Abstract
IntroductionWith the widespread use of carotid artery stenting, previously unknown technical mistakes of this treatment modality are now being encountered. There are multiple strategies for the treatment of in-stent restenosis. With regard to surgical management, endarterectomy and patch plasty are favored. To the best of our knowledge, this report is the first description of a complete stent removal by the eversion technique.Case presentationWe report the case of a 63-year-old Caucasian man with misdeployment of two stents into his stenotic proximal internal carotid artery, resulting in a high-grade mechanical obstruction of the internal carotid artery lumen. With the contralateral internal carotid artery already occluded and associated stenoses of both proximal and distal vertebral arteries, an interdisciplinary therapeutic concept was applied. Bilateral balloon angioplasty and stenting of the proximal and distal stenotic vertebral arteries were carried out to provide sufficient posterior collateral blood flow, followed by successful surgical stentectomy and carotid endarterectomy using the eversion technique. Duplex scanning and neurological assessments were normal over a 12-month follow-up period.ConclusionsInterdisciplinary treatment is a recommended option to protect patients from further impairment. Further evaluation in larger studies is highly recommended.
Highlights
With the widespread use of carotid artery stenting, previously unknown technical mistakes of this treatment modality are being encountered
Case presentation: We report the case of a 63-year-old Caucasian man with misdeployment of two stents into his stenotic proximal internal carotid artery, resulting in a high-grade mechanical obstruction of the internal carotid artery lumen
We report the case of a patient in whom a proximal internal carotid artery (ICA) stenosis was stented in another hospital
Summary
Stroke is the most common cause of disability. Prevention of stroke by carotid endarterectomy (CEA) or carotid artery stenting (CAS) is widely accepted, and they are basically equivalent treatment modalities [1,2]. Three months later, our patient was referred to our hospital with clinical signs and symptoms of a transient left hemispheric ischemia, including global aphasia, right hemiparesis, and paresthesia of the right upper extremity. Communicating artery were widely patent and the left external carotid artery contributed to the supply of the left hemisphere via the ophthalmic artery When giving his informed consent, our patient was informed of a peri-procedural and post-procedural mortality and morbidity rate of between 3% and 5%, and an increased risk of peri-operative bleeding due to the antiplatelet medication. The removal of the proximal stent from the common carotid artery was possible without any neurological deficit, and we decided to proceed with the eversion technique. Follow-up duplex scanning surveillance and neurological assessments were unremarkable after 12 months
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