Related Experiment Videos
Endovascular treatment for cervical carotid artery stenosis presenting with progressing stroke: three case reports
Kentaro Hayashi1, Naoki Kitagawa, Hideaki Takahata
1Department of Neurosurgery, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki-City, Nagasaki 852-8501, Japan.
Insights
Endovascular intervention offers a less invasive option for progressing ischemic stroke due to carotid stenosis. Stent placement effectively resolved stenosis but carries risks like hyperperfusion syndrome.
Area of Science:
- Neurology
- Vascular Surgery
- Interventional Cardiology
Background:
- Progressing stroke, characterized by worsening neurological deficits, presents a critical challenge in ischemic stroke management.
- Current conservative treatments for progressing stroke include volume expansion with antithrombotic or anticoagulative agents.
- Emergency carotid endarterectomy (CEA) has been employed for carotid stenosis, yielding variable outcomes.
Observation:
- This report details three cases of progressing ischemic stroke managed with endovascular surgical intervention for cervical carotid artery stenosis.
- Endovascular treatment was utilized as an acute phase intervention due to its less invasive nature.
- Local thrombolysis alone demonstrated limited efficacy in these cases.
Findings:
- Stent placement successfully achieved complete resolution of carotid artery stenosis in the observed cases.
- A potential complication of stent placement is the development of hyperperfusion syndrome or hemorrhagic infarction.
- Endovascular approaches provide a feasible alternative for acute stroke management.
Implications:
- Percutaneous transluminal angioplasty with adequate dilatation is recommended in emergency settings.
- Carotid endarterectomy or stenting may be considered once the patient's clinical condition has stabilized.
- Endovascular techniques represent a valuable therapeutic option for select patients with progressing ischemic stroke and carotid stenosis.
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.
Case Description:
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.