Case Summary: In less than 400 words, please summarize the case. Briefly describe the case and any particular complexities and/or complications encountered.: A 73 year olds male patient admitted to the hospital due to recurent Transient Ischemic Attack (TIA) several times in 6 months with a Medical history of stenosis in ICA of both sides (70-80%), stenting Right ICA 2020 and restenosis Right ICA 50%.
Later imagine of carotid ultrasound showed that the Stenosis in Left ICA had decreased up to 80%.
1 day after the patient had endarterectomy at the Left ICA, in early morning, right after recover from anesthesia, the patient had hemiplagia, head-eye turn left, lost speeches.
CT scanner angiography of brain revealed that there was no imagine of Left ICA as well as no hemorrhage. The patient was asumpted to have acute cerebral infarction in a situation of peri- endarterectomy surgery, that meaned this was an unknown onset stroke
RAPID score was made right away. Its result was below: ADC < 620: 43mL; Mismatch 124mL; and mismatch ratio: 3.9.
We decided to do emergency intervention for the patient.
The DSA imagine showed a totally occlusion from the Left CCA. Assumpting that this must be a dissection lesion, carotid stenting was perform with 2 Carotid stent 8x40mm from CCA up to ICA after a loading dose of DAPT. After procedure, the patient was recovery at mRS of 1.
Unfortunately, after 10days of DAPT, the patient had bleeding in the ìnfart core. As a result, DAPT must be stop using. After 2 week, the stents was fine seeing via vascular ultrasound. Monotherapy of antiplatelet was used with clopidogrel. Up till now, after 10 months, the patient has recovered to mRS 0-1 with discreet weekness of the right arm.