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Emergent rescue extracranial-intracranial bypass for acute carotid stent thrombosis- case report
EANS Academy. Mrak G. Sep 27, 2019; 276164; EP01124
Assoc. Prof. Goran Mrak
Assoc. Prof. Goran Mrak

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Abstract
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Background: Acute carotid stent thrombosis is a rare event following carotid artery stenting procedures, with 14 reports describing it as an intraprocedural complication. Risk factors include vessel injury such as dissection, embolic protection device thrombosis, and hypercoagulability. In a review summarizing 26 acute carotid stent thrombosis cases, an algorithm for managing those occurring intraprocedurally suggests thrombectomy, thromboaspiration, or thrombolysis. This case report demonstrates how neurosurgical management could be considered as another valid modality, especially in cases of failed endovascular treatment.
Methods: We describe a case of carotid artery dissection treated endovascularly and complicated by intraprocedural stent thrombosis which was ultimately managed by emergent extracranial-intracranial bypass with radial artery graft connecting the external carotid artery to ipsilateral middle cerebral artery
Results: Next day angiography demonstrated distal third bypass narrowing indicating moderate vasospasm, but without flow delay. Control angiography on the 9th postoperative day demonstrated complete vasospasm resolution and an increase in bypass flow.
Conclusion: Neurosurgical management may represent a rescue option for otherwise unmanageable acute carotid stent thrombosis.
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