Published online Aug 6, 2021. doi: 10.12998/wjcc.v9.i22.6410
Peer-review started: March 11, 2021
First decision: April 13, 2021
Revised: April 25, 2021
Accepted: May 27, 2021
Article in press: May 27, 2021
Published online: August 6, 2021
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.
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.
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.
Core Tip: Nervous system embolism is a common complication after carotid artery stenting (CAS), and the occurrence of vascular embolism outside the nervous system is rare, especially, mesenteric artery embolism leading to ileal hemorrhagic infarction. However, we should still pay attention to these cases in order to timely find, diagnose, and properly treat them. We report an elderly man who developed intestinal obstruction after CAS. Fortunately, the complication was found and diagnosed in timely. After surgical operation, the symptoms of intestinal obstruction were relieved. As a result, the patient's life was saved. At the 6-mo follow-up, there was no stroke or intestinal infarction.