title: Carotid stent removal of symptomatic plaque protrusion after carotid angioplasty stenting.
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.
authors.affiliation: Vascular and Endovascular Surgery Unit, Mauriziano Umberto I Hospital, Largo Turati 62, 10128 Turin, Italy. emaferrero@libero.it
authors.forename: Emanuele
authors.initials: E
authors.lastname: Ferrero
authors.forename: Michelangelo
authors.initials: M
authors.lastname: Ferri
authors.forename: Andrea
authors.initials: A
authors.lastname: Viazzo
authors.forename: Franco
authors.initials: F
authors.lastname: Nessi
mesh_terms: 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