Stent folding deformation in carotid artery stenting with open-cell stent: a case report

Abstract

Objective: We report a case of deformation of open-cell stent that occurred during carotid artery stenting (CAS) using Mo.Ma Ultra (MOMA) device in stenotic common carotid artery (CCA).
Case presentation: A 66-year-old man was admitted to our hospital with recurrent right amaurosis fugax, and was diagnosed with symptomatic severe stenosis of the right carotid artery. CAS was performed under proximal protection with MOMA. A Protégé stent was placed in the stenosis from the internal carotid artery to the CCA. After the MOMA was removed, cone-beam computed tomography revealed a folding deformation of the Protégé stent in the CCA. The patient had no ischemic complications after the procedure. Later, using simple stenosis models, we tested whether any stents could be folded in such situations. We found that the stent could be folded inward under specific circumstances such that the stent does not expand enough to be placed in the stenosis with the device that has a relatively larger diameter outside of the stent. This situation can lead the stent to be folded when post-dilatation is performed.
Conclusion: Because our experiment indicated that an open-cell stent can be folded inward in some cases, this possibility should be kept in mind by surgeons.