Endovascular treatment for cervical carotid artery stenosis presenting with progressing stroke: three case reports.
BACKGROUND
Progressing stroke is said to occur when symptoms and signs worsen in cases of ischemic stroke. Although conservative methods using volume expansion with antithrombotic or anticoagulative agents are widely used for progressing stroke, in some hospitals, emergency carotid endarterectomy (CEA) has been performed for carotid stenosis, with mixed results. Here we report three cases with progressing ischemic stroke that were managed by endovascular surgical intervention.


METHODS
We performed endovascular surgery in three patients with cervical carotid artery stenosis presenting with progressing stroke or crescendo transient ischemic attacks. Endovascular treatment was less invasive and feasible for acute phase treatment. While local thrombolysis alone was found to be less effective, stent placement induced complete resolution of stenosis, but may result in hyperperfusion syndrome or hemorrhagic infarction.


CONCLUSIONS
In an emergency, percutaneous transluminal angioplasty with proper dilatation is preferred, and then CEA or stenting should be considered after the patient's condition stabilizes.
Hayashi
Kentaro
K
Department of Neurosurgery, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki-City, Nagasaki 852-8501, Japan.
Kitagawa
Naoki
N
Takahata
Hideaki
H
Morikawa
Minoru
M
Yoshioka
Tsutomu
T
Shabani
Hamisi K
HK
Kitange
Gaspar
G
Ochi
Makoto
M
Kaminogo
Makio
M
Shibata
Shobu
S
D000368:Aged; D002545:Brain Ischemia / Q000150:complications* / Q000209:etiology; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D002574:Cervical Vertebrae; D003937:Diagnosis, Differential; D004691:Endarterectomy; D005260:Female; D006801:Humans; D008297:Male; D020521:Stroke / Q000175:diagnosis / Q000209:etiology*; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome