2025 Volume 53 Issue 3 Pages 182-188
Ischemic complications often occur perioperatively after carotid artery stenting (CAS). Embolization of plaque or thrombosis is the most common cause, but there are few reports of cerebral vasospasm. Herein, we report a case of symptomatic cerebral vasospasm after CAS.
The patient was a 71-year-old male. He was admitted to the hospital with mild right-sided paralysis. Magnetic resonance imaging (MRI) showed a left cerebral infarction, while magnetic resonance angiography revealed stenosis in the left internal carotid artery. Ultrasonography of the carotid artery revealed a hypoechoic plaque, indicating an unstable plaque. CAS was performed to prevent recurrence. Two hours after surgery, the patient presented with right-sided paralysis and aphasia, and MRI revealed a new cerebral infarction on the operated side. The following day, a cerebral perfusion test showed decreased blood flow in the left cerebral hemisphere, and cerebral angiography revealed cerebral vasospasm on the operated side. Conservative treatment resulted in the resolution of neurological symptoms on the 11th day after surgery, and cerebral angiography one month after surgery showed improvement in cerebral vasospasm.
Although cerebral vasospasm is a rare cause of ischemic complications after CAS, it should also be considered. It is important to promptly distinguish between hyperperfusion syndrome and low blood pressure.
