A Case of Carotid Artery Stenting after Aspiration of Thrombus and Unstable Plaque

Abstract

There is no established method for carotid artery stenting (CAS) for internal carotid artery stenosis with vulnerable plaque and thrombosis. We report a case in which CAS was performed by aspiration using the Penumbra system for thrombosis that increased in the subacute phase in symptomatic cervical internal carotid artery stenosis. Case Presentations: A 59-year-old man with a history of lacunar infarction visited the emergency department with weakness in the right upper limb. He was admitted for cerebral infarction in the left corona radiata and basal ganglia. During the course, additional multiple cerebral infarctions developed in the left cerebral hemisphere. The patient was diagnosed with left internal carotid artery stenosis and underwent CAS. As mural thrombus increased compared with preoperative imaging, CAS was performed after thrombus aspiration using the Penumbra system. A large amount of plaque was observed in the aspirated blood. Conclusion: Thrombus aspiration using the Penumbra system was effective as distal embolic protection during CAS for internal carotid artery stenosis with increased and shape-changing thrombus. The aspirated blood exhibited pathological findings of plaque tissue and thrombus. Keywords▶ carotid artery stenting, unstable plaque, aspiration of thrombus This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives International License.

Carotid Free-Floating Thrombus Treated With a Combined Technique Using Embotrap III for Distal Protection

“…Recently, in addition to conventional treatments, endovascular thrombectomy for carotid FFT has been reported [2,4,5,[7][8][9][10][11][12][13][14]. However, when balloon protection is used for distal protection, complete interruption of the ICA flow is undesirable in patients without hemodynamic intolerance.…”

A Case of Internal Carotid Artery Occlusion Caused by En Bloc Distal Embolization of Carotid Free-Floating Thrombus Treated by Mechanical Thrombectomy

“…Fitzpatrick et al 6) and Giragani et al 8) performed treatment using a stent retriever by combining proximal balloon protection or distal filter protection, and they were able to remove the FFT without complications. Otawa et al 9) and Kubo et al 10) reported cases in which the FFT was removed by aspiration using an aspiration catheter followed by CAS applied to the residual lesion. Carr et al reported a case in which ADAPT was performed for the first pass, but it was only partially removed; therefore, they used the technique combining a stent retriever and an aspiration catheter for the second pass, and the FFT was able to be completely removed without complications.…”