Abstract

Carotid artery stenting (CAS) for carotid artery stenosis has become an alternative for treating patients not eligible for carotid endarterectomy (CEA). Even though the CAS is relatively simply in many cases, various complications such as distal embolization and hyperperfusion can occur. We repot a rare case of CAS using the Carotid Wallstent, which was complicated by acute shortening of the stent after successful CAS, and discuss the possible mechanisms of this complication.

A 79-year-old male presented with amaurosis fugax in the left internal carotid artery (ICA) territory. Digital subtraction angiography (DSA) showed severe left ICA stenosis (NASCET criteria; 90%). CAS was performed under local anesthesia using a 10 × 24 mm Carotid Wallstent and PercuSurge GuardWire protection system. Immediate post-stent angiography showed successful stent implantation without any complication. A follow-up cervical x-ray film a half day after stenting showed stent shortening toward the proximal end, and DSA obtained 4 days later revealed residual stenosis of the distal portion of the stent. Therefore an additional CAS was done using a Precise stent.

Shortening of Carotid Wallstent seemed to be induced by marked diameter mismatch between the distal and proximal ICA or the ICA and CCA, and can occur even after successful CAS. An expansion of Carotid Wallstent at the large diameter of ICA and CCA level might have caused stent shortening, which pulled the distal end of the stent downward. Therefore, short term follow-up evaluation is important to detect unexpected complications such as stent shortening.