Intraprocedural plaque protrusion resulting in cerebral embolism during carotid angioplasty with stenting.
An 82-year-old man with an asymptomatic left high-grade carotid stenosis was treated with carotid artery stenting (CAS) under distal protection. The procedure consisted with predilation with a 5 x 40 mm percutaneous transluminal angioplasty (PTA) balloon, deployment of a 10 x 20 mm self-expandable stent, post-dilation with a 7 x 20 mm PTA balloon, and aspiration of debris with 60 ml of blood. The cervical carotid angiogram immediately after deflation of the distal blocking balloon demonstrated a small in-stent filling defect of the contrast medium that protruded from the anterior wall of the carotid artery. The following cranial carotid angiogram showed abrupt occlusion of the left middle cerebral artery (MCA). Because the in-stent lesion had vanished in the repeat study after recognition of this embolic event, it was suggested that an embolus had been liberated from the in-stent lesion, reaching the left MCA and obliterating it. In this case, the embolus was speculated to originate in the ruptured plaque, which protruded into the stent through the cells of the device and became liberated into the bloodstream. Attention should be paid so as not to overlook any plaque protrusion, which may be seen subsequently as a cerebral embolism on the angiogram obtained immediately after CAS.
Aikawa
Hiroshi
H
Department of Neurosurgery, Fukuoka University Chikushi Hospital, Chikushino, Japan.
Kodama
Tomonobu
T
Nii
Kouhei
K
Tsutsumi
Masanori
M
Onizuka
Masanari
M
Iko
Minoru
M
Matsubara
Shuko
S
Etou
Housei
H
Sakamoto
Kimiya
K
Kazekawa
Kiyoshi
K
D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects*; D016893:Carotid Stenosis / Q000628:therapy*; D002533:Cerebral Angiography; D003287:Contrast Media; D006801:Humans; D020766:Intracranial Embolism / Q000000981:diagnostic imaging* / Q000209:etiology*; D008297:Male; D015607:Stents / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed
D003287:Contrast Media