Emergency Carotid Artery Stenting in Persistent Hemodynamic Deficit Associated with Severe Carotid Stenosis
Benjamin S. Geislera,
Joachim Rötherb,
Thomas Kucinskia,
Hermann Zeumera and
Bernd Eckerta
a Department of Neuroradiology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
b Department of Neurology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
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FIG 1. MR imaging 2 hours after the onset of stroke.
A and D, Acute MR imaging with two representative sections of DW imaging revealing a small lesion in the subcortical white matter (A, arrow), suggesting hemodynamic infarction.
B and E, Acute MR imaging with the same sections of TTP, demonstrating a perfusion delay in almost the entire right MCA territory and in both ACA territories.
C and F, Acute MR imaging with the same sections of CBF showing a decrease of cerebral blood flow in almost the entire right MCA territory and in both ACA territories, matching the TTP results.
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FIG 2. Before CAS placement.
A, Initial CE-MRA displaying a high-grade stenosis of the proximal right ICA (arrow), a moderate stenosis of the left ICA, and lack of an A1-segment of the left ACA.
B, Diagnostic angiography of the right ICA (anteroposterior) after selective injection in the right CCA, revealing the >95% stenosis of the proximal right ICA (arrow).
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FIG 3. Three angiographic depictions during CAS (after selective CCA injection; anteroposterior views).
A, Guidewire placed through the stenosis.
B, Stent deployment along the stenosis.
C, Complete recanalization of the proximal right ICA after treatment.
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FIG 4. MR imaging at follow-up.
A and D, MR imaging 24 hours after treatment with corresponding sections of DW imaging without any new cortical or subcortical ischemic lesions.
B and E, MR imaging 24 hours after treatment with the same sections of TTP demonstrating a timely reperfusion of the right MCA and both ACA territories.
C and F, MR imaging 24 hours after treatment with the same sections of CBF showing a normalized cerebral blood flow, matching the TTP results.
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