title: Rescue strategy for acute carotid stent thrombosis during carotid stenting with distal filter protection using forced arterial suction thrombectomy with a reperfusion catheter of the Penumbra System: a technical note.
abstract: BACKGROUND
  Among the procedural complications related to carotid artery stenting (CAS), internal carotid artery (ICA) flow arrest is one of the most drastic complications, as it can cause major ischemic stroke. Acute carotid stent thrombosis (ACST) is a rare etiology of ICA flow arrest during carotid artery stenting with distal filter protection, but the most devastating. Moreover, no definitive management strategy has been established so far for treating ACST.
  
  
  METHODS
  We introduce a rescue management strategy for differential diagnosis of ICA flow arrest and for recanalization of ACST with a simple endovascular mechanical thrombectomy technique.
  
  
  RESULTS
  In three cases of ICA flow arrest caused by ACST, selective angiography with a 1.7 F microcatheter provided confirmative diagnosis. Recanalization was then achieved with a Penumbra System (PS) reperfusion catheter using the forced arterial suction thrombectomy (FAST) technique. Successful recanalization with a Thrombolysis In Cerebral Infarction score of 3 was achieved for all three patients. Recanalization was confirmed with follow-up angiography at least 24 h after the procedure. No complications associated with this technique occurred.
  
  
  CONCLUSIONS
  Based on our preliminary experiences, selective microangiography can be helpful for rapid diagnosis of ACST, and the present mechanical thrombectomy technique, using a modification of the PS, can play a role in adjuvant management or as a last resort for the treatment of ACST during CAS.
authors.affiliation: Department of Neurology, Cerebrovascular Center, Kyungpook National University Hospital, Daegu, Republic of Korea.
authors.forename: Yong-Won
authors.initials: YW
authors.lastname: Kim
authors.forename: Dong-Hun
authors.initials: DH
authors.lastname: Kang
authors.forename: Jeong-Hyun
authors.initials: JH
authors.lastname: Hwang
authors.forename: Jaechan
authors.initials: J
authors.lastname: Park
authors.forename: Yang-Ha
authors.initials: YH
authors.lastname: Hwang
authors.forename: Yong-Sun
authors.initials: YS
authors.lastname: Kim
mesh_terms: D000208:Acute Disease; D000368:Aged; D000792:Angiography / Q000379:methods; D002341:Carotid Artery Thrombosis / Q000601:surgery*; D017536:Carotid Artery, Common / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000601:surgery*; D057785:Catheters; D005374:Filtration / Q000295:instrumentation; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents / Q000009:adverse effects*; D013396:Suction / Q000295:instrumentation; D017131:Thrombectomy / Q000379:methods