Recurrent Ischemic Stroke after Carotid Artery Stenting for Thyroid Cartilage Induced CCA Stenosis: Was Stenting an Appropriate Treatment?

Mechanical stimulation of the common carotid artery (CCA) by the hyoid bone or thyroid cartilage can cause common carotid artery (CCA) stenosis and cerebral infarction. A 71-year-old man presented with symptomatic CCA stenosis. Imaging revealed CCA plaque at the site of contact with the thyroid cartilage, and ultrasonography revealed dynamic compression during swallowing. Despite technically successful carotid artery stenting, infarctions can recur without typical stent-related complications. The plaque may be trapped by the stent under persistent external mechanical stress, resulting in intermittent protrusions. Additional stenting prevented the recurrence. This case highlights the importance of considering external mechanical factors when selecting a treatment strategy.