Contralateral Cerebral Infarction after Stent Placement in Carotid Artery : An Unexpected Complication
- Author(s)
- Seong-Ho Park; Chang Young Lee
- Keimyung Author(s)
- Lee, Chang Young
- Department
- Dept. of Neurosurgery (신경외과학)
Brain Research Institute (뇌연구소)
- Journal Title
- 대한신경외과학회지
- Issued Date
- 2008
- Volume
- 44
- Issue
- 3
- Keyword
- Carotid stenosis; Stenting; Complication
- Abstract
- Stenting is a useful alternative treatment modality in carotid artery stenosis patients who are too high-risk to undergo carotid endarterectomy
(CEA). We report a case of contralateral cerebral infarction after stenting for extracranial carotid stenosis. A 78-year-old woman was admitted to
the hospital with left-sided weakness. Based on magnetic resonance imaging (MRI) of the brain and conventional angiography, she was
diagnosed with an acute watershed infarct of the right hemisphere secondary to severe carotid stenosis. Stenting was performed for treatment
of the right carotid artery stenosis after a one-week cerebral angiogram was completed. Thirty minutes after stent placement, the patient
exhibited a generalized seizure. Four hours later, brain MRI revealed left hemispheric cerebral infarction. Complex aorta-like arch elongation,
tortuosity, calcification, and acute angulation at the origin of the supra-aortic arteries may increase the risk of procedural complications. In our
case, we suggest that difficult carotid artery catheterization, with aggressive maneuvering during stenting, likely injured the tortuous,
atherosclerotic aortic arch, and led to infarction of the contralateral cerebral hemisphere by thromboemboli formed on the wall of the
atherosclerotic aorta.
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