PMC10203154_01
CT angiography shows severe stenosis in the left proximal ICA (A) and diffusion-weighted imaging reveals multiple scattered acute infarctions in the left hemisphere (B-D).
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Computerized tomography angiography (CTA) revealed severe stenosis of the left proximal internal carotid artery (ICA; Figure 1A). Diffusion-weighted imaging showed multiple scattered cortical infarctions along the left cerebral hemisphere (Figures 1B-D).
Sequential images of the carotid stenting. Cerebral angiography revealed ~87% stenosis of the left ICA according to NASCET criteria. The diameter of the stenotic segment was 0.56 mm (thin arrow), and the diameter of the distal ICA was 4.41 mm (thick arrow), but the diameter of the distal common carotid artery was 7.63 mm (red arrow) (A). (B) Balloon angioplasty before carotid stenting. (C) Angiography after balloon angioplasty. (D) Carotid Wallstent deployment. (E) Native fluoroscopy after poststent balloon angioplasty. (F) Angiography after post-stent balloon angioplasty. (G, H) Native fluoroscopy and final angiography.
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Then, 5 days after starting the medication, trans-femoral cerebral angiography confirmed 87% stenosis in the left proximal ICA using NASCET criteria (Figure 2A). Prior to CAS, balloon angioplasty was performed using a 4 x 20 mm angioplasty balloon (Submarine Rapido, Invatec, Italy; Figures 2B, C). Wallstent (Boston Scientific, Natick, MA, USA) was deployed across the stenotic lesion (Figure 2D). We performed additional balloon angioplasty after carotid stenting for stent apposition (Figures 2E, F). After the careful withdrawal of the EPD, a carotid angiogram demonstrated successful stent implantation without residual stenosis (Figures 2G, H).
The day after CAS, early shortening of the CAS and distal stenosis are demonstrated in CTA and the cerebral angiogram (A-C). After additional carotid stenting, the final angiography showed successful expansion and implantation of the carotid stent (D, E). There was no shortening and malposition of the CAS 1 month after additional carotid stenting (F).
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Follow-up CTA and cerebral angiography were performed the day after CAS showed downward shortening of the carotid stent and exposed stenotic area (Figures 3A-C). Successful expansion and implantation were confirmed by the final angiogram (Figures 3D, E). A 1-month follow-up CTA showed successful implantation of the stent without shortening and malposition (Figure 3F).