Related Experiment Video
Updated: Aug 26, 2025
Bilateral Common Carotid Artery Occlusion as an Adequate Preconditioning Stimulus to Induce Early Ischemic Tolerance to Focal Cerebral Ischemia
Published on: May 9, 2013
Case report: Combined acute revascularization in early bilateral carotid stent occlusion
David Černík1, Robert Bartoš2, Jarmila Neradová1
1Comprehensive Stroke Center, Neurology, Masaryk Hospital, Ústí nad Labem, Czechia.
Insights
Early carotid stent occlusion is a serious complication. Bilateral middle cerebral artery ECIC bypass revascularization proved effective when endovascular treatments failed, offering a viable solution for maintaining blood flow.
Area of Science:
- Vascular Surgery
- Interventional Neurology
- Cardiovascular Research
Background:
- Effective antiplatelet therapy is crucial for maintaining carotid stent patency.
- Carotid artery stenting is a common endovascular procedure for treating stenotic arteries.
Observation:
- A 73-year-old male patient experienced stroke recurrence after discontinuing antiplatelet therapy.
- Computed tomography angiography confirmed the closure of recently implanted carotid artery stents.
- Initial treatment with intravenous thrombolysis and mechanical thrombectomy achieved partial recanalization, but restenosis recurred.
Findings:
- Despite maximal medical management and multiple endovascular interventions, carotid stent patency could not be maintained.
- Bilateral neurosurgical revascularization using extracranial-to-intracranial (ECIC) bypasses of the middle cerebral arteries was successfully performed.
- Prolonged low-dose intravenous thrombolysis served as an effective bridging therapy until surgical intervention.
Implications:
- Early carotid stent occlusion is a significant complication that can occur despite optimal medical and endovascular management.
- ECIC bypass revascularization of the middle cerebral artery presents a highly effective therapeutic option for managing complex cases of carotid stent occlusion.
- This case highlights the importance of considering advanced surgical revascularization when endovascular approaches are insufficient to restore and maintain cerebral blood flow.
Introduction:
The introduction of a carotid stent involves the use of effective antiplatelet therapy to maintain stent patency. We present a case report of combined acute revascularization in a patient with occlusion in recently introduced stents of both carotid arteries.
Methods:
The patient (male, 73 years) was admitted for stroke recurrence upon discontinuation of antiplatelet therapy. According to the CTA, the closure of implanted stents of both carotid arteries was confirmed. Intravenous thrombolysis and mechanical thrombectomy were performed with complete recanalization of the left carotid stent. At 3 days apart, clinical deterioration was found with progressive stent restenosis. Percutaneous transluminal stent angioplasty, mechanical embolectomy and prolonged low-dose intravenous thrombolysis have been used repeatedly.
Results:
With the impossibility of maintaining the patency of carotid stents even on the maximum drug therapy and despite endovascular procedures, bilateral neurosurgical revascularization of the middle cerebral arteries using ECIC bypasses was successfully performed. Prolonged low-dose intravenous thrombolysis (20 mg recombinant plasminogen aktivator (rTPA)/10 h) has proven to be an acute bridging therapy until surgery.
Conclusion:
Early occlusion of the carotid stent is a significant complication of endovascular treatment of stenotic arteries. ECIC bypass revascularization of the middle cerebral artery can be a highly effective therapeutic procedure.
