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Proximal Embolic Protection Devices in Complicated Carotid Artery Stenting

Andrea Gaggiano1, Holta Kasemi2, Antonella Laurito1

  • 1Department of Surgery, Vascular Surgery Unit, "Cardinal Massaia" Hospital, Asti, Italy.

Annals of Vascular Surgery
|May 10, 2017
PubMed

Insights

Carotid artery stenting (CAS) complications like embolization can be managed with proximal embolic protection devices (EPDs). These devices facilitate emergency surgery by enabling temporary vessel clamping, showcasing their versatility.

Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Neurosurgery

Background:

  • Carotid artery stenting (CAS) is a common procedure to prevent stroke.
  • Intraoperative distal embolization is the most frequent complication during CAS.
  • Embolic protection devices (EPDs) are crucial for minimizing embolization during CAS.

Observation:

  • A case of internal carotid artery (ICA) plaque rupture during CAS using a proximal EPD (Mo.Ma system) is reported.
  • The proximal occlusive protective system allowed for endovascular clamping of the common carotid artery and ICA.
  • This clamping provided the necessary time for immediate surgical conversion to carotid endarterectomy.

Findings:

  • Proximal EPDs can be effectively used even in emergent situations.
  • The Mo.Ma system facilitated a seamless transition from endovascular intervention to open surgery.
  • Successful management of plaque rupture during CAS was achieved through prompt surgical intervention facilitated by the EPD.

Implications:

  • EPD selection should be tailored to patient and lesion characteristics.
  • Proximal EPDs can serve as valuable 'bridge' devices in complex CAS cases.
  • This case highlights the potential of EPDs to enable timely surgical management of CAS complications.

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