A Patient with Central Retinal Artery Embolization and Hemisphere Hyperperfusion after Transient Hypoperfusion Following Carotid Artery Stenting for Carotid Stenosis

Abstract

Objective: We report a case of central retinal artery embolization and hemisphere hypoperfusion after carotid artery stenting (CAS).

Case Presentation: A 75-year-old man presented with asymptomatic progressive stenosis in the right internal carotid artery. CAS was performed for stenosis of the right internal carotid artery using a double protection device and an open-cell stent. Immediately after CAS, the patient complained of blurred vision, and after a while, he experienced disturbance of consciousness, left hemiparesis and hemispatial neglect. MRA and carotid ultrasound indicated good patency in the right internal carotid artery; however, the following day, the perfusion CT image indicated that the status changed from hypoperfusion to hyperperfusion in the ipsilateral hemisphere. These findings were temporary, and the patient was discharged without any neurologic deficit except right blindness.

Conclusion: Hemisphere hyperperfusion after hypoperfusion is rare but can occur after CAS. These results suggest that unstable plaque may develop, so it is important to confirm with the image for the appropriate treatment.