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Abstract
Introduction A 75-year-old female presented to the hospital for treatment of asymptomatic right carotid artery (CA) restenosis 1 year after endarterectomy. CT angiography showed 90% stenosis of the right ICA at bulbus area.
Aim of Study Regular carotid artery stenting (CAS) procedure was anticipated.
Methods Selective catheterization and digital subtraction angiography (DSA) of the CA confirmed critical stenosis of ICA bulbus area.
A CAS procedure was performed in a standard protocol: placement of a 5 mm filter protection device over the 0.014’ wire distal to stenosis, predilatation of subocclusion area with 3,5 x 20 mm monorail angioplasty balloon, 7 x 30 mm stent placement, postdilation by 5 x 20 mm balooncatheter to 7atm. The final DSA showed resolution of stenosis, intracranial DSA without any pathology.
7 hours after procedure the patient developed slight left sided hemiparesis. Non-enhanced CT performed, revealing intracerebral (ICH) and subarachnoid hemorrhage in right frontal lobe.
Results ICH may occur as a hyperperfusion phenomenon after CAS, in the presence of mild to moderate arterial hypertension, but is extremely rare (0.6%). The main risk factors are periprocedural hypertension and severe stenosis/subocclusion. Dual antiplatelet (DAP) therapy was stopped in hemorrhage occurred and was restarted three days later. No stent thrombosis was found during duplex ultrasound on the 3d day after ICH.
Conclusion ICH usually occurs a few hours after CAS and often leads to catastrophic results. Close monitoring of the patients with CAS for subocclusion of ICA should be performed with prolonged blood pressure monitoring for next 24 hours after procedure.
Disclosure of Interest Nothing to disclose