A Case of Treated Side Hypoperfusion and Reversible Neurological Deficits following Carotid Artery Stenting

Abstract

A 75-year-old man with medically refractory ischemic stroke caused by left ICA stenosis underwent carotid artery stenting (CAS). A distal protection device, FilterWire EZ, was used during the procedure. Intraoperatively, rupture of the fibrous cap was observed, and debris was identified within the retrieved filter. Twelve hours after the procedure, the patient developed right-sided hemiparesis and impaired consciousness. Although neither extensive ischemic stroke nor major carotid/cerebral artery occlusion was detected, ¹²³I-IMP single-photon emission computed tomography demonstrated decreased tracer uptake on the treated side. In addition, transcranial color-coded flow imaging revealed reduced blood flow velocity in the middle cerebral artery (MCA) on the treated side. Cerebral blood flow in the treated hemisphere gradually improved over time, accompanied by resolution of the neurological symptoms. Hypoperfusion caused by microcirculatory disturbance due to the dissemination of plaque-derived components was suggested as a differential diagnosis.