Contralateral Cerebral Infarction after Unilateral Carotid Angioplasty with Stenting
Min Ju Kim, MD Suk Yun Kang, MD, Seok-Beom Kwon, MD, San Jung, MD, Mi Jeong Lee, MD, Min-Gyeong Jeong, MD, Ki-Han Kwon, MD, Byung-Chul Lee, MD, PhD and Sung-Hee Hwang, MD, PhD
Department of Neurology, Hallym University College of Medicine, Seoul, Korea
ABSTRACT
Background: Common complication of carotid angioplasty with stenting (CAS) may be ipsilateral cerebral infarction from embolic event during the procedure. Contralateral cerebral infarction is uncommon and the pathogenic mechanism is unclear. Case Report: A 61- year-old man had acute concurrent left anterior cerebral artery (ACA) and middle cerebral artery (MCA) infarction. Conventional angiography showed that tight focal stenosis of right cervical internal carotid artery (ICA) and complete occlusion of left cervical ICA. Left MCA was supplied by the blood flow of basilar artery via left posterior communicating artery (PComA). Both ACAs were supplied by left MCA. After CAS, both ACAs were supplied by right ICA, and he had a new and extension of lesion of previous ACA territory infarction. Conclusions: The reversed blood flow might aggravate regional perfusion deficit in left ACA territory. Our case emphasizes that comprehension of cerebral hemodynamics before procedure and arterial characteristics should be considered for patient selection.
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