[Limb-shaking transitory ischaemic attack in a patient with subocclusion of the internal carotid artery]

Described in the article is a clinical case report concerning symptomatic subocclusion of the internal carotid artery in a male patient with a rare variant of recurrent limb-shaking transitory ischaemic attacks (LS-TIA). The patient presented with a three-month history of episodes of involuntary jerky movements in his left hand. These episodes occurred invariably on assuming a vertical position. The findings of duplex scanning revealed subocclusion of the right internal carotid artery. The patient was subjected to stenting with the use of the system of proximal cerebral protection. The postoperative period was complicated by the development of cerebral hyperperfusion syndrome the risk of which in patients with LS-TIA is known to be elevated. Via telephone interviewing carried out at 1, 6 and 12 months after the intervention, the patient confirmed that the episodes of hand shaking did not recur. This case report highlights the importance of accurately assessing the clinical findings while selecting patients for carotid revascularization, since such ischaemic episodes are strongly suggestive of a severe lesion of the contralateral carotid artery. Once subocclusion is revealed, it is optimal to perform stenting with the use of a system of proximal protection, as a safer and more effective method of surgical revascularization in such conditions.