Trapped Embolic Protection Device: A Salvage Technique.

Anna Luisa Kuhn,Jasmeet Singh,Ajit S Puri,Katyucia De Macedo Rodrigues,Francesco Massari

doi:10.7759/cureus.9228

Anna Luisa Kuhn, Jasmeet Singh + Show 3 more

Open Access

https://doi.org/10.7759/cureus.9228

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Journal: Cureus	Publication Date: Jul 16, 2020
Citations: 2	License type: cc-by

Affiliation: University of Massachusetts Chan Medical School

Abstract

After carotid artery stenting, retrieval of the embolic protection device can sometimes be difficult due to incomplete stent expansion, stent fracture, vasospasm, and vessel tortuosity. In this technical report, we describe a novel rescue technique used in a patient with diffuse calcific atherosclerosis of the left common and proximal left internal carotid arteries who underwent left internal carotid artery stenting with cerebral protection and in whom, due to an under-expanded proximal carotid stent strut in relation to a densely calcified plaque, we were initially unable to advance the retrieval device.

Highlights

Carotid artery stenting is the preferred treatment for patients with symptomatic carotid stenosis and who are considered “high risk” for carotid endarterectomy [1]
A middle-aged patient presented to our clinic with a past medical history of multiple prior strokes, hypertension, hyperlipidemia, chronic kidney disease, and chronic obstructive pulmonary disease (COPD)
Calcified plaques and vessel tortuosity are independent risk factors associated with the difficult retrieval of embolic protection devices [9]

Summary

Introduction

Carotid artery stenting is the preferred treatment for patients with symptomatic carotid stenosis and who are considered “high risk” for carotid endarterectomy [1]. A 4.5 mm x 20 mm MonorailTM over-the-wire balloon (Boston Scientific, Natick, MA) was advanced over the EPD wire to perform pre-stenting angioplasty of the CCA and proximal left cervical ICA (Figure 2B and 2C). Successful placement of an embolic protection device in the distal cervical left ICA and pre-stent angioplasty (B and C). Two 8 x 29 mm overlapping Carotid Wallstents (Boston Scientific) were placed across the severely diseased left CCA (Figure 5A-C) up to its origin in the aorta and angioplasty of the stented vessel segment was performed using a 5 mm x 20 mm Monorail balloon (Boston Scientific). After the recapture of the embolic protection device, placement of two additional overlapping 8 x 29 mm Carotid Wallstents (Boston Scientific) to cover the diseased left CCA (A-C). The final angiogram upon completion of the procedure is shown in image C

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Disclosures