Article ID: cr.2017-0043
Objective: We report a patient who underwent staged angioplasty (SAP) for stenosis of the cervical internal carotid artery (ICA), but developed hyperperfusion syndrome.
Case Presentation: The patient was an 84-year-old male. Stenosis of the left cervical ICA (pseudo-occlusion) related to cerebral infarction was observed. Emergency angioplasty was performed. At 9 days after the procedure, carotid artery stenting (CAS) was conducted. Restlessness was noted immediately after CAS. In addition, right hemiparesis and aphasia were exacerbated, and a convulsive seizure occurred 4 days later. MRI did not reveal the new onset of cerebral infraction. Single-photon emission computed tomography (SPECT) showed an increase in cerebral blood flow (CBF) in the left parietal lobe, leading to a diagnosis of hyperperfusion syndrome. An anticonvulsive drug was administered, and strict blood pressure control was performed. There was no hemorrhagic complication. The patient was referred to a rehabilitation hospital.
Conclusion: The present case developed hyperperfusion syndrome despite SAP was performed. Currently, there is no consensus for the interval; it is important to carefully determine the interval in each patient by evaluating cerebral perfusion status.
