Dilation of proximal internal carotid artery collapse due to severe distal stenosis after angioplasty for distal stenosis: A case report

BACKGROUND: We report a case of proximal internal carotid artery (ICA) collapse due to severe distal stenosis that dilated after angioplasty for distal stenosis. CASE DESCRIPTION: A 69-year-old woman underwent thrombectomy for the left ICA occlusion due to stenosis of C3 portion and was discharged home with a modified Rankin Scale score of 0. One year later, she developed cerebral infarction due to progressive stenosis of the C3 portion of the left ICA with proximal ICA collapse and underwent emergency percutaneous transluminal angioplasty (PTA) for distal stenosis. Device guidance to the stenosis was difficult due to proximal ICA collapse. After PTA, blood flow in the left ICA increased, and proximal ICA collapse dilated over time. Due to severe residual stenosis, she underwent more aggressive PTA followed by Wingspan stenting. Device guidance to the residual stenosis was facilitated because proximal ICA collapse had already dilated. Six months later, proximal ICA collapse further dilated. CONCLUSION: PTA for severe distal stenosis with proximal ICA collapse may result in dilation of proximal ICA collapse over time.