Postoperative fragmentation and distal migration of Carotid Stent in vascular Eagle Syndrome

Objectives: Vascular Eagle syndrome (ES) is a rare condition involving vessel compression by an elongated styloid process, leading to neurologic symptoms. Here, we present the case of a patient with a complication of carotid artery stenting for vascular ES and discuss the implications of treatment of this rare condition.

Case description: A 35-year-old previously healthy male patient presented with transient aphasia and right-sided hemiparesis following ischemic stroke in left frontal lobe. Digital subtraction angiography revealed a large aneurysm with stenosis of the left cervical internal carotid artery, and computed tomography (CT) demonstrated elongated ipsilateral styloid process. Progressive aneurysm enlargement required coil embolization and carotid artery stenting (CAS). Cervical X-ray obtained 1 year later revealed the fracture and fragmentation of the carotid stent. Imaging studies identified multiple stent fragments dispersed in distal arteries and a dissecting aneurysm with an irregular wall at the site of the stent site. Dynamic cone-beam CT scan without contrast performed during neck movement, revealed that the styloid process tip was adjacent to the stent fracture line, confirming vascular ES. The symptomatic left styloid process was resected, followed by repeat CAS. The dissecting aneurysm was thrombosed post-CAS, and the patient remained asymptomatic without complications at 6-month follow-up.

Conclusion: In patients with vascular ES, diagnostic imaging should include dynamic evaluations to assess cervical dynamics and the resection of styloid process is essential to prevent chronic stent fracture.