Article ID: cr.2021-0016
Objective: Limb shaking is an aparoxysmal symptom of transient ischemic attack in patients with high-grade occlusive diseases of the internal carotid artery or Moyamoya disease. We report a rare case of limb shaking seen during carotid artery stenting (CAS) using distal balloon protection in a patient with symptomatic carotid stenosis.
Case Presentation: A 68-year-old woman presented with repeated transient right hemiparesis. Single photon emission computed tomography (SPECT) revealed low perfusion in the left hemisphere owing to the left carotid stenosis and poor collaterals. She was treated with CAS using distal balloon protection. During the procedure, she developed involuntary movement on the right upper and lower limbs. This involuntary movement disappeared after deflation of the protective balloon. A further reduction in the left cerebral blood flow due to balloon protection during CAS seemed to have caused the limb shaking.
Conclusion: An appropriate strategy for CAS that considers limb shaking as an ischemic symptom in patients with preoperative ipsilateral hypoperfusion is needed.
