Cervical Carotid Stent Collapse During Balloon Guide Catheter Aspiration

Balloon guide catheters (BGCs) can be used during cervical carotid stenting as a proximal protection strategy to minimize thromboembolic procedural complications (Video 1). A 9-French BGC can be swiftly inflated before each embologenic step of carotid stenting (microwire crossing, prestent angioplasty, stenting, poststent angioplasty); aspirated; and deflated. We present 2 unique cases in which the impact of BGC aspiration is demonstrated on cervical carotid stenting for atherosclerotic stenoocclusive disease. On deflation of the poststent angioplasty balloon with concomitant aspiration of the BGC through a 60-mL vacuum syringe, stent collapse was noted. Stent self-reexpansion was documented after reversal of negative pressure from the vacuum syringe, allowing for gentler aspiration. Awareness and early recognition of this potential for vessel wall collapse with aspiration are important to prevent vessel/stent collapse, inefficient aspiration, and resultant embolization of debris. Gradual aspiration is favored.