Korean J Radiol.  2014 Dec;15(6):858-861. 10.3348/kjr.2014.15.6.858.

Delayed Cerebral Infarction due to Stent Folding Deformation Following Carotid Artery Stenting

• Seo KD
• Lee KY
• Kim BM
• Suh SH

• KMID: 1794660
• DOI: http://doi.org/10.3348/kjr.2014.15.6.858

Abstract

We report a case of delayed cerebral infarction due to stent longitudinal folding deformation following carotid artery stenting using a self-expandable stent with an open-cell design. The stented segment of the left common carotid artery was divided into two different lumens by this folding deformation, and the separated lumens became restricted with in-stent thrombosis. Although no established method of managing this rare complication exists, a conservative approach was taken with administration of anticoagulant and dual antiplatelet therapy. No neurological symptoms were observed during several months of clinical follow-up after discharge.

Keyword

Carotid artery stenting; Stent deformation; Complication; Stroke

MeSH Terms

Aged
Anticoagulants/therapeutic use
Carotid Arteries/radiography
Cerebral Infarction/*diagnosis/therapy
Humans
Male
Platelet Aggregation Inhibitors/therapeutic use
Stents/*adverse effects
Thrombosis/drug therapy/*etiology
Ticlopidine/analogs & derivatives/therapeutic use
Tomography, X-Ray Computed
Anticoagulants
Platelet Aggregation Inhibitors
Ticlopidine

Figure

• 

  Fig. 1 72-year-old male with longitudinal folding deformation of carotid stent. Segmental stenosis was seen in left common carotid artery angiography (A) and plain film showed carotid stent was placed with fully expansion (B). After 4 years, plain radiography revealed longitudinal folding deformation of carotid stent (C), and angiography confirmed stented segment was separated into two stenotic lumens and in-stent thrombosis (D). Computed tomography angiography (CTA) source images showed significantly eccentric stenosis of 40-mm length, and neither calcification nor external mass around stenotic segment of left common carotid artery (E) occurred. After 4 years, CTA images of same level demonstrated that medial side of carotid stent was folded longitudinally in half, and this collapsed side was abutting on lateral side of stent. Intraluminal filling defect in distal segment of stent (F) was present.

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