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Updated: May 22, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Limb-shaking transient ischemic attacks successfully treated with external carotid artery stenting
George N Kouvelos1, Christos Nassis, Nektario Papa
1Vascular Surgery, Unit Department of Surgery, Medical School, University of Ioannina, 45110 Ioannina, Greece.
Insights
External carotid artery (ECA) stenting effectively treated limb-shaking transient ischemic attacks (TIAs) in a patient with severe carotid disease. This endovascular approach offers a viable alternative for managing complex carotid artery stenosis.
Area of Science:
- Vascular Surgery
- Neurology
- Interventional Cardiology
Background:
- The external carotid artery (ECA) is a key collateral source for cerebral blood flow, particularly during internal carotid artery (ICA) compromise.
- Endovascular research has predominantly focused on the ICA, with limited attention to the ECA.
- Limb-shaking transient ischemic attacks (TIAs) are an uncommon symptom of carotid artery disease, characterized by repetitive limb movements.
Observation:
- A case involving an 80-year-old male with bilateral ICA and contralateral ECA occlusion presented with limb-shaking TIAs.
- The patient exhibited significant stenosis in the right ECA as the cause of his symptoms.
- The patient had bilateral internal carotid artery and contralateral external carotid artery occlusion.
Findings:
- Percutaneous revascularization of the stenosed right ECA was successfully performed using angioplasty and stenting.
- At 12-month follow-up, the patient remained neurologically stable with complete resolution of TIAs.
Implications:
- External carotid artery (ECA) stenting is a feasible treatment option for limb-shaking TIAs.
- This endovascular strategy is particularly beneficial for patients with contralateral carotid stenosis, compromised circle of Willis, or significant comorbidities.
- ECA stenting presents a reasonable alternative to open surgical repair in select patient populations.
Abstract:
The external carotid artery (ECA) is one of the most important extracranial-to-intracranial sources of collateral circulation, contributing significantly to the cerebral blood flow especially when perfusion through the internal carotid artery (ICA) is compromised. Most of the endovascular studies so far have been dedicated to ICA, with little focus on the ECA. Limb-shaking transient ischemic attacks (TIAs) are a relatively rare manifestation of carotid artery disease that may present with repetitive shaking movements of the affected limbs. We report a case of an 80-year-old male with bilateral internal and contralateral external carotid artery occlusion who developed limb-shaking TIAs as a result of significant stenosis of the right ECA. Percutaneous revascularization of the ECA was performed by angioplasty and stenting. At the follow-up 12 months later, the patient remained neurologically intact with complete resolution of his symptoms. Stenting of the ECA should be considered as a reasonable alternative to conventional open repair especially in patients with contralateral carotid stenosis, insufficient circle of Willis, and significant comorbidities.
