Stent Retriever-Assisted Embolic Protection During Recanalization of Chronic Internal Carotid Artery Occlusion with...

Chronic internal carotid artery occlusion (CICAO) with contralateral stenosis confers high stroke risk, particularly when thrombocytopenia complicates dual antiplatelet therapy (DAPT). We report a single case of staged carotid revascularization in which a stent retriever was used as a temporary distal protection device during CICAO recanalization after hematologic optimization.

A 69-year-old woman with chronic hepatitis B-related thrombocytopenia (20-68 × 10⁹/L) presented with progressive imbalance (NIHSS 3, mRS 2). Imaging revealed bilateral parieto-occipital infarcts, chronic left ICA occlusion, and severe right ICA stenosis (80% North American Symptomatic Carotid Endarterectomy Trial (NASCET)). After eltrombopag therapy increased platelet counts to >300 × 10⁹/L, DAPT was initiated. Revascularization was performed in two stages: right ICA stenting with distal filter protection, followed 14 days later by left CICAO recanalization using a Catch Mini stent retriever (Balt, Montmorency, France) as temporary embolic protection and dual-stent reconstruction (proximal Wallstent (Boston Scientific, Marlborough, MA, USA) and distal braided Leo+ stent (Balt, Montmorency, France)). Both procedures were completed without periprocedural complications. At 6 months, CTA demonstrated distal re-occlusion of the cavernous (C4) segment; however, the patient remained clinically stable (NIHSS 0) without recurrent ischemic events.

The stent retriever-assisted approach was technically feasible in this single carefully selected patient and may offer a solution to the inherent limitation of conventional embolic protection devices in CICAO recanalization; however, its protective efficacy cannot be established without post-procedural imaging, which was not obtained in this case.