# Eagle Syndrome as a Delayed Vascular Complication: Carotid Stent Deformation After Stenting for High Cervical Stenosis

## TL;DR

A case study shows how an elongated styloid process can cause stent deformation and stroke after carotid stenting, emphasizing the need to consider bony anatomy in such procedures.

## Contribution

This paper presents a novel clinical case linking Eagle syndrome with delayed vascular complications following carotid stenting.

## Key findings

- An elongated styloid process caused stent deformation and restenosis after carotid artery stenting.
- Transcervical styloidectomy improved outcomes and prevented stroke recurrence in the patient.
- Bony anatomical structures should be evaluated in patients undergoing high cervical carotid stenting.

## Abstract

Eagle syndrome, caused by elongation of the styloid process or calcification of the stylohyoid ligament, can present with a variety of symptoms. The vascular variant, stylocarotid syndrome, involves mechanical compression of the internal carotid artery (ICA) and may lead to cerebrovascular complications such as dissection, transient ischemic attacks, or ischemic stroke. While carotid artery stenting (CAS) is widely used for carotid stenosis, mechanical complications related to surrounding bony structures remain rare.

We report a case of a 75-year-old woman who underwent CAS for high cervical ICA stenosis. Although the procedure was initially successful, the patient later developed recurrent ischemic stroke. Imaging revealed in-stent restenosis caused by deformation of the carotid stent, which was in close proximity to an elongated styloid process (44 mm). The patient underwent percutaneous transluminal angioplasty, followed by transcervical styloidectomy. After the final intervention, the patient remained free of restenosis or stroke recurrence during a one-year follow-up period.

This case highlights the importance of evaluating bony anatomical structures in patients undergoing CAS, particularly for high cervical lesions. An elongated styloid process may cause delayed mechanical stent deformation and restenosis. Early recognition and consideration of styloidectomy may help prevent complications and improve long-term outcomes in vascular Eagle syndrome.