Asymptomatic Cerebral Vasoconstriction after Carotid Artery Stenting

Area of Science:

• Neurology
• Interventional Neuroradiology
• Vascular Surgery

Background:

• Carotid artery stent placement is a common procedure for treating carotid stenosis.
• Near-total occlusion of the internal carotid artery (ICA) presents unique challenges.

Purpose of the Study:

• To investigate the occurrence of cerebral vasoconstriction in the ipsilateral anterior circulation.
• To analyze immediate post-stenting angiographic findings in patients with proximal ICA near-total occlusion.

Main Methods:

• Retrospective review of 28 patients undergoing carotid artery stent placement for near-total occlusion (2008-2018).
• Two neuroradiologists assessed final cerebral angiographic findings for vasoconstriction or vasodilation.

Main Results:

• Ten of 28 patients (35.7%) exhibited vasoconstriction post-stenting.
• Vasoconstriction was more frequent in patients with isolated cerebral circulation (66.7% vs. 12.5%, P < .05).
• No significant differences in comorbidities, symptoms, medication, or procedural factors were found between groups; no adverse events were reported in vasoconstriction group.

Conclusions:

• Cerebral vasoconstriction post-carotid artery stenting may be more common than previously thought.
• Occurrence is higher in patients with near-total ICA occlusion and isolated cerebral circulation.
• Further large-scale studies are needed to determine the clinical implications of this phenomenon.