A Rare Complication of Carotid Artery Stenting: Displacement of Marker Ring Causing Locking of Stent and Incomplete Stent Expansion

Abstract Background Contrast encephalopathy is a rare complication of carotid artery stenting (CAS). Contrast encephalopathy is a diagnosis of exclusion that often needs to be distinguished from high perfusion syndrome, cerebral haemorrhage, subarachnoid haemorrhage (SAH), cerebral infarction and so on. Case presentation In this study, we report on a 70-year-old man who was admitted to the hospital with transient ischaemic attacks presenting paroxysmal weakness of limbs in the previous 2 years. He had severe stenosis of the left internal carotid artery diagnosed by digital subtraction angiography (DSA) and underwent CAS. Two hours after the operation, the patient developed paralysis of the right upper limb, unclear speech, fever and restlessness. Emergency skull computed tomography (CT) showed swelling and a linear high-density area in the left cerebral hemisphere. To clarify the components of this high-density area in the traditional CT, the patient had spectral CT, which made the diagnosis of the leakage of contrast clear. After 1 week of supportive treatment, the patient improved. Conclusions Spectral CT can easily distinguish the components of high-density areas on traditional CT, which is haemorrhage, calcification or iodine contrast leakage. Therefore, spectral CT is worth consideration for the differential diagnosis of complications of vascular intervention.

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Isolated Intraventricular Hemorrhage after Carotid Artery Stenting

Journal of the Korean Neurological Association ◽

10.17340/jkna.2021.3.13 ◽

2021 ◽

Vol 39 (3) ◽

pp. 188-191

Author(s):

Jiyong Shin ◽

Jihee Ko ◽

Minju Kim ◽

Chul-Hoo Kang ◽

Jay Chol Choi ◽

...

Keyword(s):

Blood Pressure ◽

Blood Flow ◽

Cerebral Blood Flow ◽

Carotid Artery ◽

Pressure Fluctuation ◽

Carotid Artery Stenting ◽

Intraventricular Hemorrhage ◽

Rare Complication ◽

Hyperperfusion Syndrome ◽

Blood Pressure Fluctuation

Cerebral intraventricular hemorrhage (IVH) is an extremely rare complication of carotid artery stenting (CAS). Fully dilated terminal arteries of a chronic, severely stenosed proximal artery could be ruptured by impaired autoregulation of cerebral blood flow. Hyperperfusion syndrome can occur even if there is no blood pressure fluctuation during the CAS. We report a case of an isolated IVH that occurred hours after CAS.

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Rare complication characterized by late-onset transient neurological symptoms without hyperperfusion after carotid artery stenting: A report of three cases

Interventional Neuroradiology ◽

10.15274/inr-2014-10099 ◽

2015 ◽

Vol 21 (1) ◽

pp. 72-79 ◽

Cited By ~ 1

Author(s):

Yutaka Fukushima ◽

Ichiro Nakahara ◽

Tsuyoshi Ohta ◽

Shoji Matsumoto ◽

Ryota Ishibashi ◽

...

Keyword(s):

Carotid Artery ◽

Signal Intensity ◽

Carotid Artery Stenting ◽

Late Onset ◽

Rare Complication ◽

Photon Emission ◽

High Signal Intensity ◽

Neurological Symptoms ◽

High Signal ◽

Emission Computed Tomography

We experienced a rare complication after carotid artery stenting (CAS) characterized by transient neurological symptoms with no evidence of distal emboli or hyperperfusion. Using neuroimaging, we investigated the pathogenesis of the complication that occurred after CAS in three patients who developed neurological symptoms over a period of ten hours after CAS and improved within two days. None of the three patients showed signs of fresh infarctions on diffusion-weighted imaging or hyperperfusion on single-photon emission computed tomography. However, high signal intensity was observed in the leptomeningeal zone of the cerebral hemisphere on the stent side in all three patients and in the leptomeningeal zone of the contralateral anterior cerebral artery territory in one patient. These areas were assessed using fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging without gadolinium administration. The high signal intensity in the leptomeningeal zone disappeared as the symptoms improved. Based on the transient nature of the neurological disorders and the normalization of FLAIR imaging findings in these patients, the pathogenesis of this complication might have been vasogenic edema due to vasoparalysis of the local vessels caused by the hemodynamic changes occurring after CAS.

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Lateral abdominal wall hematoma as a rare complication after carotid artery stenting: a case report

World Journal of Emergency Surgery ◽

10.1186/1749-7922-4-39 ◽

2009 ◽

Vol 4 (1) ◽

pp. 39 ◽

Cited By ~ 3

Author(s):

Naoto Fukunaga ◽

Shizuo Ikeyama ◽

Jyunichiro Satomi ◽

Koichi Satoh

Keyword(s):

Case Report ◽

Carotid Artery ◽

Abdominal Wall ◽

Carotid Artery Stenting ◽

Rare Complication ◽

Lateral Abdominal Wall

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Reversible cerebral vasoconstriction complicated with brain infarction immediately after carotid artery stenting

Interventional Neuroradiology ◽

10.1177/1591019918781778 ◽

2018 ◽

Vol 24 (6) ◽

pp. 688-692 ◽

Cited By ~ 1

Author(s):

Eiji Higashi ◽

Takeshi Uwatoko ◽

Taichiro Mizokami ◽

Yusuke Sakaki ◽

Shuji Sakata ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenting ◽

Clinical Course ◽

Rare Complication ◽

Brain Infarction ◽

Left Carotid Artery ◽

Perfusion Computed Tomography ◽

Cerebral Vasoconstriction ◽

Consciousness Disturbance ◽

Symptomatic Stenosis

Reversible cerebral vasoconstriction is a very rare complication after carotid artery stenting (CAS). It has been reported to occur more than several hours after CAS and to have a good clinical course. A 73-year-old man underwent CAS for a high-grade symptomatic stenosis of his left carotid artery. Immediately after CAS, he had consciousness disturbance and right hemiparesis. We first suspected hyperperfusion syndrome, but antihypertensive therapy exacerbated his symptoms. On repeated postoperative angiography, the middle cerebral artery (MCA) appeared to become progressively narrower. Perfusion computed tomography indicated hypoperfusion in the left MCA territory, so we diagnosed the patient with ischemic symptoms due to hypoperfusion associated with MCA vasoconstriction. Although these findings were temporary, right weakness and cognitive dysfunction lingered and caused severe disability. As vasoconstriction after CAS may result in a poor outcome, it must be promptly distinguished and treated accordingly.

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Rare complication characterized by late-onset transient neurological symptoms without hyperperfusion after carotid artery stenting: A report of three cases

Interventional Neuroradiology ◽

10.1177/inr-2014-10099 ◽

2015 ◽

Vol 21 (1) ◽

pp. 72-79

Author(s):

Yutaka Fukushima ◽

Ichiro Nakahara ◽

Tsuyoshi Ohta ◽

Shoji Matsumoto ◽

Ryota Ishibashi ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenting ◽

Late Onset ◽

Rare Complication ◽

Neurological Symptoms

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Cerebral Hyperperfusion Syndrome following Protected Carotid Artery Stenting

Case Reports in Vascular Medicine ◽

10.1155/2013/207602 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4

Author(s):

Rainer Knur

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Carotid Artery Stenting ◽

Internal Carotid ◽

Rare Complication ◽

Left Internal Carotid Artery ◽

Cerebral Hyperperfusion Syndrome ◽

Hyperperfusion Syndrome ◽

Cerebral Hyperperfusion ◽

Almost All

The cerebral hyperperfusion syndrome is a very rare complication after revascularization of the carotid artery and accompanied by postoperative or postinterventional hypertension in almost all patients. We report a case of a 77-year-old man who developed a complete aphasia and increased right-sided weakness following endovascular treatment of severe occlusive disease of the left internal carotid artery. We discuss the risk and management of cerebral hyperperfusion syndrome after carotid artery stenting.

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Abrupt Flow Arrest in the Internal Carotid Artery during Carotid Artery Stenting Using the Parodi Anti-Emboli System

Interventional Neuroradiology ◽

10.1177/159101990501100412 ◽

2005 ◽

Vol 11 (4) ◽

pp. 383-386

Author(s):

H. Oishi ◽

N. Horinaka ◽

H. Arai

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Carotid Artery Stenosis ◽

Carotid Artery Stenting ◽

Internal Carotid ◽

Rare Complication ◽

Artery Stenosis

We report a rare complication of carotid artery stenting (CAS) in a patient with severe carotid artery stenosis. CAS with a protection of the Parodi Anti-Emboli System was complicated by an abrupt flow arrest in the internal carotid artery before the guidewire passage through the stenotic site.

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Acute intracerebral haemorrhage complication after carotid artery stenting

Romanian Neurosurgery ◽

10.1515/romneu-2015-0025 ◽

2015 ◽

Vol 29 (2) ◽

pp. 177-182

Author(s):

A. Chiriac ◽

Georgiana Ion ◽

N. Dobrin ◽

I. Poeata

Keyword(s):

Basal Ganglia ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Intracerebral Haemorrhage ◽

Stent Placement ◽

Carotid Artery Stenting ◽

Internal Carotid ◽

Rare Complication ◽

Carotid Angioplasty ◽

Basal Ganglia Hemorrhage

Abstract Intracranial hemorrhage following carotid artery stenting is a recognized rare complication but with potentially devastating evolution. Reports of acute cerebral hemorrhage injury following internal carotid artery (ICA) angioplasty are few, and usually were discussed in correlation with hyperperfusion syndrome. In this article we present a patient who experienced a fatal ipsilateral basal ganglia hemorrhage within 10 minutes after carotid angioplasty and stent placement

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Pseudoaneurysm of the left internal carotid artery following tonsillectomy

VASA ◽

10.1024/0301-1526/a000153 ◽

2011 ◽

Vol 40 (6) ◽

pp. 491-494 ◽

Cited By ~ 4

Author(s):

Vávrová ◽

Slezácek ◽

Vávra ◽

Karlová ◽

Procházka

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Rare Complication ◽

Left Internal Carotid Artery ◽

Acute Tonsillitis ◽

Artery Pseudoaneurysm ◽

Complete Occlusion ◽

Endovascular Approach ◽

Deep Neck Infections

Internal carotid artery pseudoaneurysm is a rare complication of deep neck infections. The authors report the case of a 17-year-old male who presented to the Department of Otorhinolaryngology with an acute tonsillitis requiring tonsillectomy. Four weeks after the surgery the patient was readmitted because of progressive swallowing, trismus, and worsening headache. Computed tomography revealed a pseudoaneurysm of the left internal carotid artery in the extracranial segment. A bare Wallstent was implanted primarily and a complete occlusion of the pseudoaneurysm was achieved. The endovascular approach is a quick and safe method for the treatment of a pseudoaneurysm of the internal carotid artery.

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