Yoshida Yoichi, Kobayashi Eiichi, Kubota Masaaki, Adachi Akihiko, Iwadate Yasuo
Department of Neurological Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan.
J Neuroendovasc Ther. 2022;16(2):106-115. doi: 10.5797/jnet.cr.2019-0123. Epub 2021 Jun 22.
We herein report two cases of transient cerebral vasoconstriction after carotid artery stenting (CAS).
An 81-year-old man presented with asymptomatic severe stenosis in the right carotid artery accompanied by a slight reduction in cerebrovascular reactivity. CAS was performed, but the patient had a generalized seizure because of transient cerebral ischemia caused by intolerance to carotid artery occlusion with balloon protection. Confusion and left hemiparesis persisted. DSA suggested cerebral ischemia due to vasoconstriction as the cause of these prolonged symptoms. A 66-year-old man presented with asymptomatic severe stenosis in the right carotid artery with slight hypoperfusion. CAS was performed. The patient developed left hemispatial neglect, dysarthria, and left hemiparesis 12 hours after the procedure. DSA revealed cerebral vasoconstriction in the responsible territory. The conditions of both patients improved within several days with medical treatment and they were discharged without neurological deficits.
The cases presented herein show that transient ischemic complications caused by cerebral vasoconstriction may develop after CAS.
我们在此报告两例颈动脉支架置入术(CAS)后发生短暂性脑血管收缩的病例。
一名81岁男性,右侧颈动脉存在无症状的严重狭窄,同时脑血管反应性略有降低。进行了CAS,但由于球囊保护下颈动脉闭塞不耐受导致短暂性脑缺血,患者出现全身性癫痫发作。意识模糊和左侧偏瘫持续存在。数字减影血管造影(DSA)提示血管收缩导致脑缺血是这些持续症状的原因。一名66岁男性,右侧颈动脉存在无症状的严重狭窄且有轻微灌注不足。进行了CAS。术后12小时,患者出现左侧半侧空间忽视、构音障碍和左侧偏瘫。DSA显示责任区域脑血管收缩。两名患者经药物治疗后数天内病情均有改善,出院时无神经功能缺损。
本文所呈现的病例表明,CAS后可能发生由脑血管收缩引起的短暂性缺血并发症。