Fracture of a carotid stent and restenosis of common carotid artery

In recent years we have observed dynamic growth in the amount of carotid stenting (CAS) as an alternative to surgical endarterectomy (CEA) [1]. We present a case of stent fracture of a balloon-expanding stent in a patient who underwent stenting for stenoses of the common and internal left carotid arteries. A 56-year-old hypertensive woman was admitted to our institution in March 2007 due to symptomatic recurrent left carotid artery stenosis, manifested by headaches, dizziness, and transient visual disorders. In 1998, she experienced a stroke, after which she underwent a bilateral carotid endarterectomy. On admission, the patient reported periodic headaches and dizziness, transient visual disorders, and persistent aphasia. Additionally, she complained of some chest pain on exertion (class 3 CCS). Neurological examination revealed discrete symptoms of left-sided paresis, pyramidal signs on the right side, and a small motor aphasia. The patient was on permanent treatment with aspirin, clopidogrel, β-blockers, angiotensinconverting enzymes inhibitors, calcium channel blockers, diuretics and statins. Nuclear magnetic resonance (NMR) performed in ambulatory conditions did not indicate central nervous system damage. An ultrasound scan revealed a high-grade stenosis in the left internal carotid artery (LICA) – restenosis after CEA, with no significant flow disturbances in the right internal carotid artery (RICA). On angiography, the LICA stenosis was confirmed, but also a second critical stenosis was diagnosed at the ostium of the left common carotid artery (LCCA, Figure 1). A decision for carotid stenting was made, and this was performed on March 27, 2007. A balloon-expandable, stainless-steel Genesis stent (Cordis), 8 mm × 24 mm, was implanted (10 atm – 30 s) at the ostium of the LCCA. There was not much resistance in dilating the stenotic segment. At this moment we decided to stop the procedure (Figure 2), and to perform the stenting of the LICA in the second stage, a couple of weeks later. The patient was discharged from the hospital with no complications after 2 days. Combined antiplatelet therapy was recommended, with 75 mg clopidogrel, for 4 weeks, in combination with 75 mg aspirin as permanent therapy. On July 8, 2007 the patient was readmitted with the intent of treating the LICA stenosis. However, selective left carotid angiography revealed an Corresponding author: Wojciech Wróbel MD, PhD 2 Clinic of Cardiology Dr. J. Biziel Memorial University Hospital No. 2 75 Ujejskiego St 85-168 Bydgoszcz, Poland Phone/fax: +48 52 365 56 53 E-mail: [email protected] Letter to the Editor