Subacute In-Stent Occlusion 2 Weeks after CASPER Rx Stenting: A Case Report

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Neurology

Background:

• Carotid artery stenosis poses a significant risk for stroke.
• Dual-layer micromesh stents, like the CASPER Rx stent, are designed for treating carotid artery stenosis, including cases with vulnerable plaque.
• The CASPER Rx stent is indicated for carotid artery stenosis, aiming for safety and efficacy.

Observation:

• A 78-year-old male with symptomatic severe cervical internal carotid artery stenosis and unstable plaque underwent CASPER Rx stent placement.
• The procedure and initial recovery were uneventful, with discharge one week post-procedure.
• Two weeks post-procedure, the patient experienced a transient ischemic attack, revealing acute in-stent and distal internal carotid artery occlusion due to thrombus.

Findings:

• The CASPER Rx stent, intended for carotid artery stenosis, was associated with acute in-stent occlusion two weeks post-implantation.
• Thrombus formation within the stent led to occlusion and subsequent transient ischemic attack.
• Mechanical thrombectomy successfully recanalized the occluded artery, but resulted in postoperative cerebral infarction.

Implications:

• This case highlights a potential complication of CASPER Rx stenting, specifically early in-stent occlusion.
• Further investigation into the safety and long-term patency of dual-layer micromesh stents in vulnerable carotid artery plaque is warranted.
• Understanding the risk factors and mechanisms of early stent thrombosis is crucial for optimizing patient selection and management strategies in carotid artery stenting.