A case of symptomatic cerebral vasospasm after carotid artery stenting

Abstract

Delayed symptomatic vasospasm after carotid artery stenting (CAS) is extremely rare. We report a case of delayed vasospasm after CAS. A 73-year-old man with asymptomatic severe right carotid stenosis underwent CAS using a filter and open-cell stent under local anesthesia. No intraoperative complications occurred. He presented with disturbance of consciousness (Japan Coma Scale II-10), left hemispatial neglect and fever elevation 20 hours after CAS. ¹²³I-IMP single-photon emission computed tomography (¹²³I-IMP-SPECT) showed hypoperfusion in the right middle cerebral artery area. Angiography on the same day showed vasospasm in the right middle cerebral artery. Intravenous Edaravone 60 mg, intravenous Ozagrel sodium 80 mg and oral anticonvulsant drug (lacosamide) were administered. Additionally, we performed normotension therapy. His symptoms had resolved 3 days after CAS and cerebral blood flow was recovered on ¹²³I-IMP-SPECT 8 days after CAS.