Successful Management of Intraprocedural Arterial Dissection During Carotid Artery Stenting With an Overlapping CASPER Rx Stent for Tortuous Vessel: A Case Report

Carotid artery stenosis is a significant cause of ischemic stroke, often necessitating interventions like carotid artery stenting (CAS) to restore adequate blood flow. However, complications like intraprocedural arterial dissection can arise during the procedure. This report presents a case of intraprocedural arterial dissection during CAS using a CASPER Rx stent. A 77-year-old male, previously diagnosed with asymptomatic right internal carotid artery (ICA) stenosis two years earlier, was presented to our institution with transient left upper limb paralysis. CAS with a CASPER Rx stent was planned due to the progression of symptomatic ICA stenosis. During the procedure, an arterial dissection occurred in the vessel wall just distal to the stent but was successfully managed with additional stenting. The patient experienced no postoperative neurological deficits and was discharged in stable condition. This case highlights the importance of careful resheathing to avoid unintended advancement of the stent system, particularly in cases of ICA stenosis with severe vessel tortuosity. Furthermore, the present case also emphasizes the critical need of timely intervention to prevent serious complications.