Carotid stenting for radiation-induced carotid disease was complicated by recurrent aneurysm formation, suggesting a need to avoid oversizing stents due to loss of vessel integrity.
Case Report (n=1)
Low lesion yield pressure during carotid stenting for radiation-induced arteritis may reflect loss of vessel integrity, highlighting the need to avoid stent oversizing to prevent aneurysm formation.
We describe a 56-year-old male who underwent successful carotid stenting (CS) with adjuvant distal protection in response to symptomatic radiation-induced carotid disease. During the CS procedure, it was incidentally noted that the lesion yield pressure was surprisingly low (2 atm). The patient returned with local symptoms from common carotid aneurysmal dilation at the proximal edge of the stent that was successfully treated with a stent graft. A second aneurysm developed proximal to the stent graft and, based on intravascular ultrasound mapping, he ultimately underwent venous bypass covered by a free-muscle graft. We believe the low lesion yield pressure in this case reflected loss of vessel integrity and it may be prudent to avoid oversizing the stent in such patients.
Bates et al. (Mon,) conducted a case report in Symptomatic radiation-induced carotid disease (n=1). Carotid stenting with adjuvant distal protection was evaluated. Carotid stenting for radiation-induced carotid disease was complicated by recurrent aneurysm formation, suggesting a need to avoid oversizing stents due to loss of vessel integrity.