Successful Treatment of a Symptomatic Vasospasm Following Carotid Artery Stenting With an Intra-arterial Infusion of Fasudil Hydrochloride: A Case Report

Symptomatic vasospasm (SVS), a rare complication of carotid artery stenting (CAS), typically improves with medical treatment but can occasionally lead to severe sequelae. We report a case in which SVS following CAS was successfully treated with an intra-arterial infusion of fasudil hydrochloride (FSD). A 74-year-old woman with symptomatic left carotid artery stenosis underwent left CAS using a distal filter protection device. However, she developed a seizure, aphasia, and right hemiparesis seven hours after the procedure. The following day, magnetic resonance imaging (MRI) of the brain revealed a small high-signal area on diffusion-weighted imaging in the left frontal cortex, along with decreased visualization of the middle cerebral artery (MCA). Angiography demonstrated hypoperfusion due to a vasospasm in the distal segment of the left MCA. Despite ongoing medical treatment, her neurological symptoms worsened. Consequently, we performed a local intra-arterial infusion of FSD, which resulted in a significant improvement of the vasospasm and gradual recovery of neurological function. On the day following FSD infusion, magnetic resonance angiography revealed an improved visualization of the left MCA. A week after CAS (six days after FSD infusion), the patient's neurological symptoms had completely resolved, and the abnormal MRI findings had nearly disappeared. She was discharged in the same condition as before undergoing CAS. These findings suggest that a local intra-arterial infusion of FSD may represent an effective treatment option for SVS that does not respond to medical therapy.