Higashi Eiji, Uwatoko Takeshi, Mizokami Taichiro, Sakaki Yusuke, Sakata Shuji, Sugimori Hiroshi
1 Department of Cerebrovascular Medicine, Saga Medical Centre, Saga, Japan.
2 Department of Neurosurgery, Saga Medical Centre Koseikan, Saga, Japan.
Interv Neuroradiol. 2018 Dec;24(6):688-692. doi: 10.1177/1591019918781778. Epub 2018 Jul 3.
Reversible cerebral vasoconstriction is a very rare complication after carotid artery stenting (CAS). It has been reported to occur more than several hours after CAS and to have a good clinical course. A 73-year-old man underwent CAS for a high-grade symptomatic stenosis of his left carotid artery. Immediately after CAS, he had consciousness disturbance and right hemiparesis. We first suspected hyperperfusion syndrome, but antihypertensive therapy exacerbated his symptoms. On repeated postoperative angiography, the middle cerebral artery (MCA) appeared to become progressively narrower. Perfusion computed tomography indicated hypoperfusion in the left MCA territory, so we diagnosed the patient with ischemic symptoms due to hypoperfusion associated with MCA vasoconstriction. Although these findings were temporary, right weakness and cognitive dysfunction lingered and caused severe disability. As vasoconstriction after CAS may result in a poor outcome, it must be promptly distinguished and treated accordingly.
可逆性脑血管收缩是颈动脉支架置入术（CAS）后一种非常罕见的并发症。据报道，它在CAS术后数小时以上发生，且临床过程良好。一名73岁男性因左颈动脉高度症状性狭窄接受了CAS。CAS术后即刻，他出现意识障碍和右侧偏瘫。我们首先怀疑是高灌注综合征，但降压治疗使他的症状加重。术后重复血管造影显示，大脑中动脉（MCA）似乎逐渐变窄。灌注计算机断层扫描显示左MCA区域灌注不足，因此我们诊断该患者因MCA血管收缩相关的灌注不足出现缺血症状。尽管这些表现是暂时的，但右侧无力和认知功能障碍持续存在并导致严重残疾。由于CAS后的血管收缩可能导致不良后果，必须及时鉴别并相应治疗。
