Abstract
Objective: Cervical internal carotid artery (ICA) vasospasms are rare, and their treatment is not established. We report 2 cases of recurrent cervical ICA vasospasms and their treatment using carotid artery stenting (CAS).
Case 1: A 47-year-old woman presented with dysarthria. Three-dimensional computed tomography angiography (3D-CTA) showed severe stenosis of the right cervical ICA, but her symptoms gradually improved. The patient underwent follow-up magnetic resonance angiography (MRA) every 3 months and was admitted to the hospital 2 times with left hemiparesis. In each ischemic attack, digital subtraction angiography (DSA) showed stenosis of the right cervical ICA. Percutaneous transluminal angioplasty was performed, and the stenotic ICA was recanalized. Subsequently, her symptoms improved. The cervical ICA vasospasm caused 3 ischemic attacks; as a result, we performed CAS to prevent further vasospasms.
Case 2: A 46-year-old woman was admitted with dysarthria and left hemiplegia. The patient had a history of recurrent transient cervical ICA stenosis accompanied by right hemiplegia. DSA on admission showed severe stenosis of the left cervical ICA. Stenosis due to vasospasm was diagnosed and CAS was performed. In both cases, the patients remained free of subjective symptoms for a 24-month period following CAS.
Conclusion: Cervical ICA vasospasms can occur spontaneously and should be considered in patients with repeated ischemic strokes. However, an effective standard treatment for vasospasm has not yet been established. For patients with repeated vasospasms, CAS may be effective for preventing spontaneous vasospasms.
