Carotid Endarterectomy to Remove Retained Solitaire Stent Retriever inside Carotid Stent after Mechanical Thrombectomy.
BACKGROUND
Tandem occlusions of the internal carotid artery (ICA) and middle cerebral artery (MCA) occur in up to a third of patients with acute ischemic strokes undergoing endovascular mechanical thrombectomy. Understanding open neurosurgical management of associated complications with this procedure is important.


METHODS
A 67-year-old man with acute onset of left hemiparesis and a tandem right ICA and MCA occlusion. He underwent carotid stent angioplasty of a stenotic ICA, followed by attempted Solitaire stent retrieval of an MCA clot. On withdrawal, the tines of the Solitaire stent lodged inside the Precise carotid stent. The patient was started on aspirin, Plavix, and heparin infusion, and underwent a carotid endarterectomy (CEA) with safe removal of the stents and primary vessel repair.


CONCLUSIONS
This is the first case reported to date of a Solitaire stent becoming lodged inside a Precise carotid stent, salvaged by CEA with safe removal of the stents and primary vessel repair. We discuss the timing, indication, alternatives, and technical nuances of a CEA in this setting.
Duke University Hospitals, Department of Neurosurgery, Durham, North Carolina. Electronic address: maryih.cobb@duke.edu.
Mary In-Ping Huang
MIH
Cobb
Duke University Hospitals, Department of Radiology, Division of Interventional Radiology, Durham, North Carolina.
Tony P
TP
Smith
Duke University Hospitals, Department of Radiology, Division of Interventional Radiology, Durham, North Carolina.
Patrick A
PA
Brown
Duke University Hospitals, Department of Neurosurgery, Durham, North Carolina.
L Fernando
LF
Gonzalez
Duke University Hospitals, Department of Neurosurgery, Durham, North Carolina.
Ali R
AR
Zomorodi
D000368:Aged; D000792:Angiography; D000800:Angioplasty, Balloon / Q000295:instrumentation*; D002545:Brain Ischemia / Q000209:etiology; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D020878:Device Removal / Q000379:methods*; D016894:Endarterectomy, Carotid; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D010291:Paresis / Q000209:etiology; D011474:Prosthesis Design; D015607:Stents; D020521:Stroke / Q000209:etiology; D017131:Thrombectomy / Q000009:adverse effects / Q000295:instrumentation*; D016896:Treatment Outcome
Carotid endarterectomy; carotid stenosis; carotid stent; mechanical thrombectomy; retained stent; solitaire stent; tandem occlusion