title: Reversible cerebral vasoconstriction syndrome is a rare cause of stroke after carotid endarterectomy.
abstract: Neurologic events after carotid endarterectomy (CEA) require prompt diagnosis and management to avoid potentially catastrophic sequelae. This report describes a 69-year-old gentleman who underwent a left CEA for a high-grade asymptomatic carotid stenosis with concomitant contralateral carotid occlusion. He had transient and crescendo neurologic events in the first 3 postoperative weeks that culminated in right hand weakness and paresthesia, despite dual antiplatelet therapy, maximal anticoagulation, and undergoing stenting of the endarterectomy site. Neurologic events recurred despite these measures and subsequent angiography showed reversible cerebral vasoconstriction syndrome that was successfully managed without further events. Reversible cerebral vasoconstriction syndrome is an unusual but important cause of neurologic events after CEA that requires aggressive and directed medical therapy.
authors.affiliation: Department of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, Calif. Electronic address: mwcausey@msn.com.
authors.forename: Marlin Wayne
authors.initials: MW
authors.lastname: Causey
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Amans
authors.affiliation: Department of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, Calif.
authors.forename: Sukgu
authors.initials: S
authors.lastname: Han
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif.
authors.forename: Randall T
authors.initials: RT
authors.lastname: Higashida
authors.affiliation: Department of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, Calif.
authors.forename: Michael
authors.initials: M
authors.lastname: Conte
mesh_terms: D000368:Aged; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D002533:Cerebral Angiography / Q000379:methods; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology*; D000072226:Computed Tomography Angiography; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology*; D016896:Treatment Outcome; D014661:Vasoconstriction / Q000187:drug effects; D014665:Vasodilator Agents / Q000627:therapeutic use; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology
chemical_list: D014665:Vasodilator Agents