title: Immediate surgery for acute internal carotid artery  dissection and thrombosis during filter deployment  prior to stenting: a case report.
abstract: Carotid artery stenting (CAS) is a validated option in the treatment of selected extracranial carotid artery stenosis. Carotid artery dissection during CAS is a rare but potentially devastating complication. We report a case of acute dissection and thrombosis of the left internal carotid artery during filter tip wire engaging maneuvers, complicated by intraoperative complete blindness of the left eye. Immediate conversion to carotid endarterectomy was performed under general anesthesia with electroencephalographic monitoring. The patient was discharged home symptomless and remains asymptomatic eight months after the operation, with normal left internal carotid patency and fully recovered eyesight. In conclusion, the management of acute carotid occlusion during CAS requires emergent evaluation and definitive endovascular or open surgical repair to minimize neurologic morbidity. We advocate that all endovascular procedures are carried out in a well-established surgical environment.
authors.affiliation: Vascular Surgery, Department of General Surgery, Istituto Auxologico Italiano IRCCS, Milan, Italy. v.tolva@auxologico.it
authors.forename: V
authors.initials: V
authors.lastname: Tolva
authors.forename: G B
authors.initials: GB
authors.lastname: Bertoni
authors.forename: P G
authors.initials: PG
authors.lastname: Bianchi
authors.forename: G C
authors.initials: GC
authors.lastname: Keller
authors.forename: R
authors.initials: R
authors.lastname: Casana
mesh_terms: D020215:Carotid Artery, Internal, Dissection; D016893:Carotid Stenosis / Q000601:surgery; D016894:Endarterectomy, Carotid; D006801:Humans; D015607:Stents; D013927:Thrombosis