Staged Angioplasty for Vasculo-Behçet Disease with Severe Cerebral Ischemia

Abstract

We report our good outcome of a staged angioplasty for an 18-year-old woman with vasculo-Behçet disease complicated with severe cerebral ischemia. Although she had undergone medical therapy for 12 months, her cerebral ischemic symptoms caused by bilateral common carotid artery (CCA) and left subclavian artery (SCA) occlusions developed gradually. Finally, a cerebral infarction occurred, and she suffered from prolonged symptoms involving higher brain dysfunction, fatigability, and articulation disorder. On admission, computed tomography revealed bilateral CCA and left SCA occlusions. Furthermore, the right SCA, which was the only source of cerebral blood flow, was severely stenotic. Therefore, an endovascular treatment (EVT) was performed to treat the severe cerebral ischemia. At first, percutaneous balloon angioplasty for the left CCA was performed to prevent cerebral hyperperfusion syndrome. Subsequently stentgraft implantation into left CCA and balloon angioplasty for the right CCA and SCA were performed 3 days after first EVT. There were no incidences of brain infarction or hyperperfusion after EVT, and the preoperative symptoms of high brain dysfunction disappeared. No recurrence has been observed over the last 3 years following EVT.