Transient contrast encephalopathy after carotid artery stenting

Purpose: To report an unusual case of transient contrast encephalopathy ari sing after carotid artery stenting. Case Report: An 82-year-old right-handed man with a recent history of trans ient ischemic events was admitted to the hospital for evaluation of carotid artery disease. During cerebral angiography, which identified a 90% right internal carotid artery stenosis, the patient received 25 mt of an ionic, l ow-osmolar contrast agent (ioxaglate) in each carotid artery. The following day he underwent successful carotid stenting, during which 180 mt of ioxag late were used. He developed rapidly worsening confusion and left hemipares is on the table. Noncontrast computed tomography showed marked cortical enh ancement and edema of the right cerebral hemisphere in the distribution of the right anterior and middle cerebral arteries. The patient improved rapid ly and by day 2 was completely recovered; magnetic resonance imaging docume nted no cortical edema and normal sulci. One month after the procedure, he was well, with patent carotid arteries. Conclusions: Transient neurotoxicity after carotid interventions must be di fferentiated from massive cerebral infarction and hyperperfusion syndrome, but the prognosis is excellent. However, subsequent contrast studies in a p atient with this complication should be undertaken with extreme caution.