Carotid Artery Stenosis

Delayed life-threatening bleeding after facial fractures

October 27, 2021

Brain Stem Cavernous Malformation

October 27, 2021

Figure 1. A) Diffusion positive strokes; B) Right ICA Angiogram with 80-90% Stenosis

Figure 2. A) Right ICA post stent immediate; B) CTA at 6 months

KEY LEARNING POINTS:

Transient or mild neurologic symptoms may represent warnings signs for severe underlying carotid artery vascular disease.
Carotid Artery Angioplasty and Stenting is an excellent durable option for revascularization, especially in high-risk patients presenting with distal stenosis or bilateral disease.

REFERENCES:

Cole TS, Mezher AW, Catapano JS, et al. Nationwide Trends in Carotid Endarterectomy and Carotid Artery Stenting in the Post-CREST Era. Stroke. 2020;51(2):579-587. doi:10.1161/STROKEAHA.119.027388
Brott TG, Howard G, Roubin GS, et al. Long-Term Results of Stenting versus Endarterectomy for Carotid-Artery Stenosis. N Engl J Med. 2016;374(11):1021-1031. doi:10.1056/NEJMoa1505215

CATEGORY: BRAIN // CAROTID ARTERY STENOSIS

A 63-year-old woman experienced transient dysarthria, mild left-sided weakness, and paresthesia of the left arm and leg. MRI demonstrates distal embolic strokes of the superior right frontal and parietal lobes. Symptomatic high-grade right Internal Carotid Artery (ICA) stenosis is confirmed. Contralateral high-grade asymptomatic stenosis of the left ICA was also present. Right ICA angioplasty and stenting with distal embolic protection was performed on a focal 80-90% post bulbar stenosis. She achieved complete and durable revascularization with
complete functional recovery and a return to her daily life. Revascularization of her asymptomatic left carotid artery is planned to further reduce her risk of a disabling stroke.

AUTHORS:
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John Pile-Spellman M.D., F.A.C.R.

Authors

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