Reversible cerebral vasoconstriction syndrome is a rare cause of stroke after carotid endarterectomy Marlin Wayne Causey, MD, Matthew R. Amans, MD, Sukgu.

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Presentation transcript:

Reversible cerebral vasoconstriction syndrome is a rare cause of stroke after carotid endarterectomy Marlin Wayne Causey, MD, Matthew R. Amans, MD, Sukgu Han, MD, Randall T. Higashida, MD, Michael Conte, MD Journal of Vascular Surgery Volume 64, Issue 6, Pages 1847-1850 (December 2016) DOI: 10.1016/j.jvs.2016.01.020 Copyright © 2016 Terms and Conditions

Fig 1 Preoperative computed tomography angiography showing A, an occlusion of the right internal carotid artery (ICA; white arrow), and B, 80% to 90% stenosis of the proximal left ICA (white arrow). C, The cross-sectional imaging at the level of the carotid bulb and proximal ICA. Journal of Vascular Surgery 2016 64, 1847-1850DOI: (10.1016/j.jvs.2016.01.020) Copyright © 2016 Terms and Conditions

Fig 2 After the patient had repeated neurologic events, he underwent noninvasive imaging with ultrasound (not shown). A and B, Computed tomography angiography; and magnetic resonance angiography (not shown) (proximal end point depicted with the gray arrow and the distal end point noted with the white arrows). C and D, Subsequent cerebral angiography showed similar findings with a caliber change at the proximal endarterectomy site (gray arrow) and a possible kink/clamp site at the distal end point (white arrow). Because of the concern for these as possible embolic sources despite dual antiplatelet therapy, the carotid artery was stented using an uncovered 7- to 10-mm taped stent. Journal of Vascular Surgery 2016 64, 1847-1850DOI: (10.1016/j.jvs.2016.01.020) Copyright © 2016 Terms and Conditions

Fig 3 Despite carotid stenting of the concerning areas, the patient had another neurologic event in the same neurologic territory. A, Intracranial angiography showed a narrowing and dilation of the ophthalmic artery and distal anterior cerebral artery (black arrows) with a lack of parenchymal filling in the motor cortex (white arrow). This was far more pronounced than the findings of the previous angiogram. B, Intra-arterial administration of 15 mg of verapamil showed much less pronounced vasoconstriction with rapid and full filling of the motor cortex (white arrows). Journal of Vascular Surgery 2016 64, 1847-1850DOI: (10.1016/j.jvs.2016.01.020) Copyright © 2016 Terms and Conditions