Carotid Artery Stent Placement for Progressing Stroke: Reports of a 3 Cases

We successfully performed carotid artery stent placement (CAS) in 3 patients with cervical carotid artery stenosis presenting with progressing stroke. In our presented cases, we used intravascular ultrasonographic virtual histology (IVUS-VH) to evaluate carotid plaque and continuous monitoring of regional cerebral oxygenation by near-infrared spectroscopy to detect early hemodynamic complications. These techniques significantly helped to improve neurological outcome after CAS in patients with progressing stroke. In Case 1, an 80-year-old female presented with progressing right hemiparesis due to severe stenosis of the cervical portion of the left carotid artery. IVUS-VH revealed the plaque as mainly fibrous and partially necrotic and fibrolipidic, and under distal protection, CAS was successfully performed. In Case 2, a 70-year-old male presented with repeated transient loss of consciousness. 3D-CT angiography demonstrated severe stenosis of the cervical portion of the right carotid artery, and under the distal protection, CAS was conducted. During placement of the carotid stent, near infrared spectroscopy revealed a marked change in cerebral oximetry. His blood pressure was carefully controlled for 3 days to avoid hyperperfusion syndrome. In Case 3, a comatose 76-year-old male was admitted to our hospital with right-sided hemiparesis. He had suffered several transient ischemic attacks 6 months previously. Intravenous rt-PA therapy was performed, and his symptoms improved rapidly. 3D-CT angiography demonstrated severe stenosis of the right cervical carotid artery with dense calcified plaque. However, IVUS-VH revealed the plaque as mainly fibrous with partial calcification, and CAS was successfully performed.