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Case Reports
. 2023 May 9:14:1184210.
doi: 10.3389/fneur.2023.1184210. eCollection 2023.

Case report: Early carotid stent shortening in patient with radiation-induced carotid stenosis

Woochan Choi  1 , Yang-Ha Hwang  1   2 , Yong-Won Kim  1   2
Affiliations
Case Reports

Case report: Early carotid stent shortening in patient with radiation-induced carotid stenosis

Woochan Choi et al. Front Neurol. .

Abstract

Carotid artery stenting (CAS) for carotid stenosis has been widely used as an alternative treatment in patients not eligible for surgery. The shortening of a carotid stent rarely occurs. We report a case of early shortening of CAS in a patient with radiation-induced carotid stenosis and discuss the potential pathophysiology and strategies for prevention. This case presents a 67-year-old man who underwent radiotherapy for oral cavity squamous cell carcinoma 7 years ago and subsequently developed severe stenosis in the left proximal internal carotid artery. The patient underwent CAS for symptomatic severe carotid stenosis. Follow-up CT angiography revealed shortening of the carotid stent, and additional carotid stenting was performed. We speculate that the possible mechanism of early complication of CAS could be slippage and shortening of the stent due to weak anchoring between the stent strut and the fibrotic arterial wall in radiation-induced carotid stenosis.

Keywords: carotid artery stenosis; carotid stent; closed cell stent; radiation-induced carotid stenosis; stent shortening.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
CT angiography shows severe stenosis in the left proximal ICA (A) and diffusion-weighted imaging reveals multiple scattered acute infarctions in the left hemisphere (B–D).
Figure 2
Figure 2
Sequential images of the carotid stenting. Cerebral angiography revealed ~87% stenosis of the left ICA according to NASCET criteria. The diameter of the stenotic segment was 0.56 mm (thin arrow), and the diameter of the distal ICA was 4.41 mm (thick arrow), but the diameter of the distal common carotid artery was 7.63 mm (red arrow) (A). (B) Balloon angioplasty before carotid stenting. (C) Angiography after balloon angioplasty. (D) Carotid Wallstent deployment. (E) Native fluoroscopy after poststent balloon angioplasty. (F) Angiography after post-stent balloon angioplasty. (G, H) Native fluoroscopy and final angiography.
Figure 3
Figure 3
The day after CAS, early shortening of the CAS and distal stenosis are demonstrated in CTA and the cerebral angiogram (A–C). After additional carotid stenting, the final angiography showed successful expansion and implantation of the carotid stent (D, E). There was no shortening and malposition of the CAS 1 month after additional carotid stenting (F).
See this image and copyright information in PMC

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