J Korean Soc Radiol.  2011 Dec;65(6):569-572. 10.3348/jksr.2011.65.6.569.

Self-Expandable Stenting over a Stent Graft for the Exclusion of a Carotid Stump: Troubleshooting for Device Incompatibility

• Youn SW
• Kim HK
• Do JK
• Kim YW

• KMID: 2002923
• DOI: http://doi.org/10.3348/jksr.2011.65.6.569

Abstract

Carotid stump, the blind remnant of an occluded internal carotid artery, can be a potential source of microemboli, and warrants its exclusion from the vascular lumen to prevent the recurrence of a microembolism. In a 69-year-old male with a symptomatic carotid stump and acute angle between left common carotid artery and aortic arch, a 7-Fr. shuttle sheath was scarcely placed into the left carotid artery but the 7-mm-diameter stent-graft-loading balloon could not be inserted into the 7-Fr. shuttle sheath. With the mounting a stent graft over a 5-mm balloon, the balloon-expandable stent graft was unfolded. The self-expandable stent was placed over the stent graft, and an 8-mm balloon was subsequently expanded. Self-expanding stenting can be useful for troubleshooting in a case of device incompatibility coming from the different calibers of the external and common carotid arteries for the successful exclusion of a symptomatic carotid stump.

MeSH Terms

Aged
Aorta, Thoracic
Carotid Arteries
Carotid Artery, Common
Carotid Artery, Internal
Humans
Male
Recurrence
Stents
Transplants

Figure

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  Fig. 1 Fig. 1. A 69-year-old man with a symptomatic carotid stump. A. Left common carotid injection angiogram shows the occlusion of internal carotid artery (ICA) with stump (asterisk) and reconstituted ophthalmic flow into the distal ICA (arrowhead). B. Retrograde filling (arrow) from the ophthalmic artery (arrowhead) supplies anterior cerebral circulation. C. Arch aortogram reveals severe elongation of the aortic arch, making an acute angle with the common carotid artery. The left ICA is not seen with the remaining stump (asterisk). D. Native radiography after a stent graft reveals the self-expandable stent (black arrows) within the stent graft (white arrows) and the excluded stump with contrast stasis (asterisk).

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