Print this pageDelayed Deformation of Self-Expanding Stent Following Carotid Artery Stenting for Post-Endarterectomy Restenosis
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Wei Zhou, MD, Sasi Yallampalli, BS, Peter Lin, MD, Ruth L Bush, MD, Alan B Lumsden, MD.
Baylor College of Medicine, Houston, TX, USA.
Background: Carotid artery stenting has become an acceptable alternative to treat patients with severe atherosclerotic diseases, particular in those with high surgical risks. Stent deformation, a phenomenon primarily associated with balloon-expandable stents, is largely avoided by exclusively utilizing self-expanding stents in treating carotid artery stenosis. Nonetheless, we identified two patients that presented with delayed deformation of Wallstent® following carotid artery stenting for post-endarterectomy restenosis.
Patient #1: A 72 year-old gentleman with a history of carotid artery endarterectomy for symptomatic carotid artery stenosis developed recurrent high-grade stenosis that required repeat endarterectomy and subsequent stenting (Figure 1). He again presented with high-grade re-stenosis that was evident on follow-up ultrasound. Carotid angiography showed deformed stent with widened middle portion against the patched carotid bulb and narrowed distal end in the native internal carotid artery that substantially limited distal blood flow (Figure 2). This was treated with balloon angioplasty followed by a Palmaz stent placement to provide radial support for the distal end of the Wallstent®. The completion angiogram demonstrated patent stent with brisk antegrade flow. The patient recovered well from the procedure and remained symptom-free one year later without evidence of recurrence on follow-up ultrasound.
Patient #2: A 65 year-old gentleman with a history of carotid artery endarterectomy for symptomatic high-grade lesion developed restenosis that was treated with carotid stenting. However, he required further cutting balloon angioplasty for in-stent restenosis three months and six months later, as well as a second Wallstent® placement. Follow-up ultrasound demonstrated high-grade stenosis that was confirmed by angiography. In addition, deformation of the Wallstent® with enlarged proximal end and a significant narrowed distal was shown on angiogram. The patient was treated with balloon angioplasty and an additional stent placement with satisfactory result.
Conclusion: These cases illustrate the need for caution as deformation of self-expanding stent being demonstrated in patients undergoing carotid stenting for post-endarterectomy restenosis, particular in patients with large size discrepancy between the patched carotid bulb and the native internal carotid artery. Furthermore, as demonstrated here, post-stent surveillance is imperative in identifying those patients with severe lesion that need re-interventions. 
