Horner's syndrome after carotid artery stenting: Case report

BACKGROUND Angioplasty and stenting of various lesions of the carotid artery is gainin g in popularity. Our knowledge of the efficacy and limitations of this prom ising technology is incomplete. Although Horner's syndrome and its variants have been described after traumatic, spontaneous, or surgical carotid diss ection, it has not been reported after carotid artery stenting. CASE DESCRIPTION A 36-year-old woman presented with left neck and ear pain and a 3-year hist ory of rushing noises in her left ear. Angiography demonstrated evidence of dissection of the left internal carotid artery at the skull base with a ps eudoaneurysm. The pseudoaneurysm was treated with a 6-mm diameter self-expanding stent in a 4-mm diameter left internal carotid artery. A few hours later, she devel oped partial Horner's syndrome with a subtle ipsilateral ptosis and miosis without anhidrosis. Angiography performed on the next day did not demonstra te further dissection or aneurysm growth but did show distention of the art ery wall because of the stent. She did not develop any further sequelae. CONCLUSION This case suggests that stretching of the artery wall may result in stretch ing of surrounding structures. The sympathetic fibers surrounding the inter nal carotid artery are clearly sensitive to this degree of stretch. Possibl e complications associated with stretch injury must be considered when choo sing the stent diameter. (C) 2000 by Elsevier Science Inc.