Carotid Artery Stenting to Internal Carotid Artery Stenosis at the Distal Cervical Portion near the Carotid Canal: A Report of Six Cases

Objective: Six cases in which carotid artery stenting (CAS) was performed using a distal embolic protection device (EPD) for distal internal carotid artery (ICA) stenosis near the carotid canal are reported. Case Presentations: Of the 504 consecutive cases of ICA stenosis endovascularly treated at our hospital between April 1, 2008 and December 31, 2016, six cases with lesions in the distal potion of the cervical ICA near the carotid canal underwent CAS using Carotid Guardwire PS. The six patients were all males aged 68–80 years (median: 78.5 years), and three patients were symptomatic. The mean percent stenosis was 91% (80%–96%) preoperatively and 10.3% (0%–27%) postoperatively. In five patients, gross debris was detected in the blood aspirated during the procedure. In the patient with 27% residual stenosis, calcified plaque was confirmed at the entry of the carotid canal on postoperative CTA. No stroke, myocardial infarction, or death was noted within 30 days after the perioperative period, but a new ischemic lesion was detected in one patient on diffusion-weighted MRI. The mean follow-up period in the six patients was 28 months (7–66 months), and ipsilateral stroke or restenosis was not observed. Conclusion: CAS using EPD is considered an effective option for the treatment of distal ICA stenosis near the carotid canal.