Case ReportAdvantages of Staged Angioplasty in a Patient with Internal Carotid Artery Pseudo-Occlusion Besides Prevention of Cerebral Hyperperfusion Syndrome
Introduction
Staged angioplasty has been reported to be effective in preventing postoperative cerebral hyperperfusion syndrome (CHS) in patients with severe carotid artery stenosis1, 2; thus, it is also recommended in patients with internal carotid artery (ICA) pseudo-occlusion.
Here, we report on a patient with left ICA pseudo-occlusion that was successfully treated by staged angioplasty. Some previously unreported advantages of staged angioplasty in patients with acute ICA pseudo-occlusion are discussed.
Section snippets
Onset and Course
An Asian man in his 50s presented at the emergency room with the chief complaint of motor aphasia and severe motor weakness (manual muscle test score of 2/5) mainly in his right upper extremity. Magnetic resonance imaging showed a high-intensity area in his left frontal lobe on diffusion-weighted imaging–fluid-attenuated inversion recovery, suggesting acute cerebral infarction (Figure 1C and D). The time of symptom onset was unknown, and the patient could not be treated by intravenous injection
Discussion
Pseudo-occlusion of the ICA is characterized by an extremely narrow residual lumen and a collapsed distal portion induced by hypoperfusion.3 The treatment strategy for ICA pseudo-occlusion is controversial, and data from 2 major clinical trials (i.e., ECST [European Carotid Surgery Trial] and NASCET [North American Symptomatic Carotid Endarterectomy Trial]4) have shown that the rate of stroke among patients with pseudo-occlusion is not higher than that among patients with high-grade ICA
Conclusions
We treated a patient with progressing ICA pseudo-occlusion by means of a staged angioplasty. In the present case, besides preventing CHS, staged angioplasty allowed us to ensure full dilatation of the distal ICA before stent placement. Thus, we emphasize that staged angioplasty is advantageous in treating patients with ICA pseudo-occlusion because the extent of dilation of the distal ICA after PTA can be assessed before stent placement.
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Cited by (1)
Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.