Journal article
Transient ipsilateral mydriasis following carotid artery stenting
British journal of neurosurgery, v 38(4), pp 968-971
Aug 2024
PMID: 34553660
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Background and importance
One of the most feared and devastating complications of carotid revascularization procedures is hyperperfusion hemorrhage. The acute onset of an ipsilateral mydriatic pupil following carotid endarterectomy (CEA) or carotid artery stenting (CAS) should prompt immediate neurosurgical evaluation to rule out hyperperfusion injury.
Clinical presentation
We describe a case of benign, transient ipsilateral mydriasis following CAS. After undergoing right common and internal carotid artery (ICA) angioplasty and stenting with distal embolic protection, the patient developed anisocoria with a right-sided 5 mm minimally reactive pupil. Imaging demonstrated no acute pathology, and the mydriasis resolved spontaneously within 48 hours. We hypothesise that the pathophysiologic mechanism is secondary to transient ischemia of parasympathetic structures within the petrous/cavernous ICA from arterial ostium occlusion that occurred during device placement. Alternatively, sympathetic stimulation during angioplasty is also plausible.
Conclusions
Although an ipsilateral mydriatic pupil following carotid revascularization necessitates evaluation, it may represent a self-limiting process especially in the absence of other focal neurologic deficits.
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Details
- Title
- Transient ipsilateral mydriasis following carotid artery stenting
- Creators
- Evan Luther - University of MiamiEmily Swafford - Neurological SurgeryVasu Saini - University of Miami Health SystemHunter King - Drexel Univ, Coll Med, Philadelphia, PA 19104 USAJoshua Burks - University of MiamiAria Jamshidi - University of MiamiMichael Silva - University of MiamiRobert Starke - University of Miami Health System
- Publication Details
- British journal of neurosurgery, v 38(4), pp 968-971
- Publisher
- Taylor & Francis
- Number of pages
- 4
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Drexel University
- Web of Science ID
- WOS:000698704300001
- Scopus ID
- 2-s2.0-85115416414
- Other Identifier
- 991021860760304721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Clinical Neurology
- Surgery