Mobility of an in-stent plaque protrusion detected with carotid duplex during the carotid artery stenting procedure: a case report

Abstract

In-stent plaque protrusion (ISP) is a predictor for ischemic complications in carotid artery stenting (CAS). Because its mobility would further increase the distal embolization risk, the intraprocedural detection of mobility is important but has not yet been reported. We present an 87-year-old male with symptomatic right carotid artery stenosis who underwent CAS. Intravascular ultrasound (IVUS) after stent deployment revealed a small ISP, and simultaneous extravascular carotid duplex disclosed its mobility. After coverage of the ISP with stent-in-stent implantation, no remaining protrusion was observed with either IVUS or carotid duplex. The patient experienced no periprocedural strokes. Carotid duplex is suited to evaluate targets' movement because of its excellent temporal resolution. Carotid duplex has potential value for intraprocedural risk estimation of ISP.

Commentary: Double-Layer Carotid Stents: From the Clinical Need, through a Stent-in-Stent Strategy, to Effective Plaque Isolation… the Journey Toward Safe Carotid Revascularization Using the Endovascular Route

“…The stent-in-stent technique to prevent or treat plaque protrusion is presently employed not only in the US but also in other geographic areas where the new dual-layer carotid stents are not yet routinely available. 27,37,39,42 Different stent-in-stent strategies have been reported, most usually involving nested closed-cell stents or a closed-cell stent implanted within an open-cell stent in reaction to plaque prolapse. 27,37,39,42 Figure 1.…”

“…27,37,39,42 Different stent-in-stent strategies have been reported, most usually involving nested closed-cell stents or a closed-cell stent implanted within an open-cell stent in reaction to plaque prolapse. 27,37,39,42 Figure 1. Example of the Xact closed-cell stent-in-stent technique to prevent plaque prolapse during carotid artery stenting in an asymptomatic 72-year-old man with 6-month progression of duplex readings indicating a soft carotid lesion with high embolic burden.…”