Cerebral hyperperfusion syndrome after spontaneous recanalisation of carotid in-stent thrombosis

A 68-year-old man with medical history significant for hypertension and stroke was transferred to our hospital with new onset dysarthria, right face and arm weakness following left carotid stent deployed 24 hours before. The National Institutes of Health Stroke Scale at admission was 7. Head and neck CT angiographies (CTAs) were performed demonstrating in-stent thrombosis of the left carotid artery (figure 1A) and a CT perfusion showed no core infarct but a perfusion defect within the left middle cerebral artery (MCA) territory, as defined by a Tmax greater than 6 s, measuring 78.9 mL (figure 1B). Figure 1 Initial diagnostic images. (A) CT angiography of the neck demonstrating in-stent thrombosis in the left carotid artery and no contrast filling of the internal carotid artery beyond the stent reconstruction. (B) Initial CT perfusion depicting prolonged time (Tmax) within the territory of the left middle cerebral artery. CBF, cerebral blood flow; CBV, cerebral blood volume; MTT, mean transit time; Tmax, time to peak. Decision was made to treat him …