Ileal hemorrhagic infarction after carotid artery stenting:A case report and review of the literature

BACKGROUND Ileal hemorrhagic infarction after carotid artery stenting(CAS)is a fatal complication.The prognosis of ileal hemorrhagic infarction after CAS is very poor if not treated in a timely manner.We describe a rare case of ileal hemorrhagic infarction due to acute embolism of the mesenteric artery after CAS.CASE SUMMARY A 67-year-old man with acute ischemic stroke underwent CAS via the right femoral artery approach 21 d after intensive medical treatment.On the first day after surgery,the patient had abdominal distension and abdominal pain.Abdominal enhanced computed tomography revealed intestinal obstruction,severe stenosis of the superior mesenteric artery,and poor distal angiography.An exploratory laparotomy was performed,and pathological examination showed hemorrhagic ileal infarction.It was subsequently found that the patient had intestinal flatulence.With the guidance of an ultrasound scan,the patient underwent abdominal puncture,drainage,and catheterization.After 58 d of treatment,the patient was discharged from hospital with a National Institutes of Health Stroke Scale score of 2 points,and a Modified Rankin Scale score of 1 point.At the 6-mo follow-up,the patient had an excellent functional outcome without stroke or mesenteric ischemia.Furthermore,computed tomography angiography showed that the carotid stent was patent.CONCLUSION Ileal hemorrhagic infarction is a fatal complication after CAS,usually caused by mesenteric artery embolism.Thus,more attention should be paid to the complications of embolism in the vascular system as well as the nervous system after CAS,and the complications should be identified and treated as early as possible.

Atypical clinical and pathological findings in a patient with isolated cortical vein thrombosis

Isolated cortical vein thrombosis often produces a focal lesion. Because of the rapid development of collateral circulation, increased intracranial pressure has never been reported in a patient with isolated cortical vein thrombosis. The diagnosis of isolated cortical vein thrombosis is based mainly on MRI, catheter digital subtraction angiography, and histological findings, but may be challenging. We report a patient who presented with intermittent seizures and left-sided limb weakness. Her symptoms gradually progressed, and she eventually developed signs of increased intracranial pressure. Imaging studies showed a space-occupying lesion in the right frontal lobe of the brain. As we could not diagnose isolated cortical vein thrombosis based on the preoperative findings, surgical excision of the lesion was performed under general anesthesia. Histological examination showed destruction of the brain parenchyma with infiltration of macrophages, proliferation of reactive astrocytes and small vessels, and foci of hemorrhage. Further examination found that a number of small vessels in both the subarachnoid space and brain parenchyma were filled with thrombus, some of which was organized. Elastic fiber staining showed that the obstructed vessels were veins. We diagnosed isolated cortical vein thrombosis with atypical clinical features.