Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jun 5;5(23):CASE2341.
doi: 10.3171/CASE2341. Print 2023 Jun 5.

Vessel wall imaging and carotid artery stenting for recurrent cervical internal carotid artery vasospasm syndrome: illustrative case

Shinya Tokunaga  1 , Yukihiro Yamao  1 , Takakuni Maki  2 , Akira Ishii  1 , Tomoaki Miyake  2 , Ken Yasuda  2 , Yu Abekura  1 , Masakazu Okawa  1 , Takayuki Kikuchi  1 , Yasutaka Fushimi  3 , Kazumichi Yoshida  1 , Susumu Miyamoto  1
Affiliations

Vessel wall imaging and carotid artery stenting for recurrent cervical internal carotid artery vasospasm syndrome: illustrative case

Shinya Tokunaga et al. J Neurosurg Case Lessons. .

Abstract

Background: Recurrent cervical internal carotid artery vasospasm syndrome (RCICVS) causes cerebral infarction, ocular symptoms, and occasionally chest pain accompanied by coronary artery vasospasm. The etiology and optimal treatment remain unclear.

Observations: The authors report a patient with drug-resistant RCICVS who underwent carotid artery stenting (CAS). Magnetic resonance angiography revealed recurrent vasospasm in the cervical segment of the internal carotid artery (ICA). Vessel wall imaging during an ischemic attack revealed vascular wall thickening of the ICA, similar to that in reversible cerebral vasoconstriction syndrome. The superior cervical ganglion was identified at the anteromedial side of the stenosis site. Coronary artery stenosis was also detected. After CAS, the symptoms of cerebral ischemia were prevented for 2 years, but bilateral ocular and chest symptoms did occur.

Lessons: Vessel wall imaging findings suggest that RCICVS is a sympathetic nervous system-related disease. CAS could be an effective treatment for drug-resistant RCICVS to prevent cerebral ischemic events.

Keywords: carotid artery stenting; recurrent cervical internal carotid artery vasospasm syndrome; vessel wall imaging.

PubMed Disclaimer

Conflict of interest statement

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Figures

FIG. 1.
FIG. 1.
MRI performed during an attack at the age of 16, revealing cerebral infarction in the left frontal lobe (A), with MRA showing severe stenosis of the internal carotid artery (B). MRA (C) during the attack showed severe stenosis at the cervical segment of the left ICA. The stenosis site is the same at each attack (white arrow). D: MRA performed during the remission interval, showing no stenosis at the left ICA.
FIG. 2.
FIG. 2.
During the attack, the DANTE-prepared MRI sequences reveal vascular wall thickening with mild enhancement (white double arrows, A and B) in the long segment of the ICA, from the bifurcation over the petrous portion (white arrows), including the stenosis (A, plain; B, enhancement by a contrast medium). During the remission interval, no vascular wall thickening is observed (C). Axial image (D) during the attack reveals that the stenosis site of the ICA (asterisk) is located just behind the superior cervical ganglion (arrowhead) and in front of the inferior ganglion of the vagus nerve (double arrowheads).
FIG. 3.
FIG. 3.
A: Left ICA angiography, lateral view, shows no stenosis before CAS. B: The stent is placed covering the stenosis region (white arrows, edges of the stent). C: Postoperative 3D-CT angiography demonstrates no stenosis and patency of the left ICA.
See this image and copyright information in PMC

References

    1. Yoshimoto H, Asakuno K, Matsuo S, et al. Idiopathic carotid and coronary vasospasm: a case treated by carotid artery stenting. Surg Neurol Int. 2014;5(12) suppl 12:S461–S464. - PMC - PubMed
    1. Takahira K, Kataoka T, Ogino T, et al. Treatment of idiopathic recurrent internal carotid artery vasospasms with bilateral carotid artery stenting: a case report. J Neuroendovascular Ther. 2017;11(5):246–252.
    1. Graham E, Orjuela K, Poisson S, Biller J. Treatment challenges in idiopathic extracranial ICA vasospasm case report and review of the literature. eNeurologicalSci. 2020;22:100304. - PMC - PubMed
    1. Yokota H, Mukai H, Hattori S, Yamada K, Anzai Y, Uno T. MR imaging of the superior cervical ganglion and inferior ganglion of the vagus nerve: structures that can mimic pathologic retropharyngeal lymph nodes. AJNR Am J Neuroradiol. 2018;39(1):170–176. - PMC - PubMed
    1. Huisa BN, Roy G. Spontaneous cervical internal carotid artery vasospasm: case report and literature review. Neurol Clin Pract. 2014;4(5):461–464. - PMC - PubMed