Emergency stenting for iatrogenic occlusion of internal carotid artery during percutaneous transluminal angioplasty: a case report

The authors report the case of a 68-year-old male who underwent emergency stenting for iatrogenic occlusion of the internal carotid artery while he was receiving percutaneous transluminal angioplasty. He presented with a 1-month history of transient ischemic attacks with right-sided hemiparesis. Carotid angiography revealed a 95% eccentric stenosis at the origin of the left internal carotid artery. As the stenotic lesion was higher than the level of the third cervical vertebral body, percutaneous transluminal angioplasty was performed instead of carotid endarterectomy. During the procedure, the left internal carotid artery was dissected, then obstructed completely with rapid deterioration of his neurological condition. The Palmaz-Schatz stent was successfully deployed over the site of dissection to restore normal patency through the dissected carotid artery. Following emergency stenting, his neurological signs quickly subsided. Since then, with oral administration of antiplatelet medication, he has suffered no recurrence of cerebral ischemic events. Echo-ultrasonography 4 months after stent implantation showed good patency of the stented segment. It has been reported that angioplasty is indicated for high-risk patients or surgically inaccessible lesions in stenotic disorders of the internal carotid artery. However, there are several complications reported, including intimal dissection and restenosis. The present case emphasizes the usefulness of emergency stenting when occlusion of the internal carotid artery is complicated during percutaneous transluminal angioplasty.