Carotid stent removal of symptomatic plaque protrusion after carotid angioplasty stenting.
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.
Ferrero
Emanuele
E
Vascular and Endovascular Surgery Unit, Mauriziano Umberto I Hospital, Largo Turati 62, 10128 Turin, Italy. emaferrero@libero.it
Ferri
Michelangelo
M
Viazzo
Andrea
A
Nessi
Franco
F
D000368:Aged; D017130:Angioplasty / Q000009:adverse effects* / Q000295:instrumentation; D019917:Blood Vessel Prosthesis Implantation; D016893:Carotid Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D002533:Cerebral Angiography; D020878:Device Removal; D057505:Embolic Protection Devices; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D002546:Ischemic Attack, Transient / Q000209:etiology; D018810:Magnetic Resonance Angiography; D008297:Male; D012720:Severity of Illness Index; D015607:Stents / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency