63 year-old woman experienced transient dysarthria, mild left-sided weakness and paresthesia of the left arm and leg. MRI demonstrates distal embolic strokes of the superior right frontal and parietal lobes. Symptomatic high-grade right Internal Carotid Artery (ICA) stenosis is confirmed. Contralateral high-grade asymptomatic stenosis of the left ICA was also present. Right ICA angioplasty and stenting with distal embolic protection was performed on a focal 80-90% post bulbar stenosis. She achieved complete and durable revascularization with complete functional recovery and return to her daily life. Revascularization of her asymptomatic left carotid artery is planned to further reduce her risk of a disabling stroke.
Figure 1. A) Diffusion positive strokes; B) Right ICA Angiogram with 80-90% Stenosis
Figure 2. A) Right ICA post stent immediate; B) CTA at 6 months
KEY LEARNING POINTS:
  1. Transient or mild neurologic symptoms may represent warnings signs for severe underlying carotid artery vascular disease.
  2. Carotid Artery Angioplasty and Stenting is an excellent durable option for revascularization, especially in high-risk patients presenting with distal stenosis or bilateral disease.
AUTHORS:
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