Stent Folding Deformation of PRECISE and PROTÉGÉ during Carotid Artery Stenting: Two Case Reports

Abstract

Objective: We report two cases of folding deformation of open-cell stents that occurred during carotid artery stenting (CAS) for internal carotid artery (ICA) stenosis. Case Presentations: Case 1: A 64-year-old man was diagnosed with asymptomatic right ICA severe stenosis. The stenosis was eccentric, comprising soft plaque with calcification. CAS was performed by standard procedure under protection with MOMA (Medtronic, Minneapolis, MN, USA) and GuardWire (Medtronic). We attempted post-dilation two times because PRECISE (Cordis, Miami, FL, USA) stent did not sufficiently dilate. Cone-beam CT showed a folding deformation of the stent. Case 2: A 60-year-old man was diagnosed with asymptomatic left carotid artery severe stenosis 5 years after radiation therapy for esophageal carcinoma. The stenosis was long, comprising soft plaque without calcification. CAS was performed under protection with MOMA and GuardWire. A PROTÉGÉ (Covidien, Irvine, CA, USA) stent was placed in the etiologic portion. After post-dilation, intravascular ultrasound (IVUS) examination showed suspected in-stent plaque protrusion, but cone-beam CT revealed a folding deformation of the PROTÉGÉ. We did not try any additional treatment. Both patients had no ischemic complications after the procedure and no infarction was detected on MRI. Conclusion: We reported two cases of folding deformation with PRECISE or PROTÉGÉ. In addition to careful attention to not using an oversized stent, it is important to select a protection device and a balloon as a device to avoid deformation. It is difficult to predict or repair stent deformity. Continuation of antiplatelet therapy and long-term follow-up are required.