Carotid stent removal of symptomatic plaque protrusion after carotid angioplasty stenting

Interact Cardiovasc Thorac Surg. 2010 Sep;11(3):254-6. doi: 10.1510/icvts.2010.241976. Epub 2010 Jun 16.

Abstract

We treated two patients with asymptomatic high grade internal carotid artery stenosis, by carotid artery stenting (CAS) with embolus protection filters 75% and 70%, respectively (North American Symptomatic Carotid Endarterectomy criteria). The immediate cranial and carotid angiogram showed a good result with regular patency of carotid and cerebral vessels. In both cases, the CAS procedure was complicated with symptomatic embolism, in one case 6 h after CAS and the other one occurring after seven days. The duplex scan (DS) control revealed the presence of plaque protrusion intra-stent in both cases. An early treatment with stent removal and carotid surgery was performed <24 h after the presenting symptoms (in one case a standard endarterectomy in the other and a carotid bypass was performed). Both patients were discharged without neurological deficit. At neurological follow-up at 30 days the patients were in good general condition without neurological symptoms or deficit and the DS follow-up at 30 days and six to 12 months show the patency of carotid vessels. These two cases demonstrate that plaque protrusion is a possible complication of CAS, where symptoms which may occur either immediately or later and can be managed successfully with urgent surgical intervention of carotid stent removal.

Publication types

  • Case Reports
  • Video-Audio Media

MeSH terms

  • Aged
  • Angioplasty / adverse effects*
  • Angioplasty / instrumentation
  • Blood Vessel Prosthesis Implantation
  • Carotid Stenosis / diagnosis
  • Carotid Stenosis / physiopathology
  • Carotid Stenosis / therapy*
  • Cerebral Angiography
  • Device Removal
  • Embolic Protection Devices
  • Endarterectomy, Carotid
  • Female
  • Humans
  • Intracranial Embolism / diagnosis
  • Intracranial Embolism / etiology
  • Intracranial Embolism / surgery*
  • Ischemic Attack, Transient / etiology
  • Magnetic Resonance Angiography
  • Male
  • Severity of Illness Index
  • Stents / adverse effects*
  • Time Factors
  • Treatment Outcome
  • Ultrasonography, Doppler, Duplex
  • Vascular Patency