Direct carotid stenting with minimal predilation after embolic protection device crossing failure in cervical internal carotid artery dissection: A case report.

This single-case experience suggests that, in cervical ICAD with repeated early reocclusion and distal EPD delivery failure, switching to proximal flow arrest, performing minimal low-pressure predilation, and proceeding to direct closed-cell carotid stenting can be a pragmatic bailout to secure sustained reperfusion. After prior IVT, a stepwise antiplatelet strategy - intra-procedural DAPT loading when emergent stenting is unavoidable, followed by withholding maintenance therapy until 24-h imaging confirms hemorrhagic stability - may help balance thrombotic and hemorrhagic risks, particularly in patients with a history of intracranial hemorrhage.