{
  "abstract": "Introduction Known post-procedural complications after CAS include ischemic stroke, hyperperfusion syndrome, and carotid thrombosis. A rare complication is reversible cerebral vasoconstriction syndrome (RCVS). Because RCVS shares overlapping features with the above complications, prompt diagnosis is both challenging and critical for appropriate management. We present a case of this rare complication post CAS.Materials and Methods Pubmed search of case reports/series.Results A 63-year-old male with of hypertension, hyperlipidemia, DM presenting with right hand hypoesthesia, right facial droop, and right leg paresis. MRI brain showed ischemic strokes in the left frontal and parietal lobes. CTA head showed left ICA cervical segment ~50% stenosis, also confirmed with carotid duplex. The patient was started on DAPT with aspirin, clopidogrel and subsequently underwent left ICA cervical segment angioplasty and stenting using distal EPD under moderate sedation via right transradial approach. Angiogram confirmed moderate ~55% stenosis and a Carotid wall stent 8mm x 29mm was deployed. No significant alterations in blood pressure and heart rate were noted with post-stenting angioplasty or with sedation. However immediately post-plasty, there was thrombus formation in the stent tines protruding into left ECA and this resolved with IV eptifibatide. Post-operative exam was at neurological baseline and he was transitioned to aspirin and ticagrelor. 12 hours later on POD 1, he developed L-MCA syndrome with left gaze preference, right paresis, and expressive aphasia. Immediate CT head was unremarkable. CTA showed diffuse narrowing of left MCA branches without clear LVO. Emergent angiogram showed left MCA moderate- severe vasospasm with mild perfusion delay (Fig-A). Vasospasm improved after inter-arterial infusion of verapamil and milrinone (Fig-B) and he was continued on IV milrinone infusion for 5 days. Repeat CTA 48 hours later showed significant improvement of vasospasm. The patient eventually improved and was discharged to rehab. MRS 0 and CTA head showed normal vasculature at 3 month follow up.Conclusion RCVS is a rare but critical complication of carotid artery stenting. The pathological mechanism is not well understood but it has been postulated that ICA stenosis can lead to chronic cerebral hypoperfusion and dysregulation of distal cerebral arterial tone. Following carotid revascularization, a relative hyper-perfusion state may induce an accentuated vasoconstrictive response in some individuals and actually lead to symptomatic hypoperfusion. Post CAS, it is important to have high suspicion for RCVS when patients develop acute neurological symptoms for timely diagnosis and appropriate intervention.Disclosures E. Biag: None. I. Quraishi: None. R. Goldstein: None. M. Ismail: None.Abstract E-072 Figure 1",
  "authors": [
    {
      "affiliations": [
        "Neurology, University of New Mexico, Albuquerque, NM"
      ],
      "name": "E Biag"
    },
    {
      "affiliations": [
        "Neurology, University of New Mexico, Albuquerque, NM"
      ],
      "name": "I Quraishi"
    },
    {
      "affiliations": [
        "Neurology, University of New Mexico, Albuquerque, NM"
      ],
      "name": "R Goldstein"
    },
    {
      "affiliations": [
        "Neurology, University of New Mexico, Albuquerque, NM"
      ],
      "name": "M Ismail"
    }
  ],
  "title": "E-072 Reversible cerebrovascular vasoconstriction syndrome after carotid artery stenting",
  "uid": "952fc244-9544-5280-9ae4-c0ff71aee5ab"
}