Cerebrovascular steal phenomenon in a patient undergoing dipyridamole nuclear perfusion cardiac imaging

• Published in: Journal of cardiology cases Vol. 5; no. 2; pp. e125 - e127
• Main Authors: Raju, Manjunath, MD, Mood, Girish, MD, Laird-Fick, Heather, MD, Shah, Dinesh O., MD, Abela, George S., MD, MSc
• Format: Journal Article
• Language: English
• Published: Japan Elsevier Ltd 01-04-2012; Japanese College of Cardiology
• Subjects: Cardiac stress test; Cardiovascular; Cerebrovascular steal phenomenon; Dipyridamole; Transient ischemic attack; Cerebrovascular steal phenomenon; Transient ischemic attack; Cardiac stress test; Dipyridamole
• ISSN: 1878-5409; 1878-5409
• DOI: 10.1016/j.jccase.2012.01.002

Summary Transient ischemic neurological deficits following intravenous dipyridamole administration during pharmacological cardiac stress test are seldom reported, but there can be serious vascular complications. We report a case of a 58-year-old Caucasian male who developed expressive aphasia after dipyridamole infusion during an elective dipyridamole-technetium cardiac stress test performed for chest pain. Computed tomography angiogram of the neck revealed a known total occlusion of the right internal carotid artery and 50% stenosis of the left internal carotid artery. The patient's aphasia spontaneously resolved within 24 h. In this paper, we report a unique case in which the administration of intravenous dipyridamole precipitated transient ischemic attack in a patient with stable asymptomatic bilateral carotid artery disease and prior carotid endarterectomy. We also discuss the intracerebral vascular steal phenomenon as a possible pathophysiological mechanism in this patient.