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Carotid Endarterectomy to Remove Retained Solitaire Stent Retriever inside Carotid Stent after Mechanical
Mary In-Ping Huang Cobb1, Tony P Smith2, Patrick A Brown2
1Duke University Hospitals, Department of Neurosurgery, Durham, North Carolina.
Insights
A rare complication during stroke thrombectomy occurred when a Solitaire stent became lodged in a Precise stent. Carotid endarterectomy successfully removed both stents, restoring blood flow.
Area of Science:
- Neurosurgery
- Interventional Neurology
- Vascular Surgery
Background:
- Tandem occlusions of the internal carotid artery (ICA) and middle cerebral artery (MCA) are common in acute ischemic stroke.
- Endovascular mechanical thrombectomy is a standard treatment for these occlusions.
- Complications require understanding of open neurosurgical management.
Background:
Tandem occlusions of the internal carotid artery (ICA) and middle cerebral artery (MCA) occur in up to a third of patients with acute ischemic strokes undergoing endovascular mechanical thrombectomy. Understanding open neurosurgical management of associated complications with this procedure is important.
Case Report:
A 67-year-old man with acute onset of left hemiparesis and a tandem right ICA and MCA occlusion. He underwent carotid stent angioplasty of a stenotic ICA, followed by attempted Solitaire stent retrieval of an MCA clot. On withdrawal, the tines of the Solitaire stent lodged inside the Precise carotid stent. The patient was started on aspirin, Plavix, and heparin infusion, and underwent a carotid endarterectomy (CEA) with safe removal of the stents and primary vessel repair.
Conclusion:
This is the first case reported to date of a Solitaire stent becoming lodged inside a Precise carotid stent, salvaged by CEA with safe removal of the stents and primary vessel repair. We discuss the timing, indication, alternatives, and technical nuances of a CEA in this setting.
