Neurosonology

The number of trans-septal punctures for treatment of structural heart diseases and catheter ablations has increased. Iatrogenic atrial septal defect (iASD) associated with these procedures is a recognized adverse effect. Although spontaneous closure of iASDs has not been uncommonly observed, cardio-cerebrovascular physicians should pay attention to estimating the presence of residual right-to-left shunt by sonological studies.

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Background and Purpose: Transoral carotid ultrasonography (TOCU) can examine cervical internal carotid artery (ICA) in a higher position. We report a case of a patient with stenting of idiopathic cervical internal artery dissections, and we evaluated the application of TOCU.
Case: A 58-year-old man was admitted to our hospital for posterior headache and left Horner syndrome. Computed tomography angiography revealed an enlargement of left ICA and a severe stenosis at C4 portion of left ICA. No worsening of neurological symptoms was observed, however, magnetic resonance angiography revealed a progression of stenosis of left cervical ICA. On day 5, endovascular stenting with three Wingspan and one Enterprise intracranial stents was performed. The angiogram indicated complete coverage of the stenotic segment by the stents. TOCU demonstrated blood flow in color Doppler through the stents. He discharged from hospital with modified Rankin Scale 0.
Conclusions: TOCU can be a useful clinical method for an evaluation after stenting of cervical ICA dissection.

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