Carotid Stent Fracture

Abstract

A 58-year-old man with a history of radiation therapyinduced (as treatment for tonsillar squamous cell carcinoma) right internal carotid artery calcified atherosclerotic stenosis treated with endovascular stenting 4 years earlier (with permeable stent on Doppler ultrasound 3 months earlier), presented with hemoptysis suspected to be due to cancer recurrence. During oropharyngeal biopsy, performed in maximal neck extension position, the patient acutely developed left hemiplegia. CT showed right middle cerebral artery infarction (Fig, Panel A and B, arrows) and calcified cerebral emboli (Fig, Panel A and B, arrowheads). These calcified cerebral emboli were absent on CT performed 4 years earlier. MRI confirmed multifocal right middle cerebral artery infarction (Fig, FLAIR sequences, Panels C and D, arrows). CT angiography (Fig, Panel E represents a 3D reconstructed image and Panel F a native coronal image) showed carotid artery occlusion associated with stent fracture (Fig, PanelFigure: Brain and vessel imaging of the patient.