J Korean Neurosurg Soc.  2008 Sep;44(3):159-162. 10.3340/jkns.2008.44.3.159.

Contralateral Cerebral Infarction after Stent Placement in Carotid Artery : An Unexpected Complication

• Park SH
• Lee CY

• KMID: 2067347
• DOI: http://doi.org/10.3340/jkns.2008.44.3.159

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.

Keyword

Carotid stenosis; Stenting; Complication

MeSH Terms

Aged
Angiography
Aorta
Aorta, Thoracic
Arteries
Brain
Carotid Arteries
Carotid Stenosis
Catheterization
Catheters
Cerebral Infarction
Cerebrum
Endarterectomy, Carotid
Female
Humans
Infarction
Magnetic Resonance Imaging
Seizures
Stents