Reversible Cerebral Vasoconstriction Syndrome Following Carotid Endarterectomy: A Case Report

Area of Science:

• Neurology
• Vascular Surgery
• Radiology

Background:

• Reversible cerebral vasoconstriction syndrome (RCVS) is a cerebrovascular condition characterized by multifocal arterial constriction and dilation.
• RCVS can be triggered spontaneously or by external stimuli.
• It is rarely reported as a complication following carotid endarterectomy (CEA).

Observation:

• A 65-year-old woman developed a thunderclap headache one day after left-sided CEA.
• Initial CT scans showed subarachnoid hemorrhage (SAH); CT angiography revealed no aneurysms or stenosis.
• The patient presented again with persistent headache and bilateral frontal SAH; MRA demonstrated multifocal intracranial stenosis.

Findings:

• The patient was diagnosed with RCVS secondary to CEA.
• Follow-up MRA 9 weeks post-CEA showed significant improvement in intracranial stenosis and vessel caliber.
• This case underscores the potential link between CEA and the development of RCVS.

Implications:

• Clinicians should consider RCVS in patients experiencing thunderclap headaches or recurrent severe headaches post-CEA.
• The presence of nonaneurysmal convexity SAH may further suggest RCVS in this context.
• Early recognition and consideration of RCVS can guide appropriate management following CEA.