Usefulness of Local Manual Compression with Cerebral Angiography for Bleeding from the Origin of the ICA with Upper Airway Stenosis after Carotid Artery Stenting

Kamatani K, Yoshida S, Tashiro N, Hashiguchi Y, Takigawa K, Yasaka M, Aikawa H, Go Y and Kazekawa K

Department of Neurosurgery, Fukuoka Neurosurgical Hospital, Japan
Department of Cerebrovascular Medicine, Fukuoka Neurosurgical Hospital, Japan

^*Correspondance to: Kaisei Kamatani 

 PDF  Full Text Research Article | Open Access

Abstract:

Background: Symptomatic hemorrhage of the Internal Carotid Artery (ICA) associated with CAS is rare. A case of upper airway stenosis due to hemorrhage at the origin of the ICA after CAS is reported along with a review of the literature. Methods: The patient was an 86-year-old man who suddenly noticed dysarthria and was transported to our hospital. On MRI, cerebral infarction was observed, along with stenosis of the right ICA. The infarction was considered to have been caused by the stenosis, so CAS was performed. An attempt was made to cross the stenotic lesion by the Spider FX using an microwire several times. Final angiography after deployment of a CASPER RX showed no abnormal findings, including acute instent occlusion or stenosis. Two hours after returning to the room, he noticed dyspnea; there was subcutaneous swelling of the neck from the right mandible to the supraclavicular region, and the pharyngeal fiberscope showed stenosis of the hypopharyngeal space. Emergency intubation was performed. Contrast-enhanced CT showed extravasation at the stenting site and a surrounding hematoma. Extravasation at the origin of the ICA was confirmed by angiography. A subcutaneous hematoma caused by intraoperative wire perforation was diagnosed. The skin was marked directly above the area of hemorrhage under angiography, and the area was manually compressed for one hour. On angiography just after compression, there was no extravasation. Results: The patient’s condition stabilized. Conclusion: Manual compression with angiography after intubation is effective in cases of perforation of the ICA during intraoperative wire manipulation.

Keywords:

CAS; Stent; Stroke; CT

Cite the Article:

Kamatani K, Yoshida S, Tashiro N, Hashiguchi Y, Takigawa K, Yasaka M, et al. Usefulness of Local Manual Compression with Cerebral Angiography for Bleeding from the Origin of the ICA with Upper Airway Stenosis after Carotid Artery Stenting. Clin Case Rep Int. 2023; 7: 1611.