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"No-reflow" phenomenon during percutaneous carotid angioplasty in a scleroderma patient
Sergey Yalonetsky1, Luis Gruberg, Rafael Beyar
1Division of Invasive Cardiology, Department of Cardiology, Rambam Medical Center, Haifa, Israel.
Insights
Systemic sclerosis can cause carotid artery stenosis. In a patient with this condition, percutaneous carotid angioplasty and stenting (CAS) using a filter device led to a no-reflow phenomenon that resolved upon filter retrieval.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Rheumatology
Background:
- Atherosclerosis is the primary cause of carotid artery stenosis.
- Percutaneous carotid angioplasty and stenting (CAS) is an increasingly accepted treatment.
- Distal embolization causing no-reflow is a known complication, primarily in saphenous vein graft interventions.
Observation:
- A patient with systemic sclerosis presented for CAS.
- A distal embolic protection device was utilized during the CAS procedure.
- The no-reflow phenomenon occurred during the intervention.
Findings:
- The no-reflow phenomenon was observed during CAS in a patient with systemic sclerosis.
- Retrieval of the distal embolic protection device led to the resolution of the no-reflow phenomenon.
Implications:
- This case highlights a potential complication of CAS in patients with systemic sclerosis.
- The use and retrieval of embolic protection devices may influence no-reflow events.
- Further investigation into systemic diseases as causes of carotid stenosis and their impact on CAS outcomes is warranted.
Abstract:
Atherosclerosis remains the most common etiology of carotid artery stenosis, but other systemic diseases can also cause this disease. Percutaneous carotid angioplasty and stenting (CAS) with and without distal embolic protection devices is gaining acceptance as the treatment of choice. No-reflow phenomenon due to distal embolization has been previously described mainly during percutaneous intervention of degenerated saphenous vein graft. We describe a patient with systemic sclerosis who underwent CAS with distal embolic protection device with occurrence of no-reflow phenomenon during the procedure that resolved after retrieval of the filter device.