Rare complication characterized by late-onset transient neurological symptoms without hyperperfusion after carotid artery stenting: A report of three cases.
We experienced a rare complication after carotid artery stenting (CAS) characterized by transient neurological symptoms with no evidence of distal emboli or hyperperfusion. Using neuroimaging, we investigated the pathogenesis of the complication that occurred after CAS in three patients who developed neurological symptoms over a period of ten hours after CAS and improved within two days. None of the three patients showed signs of fresh infarctions on diffusion-weighted imaging or hyperperfusion on single-photon emission computed tomography. However, high signal intensity was observed in the leptomeningeal zone of the cerebral hemisphere on the stent side in all three patients and in the leptomeningeal zone of the contralateral anterior cerebral artery territory in one patient. These areas were assessed using fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging without gadolinium administration. The high signal intensity in the leptomeningeal zone disappeared as the symptoms improved. Based on the transient nature of the neurological disorders and the normalization of FLAIR imaging findings in these patients, the pathogenesis of this complication might have been vasogenic edema due to vasoparalysis of the local vessels caused by the hemodynamic changes occurring after CAS.
Department of Neurosurgery, Kokura Memorial Hospital, Kokurakita-ku, Kitakyushu, Japan yutaka471104@yahoo.co.jp.
Yutaka
Y
Fukushima
Department of Neurosurgery, Kokura Memorial Hospital, Kokurakita-ku, Kitakyushu, Japan.
Ichiro
I
Nakahara
Department of Neurosurgery, Kokura Memorial Hospital, Kokurakita-ku, Kitakyushu, Japan.
Tsuyoshi
T
Ohta
Department of Neurosurgery, Kokura Memorial Hospital, Kokurakita-ku, Kitakyushu, Japan.
Shoji
S
Matsumoto
Department of Neurosurgery, Kokura Memorial Hospital, Kokurakita-ku, Kitakyushu, Japan.
Ryota
R
Ishibashi
Department of Neurosurgery, Kokura Memorial Hospital, Kokurakita-ku, Kitakyushu, Japan.
Masanori
M
Gomi
Department of Neurosurgery, Kokura Memorial Hospital, Kokurakita-ku, Kitakyushu, Japan.
Haruka
H
Miyata
Department of Neurosurgery, Kokura Memorial Hospital, Kokurakita-ku, Kitakyushu, Japan.
Hidehisa
H
Nishi
Department of Neurosurgery, Kokura Memorial Hospital, Kokurakita-ku, Kitakyushu, Japan.
Sadayoshi
S
Watanabe
D000368:Aged; D016893:Carotid Stenosis / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology*; D015607:Stents / Q000009:adverse effects*; D013997:Time Factors
Blood-brain barrier; FLAIR MRI; carotid artery stenting; reversible vasoparalysis