Carotid artery thrombosis treated with catheter intervention using proximal occlusion and flow reversal

We present a case of symptomatic carotid artery thrombosis treated with catheter intervention under proximal occlusion and flow reversal embolic protection. Although catheter intervention is contraindicated in carotid artery thrombosis due to the risk of distal embolization, the introduction of proximal occlusion embolic protection devices allow interventionalists to use catheter intervention where it was previously deemed too high a risk. A Gore Flow Reversal device was used in a 57-year-old male with obesity, uncontrolled type I diabetes mellitus, hypertension, hyperlipidemia, and prior stroke who had previously undergone left internal carotid artery revascularization with carotid artery endarterectomy and patch angioplasty. Since balloon disruption and manual aspiration through the balloon sheath of the flow reversal device was unable to remove the thrombosis, an AngioJet 4 Fr RX catheter was used to mechanically remove material via mechanical thrombectomy. As there was still residual stenosis, a stent was placed in the area to decrease the remaining blockage. Follow-up carotid artery duplex scanning showed that the procedure eliminated the carotid occlusion. The embolic protection device and the procedural technical aspects are described herein, as are reports of both clinical and anatomical follow-up. We show that by using a Gore Flow Reversal protection device, we were able to use catheter therapy to treat a carotid thrombosis, which was previously contraindicated for this condition.