cerebral vasoconstriction syndrome that was successfully managed without further events. Reversible cerebral vasoconstriction syndrome is an unusual but important cause of neurologic events after CEA that requires aggressive and directed medical therapy.
颈动脉内膜切除术（CEA）后的神经系统事件需要及时诊断和处理，以避免潜在的灾难性后果。本报告描述了一位69岁的男性，他因无症状性高级别颈动脉狭窄伴对侧颈动脉闭塞接受了左侧CEA手术。尽管进行了双重抗血小板治疗、最大程度的抗凝治疗，并对内膜切除部位进行了支架置入，但他在术后前3周出现了短暂且逐渐加重的神经系统事件，最终导致右手无力和感觉异常。尽管采取了这些措施，神经系统事件仍复发，随后的血管造影显示为可逆性脑血管收缩综合征，经成功治疗后未再出现其他事件。可逆性脑血管收缩综合征是CEA术后神经系统事件的一个不常见但重要的原因，需要积极且有针对性的药物治疗。
