Balloon-assisted Tracking of Guide Extension Catheter: A Novel Technique to Retrieve a Carotid Embolic Protection Device

Abstract

Embolic protection devices are used to minimize the risk of stroke by preventing the migration of emboli during carotid artery stenting (CAS). After the successful conclusion of the CAS procedure, these devices are meant to be retrieved. Sometimes retrieval of the filter can be difficult. This difficulty in retrieval can be due to multiple factors such as incomplete stent expansion, stent fracture, vasospasm, and vessel tortuosity causing pseudostenoses. In this case report, an under-expanded proximal carotid stent strut contributed to the filter not being retrievable in spite of maneuvers to retrieve the filter. An innovative approach was used; a coronary guide extension catheter was used to enhance support and balloon-assisted tracking of the extension catheter then permitted advancement of the retrieval device and ultimate retrieval of the filter. This technique to retrieve a carotid filter has not been previously described in the literature.

Keywords: carotid artery stenting; device retrieval; embolic prevention device.