Bilateral Superior Cerebellar Artery Infarction after Stent-Angioplasty for Internal Carotid Artery Stenosis
A 75-year-old female patient visited our hospital with bilateral weakness (left>right) which had suddenly developed and persisted for 15 days. She also had hypertension and unstable angina which had been treated with antihypertensive and antiplatelet medications for 10 years. She had no history of diabetes mellitus, hyperlipidemia, and smoking, etc.\nOn neurological examination, bilateral hemiparesis (left : Grade IV, right : Grade IV+) was detected. The brain computed tomography scan showed a low-density area only in the right post-central gyrus, and diffusion weighted-magnetic resonance imaging (d-MRI) showed bilateral anterior cerebral artery-middle cerebral artery borderzone infarction (), and MR angiography showed high grade stenosis of both proximal ICA ().\nCatheter angiography was performed 4 days after admission. Common carotid angiography showed 85% stenosis of the left ICA origin () and 90% stenosis of right ICA origin (). Vertebral angiography showed total occlusion of the right VA and multifocal stenosis of the left VA with faint flow to basilar artery (BA) (). PComAs on both sides were well visualized and filling to both posterior cerebral arteries (PCAs) (). However, retrograde flow to BA was not seen. Meanwhile, right occipital artery (OA) from right ECA supplied right VA and then BA to basilar tip ().\nWe performed stent-angioplasty for left ICA stenosis first under local anesthesia immediate after the catheter angiography (). During the procedure no remarkable events took place, and the neurologic symptoms of the patient remained unchanged after the procedure. Two days after stent-angioplasty for left ICA stenosis, treatment for right ICA lesion was performed under local anesthesia (). During the procedure no remarkable events took place, and the neurologic symptoms of the patient remained unchanged immediate after the procedure. After the 2nd session of angioplasty, we control the patient's systolic blood pressure (BP) about 120 mm Hg because of the hyperperfusion syndrome prevention. However, the consciousness level of the patient was getting worse after the procedure from alert to stuporous state. Two days after the 2nd procedure, d-MRI was performed and it showed acute cerebellar infarction in the territory of both SCAs, but no other newly developed infarction on both cerebral hemispheres ().