Emergent Carotid Stent Removal after Carotid Stent Thrombosis

Abstract

Acute carotid stent thrombosis in patients undergoing CAS is a relatively rare and potentially devastating complication influencing significantly the quality of life. With the increasing use of stenting in clinical practice, it is expected to represent a more often encountered complication for physicians performing CAS. Emergent removal of the thrombosed stent and endarterectomy is indicated when the intrastent thrombosis is not associated with intracranial carotid branch thrombosis. The technique and its peculiarities and tip and tricks of this carotid operation have not been described meticulously. We describe the steps of the surgical technique in detail, and we analyze crucial issues associated with the technique. We have performed this emergency operation in 2 patients with acute early stroke after CAS. Both patients presented recovery of their previous neurologic deficits and had uneventful postoperative course. We illustrate the technique of emergent removal of the thrombosed stent after CAS. If carotid stent thrombosis with no distal extension is documented post procedurally, emergency stent removal and endarterectomy is the preferred strategy. Special care should be taken to avoid risk of clot dislocation and consequent cerebral embolization during the surgical exposure of the carotid bifurcation and placement of the vascular clamps.