P.100 Carotid stent fracture post balloon angioplasty for unilateral recurrent ICA stenosis with pre-existing occlusion of contralateral ICA and literature review

Abstract

Background: Closed cell carotid stent fracture is rare. From our literature review, we present the first reported case in English literature of a carotid stent fracture post angioplasty for an in-stent stenosis. Methods: Case Report Results: 72-year-old male underwent left carotid stenting for symptomatic ulcerated stenosis of the proximal aspect of left ICA (71% stenosis with post-stenting 55% residual stenosis). His right ICA and right vertebral artery were occluded. 2 months later, he presented with TIA’s and severe in-stent stenosis in the proximal left ICA measuring 1 mm in diameter. Satisfactory balloon (5×40 mm) angioplasty was done with residual stenosis measuring 2.5 mm in diameter. 8 months later he presented with symptoms of compromised cerebral perfusion. Workup showed a stent fracture distally at the site of severe ICA stenosis secondary to atherosclerotic calcified plaque causing blood flow changes. His PSV (peak systolic velocity) in the left ICA was 383 m/s. As such he underwent left ICA re-stenting for symptomatic severe left ICA stenosis of 70% with 40% residual stenosis following stent deployment. Conclusions: Carotid stent fracture post balloon angioplasty for recurrent stenosis is rare but of paramount importance. We demonstrate re-stenting as a viable treatment modality when patient profile is not amenable to a surgical revascularization procedure.