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Rescue strategy for acute carotid stent thrombosis during carotid stenting with distal filter protection using forced arterial suction thrombectomy with a reperfusion catheter of the Penumbra System: a technical note

  • Technical Note - Vascular
  • Published:
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Abstract

Background

Among the procedural complications related to carotid artery stenting (CAS), internal carotid artery (ICA) flow arrest is one of the most drastic complications, as it can cause major ischemic stroke. Acute carotid stent thrombosis (ACST) is a rare etiology of ICA flow arrest during carotid artery stenting with distal filter protection, but the most devastating. Moreover, no definitive management strategy has been established so far for treating ACST.

Methods

We introduce a rescue management strategy for differential diagnosis of ICA flow arrest and for recanalization of ACST with a simple endovascular mechanical thrombectomy technique.

Results

In three cases of ICA flow arrest caused by ACST, selective angiography with a 1.7 F microcatheter provided confirmative diagnosis. Recanalization was then achieved with a Penumbra System (PS) reperfusion catheter using the forced arterial suction thrombectomy (FAST) technique. Successful recanalization with a Thrombolysis In Cerebral Infarction score of 3 was achieved for all three patients. Recanalization was confirmed with follow-up angiography at least 24 h after the procedure. No complications associated with this technique occurred.

Conclusions

Based on our preliminary experiences, selective microangiography can be helpful for rapid diagnosis of ACST, and the present mechanical thrombectomy technique, using a modification of the PS, can play a role in adjuvant management or as a last resort for the treatment of ACST during CAS.

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Fig. 1

Abbreviations

ACST:

acute carotid stent thrombosis

ACT:

activated clotting time

CAS:

carotid artery stenting

EPD:

embolic protection device

FAST:

forced arterial suction thrombectomy

ICA:

internal carotid artery

PS:

Penumbra System

TICI:

Thrombolysis In Cerebral Infarction

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Acknowledgments

We thank Wade Martin of Medical Research International for editorial revision of this manuscript.

Disclosure

The authors in the present study have no financial relationship with other people or organizations that could reasonably be perceived as conflicts of interest or as potentially influencing or biasing their work.

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Neurology, Cerebrovascular Center, Kyungpook National University Hospital, Daegu, Republic of Korea

    Yong-Won Kim & Yang-Ha Hwang

  2. Department of Neurosurgery, Cerebrovascular Center, Kyungpook National University Hospital, 130, Dongduk-ro, Jung-gu, 700-721, Daegu, Republic of Korea

    Dong-Hun Kang, Jeong-Hyun Hwang & Jaechan Park

  3. Department of Radiology, Cerebrovascular Center, Kyungpook National University Hospital, Daegu, Republic of Korea

    Yong-Won Kim, Dong-Hun Kang & Yong-Sun Kim

  4. School of Medicine, Kyungpook National University, Daegu, Republic of Korea

    Dong-Hun Kang, Jeong-Hyun Hwang, Jaechan Park, Yang-Ha Hwang & Yong-Sun Kim

Authors
  1. Yong-Won Kim
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  2. Dong-Hun Kang
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  3. Jeong-Hyun Hwang
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  4. Jaechan Park
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  5. Yang-Ha Hwang
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Corresponding author

Correspondence to Dong-Hun Kang.

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Kim, YW., Kang, DH., Hwang, JH. et al. Rescue strategy for acute carotid stent thrombosis during carotid stenting with distal filter protection using forced arterial suction thrombectomy with a reperfusion catheter of the Penumbra System: a technical note. Acta Neurochir 155, 1583–1588 (2013). https://doi.org/10.1007/s00701-013-1744-7

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  • DOI: https://doi.org/10.1007/s00701-013-1744-7

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