Abstract
Objective: The authors present a patient with acute ischemic stroke due to severe stenosis of the left internal carotid artery who was successfully treated with carotid artery stenting (CAS) in the acute stage.
Case: A 76-year-old man presented with aphasia and right hemiparesis. Intravenous administration of rt-PA was not indicated because the patient was outside the time-window. As perfusion CT revealed a large ischemic penumbra in the territory of the left middle cerebral artery, we attempted neuroendovascular therapy to rescue the penumbra from infarction. The regional saturation of oxygen (rSO2) was monitored by near-infrared spectroscopy (NIRS) during the procedure. Before the procedure, rSO2 in the left frontal area was decreased by 10% compared with that on the right side. The self-expanding stent was deployed after predilation. Just after deployment, rSO2 on the left side increased by 10% and we intentionally did not perform postdilation to avoid hyperperfusion. The procedure was finished within 6 hours and 30 minutes after ischemic onset. The postoperative course was good and there were no hemorrhagic complications.
Conclusion: NIRS monitoring allows observation of real time changes in cerebral perfusion during the dilatative procedure, which provides useful information for intraoperative decision-making on whether stenting should be added after angioplasty and then, whether postdilation should be performed during carotid artery stenting in the acute stage.
