PMC6024505_01
PMC6024505_02
Cervical angiogram initial diagnostic views prior to stent placement. (a) Anterior to posterior projection (b) and lateral projection
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F1
Initial anteroposterior and lateral common carotid artery (CCA) injections demonstrated severe stenosis of 3 mm in diameter occurring just distal to the bifurcation of the common carotid artery [Figure 1].
Cervical angiogram in oblique working projection of carotid artery bifurcation demonstrating adequate luminal diameter following stent deployment
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F2
A post stent deployment angiogram was performed in the working projections which demonstrated significant improvement in the vessel lumen with good stent wall apposition [Figure 2].
PMC6024505_03
Three-dimensional volume of interest DYNA CT highlighting the torsional configuration of the stent in an axial plane
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F3
At this point, we felt two-dimensional (2D) angiography was not adequate in diagnosis, and therefore, a volume of interest Dyna CT with 3D reconstructions were obtained. 3D reconstructions demonstrated persistent stenosis within the mid portion of the stent and reticent calcified plaque [Figure 3].
Intraoperative extraction of the retained distal protection device and carotid artery stent device. Morphology and severity of atherosclerotic stenosis is easily visualized
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F4
Upon opening the common carotid artery, the wire was cut proximally and removed from the femoral sheath [Figure 4].
Postoperative diagnostic angiogram in oblique working projection demonstrating improved stenosis without evidence of dissection or flow limiting stenosis
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F5
Postoperative angiogram demonstrated appropriate flow through the carotid artery without evidence of residual stenosis or distal thrombotic complication [Figure 5].
PMC6024505_04