scholarly journals Hyperperfusion Syndrome and Baroreflex Failure following Carotid Artery Angioplasty and Stenting for Symptomatic Radiation-Associated Carotid Artery Stenosis

2020 ◽  
Vol 12 (Suppl. 1) ◽  
pp. 76-83
Author(s):  
Hui-Meng Chang
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Nasopharyngeal Cancer ◽  
Artery Stenosis ◽  
Hyperperfusion Syndrome ◽  
Cerebral Hyperperfusion ◽  
Long Term Follow Up ◽  
Baroreflex Failure ◽  
Angioplasty And Stenting

Cerebrovascular manifestations of radiotherapy for head and neck cancers are well described. In Southeast Asia, because nasopharyngeal cancer is common, patients with late cerebrovascular consequences are encountered regularly. This case report describes the long-term follow-up of a Chinese male patient with symptomatic severe radiation-associated atherosclerosis, who had carotid artery angioplasty and stenting performed, and the subsequent complications encountered: cerebral hyperperfusion syndrome, baroreflex failure, and progressive carotid artery stenosis.

Stepwise improvement in limb shaking achieved by staged angioplasty for severe carotid stenosis

2021 ◽  
pp. 197140092110366
Author(s):  
Kento Takahara ◽  
Takenori Akiyama ◽  
Keisuke Yoshida ◽  
Hiroki Yamada ◽  
Yumiko Oishi ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Internal Carotid ◽  
Internal Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
Cerebral Hyperperfusion Syndrome ◽  
Hyperperfusion Syndrome ◽  
Cerebral Hyperperfusion ◽  
Limb Shaking

Cerebral hyperperfusion syndrome is a rare but severe complication of carotid artery stenting or carotid endarterectomy. Staged angioplasty is reportedly an effective strategy to avoid cerebral hyperperfusion syndrome. We encountered a case of internal carotid artery stenosis with a rare clinical presentation of limb shaking that was successfully improved by staged angioplasty. To our knowledge, there are no reported cases of limb shaking treated with staged angioplasty. A 76-year-old woman presented with continuous chorea in her left lower limb and shoulder. Medical examination revealed a tiny cerebral infarction in the right corona radiata and severe right internal carotid artery stenosis. Angiography showed near occlusion of the right internal carotid artery. Staged angioplasty was performed to avoid the risk of cerebral hyperperfusion syndrome. The first angioplasty resulted in an expanded diameter of 2.5 mm and was followed by definitive carotid artery stenting using a closed-cell stent 3.5 weeks later. Limb shaking improved in a stepwise manner along with an improvement in internal carotid artery stenosis and distal flow state with no signs of cerebral hyperperfusion syndrome. Patients with internal carotid artery stenosis or occlusion presenting with limb shaking have been suggested to have impaired cerebrovascular reactivity, which is also thought to be a risk factor for cerebral hyperperfusion syndrome. The stepwise improvement in limb shaking observed in this case supports the idea that the pathophysiology of limb shaking is related to cerebral haemodynamic impairment. Measures to prevent cerebral hyperperfusion syndrome, including staged angioplasty, should be actively considered in patients with limb shaking because the symptoms themselves suggest severe hypoperfusion.

Late carotid restenosis: Aetiologic factors for recurrent carotid artery stenosis during long-term follow-up

1989 ◽  
Vol 3 (3) ◽  
pp. 271-277 ◽  
Author(s):  
J-P. Salenius ◽  
A. Haapanen ◽  
E. Harju ◽  
H. Jokela ◽  
H. Riekkinen
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
Long Term Follow Up

Comparative outcomes of carotid artery stenting for asymptomatic and symptomatic carotid artery stenosis: a single-center prospective study

2014 ◽  
Vol 8 (2) ◽  
pp. 126-129 ◽  
Author(s):  
Dapeng Mo ◽  
Bo Wang ◽  
Ning Ma ◽  
Feng Gao ◽  
Zhongrong Miao
Keyword(s):  
Myocardial Infarction ◽  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Carotid Artery Stenting ◽  
Artery Stenosis ◽  
Acute Thrombosis ◽  
Symptomatic Carotid ◽  
Long Term Follow Up

BackgroundCarotid artery stenting (CAS) for symptomatic carotid artery stenosis (SCS) has been proved to be safe and effective in many randomized controlled trials, but the safety and efficacy of CAS for asymptomatic carotid artery stenosis (ACS) is not clear.ObjectiveTo prospectively compare the outcomes of CAS between patients with ACS and SCS.Methods402 consecutive patients, 233 with ACS and 169 with SCS, underwent CAS. The primary outcome was a composite of death, stroke or myocardial infarction at 30 days and during the follow-up period. Procedural success and complications such as hyperperfusion, sinus-cardiac reflex, gastrointestinal hemorrhage, myocardial infarction, acute thrombosis, and vagus nerve reflex were also compared between the ACS and SCS groups.ResultsCAS was successful in all patients. There were no significant differences in baseline characteristics of the patients (age, gender, hypertension, diabetes, smoking, alcohol consumption and dyslipidemia) and in 30-day or long-term follow-up outcomes between the ACS and SCS groups.ConclusionsPeriprocedural and long-term follow-up outcomes of CAS appear similar for ACS and SCS.

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