Surgical Retrieval of an Intracranial Carotid Artery Cerebral Protection Filter Following Carotid Artery Stenting

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Lem B. Kirby, MD.
Mission Hospitals/Carolina Vascular, Asheville, NC, USA.

BACKGROUND: Carotid Artery stenting (CAS) has been approved for treating high surgical risk patients with symptomatic carotid artery stenosis. The current devices that have been Food and Drug Administration (FDA) approval or are in line for FDA approval all include cerebral protection devices to decrease the risk of distal embolization. This case report describes the surgical retrevial of the NeuroSheild Cerebral Protection Filter (MedNova, Galway, UK), currently known as the Embosheild (Abbott Laboratories, Abbott Park, Ill)
METHODS: The patient had a symtomatic internal carotid artery stenosis and underwent CAS in a trail setting (SECURITY) utilizing the NeuroShield filter. Because the incorrect wire had been used, the free floating filter migrated into an intracranial position and could not be removed. Attempts at endovascular retrievial led to internal carotid dissection and loss of wire access. The patient showed signs of cerebral ischemia and required surgical removal of the intracranial filter.
RESULTS:  After sucessful carotid endarterectomy and filter removal, the patient awoke and returned to her baseline neurologic status and was discharged home on postopervative day three.
CONCLUSIONS: As we embark on on this less invassive means of treating carotid disease, it is important to remember that endovascluar procedures can be quite complex and offer little room for error. As more carotid stenting systems (including the Xact Carotid Stent System with the Emboshield protecton device) become approved the number of technical complications requiring surgical salvage will certiainly also increase.

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