Abstract
A 78-year-old man was admitted to our hospital because of right hand weakness due to small cortical infarction at left precentral gyrus. Neck MR angiography revealed left neck internal carotid artery stenosis. The stenotic part was fragile plaque with intra-plaque hemorrhages. We performed carotid artery stenting (CAS) approximately 2 months after the onset. Because fragile plaque was suggested, we chose the distal protection using the Carotid GuardWire PS (Medtronic, Santa Rosa, CA, USA), not a filter. Immediately after the distal balloon was inflated on trial, the patient presented right side hemiparesis, aphasia, and consciousness disturbance. Carotid Wall stent (Boston Scientific Natick, MA, USA) was placed in a rapid manner under sedation. Total occlusion time was 8 minutes 50 seconds. After the distal balloon became deflated, his symptoms did not disappear regardless of any distal embolisms in the final angiography. Three hours later, his right hemiparesis was recovered almost fully, but his aphasia continued. At last, his neurological deficits disappeared completely after 2 days. The CAS procedure using balloon protection has problems about the ischemic intolerance. Commonly, the symptoms of intolerance are improved rapidly after restore patency of blood flow. In this case, ischemic symptoms prolonged for 2 days in spite of cerebral infarction not being seen. It was thought that the ischemic intolerance purely caused this symptom.
