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Ipsilateral Reversible Cerebral Vasculopathy Secondary to Carotid Artery Revascularization: A Case Report.
Neurohospitalist. 2021 Apr; 11(2):165-169.N

Abstract

Background

The emergence of neurologic symptoms after carotid revascularization is not uncommon and typically caused by perioperative ischemic stroke or hyperperfusion. Postoperative vasculopathy, including reversible cerebral vasoconstriction syndrome (RCVS) is a rare complication of carotid intervention and may be an under-identified cause of neurologic deficit after revascularization. We report a case of reversible postoperative vasculopathy following carotid revascularization as well as its management.

Case Presentation

A 74 year old right-handed woman presented to the emergency department with sudden onset left arm weakness and episodic shaking while hypotensive. Computed tomography angiography revealed total occlusion of her right internal carotid artery. Transcranial Doppler monitoring demonstrated active embolic events in her right middle cerebral artery raising concern for continued stump embolization. She underwent carotid revascularization with carotid endarterectomy, mechanical thrombectomy, and carotid angioplasty and initially did well postoperatively. On postoperative day 5, she developed a fixed right gaze and left hemiparesis. Computed tomography revealed new right frontal lobe and basal ganglia infarcts, and angiography showed new right internal carotid, middle cerebral, and anterior cerebral artery vasoconstriction consistent with postoperative vasculopathy. Despite treatment with pressure augmentation and vasodilator therapy, her symptoms persisted resulting in left hemiplegia at discharge.

Discussion

This case highlights postoperative vasculopathy (including RCVS) as a rare potential complication after carotid revascularization that should be considered in a patient with persistent acute neurologic symptoms. Information regarding incidence and predisposing risk factors is limited. Multiple diagnostic and therapeutic modalities may be necessary in the recognition and treatment of postoperative vasculopathy.

Authors+Show Affiliations

Cerebrovascular Center, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.Cerebrovascular Center, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.Cerebrovascular Center, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.Cerebrovascular Center, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.Cerebrovascular Center, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA. Epilepsy Center, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

33791063

Citation

Shoskes, Aaron, et al. "Ipsilateral Reversible Cerebral Vasculopathy Secondary to Carotid Artery Revascularization: a Case Report." The Neurohospitalist, vol. 11, no. 2, 2021, pp. 165-169.
Shoskes A, Mullaguri N, Purohit M, et al. Ipsilateral Reversible Cerebral Vasculopathy Secondary to Carotid Artery Revascularization: A Case Report. Neurohospitalist. 2021;11(2):165-169.
Shoskes, A., Mullaguri, N., Purohit, M., George, P., & Newey, C. R. (2021). Ipsilateral Reversible Cerebral Vasculopathy Secondary to Carotid Artery Revascularization: A Case Report. The Neurohospitalist, 11(2), 165-169. https://doi.org/10.1177/1941874420966850
Shoskes A, et al. Ipsilateral Reversible Cerebral Vasculopathy Secondary to Carotid Artery Revascularization: a Case Report. Neurohospitalist. 2021;11(2):165-169. PubMed PMID: 33791063.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ipsilateral Reversible Cerebral Vasculopathy Secondary to Carotid Artery Revascularization: A Case Report. AU - Shoskes,Aaron, AU - Mullaguri,Naresh, AU - Purohit,Meghan, AU - George,Pravin, AU - Newey,Christopher Ryan, Y1 - 2020/10/15/ PY - 2022/04/01/pmc-release PY - 2021/4/1/entrez PY - 2021/4/2/pubmed PY - 2021/4/2/medline KW - carotid artery disease KW - carotid stenosis KW - case report KW - cerebrovascular disease KW - orthostatic hypotension KW - vasospasm SP - 165 EP - 169 JF - The Neurohospitalist JO - Neurohospitalist VL - 11 IS - 2 N2 - Background: The emergence of neurologic symptoms after carotid revascularization is not uncommon and typically caused by perioperative ischemic stroke or hyperperfusion. Postoperative vasculopathy, including reversible cerebral vasoconstriction syndrome (RCVS) is a rare complication of carotid intervention and may be an under-identified cause of neurologic deficit after revascularization. We report a case of reversible postoperative vasculopathy following carotid revascularization as well as its management. Case Presentation: A 74 year old right-handed woman presented to the emergency department with sudden onset left arm weakness and episodic shaking while hypotensive. Computed tomography angiography revealed total occlusion of her right internal carotid artery. Transcranial Doppler monitoring demonstrated active embolic events in her right middle cerebral artery raising concern for continued stump embolization. She underwent carotid revascularization with carotid endarterectomy, mechanical thrombectomy, and carotid angioplasty and initially did well postoperatively. On postoperative day 5, she developed a fixed right gaze and left hemiparesis. Computed tomography revealed new right frontal lobe and basal ganglia infarcts, and angiography showed new right internal carotid, middle cerebral, and anterior cerebral artery vasoconstriction consistent with postoperative vasculopathy. Despite treatment with pressure augmentation and vasodilator therapy, her symptoms persisted resulting in left hemiplegia at discharge. Discussion: This case highlights postoperative vasculopathy (including RCVS) as a rare potential complication after carotid revascularization that should be considered in a patient with persistent acute neurologic symptoms. Information regarding incidence and predisposing risk factors is limited. Multiple diagnostic and therapeutic modalities may be necessary in the recognition and treatment of postoperative vasculopathy. SN - 1941-8744 UR - https://www.unboundmedicine.com/medline/citation/33791063/Ipsilateral_Reversible_Cerebral_Vasculopathy_Secondary_to_Carotid_Artery_Revascularization:_A_Case_Report. L2 - https://journals.sagepub.com/doi/10.1177/1941874420966850?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -
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