Early and long-term mechanical complications after carotid artery stenting

Mechanical complications of carotid artery stenting are more common than believed. We report one periprocedural and one long-term mechanical complications of carotid artery stenting. The periprocedural case involved a SpiderFX distal protection device (Medtronic) hooked on the implanted stent, preventing retrieval. The long-term case involved symptomatic carotid stent fracture with in-stent thrombus. Both patients underwent successful open surgical management with segmental resection of the stent-covered carotid segment and replacement with a 6-mm Dacron interposition graft. Both grafts remained patent over a mean follow-up of 8 years. Periprocedural mechanical complications require immediate surgical intervention; symptomatic or restenosis-associated stent fractures also require prompt treatment.