A Case of Complete Resolution of Repeated Syncope Attacks After a Right-Sided Carotid Endarterectomy
Shuki Mizukami1, Akihito Hashiguchi1, Kensuke Sasaki1
1Neurological Surgery, Tokuda Neurosurgical Hospital, Kanoya, JPN.
Insights
Severe carotid artery stenosis can cause recurrent syncope (fainting). Surgical intervention to restore blood flow to the brain effectively resolved syncope in a patient with unilateral internal carotid artery stenosis.
Area of Science:
- Neurology
- Cardiology
- Vascular Surgery
Background:
- Syncope is a common condition often linked to cerebral hypoperfusion.
- The precise cause of syncope can be difficult to determine, even after thorough evaluation.
Observation:
- A patient experienced recurrent syncope despite extensive cardiac workup revealing no abnormalities.
- The patient had severe stenosis in the right internal carotid artery (ICA) but no significant disease in the left ICA or vertebrobasilar artery (VBA).
- Transient left-sided hemiparesis occurred concurrently with syncope episodes.
Findings:
- Carotid revascularization surgery for the stenosed right ICA completely resolved the patient's syncope.
- The patient showed significant clinical improvement with no reported recurrence of syncope post-surgery.
Implications:
- This case highlights a potential, albeit uncommon, link between unilateral internal carotid artery stenosis and recurrent syncope.
- It suggests that carotid artery stenosis should be considered in the differential diagnosis of unexplained syncope, particularly when accompanied by transient neurological deficits.
- Revascularization may be an effective treatment for syncope caused by significant carotid artery stenosis.
Abstract:
Syncope is a common clinical entity with variable presentations and often an elusive causal mechanism, even after extensive evaluation. In any case, global cerebral hypoperfusion, resulting from the inability of the circulatory system to maintain blood pressure (BP) at the level necessary to supply blood to the brain efficiently, is the final pathway for syncope. Steno-occlusive carotid artery disease, even if bilateral, does not usually cause syncope. However, the patient presented here had repeated syncope attacks and underwent a thorough examination for suspected cardiac disease, but no abnormality was found. Since there was severe stenosis in the right unilateral internal carotid artery (ICA), but no stenosis in the left ICA or vertebrobasilar artery (VBA), and transient left mild hemiparesis associated with syncope, carotid revascularization surgery for the right ICA was performed, and the repeated syncope attacks completely disappeared after the surgery. The patient's condition improved markedly, and no further episodes of syncope have been reported. We report the relationship between carotid artery stenosis and syncope and discuss its pathomechanism.
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