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A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Emergent Carotid Stent Removal after Carotid Stent Thrombosis
Konstantinos G Moulakakis1, Andreas M Lazaris1
1Department of Vascular Surgery, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece.
Insights
Emergent removal of acute carotid stent thrombosis after carotid artery stenting (CAS) is a viable treatment. This surgical technique can restore neurological function in patients with early stroke.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Neurology
Background:
- Acute carotid stent thrombosis is a rare but severe complication of carotid artery stenting (CAS).
- Increasing CAS procedures mean physicians will encounter this complication more frequently.
- Emergent stent removal and endarterectomy is indicated for thrombosis without intracranial branch involvement.
Observation:
- The detailed surgical technique for emergent thrombosed stent removal has not been previously described.
- This study meticulously outlines the surgical steps, peculiar aspects, and critical considerations.
- The procedure was performed on two patients experiencing early stroke post-CAS.
Findings:
- Both patients demonstrated recovery of pre-stroke neurological deficits.
- The postoperative course for both patients was uneventful.
- The described surgical technique effectively addressed acute carotid stent thrombosis.
Implications:
- Emergency stent removal and endarterectomy is the preferred strategy for carotid stent thrombosis without distal extension.
- Careful surgical technique is crucial to prevent clot dislocation and cerebral embolization.
- This approach offers a solution for a devastating complication, improving patient outcomes.
Background:
Acute carotid stent thrombosis in patients undergoing CAS is a relatively rare and potentially devastating complication influencing significantly the quality of life. With the increasing use of stenting in clinical practice, it is expected to represent a more often encountered complication for physicians performing CAS. Emergent removal of the thrombosed stent and endarterectomy is indicated when the intrastent thrombosis is not associated with intracranial carotid branch thrombosis.
Methods:
The technique and its peculiarities and tip and tricks of this carotid operation have not been described meticulously. We describe the steps of the surgical technique in detail, and we analyze crucial issues associated with the technique.
Results:
We have performed this emergency operation in 2 patients with acute early stroke after CAS. Both patients presented recovery of their previous neurologic deficits and had uneventful postoperative course.
Conclusions:
We illustrate the technique of emergent removal of the thrombosed stent after CAS. If carotid stent thrombosis with no distal extension is documented post procedurally, emergency stent removal and endarterectomy is the preferred strategy. Special care should be taken to avoid risk of clot dislocation and consequent cerebral embolization during the surgical exposure of the carotid bifurcation and placement of the vascular clamps.
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